The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) Saint Lucia Health System Strengthening Project (P166783) LATIN AMERICA AND CARIBBEAN | St. Lucia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2019 | Seq No: 6 | ARCHIVED on 29-May-2021 | ISR46244 | Implementing Agencies: Ministry of Finance, Economic Growth, Job Creation, and External Affairs, Ministry of Health and Wellness, Saint Lucia, Ministry of Finance, Economic Growth, Job Creation and External Affairs Key Dates Key Project Dates Bank Approval Date: 28-Sep-2018 Effectiveness Date: 15-Jan-2019 Planned Mid Term Review Date: 11-Jun-2021 Actual Mid-Term Review Date: Original Closing Date: 31-Oct-2023 Revised Closing Date: 31-Oct-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective is to improve the accessibility, efficiency, and responsiveness of key health services. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The development objective is to improve the accessibility, efficiency, and responsiveness of key health services, and provide a response in the event of eligible crises or emergencies. Components Table Name Component 1: Design and Implementation of an Essential Health Services Package:(Cost $5.50 M) Component 2: Strengthening Service Delivery in Support of the Essential Package of Health Services:(Cost $13.00 M) Component 3: Institutional Capacity Building, Project Management and Coordination:(Cost $1.50 M) Component 4: Contingent Emergency Response Component:(Cost $5.94 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Since COVID-19 was declared a pandemic, Saint Lucia requested activation of the Contingency Emergency Response Component (CERC) which was approved on April 27, 2020 for US$5 million, of which US$2.5 million from the COVID- 19 Fast-Track Facility and US$2.5 million from the national Performance-Based Allocation (PBA). Swift Bank approval on the CERC activation provided Saint Lucia resources to ensure safety of health and laboratory workers with purchases of personal protective equipment, medical supplies and pharmaceuticals to enhance treatment and 5/29/2021 Page 1 of 8 The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) testing of COVID-19. Following CERC activation, an Additional Financing was approved on June 26, 2020 to formally reflect and fill the financing gap resulting from the activation of the CERC as well as replenish financing for the original project activities. The Additional Financing also restructured the original project to modify the Project Development Objective and Results Framework to reflect COVID-19 activities. In November 2020, PEF funds were granted to the project in the amount of US$ 942,857. The First and Second Additional Financing both became effective on December 4, 2020 and the CERC has disbursed US$2.6 million to date, with the PEF resources fully disbursed. The CERC has supported the purchase of medical equipment, supplies and consumables. In 2021, project activities will mainly focus on completing CERC activities and accelerating activities under Component 1 and 2 related to the Performance-based Financing and National Health Insurance schemes. Currently, the Department of Health and Wellness is accelerating the preparatory work necessary to launch Phase 1 of the PBF Pilot in July 2021. The PBF is an entry point for strategic purchasing of health services and can serve as a preparatory stage for the NHI scheme. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Moderate Moderate Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Substantial Technical Design of Project or Program Substantial Moderate Substantial Institutional Capacity for Implementation and High Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Moderate Moderate Stakeholders Moderate Moderate Moderate Other Moderate -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes The development objective is to improve the accessibility of key health services IN00978598 ►Number of people registered under the National Health Scheme (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100,000.00 Date 24-May-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The number of people formally registered in the National Health Scheme. The scheme will be developed Comments: under Component 1 of the Project. As such, the baseline is 0. 5/29/2021 Page 2 of 8 The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) IN00978667 Number of people registered under the National Health Scheme (women) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50,000.00 Date 25-Jun-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The development objective is to improve the efficiency of key health services IN00978599 ►Percent of diabetic patients > 18 years at public primary health facilities managed according to national protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 24-May-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The share of people > 18 years at public primary health facilities with diabetes managed according to Comments: national protocols. These protocols will be developed under the Project. As such, the baseline is 0. IN00978668 Percent of diabetic patients > 18 years at public primary health facilities managed according to national protocols (women) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 IN00978669 ►Percent of hypertensive patients > 18 years at public primary health facilities managed according to national protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 24-May-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The share of people > 18 years at public primary health facilities with hypertension managed according to Comments: national protocols. These protocols will be developed under the Project. As such, the baseline is 0. IN00978670 Percent of hypertensive patients > 18 years at public primary health facilities managed according to national protocols (women) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 The development objective is to improve the responsiveness of key health services IN00978600 ►Compliance with 2005 International Health Regulations (IHR) by maintaining a trained Rapid Response Team (RRT) to respond to events that may constitute a public health emergency (Yes/No, Custom) 5/29/2021 Page 3 of 8 The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) Baseline Actual (Previous) Actual (Current) End Target Value Yes Yes Yes Yes Date 22-Jun-2018 19-Oct-2020 03-May-2021 31-Oct-2023 This is one of the key actions which the Government is asked to comply with on a yearly basis by the World Health Organization (WHO) as a critical activity under the 13 core capacity areas of the 2005 Comments: International Health Regulations (IHR). IN00978666 ►Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 1.00 Date 18-May-2020 19-Oct-2020 03-May-2021 31-Dec-2021 Intermediate Results Indicators by Components Component 1. Design and Implementation of an Essential Package of Health Services IN00978671 ►Essential package of benefits formally adopted and reviewed on an annual basis (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 24-May-2018 10-Dec-2018 03-May-2021 31-Oct-2023 This indicator reflects whether a formal review of the essential benefits package was conducted and Comments: agreed upon by the Ministry of Health and Wellness. IN00978674 ►Primary care service utilization rates (public health sector) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 37,320.00 37,320.00 37,320.00 55,000.00 Date 06-Jul-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The number of visits to public primary health facilities during one year relative to the total population in the Comments: same geographic area. Rates are reported per 100,000 population. IN00978677 Primary care service utilization rates (public health sector) (women) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 44,447.00 44,447.00 44,447.00 60,000.00 Date 26-Jun-2018 10-Dec-2018 03-May-2021 31-Oct-2023 IN00978678 5/29/2021 Page 4 of 8 The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) ►Percentage of Primary Health Care (PHC) facilities that have implemented exit surveys with service users in a one-year period and presenting results to the MOHW (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 22-Jun-2018 10-Dec-2018 03-May-2021 31-Oct-2023 Component 2. Strengthening Service Delivery in Support of the Essential Package of Health Services IN00978672 ►Number of public primary care health facilities equipped for NCD management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 24-May-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The number of primary care facilities in the public sector equipped with medicines, equipment and basic Comments: technologies according to national guidelines. Equipping of these facilities will be conducted under the project. As such, the baseline is 0. IN00978675 ►Number of public sector providers registered under the PBF scheme (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 18-Jun-2018 10-Dec-2018 03-May-2021 31-Oct-2023 This indicates the number of public sector primary care facilities registered to participate in the PBF Comments: scheme. Providers are considered registered if they have signed an agreement with the MOHW to participate in the PBF. The PBF scheme will be developed under the Project. As such, the baseline is 0. IN00978676 ►Number of patients > 18 years screened for diabetes at public primary health facilities based on national protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20,000.00 Date 18-Jun-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The number of people from the at-risk population aged > 18 years screened for diabetes at public primary Comments: health facilities based on national protocols. These protocols will be developed under the Project. As such, the baseline is 0. IN00978679 Number of patients > 18 years screened for diabetes at public primary health facilities based on national protocols (women) (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10,000.00 IN00978680 ►Number of patients > 18 years screened for hypertension at public primary health facilities based on national protocols (Number, Custom) 5/29/2021 Page 5 of 8 The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20,000.00 Date 18-Jun-2018 10-Dec-2018 03-May-2021 31-Oct-2023 The number of people from the at-risk population aged > 18 years screened for hypertension at public Comments: primary health facilities based on national protocols. These protocols will be developed under the Project. As such, the baseline is 0. IN00978681 Number of patients > 18 years screened for hypertension at public primary health facilities based on national protocols (women) (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10,000.00 IN00978682 ►Percentage of Primary Health Care facilities participating in the Performance Based Financing (PBF) scheme that have developed an action plan based on the results of the quarterly satisfaction surveys (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 22-Jun-2018 10-Dec-2018 03-May-2021 31-Oct-2023 This indicator will measure the numerator as the number of PHC facilities participating in the PBF scheme that have developed an action plan based on the quarterly satisfaction surveys and the denominator as Comments: the total number of PHC facilities participating in the PBF scheme. The PBF scheme will be developed under the Project. As such, the baseline is 0. Component 4. Contingent Emergency Response Component IN00978673 ►Number of equipped health facilities with isolation capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1.00 3.00 Date 18-May-2020 18-May-2020 03-May-2021 31-Dec-2021 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P166783 IDA-63160 Effective USD 20.00 20.00 0.00 6.00 14.00 30% P166783 IDA-67290 Effective USD 5.00 5.00 0.00 0.00 5.00 0% 5/29/2021 Page 6 of 8 The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) P166783 TF-B4523 Closed USD 0.94 0.94 0.00 0.94 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P166783 IDA-63160 Effective 28-Sep-2018 27-Nov-2018 15-Jan-2019 31-Oct-2023 31-Oct-2023 P166783 IDA-67290 Effective 26-Jun-2020 17-Nov-2020 04-Dec-2020 31-Oct-2023 31-Oct-2023 P166783 TF-B4523 Closed 16-Nov-2020 04-Dec-2020 04-Dec-2020 31-Jan-2021 31-Jan-2021 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) 5/29/2021 Page 7 of 8 The World Bank Implementation Status & Results Report Saint Lucia Health System Strengthening Project (P166783) P174228-Additional Financing - Saint Lucia Health System Strengthening Project ,P174797-Second Additional Financing to the Saint Lucia Health System Strengthening Project 5/29/2021 Page 8 of 8