The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Health System Resiliency Strengthening (P150481) MIDDLE EAST AND NORTH AFRICA | West Bank and Gaza | Health, Nutrition & Population Global Practice | Special Financing | Investment Project Financing | FY 2015 | Seq No: 14 | ARCHIVED on 11-Sep-2019 | ISR38326 | Implementing Agencies: Ministry of Health, Ministry of Finance, World Health Organization, USAID/Intrahealth Project Key Dates Key Project Dates Bank Approval Date: 21-Jan-2015 Effectiveness Date: 16-Feb-2015 Planned Mid Term Review Date: 15-May-2017 Actual Mid-Term Review Date: 17-Jul-2017 Original Closing Date: 30-Jun-2020 Revised Closing Date: 30-Jun-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project PDO is to support the Palestinian Authority in securing continuity in healthcare service delivery and building its resilience to withstand future surge in demand for effective healthcare coverage. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency and Rapid Response Window:(Cost $2.00 M) Component 2: Rationalizing Outside Medical Referrals:(Cost $3.50 M) Component 3: Supporting health coverage to strengthen sector resilience:(Cost $2.00 M) Component 4: Project Management and Capacity Building:(Cost $1.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Satisfactory Overall Risk Rating High Substantial Implementation Status and Key Decisions The Health System Resiliency Strengthening project has made substantive progress for the last six months. To date, 63% or USD 5.2 million out of a total of USD 8.5 Million has been disbursed, with full disbursement under Component 1. The Ministry of Health (MOH) has accelerated implementation of critical activities under Component 2. This is expected to result in better monitoring and harnessing of the growth rate of expenditures from OMRs. Based on the recent substantive progress in key activities to achieve the PDO, the overall PDO rating was upgraded to Moderately Satisfactory in August 2019. Component 1: Emergency and Rapid Response Window 9/11/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) All the funds were disbursed to finance non-medical expenditures to operate and maintain the MOH facilities in the Gaza strips. The World Bank team, together with the MOH, is closely monitoring service delivery and access to care in Gaza, specifically the possible disruption of health care service delivery. This is due to the increasing number of casualties and lack of basic commodities (such as electricity and medicines). Component 2: Rationalizing Outside Medical Referrals The project supports the MOH to improve operational and technical capacity of the SPU, which manages medical referrals within and/or outside of Palestinian Territory. Over the last six months, the MOH has made substantive progress in key activities to achieve the PDO, namely: (1) piloting contracts with selected hospitals using as inputs for the National Price Reference tool; and (2) concluding new referral contracts and Memorandum of Understandings with referral hospitals. In addition, Government Health Insurance Management Information System is currently developed by private firms contracted by the MOH and on track to be completed in June 2020. Component 3: Supporting Health Coverage to Strengthen Sector Resilience The Palestinian National Institute of Public Health (an implementing agency contracted by the MOH) has made progress on each sub-component, namely health financing, human resources for health and family health practice. The World Bank team is closely monitoring the progress of the implementation and providing necessary technical guidance. To fully respond to the MOH's needs and leverage with other development partners' assistance, the work program would be reviewed and could be revised as needed. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- High High Sector Strategies and Policies -- High Substantial Technical Design of Project or Program -- High Substantial Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- Substantial Substantial Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- -- -- Overall -- High Substantial Results PDO Indicators by Objectives / Outcomes Project Development Objectives IN00737227 ►Utilization rates (out-patient, emergency and obstetrics) in the hospitals of Shifa, Rafedia and Alia Hospital do not deteriorate or improve up to 10% compared to a baseline end-September, 2014 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/11/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Shifa occupancy: 149.8%, Shifa occupancy: 94.6%, Rafedia occupancy: Rafedia occupancy: 103.0%; Shifa occupancy: 89%, 95.77%; Alia occupancy: Rafedia occupancy: Alia occupancy: 141.2% 144.8% 85%, Alia occupancy: Shifa occupancy: 89%, Obstetrics Shifa:154% Obstetrics Shifa:95.5% 136% Rafedia occupancy: 85% Obstetrics Rafedia: Obstetrics Rafedia: Obstetrics Shifa: 76% Obstetrics Shifa: 76% 85.3% 92.2% - Obstetrics Rafedia: Obsetrics Rafedia: 94% Value Obstetrics Alia: 127% Obstetrics Alia: 94% - Obstetrics Alia: Outpatient Shifa: Outpatient Shifa: OC= 123.6% 105% 578,646 174,900, ER= 281,849 Outpatient Shifa: OPD Outpatient Shifa: Outpatient Rafedia: Oupatient Rafedia: = 71,518, ER = 88,179 578,646 - Outpatient 163,262 61,434 Oupatient Rafedia: Rafedia: 163,262 - Outpatient Alia: OPD = 30,281, ER = Outpatient Alia: OC=104,655, ER=99,902 49,424 102046 Outpatient Alia: OPD = 45,682, ER = 46,193 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 Based on the project's assessment, baseline for numbers of outpatient department visits at Shifa and Rafidia hospitals need to be modified as follows: Shifa OPD: 180,000 - Current baseline (547,121 included all outpatient department visits for all hospitals in Gaza, not only Shifa hospital in 2014). Comments: Rafidia OPD: 60,000 - Current baseline (163,262 included both cases from the outpatient and emergency medicine departments at Rafidia in 2014). These baseline would be modified in upcoming restructuring. Based on 2018 data, utilization at above departments at Shifa and Rafidia hospitals exceeded the accurate baseline. IN00737228 ►Average annual growth of total expenditure in OMRs of a four-year period lower than the proposed baseline which is the period 2012-2015 (<13.19%) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.19% 13.19% 14.0% <13.19% Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737229 ►Gap in geographic equity for referral cost (between the West Bank and Gaza) reduced by 80 percent relative to baseline (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.7:1 1.7:1 1.7:1 1:15:1 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 Intermediate Results Indicators by Components Intermediate Results IN00737230 ►Utilization rates (outpatient, emergency, and obstetrics) in the hospitals of Shifa, Rafedia and Alia do not deteriorate or improve by up to 10% compared to a baseline end September 2014 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Shifa occupancy:89% - Shifa occupancy: 94.6% Shifa occupancy: Same ratio as baseline Value Nasser occupancy: 74% Nasser occupancy: 122% 149.8% or improve up to 10% 9/11/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) European Gaza Hospital: European Gaza Hospital Nasser occupancy: 79% occupancy: 94% 99.7% European Gaza Hospital occupancy: 89.8% Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 Achieved as of June 2019 Comments: IN00737231 ►Referral protocols and procedures for the ten costliest conditions defined and rendered operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 8.00 10.00 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737232 ►A consolidated Government Health Information System (HIS) for referrals and health insurance is operational (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target A web-based system operational in all Value 0.00 not operational Partially operational hospitals taking referrals Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737233 ►HIS operational in selected hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 12.00 12.00 10.00 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 Achieved as of June 2018. One more hospital is currently in process to operationalize HIS. Comments: IN00737234 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 2.00 Date 25-Jan-2015 26-Feb-2019 26-Feb-2019 31-Dec-2019 Achieved as of December 2018. Comments: IN00737235 Direct project beneficiaries (no), of which female (%) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 45.50 45.50 53.00 IN00737236 ►New referral contracts/ MOUs negotiated with all outside providers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/11/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Value 0.00 16.00 21.00 30.00 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737237 ►Purchasing agency (either independent or part of the MOH) created, staffed and made operational (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 Functional Functional Functional Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 Achieved as of August 2018. Comments: IN00737238 ►People with access to a basic package of health, nutrition or reproductive health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 90.00 90.00 90.00 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737239 Direct project beneficiaries (no), of which female (%) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 62.00 50.00 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737240 ►External audit (medical and financial) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Financial audit report for 2017 has been cleared and approved by the Ministry of Finance and Planning. Medical audit Achieved as of June Value Not available Functional for referrals at the SPU 2019 were conducted by medical auditors and case managers as of December 2018. Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737241 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 635.00 700.00 500.00 Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 Achieved as of December 2018 Comments: IN00737242 9/11/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) ►Grievance and Redress Mechanism (GRM) for OMRs and access to Health Care designed and fully operational by end of the project (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target As of December 2018, a patient can document a complaint on the complaint website which is a part of the MOH website. The MOH reports the number of Achieved as of June Value Not available received complaints to Fully functional 2019 Annual Complaint Report, which is published by the General Secretariat of the Council of Ministers, General Directorate of Complaints. Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737243 ►Communciation strategy on UHC developed and consultation workshops conducted to promote the concept of citizens' engagement (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target As of December 2018, Communication Strategy was developed, following by consultation Partially achieved. One consultation Value 0.00 workshops with key MOH Implementation takes workshop conducted departments (referral, place in 2019. insurance, complaint, media and public relations) Date 25-Jan-2015 26-Feb-2019 21-Aug-2019 31-Dec-2019 IN00737244 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 175,554.00 175,554.00 526,662.00 Date 01-Jan-2017 31-Dec-2017 31-Dec-2017 31-Dec-2019 IN00737245 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 138,116.00 138,116.00 414,348.00 Date 01-Jan-2017 31-Dec-2017 31-Dec-2017 31-Dec-2019 IN00737246 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 37,438.00 37,438.00 112,314.00 Date 01-Jan-2017 31-Dec-2017 31-Dec-2017 31-Dec-2019 9/11/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P150481 TF-18986 Effective USD 8.50 8.50 0.00 5.33 3.17 63% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P150481 TF-18986 Effective 04-Feb-2015 04-Feb-2015 16-Feb-2015 30-Jun-2020 30-Jun-2020 Cumulative Disbursements Restructuring History Level 2 Approved on 07-Sep-2015 ,Level 2 Approved on 17-Jan-2018 Related Project(s) 9/11/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) There are no related projects. 9/11/2019 Page 8 of 8