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: 15 | ARCHIVED on 18-Mar-2020 | ISR40911 | 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: 31-Dec-2021 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 $1.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Health System Resiliency Strengthening project continues to make progress. To date, 65% of the US$ 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. Upon MOH's request, the project was restructured in January 2020 to extend the project’s closing date from June 30, 2020 to December 31, 2021 to allow the completion of key ongoing activities. With the recent COVID 19 outbreak, and upon the request of MOH, an amount of US$ 800,000 was reallocated to support the Ministry combat the outbreak. Furthermore, a new emergency operation in the amount of US$ 5 million is currently being prepared to help the Palestinian 3/18/2020 Page 1 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Authority contain the outbreak. Due to the current circumstances and the Ministry’s condensed efforts in fighting COVID-19, project implementation may experience some delay. 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 -- Substantial Substantial Technical Design of Project or Program -- Substantial Substantial Institutional Capacity for Implementation and -- High High Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Project Development Objectives IN00816226 ►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 Shifa occupancy: Shifa occupancy: 89% Shifa occupancy: 89%, 149.8%, Rafedia occupancy: Rafedia occupancy: Rafedia occupancy: 99.3% 85%, Alia occupancy: Shifa occupancy: 89%, 103.0%; Alia occupancy: 136% Rafedia occupancy: 85% Alia occupancy: 144.8% 137.7% Obstetrics Shifa: 76% Obstetrics Shifa: 76% Obstetrics Shifa:95.5% Obstetrics Shifa: 94% - Obstetrics Rafedia: Obsetrics Rafedia: 94% Value Obstetrics Rafedia: Obstetrics Rafedia: 94% - Obstetrics Alia: Outpatient Shifa: 92.2% 97% 105% 180,000 Obstetrics Alia: 123.6% Obstetrics Alia: Outpatient Shifa: Outpatient Rafedia: Outpatient Shifa: OPD = 130.2% 578,646 - Outpatient 60,000 71,518, ER = 88,179 Outpatient Shifa: OPD Rafedia: 163,262 - Oupatient Rafedia: OPD = 224,329, ER = Outpatient Alia: = 30,281, ER = 49,424 274,762 102046 3/18/2020 Page 2 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Outpatient Alia: OPD = Oupatient Rafedia: 45,682, ER = 46,193 OPD = 67,280, ER = 98,393 Outpatient Alia: OPD = 101,292 ER = 106,014 Date 25-Jan-2015 21-Aug-2019 13-Mar-2020 31-Dec-2021 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 are now captured in this ISR following the restructuring. Based on 2018 data, utilization at above departments at Shifa and Rafidia hospitals exceeded the accurate baseline. IN00816227 ►Average annual growth of total expenditure in OMRs of a three-year period lower than the proposed baseline which is the period 2013- 2015 (<16.59%) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 14.0% Value 16.59% 14.0% <16.59% Date 01-Dec-2019 21-Aug-2019 13-Mar-2020 31-Dec-2021 The indicator is partially achieved. The final audited bill for the year 2019 is still not fully audited and will be ready in first quarter of 2020. Based on the provisional data of the year 2020, there is a reduction of 7.21% in the expenditure on referrals compared to the year 2018. As for the average annual growth of a Comments: four-year period between 2016 and 2019, it will be 5.53%, which is lower than the baseline which is <13.19%, which means that the target is in the process of being achieved. IN00816228 ►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 1.45:1 1.15:1 Date 25-Jan-2015 21-Aug-2019 13-Mar-2020 31-Dec-2021 Intermediate Results Indicators by Components Component One: Emergency and Rapid Response Window IN00816229 ►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:89% - Shifa occupancy: 149.8% Nasser occupancy: Nasser occupancy: 74% Nasser occupancy: 97.1% Same ratio as baseline Value European Gaza Hospital: 99.7% European Gaza or improve up to 10% 79% European Gaza Hospital Hospital occupancy: occupancy: 89.8% 80.4% 3/18/2020 Page 3 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Date 25-Jan-2015 21-Aug-2019 13-Mar-2020 31-Dec-2021 Achieved as of June 2019 Comments: Component Two: Rationalizing Outside Medical Referrals IN00816230 ►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 21-Aug-2019 13-Mar-2020 31-Dec-2021 2 more protocols to be prepared; the SPU identified pediatric surgery and radiotherapy as priority topics. Comments: IN00816233 ►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 Partially operational Partially operational hospitals taking referrals Date 25-Jan-2015 21-Aug-2019 13-Mar-2020 31-Dec-2021 IN00816238 ►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 21-Aug-2019 13-Mar-2020 31-Dec-2021 The 13 hospitals that have Avicenna HIS system are Jenin, Watani, Tulkarem, Tubas, Jericho, Qalqilia, Hebron, Yatta, Salfeet, Beit Jala, Rafidia, PMC and recently Hugo Chavez Ophthalmic hospital. The only MOH hospital that does not have HIS is Al Muhtaseb hospital due to the old infrastructure of the Comments: building. The mental hospital in Bethlehem has HIS only in the laboratory department in order to keep data on patients’ files confidential. IN00816239 ►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 13-Mar-2020 31-Dec-2021 Achieved as of December 2018. Comments: IN00816243 Direct project beneficiaries (no), of which female (%) (Percentage, Custom Supplement) 3/18/2020 Page 4 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 45.50 45.50 53.00 IN00816245 ►Ten certified infection preventionists and ten quality improvement practitioners by the Health Care Accreditation Council who will develop infection control plans and implement IP protocols (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 10 Certified Infection Preventionists 10 Quality Value Zero Zero Zero Improvement Practitioners Date 19-Dec-2019 31-Dec-2021 13-Mar-2020 31-Dec-2021 More information will be available by the next reporting period. Comments: IN00816246 ►Reducation in Device Associated Infections to 11/1000 cathetar or ventilator day (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 19/1000 catheter or 19/1000 catheter or 19/1000 catheter or 11/1000 catheter or Value ventilator day ventilator day ventilator day ventilator day Date 19-Dec-2019 19-Dec-2019 13-Mar-2020 31-Dec-2021 More information will be available by the next reporting period. Comments: IN00816248 ►Reduction in surgical site infection to 6% (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 12% 12% 12% 6% Date 19-Dec-2019 19-Dec-2019 13-Mar-2020 31-Dec-2021 More information will be available by the next reporting period. Comments: Component 3: Supporting Health Coverage to Strengthen Sector Resilience IN00816232 ►New referral contracts/ MOUs negotiated with all outside providers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 21.00 21.00 30.00 Date 25-Jan-2015 21-Aug-2019 13-Mar-2020 31-Dec-2021 IN00816235 ►Purchasing agency (either independent or part of the MOH) created, staffed and made operational (Text, Custom) 3/18/2020 Page 5 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 Functional Functional Functional Date 25-Jan-2015 21-Aug-2019 13-Mar-2020 31-Dec-2021 Achieved as of August 2018. Comments: IN00816237 ►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 21-Aug-2019 13-Mar-2020 31-Dec-2021 IN00816241 Direct project beneficiaries (no), of which female (%) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 62.00 62.00 50.00 Date 25-Jan-2015 21-Aug-2019 13-Mar-2020 31-Dec-2021 IN00816242 ►The Electronic Health Record for Adult, Child, Vaccination and NCD is functional and generates data in the pilot PHC facilities where service delivery is based on the family practice approach (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Functional in 5 health directorates (3 in the Value Not functional yet Not functional yet Not functional yet West Bank and 2 in Gaza) Date 19-Dec-2019 19-Dec-2019 13-Mar-2020 31-Dec-2021 More information will be available by the next reporting period. Comments: IN00816244 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 175,554.00 421,329.00 526,662.00 Date 01-Jan-2017 31-Dec-2017 13-Mar-2020 31-Dec-2021 IN00816247 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 138,116.00 216,715.00 414,348.00 Date 01-Jan-2017 31-Dec-2017 13-Mar-2020 31-Dec-2021 IN00816249 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) 3/18/2020 Page 6 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 37,438.00 79,160.00 112,314.00 Date 01-Jan-2017 31-Dec-2017 13-Mar-2020 31-Dec-2021 Project Management and Capacity Building IN00816231 ►External audit (medical and financial) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Achieved as of June Value Not available Functional Functional 2019 Date 25-Jan-2015 21-Aug-2019 21-Aug-2019 31-Dec-2021 Financial audit of project for the year 2018 performed by Talal Abu Ghazaleh Co. and audit report was cleared by the Bank. Financial audit report for the year 2019 is expected in 2020. Comments: Medical auditing is performed by medical auditors recently hired at the SPU and the original staff at the SPU. IN00816234 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 700.00 700.00 500.00 Date 25-Jan-2015 21-Aug-2019 21-Aug-2019 31-Dec-2021 Achieved as of December 2018 Comments: IN00816236 ►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 Achieved as of June Value Not available Functional Fully functional 2019 Date 25-Jan-2015 21-Aug-2019 21-Aug-2019 31-Dec-2021 Achieved as of June 2019. The project supported the complaint unit at the MOH with the printing of GRM manual, complaint forms and posters with training on them. There is an electronic system http://cs.pmo.gov.ps through the prime minister’s office or through a link Comments: from the MOH website where patients can submit complaints. The MOH is referred to in the yearly report of the General Secretariat of the Council of Ministers, General Directorate of Complaints. IN00816240 ►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 3/18/2020 Page 7 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Partially achieved. One consultation Value 0.00 Implementation takes Partially achieved. workshop conducted place in 2019. Date 25-Jan-2015 21-Aug-2019 21-Aug-2019 31-Dec-2021 One workshop was conducted during the preparation of the communication strategy + several meetings with the target MOH units Two workshops and several meetings were conducted for the 3 target MOH units with the contracted company (Sky Advertising) in the participation of the Media Unit during the preparation of materials for the Comments: strategy implementation. Full achievement is expected during 2020 through the launch of a campaign including posters, stickers, magnetics, radio spots, video motion and social media messages 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 5.49 3.01 65% 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 31-Dec-2021 Cumulative Disbursements 3/18/2020 Page 8 of 9 The World Bank Implementation Status & Results Report Health System Resiliency Strengthening (P150481) Restructuring History Level 2 Approved on 07-Sep-2015 ,Level 2 Approved on 17-Jan-2018 ,Level 2 Approved on 13-Jan-2020 Related Project(s) There are no related projects. 3/18/2020 Page 9 of 9