The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Disease Prevention and Control Project (P128442) EUROPE AND CENTRAL ASIA | Armenia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 16 | ARCHIVED on 26-Oct-2020 | ISR43955 | Implementing Agencies: Ministry of Health, HPIU, Republic of Armenia Key Dates Key Project Dates Bank Approval Date: 27-Mar-2013 Effectiveness Date: 22-Jul-2013 Planned Mid Term Review Date: 31-May-2017 Actual Mid-Term Review Date: 12-Jun-2017 Original Closing Date: 15-Dec-2019 Revised Closing Date: 30-Sep-2022 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project development objective is to improve (i) Maternal and Child Health(MCH) services and the prevention, early detection, and management of selected Non-Communicable Diseases (NCD) at the Primary Health Care (PHC) level; and (ii) the efficiency and qualityof selected hospitals in Armenia. 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 objective of the Project is to (i) increase the detection of selected NCDs at the PHC level and among pregnant mothers; (ii) improve the efficiency and quality of selected hospitals; and (iii) prevent, detect and respond to the threat posed by COVID-19. Components Table Name Emergency response to COVID-19:(Cost $3.00 M) Performance-based incentives to improve MCH and NCD services in primary care faci:(Cost $4.20 M) Hospital Modernization:(Cost $34.74 M) Project Management:(Cost $3.06 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The World Bank received a request from the Ministry of Finance on July 29, 2020, for additional financing in the amount of US$ 7.4 million towards the construction of Martuni and Vayots Dzor Medical Centers (MC). 10/26/2020 Page 1 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Progress toward achievement of PDO The four screening-related PDO indicators (Component 1) have exceeded their end-of-Project target values while the 2019 target values for the PDO indicator measuring bed occupancy rates (Component 2) have been achieved. As procurement is ongoing, the progress towards the attainment of indicators related to capacity for case management in intensive care (Component 4) will be assessed at the end of the Calendar year. The intermediate results indicators have also largely achieved or exceeded their 2019 target values. Overall implementation progress Between January 1, 2015, and August 31, 2020, about 1.42 million adults between 35 and 68 years of age have been screened for hypertension; 789,750 people between 35 and 68 years of age have been screened for diabetes mellitus; 281,829 women between 30 and 60 years of age have been screened for cervical cancer; and 87,760 antenatal care attendees have been screened for diabetes and hypertension. Verification has been conducted in line with agreed protocols. However, due to the restrictions in free movement instituted since March 16, 2020, on-site verification of screening reports has not been conducted. Verification has resumed since September 2020. The impact evaluation of demand-side incentives to increase the uptake of screenings for diabetes and hypertension, financed by the HRITF and Strategic Impact Evaluation Fund, was completed in July 2020 and the final report and findings were discussed with the client. The construction of Martuni Medical Center began in July 2020. The ESMP for construction of the new building for Martuni Medical Center was prepared by the Borrower, approved by the World Bank, disclosed, and finalized with the attached minutes of public consultations. In August 2020, a full director was appointed to lead the Health Project Implementation Unit (HPIU) of the Ministry of Health of the Republic of Armenia after 10 years. The HPIU is well-staffed and satisfactorily performs Project management functions. The Project is also financing the procurement of equipment and supplies to facilitate case management, infection prevention and control, and case detection for COVID-19. Of the 16 contracts, 5 are ongoing and 11 have been delivered. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Low Low Institutional Capacity for Implementation and -- Moderate Moderate Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Low Low Stakeholders -- Moderate Moderate Other -- Substantial Substantial Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes 10/26/2020 Page 2 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) To increase the detection of selected non-communicable diseases (NCDs) in Primary Health Care (PHC) IN00907979 ►Percentage of antenatal care (ANC) attendees screened for glycosuria, hypertension and proteinuria in at least three antenatal visits (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 89.70 89.70 85.00 Date 23-Jan-2013 30-Sep-2019 30-Sep-2019 30-Sep-2022 The 2021 end-of-project target value has been met. Comments: IN00907982 ►Percentage of population aged 35-68 screened for hypertension at least once in the last year a) female; b) male (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value a)22.5 % b)17.8 % a)122.6% b)84.7% a)122.6% b)84.7% a) 76% b) 55% Date 31-Dec-2013 30-Sep-2019 30-Sep-2019 30-Sep-2022 The 2021 end-of-project target value has been met. Comments: IN00907983 ►Percentage of population aged 35-68 screened for diabetes mellitus at PHC level at least once during the last 3 years a) female; b)male (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target a)9.8% a) 48% Value a)76.0% b)48.1% a)76.0% b)48.1% b)7.5% b) 36% Date 31-Dec-2013 30-Sep-2019 30-Sep-2019 30-Sep-2022 The 2021 end-of-project target value has been met. Discussions have revealed that the actual values have been summed since Project onset rather than over consecutive 3-year periods, as stipulated in the Comments: Monitoring and Evaluation Framework. As agreed, this will be addressed under the proposed Additional Financing, through a restructuring of the parent Project. IN00907984 ►Percentage of women aged 30-60 screened for cervical cancer at least once during the last 3 years and received the results (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 8.50 40.90 40.90 35.00 Date 23-Jan-2013 30-Sep-2019 30-Sep-2019 30-Sep-2022 The 2021 end-of-project target value has been met. Comments: To improve the efficiency and quality of selected hospitals in Armenia IN00907980 ►Bed occupancy rate at the a) Artashat Medical Center; b) Sevan Medical Center (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value a) 64% b) 51% a)69.0% b)61.8% a)69.0% b)61.8% a) 70% b) 70% 10/26/2020 Page 3 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Date 23-Jan-2013 30-Sep-2019 30-Sep-2019 30-Sep-2022 The 2019 target values have been met. Comments: To prevent, detect and respond to the threat posed by COVID-19 IN00907981 ►Number of designated intensive care units that are fully equipped and functional, without stock-outs in preceding two weeks (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 23-Jan-2013 26-Mar-2020 26-Mar-2020 30-Sep-2022 Overall Comments PDO Discussions have revealed that the actual values for screening-related indicators have been summed since Project onset, rather than yearly or over consecutive 3-year periods, as stipulated in the Monitoring and Evaluation Framework. As agreed, this will be addressed under the proposed Additional Financing, through a restructuring of the parent Project. Intermediate Results Indicators by Components To increase the detection of selected non-communicable diseases (NCDs) in Primary Health Care (PHC) IN00907985 ►Proportion of PHC facilities undergoing enhanced verification of results by the HPIU (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 97.20 97.20 98.00 Date 23-Jan-2013 30-Sep-2019 30-Sep-2019 30-Sep-2022 The 2019 target value for this indicator has been achieved. Comments: IN00907988 ►Level of awareness among adults in key NCD risk factors a) high blood pressure; b) high cholesterol level; c) high salt intake; d) obesity; e) high glucose level (disaggregated by gender) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Male a)45% b) 24% c) Male a) 41% b) 24% c) Male a) 41% b) 24% c) Male a) 43% b) 26% c) 55% d) 65% e) 33%; 55% d) 64% e) 26%; 55% d) 64% e) 26%; 57% d) 66% e) 28%; Female a)58% b)32% Female a)58% b)38% Female a)58% b)38% Female a)60% b)40% Value c)64% d)64% e)42% c)68% d)76% e)43% c)68% d)76% e)43% c)70% d)78% e)45% (2012 HSPA data) (2015 HSPA data) (2015 HSPA data) Date 31-Dec-2012 01-Feb-2018 01-Feb-2018 30-Sep-2022 Actual values for this indicator to be updated following completion of next Health System Performance Comments: Assessment, scheduled to align with the Project closing date. 10/26/2020 Page 4 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) To improve the efficiency and quality of selected hospitals IN00907986 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 5.00 Date 23-Jan-2013 09-Apr-2019 09-Apr-2019 30-Sep-2022 The following facilities have been completed: Hematology Center after Professor R. Yeolyan; Artashat MC; Sevan MC; and Vanadzor MC. Comments: IN00907989 ►Number of hospital health workers receiving training in a set of new clinical practice guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 316.00 316.00 300.00 Date 23-Jan-2013 30-Sep-2019 30-Sep-2019 30-Sep-2022 The 2021 end-of-project values have been achieved. Comments: IN00907990 ►Medical Centers operational a) Sevan MC; b) Artashat MC; c) Martuni MC (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target a) Operational. a) Operational. b) Operational. b) Operational. All three Medical Value No Centers operational c) Civil works not started. c) Civil works started. Date 23-Jan-2013 09-Apr-2019 23-Oct-2020 30-Sep-2022 Artashat and Sevan MCs were put into operation on October 6 and 17, 2018. This indicator is on track to achieve the end-of-project target values. Comments: To prevent, detect and respond to the threat posed by COVID-19 IN00907987 ►The number of ventilators for management of COVID-19 cases, financed through the Project (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 50.00 75.00 10/26/2020 Page 5 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Date 23-Jan-2013 07-Apr-2020 07-Apr-2020 30-Sep-2022 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P128442 IDA-52220 Effective USD 35.00 35.00 0.00 30.01 2.25 93% P128442 TF-14138 Closed USD 1.80 1.80 0.00 1.80 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P128442 IDA-52220 Effective 27-Mar-2013 17-May-2013 22-Jul-2013 15-Dec-2019 30-Sep-2022 P128442 TF-14138 Closed 11-Jul-2013 27-Sep-2013 27-Sep-2013 31-Dec-2018 31-Dec-2019 Cumulative Disbursements 10/26/2020 Page 6 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 04-Mar-2015 ,Level 2 Approved on 13-Mar-2018 ,Level 2 Approved on 28-Jan-2020 ,Level 2 Approved on 05-Mar-2020 ,Level 2 Approved on 27-Mar-2020 Related Project(s) P175023-Additional Financing to the Disease Prevention and Control Project 10/26/2020 Page 7 of 7