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: 13 | ARCHIVED on 15-May-2019 | ISR36578 | Implementing Agencies: Ministry of Health, HSMP-PIU, 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-Jun-2021 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? No Components Table Name Performance-based incentives to improve MCH and NCD services in primary care faci:(Cost $4.70 M) Hospital Modernization:(Cost $38.20 M) Project Management:(Cost $2.10 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions An implementation support visit took place from April 1 to 9, 2019, to review the implementation progress of the project. Progress towards achieving the project development objectives (PDO) remains moderately satisfactory, and implementation progress rating remains satisfactory. Four of the five PDO indicators have achieved or exceeded their 2018 target values. Overall implementation progress 5/15/2019 Page 1 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Component 1: Performance-based financing (PBF) scheme to improve maternal and child health and non-communicable diseases services in primary health care (PHC) facilities. Between January 2018 to February 2019, PHC facilities under the Project performed 56,518 pap tests, 156,398 blood glucose tests, 295,640 blood pressure measurements, and 19,567 antenatal care (ANC) urine and blood tests, facilitating the attainment of the 2018 target values for the screening-related PDO indicators. Component 2: Improving efficiency and quality of selected hospitals. Artashat, Sevan, and Vanadzor MCs were opened for operation on October 6, October 17, and November 10, 2018, respectively. The contract for the development of the complete sets of architectural and engineering design documents for the construction of Martuni and Vayots Dzor MCs, including supervision of the civil works by the design engineer was signed on February 20, 2019. There was a delay in contract signing due to changes in licensing regulation that annulled existing licenses and required re-application for authorization of all firms. Therefore, construction is expected to start in April 2020. As completion of the construction would take approximately two years, the World Bank team and the Ministry of Health will discuss a potential extension of the closing date during the next visit. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate Macroeconomic -- Low Low Sector Strategies and Policies -- Low Low Technical Design of Project or Program -- Low Low Institutional Capacity for Implementation and Sustainability -- Moderate Moderate Fiduciary -- Substantial Substantial Environment and Social -- Low Low Stakeholders -- Low Low Other -- -- -- Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes Improve MCH services and the prevention, early detection & management of selected NCDs at PHC level IN00688894 ►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 75.00 85.00 85.00 5/15/2019 Page 2 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Date 23-Jan-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 The 2019 target value has been met for this indicator, which is on track to meet the end-of-project target Comments: values. IN00688906 ►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)105.8% b)69.4% a) 76% b) 55% Date 31-Dec-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 End-of-project target values have been achieved for this indicator. Actual values for 2019 are as of Comments: February 28, 2019 IN00688908 ►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)65.9% b)42.1% b)7.5% b) 36% Date 31-Dec-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 End-of-project target values have been achieved for this indicator. The 2019 actual values are as of Comments: February 28, 2019 IN00688907 ►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 32.30 35.40 35.00 Date 23-Jan-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 The 2018 target value (28 percent) for this indicator has been surpassed. The 2019 actual values are as Comments: of February 28, 2019 To improve the efficiency and quality of selected hospitals in Armenia IN00688895 ►Bed occupancy rate at the a) Artashat Medical Center; b) Sevan Medical Center (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target a)64% b)51% Value a) 64% b) 51% -- a) 70% b) 70% Date 23-Jan-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 While the bed occupancy rates for Artashat MC falls below the 2018 target value, this is a reflection of the recent facility opening. The facility staff and local administrators are engaged in active public outreach to Comments: ensure that residents in the catchment population are aware of service availability. It is anticipated that the actual values will be on track to reach the end target by June 2019. Overall Comments PDO 5/15/2019 Page 3 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) The four PDO indicators related to screening coverage have achieved or exceeded their end-of-project target values. The 2018 target values for the PDO indicator measuring bed occupancy rates were not achieved in Artashat (actual value = 60.5 percent versus target value = 64 percent) and Sevan (actual value = 35.7 percent versus target value = 51 percent). However, from January to March 2019, the bed occupancy rates at Artashat and Sevan Medical Centers (MC) were 89 percent and 86 percent, respectively. Thus, this indicator is also on track to achieve the end-of-project target value. Intermediate Results Indicators by Components Performance-based incentives to improve MCH and NCD services in Primary care facilities IN00688909 ►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 20-Nov-2018 09-Apr-2019 30-Jun-2021 The 2018 target value for this indicator has been achieved. The 2019 actual values are as of February 28, Comments: 2019 IN00688911 ►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) 43% b) 26% c) 55% d) 65% e) 33%; 55% d) 64% e) 26%; 57% d) 66% e) 28%; Female a)58% b)32% Female a)58% b)38% Female a)60% b)40% Value -- c)64% d)64% e)42% c)68% d)76% e)43% c)70% d)78% e)45% (2012 HSPA data) (2015 HSPA data) Date 31-Dec-2012 01-Feb-2018 01-Feb-2018 30-Jun-2021 Actual values for this indicator to be updated following completion of next Health System Performance Assessment in 2019. Comments: Improving efficiency and quality of selected hospitals IN00688910 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 6.00 Date 23-Jan-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 The following facilities have been completed: Hematology Center after Professor R. Yeolyan; Artashat MC; Sevan MC; and Vanadzor MC. Comments: 5/15/2019 Page 4 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) IN00688913 ►% of pediatric patients newly diagnosed with onco-hematology conditions by the Hematology Center who received treatment overseas inthe past year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 30.70 26.00 25.00 Date 23-Jan-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 Absolute number of pediatric patients newly diagnosed with onco-hematology conditions who received Comments: treatment overseas 2013- 13/26, 2014-10/22, 2015-10/32, 2016-15/47, 2017- 11/38, 2018-11/31 IN00688912 ►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 0.00 0.00 300.00 Date 23-Jan-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 The adoption of guidelines is in progress. Comments: IN00688914 ►Medical Centers operational a) Sevan MC; b) Artashat MC; c) Vayots Dzor MC; d) Martuni MC (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target a) Operational. b) Operational. c) Civil works not All four Medical Value No -- started. Centers operational d) Civil works not started. Date 23-Jan-2013 20-Nov-2018 09-Apr-2019 30-Jun-2021 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: Overall Comments IR Most intermediate results indicators have achieved or exceeded their 2018 target values. However, the indicator measuring treatment of pediatric onco-hematology conditions within Armenia has not achieved its 2018 target value due to administrative difficulties posed by the transition in the management of the hematology center. The 2019 target for the training of hospital health workers is projected to be achieved, given completion of development and approval of the required guidelines. 5/15/2019 Page 5 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) 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 27.41 4.86 85% P128442 TF-14138 Effective USD 1.80 1.80 0.00 1.52 0.28 84% 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-Jun-2021 P128442 TF-14138 Effective 11-Jul-2013 27-Sep-2013 27-Sep-2013 31-Dec-2018 31-Dec-2019 Cumulative Disbursements 5/15/2019 Page 6 of 7 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Restructuring History Level 2 Approved on 04-Mar-2015 ,Level 2 Approved on 13-Mar-2018 Related Project(s) There are no related projects. 5/15/2019 Page 7 of 7