The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Tamil Nadu Health System Reform Program (P166373) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | Requesting Unit: SACIN | Responsible Unit: HSAHN IBRD/IDA | Program-for-Results Financing | FY 2019 | Team Leader(s): Rifat Afifa Hasan Seq No: 2 | ARCHIVED on 11-Oct-2019 | ISR38541 | Created by: Rahul Pandey on 12-Sep-2019 | Modified by: Rifat Afifa Hasan on 04-Oct-2019 Program Development Objectives Program Development Objective (from Program Appraisal Document) The Program Development Objective (PDO) is to improve quality of care, strengthen management of non-communicable diseases and injuries, and reduce inequities in reproductive and child health services in Tamil Nadu. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO ►Satisfactory ►Satisfactory Overall Implementation Progress (IP) ►Satisfactory ►Moderately Satisfactory Implementation Status and Key Decisions The Tamil Nadu Health System Reform Program (TNHSRP) – was declared effective on July 29, 2019. There has been limited progress since the last mission in June 2019, which is concerning as there are a number of timebound disbursement-linked results (DLRs) that need to be completed by March 31, 2020 to disburse the associated financing as planned. Since the TNHSRP uses a Program-for-Results instrument, it is imperative that implementation begins promptly to ensure that timebound DLRs are met. Moreover, as the TNHSRP is an integral part of the Department of Health and Family Welfare’s (DoHFW) regular work program (rather than a standalone project), DoHFW should implement DLR-related activities through its own program with staff in the directorates and societies. The initial momentum that has been gained on the results area of quality of care should be replicated for the areas as well (non-communicable diseases and injuries; reproductive and child health). It has been agreed that the GoTN would ensure that actions related to institutional arrangements are completed urgently to help accelerate the pace of implementation. These actions include (i) a Government Order (GO) on the administrative sanction for the Program, (ii) the GO for the Program Management Unit (PMU), and (iii) sanction and transfer of budget for implementing first year activities to achieve timebound DLRs. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P166373 IBRD-89340 Effective USD 287.00 287.00 0.00 0.72 286.28 0.3% Key Dates (by loan) 10/11/2019 Page 1 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P166373 IBRD-89340 Effective 19-Mar-2019 04-Jun-2019 29-Jul-2019 31-May-2024 31-May-2024 DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IBRD89340-001 DLI1 Impl of imr in Pri Sec 1 Regular USD 43,732,000.00 Not Achieved 0.00 Tert fac DLI2 Inc no of Pub Fac with Partially 2 Regular USD 38,200,000.00 0.00 Certifi Achieved DLI3 Inc Shr of adult Hyp 3 Regular USD 48,885,500.00 Not Achieved 0.00 Diab under Cnt DLI4 Impr Prov of Trauma 4 Regular USD 17,715,000.00 Not Achieved 0.00 Care Serv DLI5 Inc Util Reprod Child 5 Regular USD 56,500,000.00 Not Achieved 0.00 Serv Prio Dis DLI6 Strgn Cont, Qual, Access 6 Regular USD 36,500,000.00 Not Achieved 0.00 Dec Mak DLI7 Strgn Coord, Integ, Perf 7 Regular USD 30,750,000.00 Not Achieved 0.00 bas Mgt Le DLI8 Inc transp, account, Citi 8 Regular USD 14,000,000.00 Not Achieved 0.00 Eng Program Action Plan Action Description Increase bidder participation: (i) establish procurement complaint redressal system; and (ii) organize annual supplier forum/conferences Source DLI# Responsibility Timing Timing Value Status TNMSC, ELCOT, Fiduciary Systems Recurrent Continuous Delayed PWD Completion Measurement (i) procurement complaint redressal system established; (ii) annual supplier forum/conferences organized (i) yet to be established, to be completed by October 31, 2019 Comments (ii) yet to be organized, to be completed by December 31, 2019 by ELCOT and PWD and by January 31, 2020 by TNMSC Strengthen FM capacity in NHM: (i) assessment to identify gaps in staffing and policies; (ii) training programs for accounting staff; (iii) Action Description greater use of expenditure module of PFMS; (iv) strengthen concurrent audit system. 10/11/2019 Page 2 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NHM Society Recurrent Continuous Delayed Completion Measurement (i) gap assessment report; (ii) training programs organized; (iii) PFMS usage report; and (iv) concurrent audit report Comments No progress made; discussions carried out with NHM and an action plan would be developed by NHM to address these actions Enhance transparency: (i) publicly disclose contract awards of value greater than INR 20 Million (approx. US$ 285,720); and (ii) collate Action Description information on fraud and corruption-related complaints and provide information to WB on a quarterly basis Source DLI# Responsibility Timing Timing Value Status TNMSC, ELCOT, Fiduciary Systems PWD; Secretariat, Recurrent Continuous Delayed DOHFW Completion Measurement (i) report on disclosure by the procurement agencies; and (ii) quarterly report on fraud and corruption-related complaints (i) to be completed by December 31, 2019 (ii) information yet to be shared with the Bank. Communication has been sent to Health Secretary’s office to establish the system Comments to share this information with the Bank Action Description BMWM: performance audits for the CTFs have to be undertaken Source DLI# Responsibility Timing Timing Value Status Environmental and Social TNHSRP PMU Recurrent Yearly Not Yet Due Systems Completion Measurement Annual performance audit conducted and reports publicly disclosed by the competent authority Comments Action Description Introduce continuous refresher trainings on biomedical and other waste management Source DLI# Responsibility Timing Timing Value Status Environmental and Social TNSHRP PMU and Recurrent Continuous Delayed Systems DME Completion Measurement New refresher training course rolled out for healthcare staff across all healthcare facilities 10/11/2019 Page 3 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Comments No progress reported Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance ►Moderate ►Moderate ►Moderate Macroeconomic ►Low ►Low ►Low Sector Strategies and Policies ►Moderate ►Moderate ►Moderate Technical Design of Project or Program ►Moderate ►Moderate ►Moderate Institutional Capacity for Implementation and Sustainability ►Low ►Low ►Low Fiduciary ►Moderate ►Moderate ►Moderate Environment and Social ►Moderate ►Moderate ►Moderate Stakeholders ►Low ►Low ►Low Other ►Low ►Low ►Low Overall ►Moderate ►Moderate ►Moderate Results PDO Indicators by Objectives / Outcomes Improved Quality of Care and Reduced Equity Gaps in Reproductive and Child Health IN00743665 ►Increased number of public facilities with quality certification (primary, secondary, and tertiary) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Tertiary (i) Tertiary facilities with facilities with entry level (i) Tertiary facilities entry level NABH (i) Tertiary facilities NABH accreditation: 0 with entry level NABH certification: 7 with entry level NABH (ii) Secondary accreditation: 0 (ii) Secondary facilities accreditation: 0 facilities with NQAS (ii) Secondary with NQAS certification: (ii) Secondary facilities certification: 7 out of which Value facilities with NQAS 70 of which 14 are in the with NQAS certification: 3 2 are in priority districts certification: 3 priority districts (iii) Primary facilities (iii) Primary facilities (iii) Primary facilities (iii) Primary facilities with with NQAS certification: 4 with NQAS certification: with NQAS certification: 4 NQAS certification: 300 22 out of which 5 are in of which 60 are in the priority districts priority districts 10/11/2019 Page 4 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 This indicator measures the number of facilities receiving quality certification during the Program period. Specifically, it monitors the: • number of medical colleges (tertiary facilities) with entry level NABH certification; • number of District Head Quarter, Taluk and non-Taluk Hospitals (secondary facilities) with full NQAS certification; • number of CHCs and PHCs Comments (primary facilities) with full NQAS certification. The indicator also monitors the number of facilities of each level receiving quality certification in priority districts. The priority districts are: Ariyalur, Dharmapuri, Ramanathapuram, The Nilgris, Theni, Thoothukkudi, Tirunelveli, Tiruvannamalai, Virudhunagar. IN00743670 ►Tertiary facilities with entry level NABH certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 7.00 Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 IN00743674 ►Secondary facilities with NQAS certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 7 out of which 2 are in 70 of which 14 are in the Value 3.00 3.00 priority districts priority districts Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 IN00743679 ►Primary facilities with NQAS certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 21 out of which 5 are in 300 of which 60 are in the Value 4.00 4.00 priority districts priority districts Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 Improved Quality of Care IN00743666 ►Improved scores in quality dashboard for primary, secondary, and tertiary level facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target NA – to be measured after to be measured after quality to be measured after quality Value quality dashboard is To be established dashboard is established dashboard is established established Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 A quality dashboard will be developed for primary, secondary, and tertiary level facilities in Year 1. This indicator will track Comments the improvement on the quality dashboard score of these facilities on an annual basis. The baseline and target scores will be established once the dashboard is developed. Strengthened Management of Non-Communicable Diseases and Injuries IN00743669 ►Increased screening in public sector facilities for cervical and breast cancers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Cervical cancer: 15.8% Cervical cancer: 15.8% Cervical cancer: 4.54% Cervical cancer: 30% 10/11/2019 Page 5 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Breast cancer: 19.5% Breast cancer: 19.5% Breast cancer: 5.77% Breast cancer: 30% Date reported from April- July 2019; final figures would be reported post March 2020 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 % of women age 30+ screened for cervical and breast cancer in public sector facilities Numerator: number of women age 30+ Comments screened for cervical/breast cancers in public sector facilities Denominator: number of women age 30+ IN00743673 ►Cervical cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 15.80 15.80 4.54 30.00 Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 IN00743677 ►Breast cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 19.50 19.50 5.77 30.00 Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 Improved Quality of Care and Strengthened Management of Non-Communicable Diseases and Injuries IN00743667 ►Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Hypertension under control: 3 percentage point NA - to be established after to be measured after STEPS to be measured after increase from baseline Value STEPS is implemented in is implemented STEPS is implemented Diabetes under control: 6 2019 percentage point increase from baseline Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 (i) % of individuals age 30+ with hypertension whose blood pressure is under control;(ii) % of individuals age 30+ with Comments diabetes whose blood glucose level is under control. Numerators and denominators specified in the DLI verification protocol. IN00743671 ►Hypertension under control (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target NA - to best established after to be measured after STEPS to be measured after STEPS 3 percentage point Value STEPS is implemented in is implemented is implemented increase from baseline 2019 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 IN00743675 ►Diabetes under control (Text, Custom Breakdown) 10/11/2019 Page 6 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) End Target NA - to best established after to be measured after STEPS to be measured after STEPS 6 percentage point Value STEPS is implemented in is implemented is implemented increase from baseline 2019 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 IN00743678 ►Improved provision of quality trauma care services (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) # of trauma centers using (i) # of trauma centers using (i) # of trauma centers using (i) # of trauma centers trauma registry: 0 trauma registry: 0 trauma registry: 0 using trauma registry: 54 (ii) % of surgical ED (ii) % of surgical ED (ii) % of surgical ED (ii) % of surgical ED Value admissions: 6.7% admissions: 6.7% admissions: 6.7% admissions: 15% (iii) % of IFT calls as a % of (iii) % of IFT calls as a % of (iii) % of IFT calls as a % of (iii) % of IFT calls as a % of total 108 system calls: total 108 system calls: 41.1% total 108 system calls: 41.1% total 108 system calls: 30% 41.1% Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 (i) Number of trauma centers using trauma registry (ii) % of surgical ER admissions in Group A and B facilities* who received surgery within 6 hours in the same institution Numerator and denominator specified in the DLI verification protocol. *Group Comments A surgeries include general, orthopedic, plastic, vascular and neuro surgeries; Group B surgeries are limited to general and orthopedic. (iii) % of inter-facility transfer calls as a % of total 108 system calls Numerator and denominator specified in the DLI verification protocol. IN00743681 ►# of trauma centers using trauma registry (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 54.00 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 IN00743682 ►% of surgical ED admissions (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 6.7% 6.7% 6.7% 15% Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 IN00743683 ►% of IFT calls as % of total 108 system calls (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 41.1% 41.1% 41.1% 30% Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 Reduced Equity Gaps in Reproductive and Child Health IN00743668 ►Increased utilization of reproductive and child health services in priority districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 10/11/2019 Page 7 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (i) Full ANC: 41.3% (i) Full ANC: 28.8% (i) Full ANC: 28.8% (i) Full ANC: 28.8% (ii) Fully immunized: Value (ii) Fully immunized: 57.9% (ii) Fully immunized: 57.9% (ii) Fully immunized: 57.9% 70.4% (iii) mCPR: 38.5% (iii) mCPR: 38.5% (iii) mCPR: 38.5% (iii) mCPR: 43.5% Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 This indicator monitors the utilization of select RCH services in the 9 priority districts: Ariyalur, Dharmapuri, Ramanathapuram, The Nilgris, Theni, Thoothukkudi, Tirunelveli, Tiruvannamalai, Virudhunagar. The priority districts were identified based on their performance on RCH indicators and proportion of ST population. Three RCH indicators will be monitored: full immunization, full antenatal care, and use of modern methods of contraception. Numerators and denominators specified in the DLI verification protocol. Full antenatal care (ANC): Pregnant women receiving at least four Comments ANC visits, at least one TT injection, and taken IFA tablets or syrup for 100 or more days. Full immunization: Children 12- 23 months receiving vaccinations against tuberculosis, diphtheria, pertussis, tetanus, polio, and measles. Modern contraceptive prevalence rate (mCPR). Modern methods include male and female sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, female and male condoms, diaphragm, foam/jelly, the standard days method, the lactational amenorrhoea method, and emergency contraception. IN00743672 ►Full ANC (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 28.80 28.80 28.80 41.30 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 IN00743676 ►Fully immunized (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 57.90 57.90 57.90 70.40 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 IN00743680 ►mCPR (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 38.50 38.50 38.50 43.50 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 Intermediate Results Indicators by Results Areas Result #1: Improved Quality of Care IN00743684 ►Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Number of primary, (i) Number of primary, (i) Number of primary, (i) Number of Value secondary, and tertiary level secondary, and tertiary level secondary, and tertiary level facilities implementing at facilities implementing at least facilities implementing at facilities implementing at least 1 endorsed quality 10/11/2019 Page 8 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) 1 endorsed quality least 1 endorsed quality least 1 endorsed quality improvement initiative improvement initiative from improvement initiative from improvement initiative from from the list of evidence- the list of evidence-based the list of evidence-based the list of evidence-based based interventions interventions specified in the interventions specified in the interventions specified in specified in the QoC QoC Strategy: 0 ………….. (ii) QoC Strategy: 0 ………….. (ii) the QoC Strategy: 0 Strategy: Primary: 570 and Number of primary, Number of primary, ………….. (ii) Number of Secondary and secondary, and tertiary secondary, and tertiary primary, secondary, and tertiary:248 ………….. (ii) facilities reporting on quality facilities reporting on quality tertiary facilities reporting Number of dashboard quarterly: 0 dashboard quarterly: 0 on quality dashboard facilities reporting on quarterly: 0 quality dashboard quarterly: Primary: 570 and Secondary and tertiary: 248 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 This indicator tracks the implementation of at least one endorsed quality improvement initiative from the list of evidence- based interventions specified in the QoC Strategy and the number of facilities reporting on the quality dashboard quarterly. The indicator monitors each intervention at the primary and secondary/tertiary facilities. The quality dashboard will include Comments indicators to measure quality of care along the three dimensions of quality: structural inputs, clinical processes, and patient outcomes. The GoTN and the World Bank will develop this dashboard jointly. The indicators will vary by level of facility. Following development of the dashboard, primary, secondary, and tertiary facilities will be monitored for quarterly reporting on the quality dashboard. Numerators and denominators specified in the DLI verification protocol. IN00743687 ►Piloting of patient experience questionnaire for secondary & tertiary care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 A detailed patient experience questionnaire – expanding the concept of the Mera Aspatal survey to measure patient satisfaction – will be developed for patients visiting secondary & tertiary facilities. This indicator will track the % of secondary Comments & tertiary facilities piloting this patient experience questionnaire. Numerator: number of secondary & tertiary facilities piloting the patient experience questionnaire. Denominator: total number of secondary & tertiary facilities Result #2: Strengthened Management of Non-Communicable Diseases and Injuries IN00743690 ►Increased share of primary & secondary facilities with at least one staff trained on mental health (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 This indicator measures the % of primary & secondary facilities with at least one staff trained on mental health. Numerator: Comments number of primary & secondary facilities with at least one staff receiving face-to-face training on mental health. Denominator: total number of primary & secondary facilities. IN00743692 ►Establishment of suicide hotline (Yes/No, Custom) 10/11/2019 Page 9 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2021 TN has a functional toll-free number (104) for counselling on health issues and grievances related to health services. Under Comments the Program, a hotline linked to the 104 health helpline will be developed for counselling related to suicide contemplation and attempts. IN00743693 ►Better equipped ambulance system to improve pre-hospital care -number of ATLS ambulances providing Level 1 care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64.00 64.00 64.00 164.00 Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 Comments Number of ATLS ambulances providing Level 1 care during the year. IN00743696 ►Improved capacity of trauma care providers - number of emergency department providers that received Level 3 (BTLS) and Level 4 training (ATLS) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Level 3: Nurses - 165; Doctors Level 3: Nurses - 165; Level 3: Nurses - 410; Level 3: Nurses - 9000; - 100. Doctors - 100. Doctors - 255. Doctors - 6000. Value Level 4: Nurses - 0; Doctors - Level 4: Nurses - 0; Doctors - Level 4: Nurses - 0; Doctors Level 4: Nurses - 900; 0. 0. - 0. Doctors - 600. Date 01-Nov-2018 14-Jun-2019 13-Sep-2019 01-Jul-2024 This indicator measures the number of emergency department providers that received Level 3 (BTLS) and Level 4 training Comments (ATLS) during the year. Result #3: Reduced Equity Gaps in Reproductive and Child Health IN00743686 ►Implementation of updated social and behavior change communication (SBCC) strategy (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 This indicator tracks progress on the implementation of annual workplans developed as part of a comprehensive SBCC Comments Strategy. The SBCC strategy will include messages on NCDs and their risk factors (including mental health), road safety, and RCH in priority districts IN00743689 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3,600,000.00 Date 29-Mar-2019 29-Mar-2019 29-Mar-2019 01-Jul-2024 Comments This indicator tracks number of children who have received immunization services in the state. 10/11/2019 Page 10 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) IN00743695 ►Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3,600,000.00 Date 29-Mar-2019 29-Mar-2019 29-Mar-2019 01-Jul-2024 Cross-Cutting Results IN00743685 ►Strengthened content, quality, accessibility, and use of data for decision making (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Conceptual Model and Conceptual Model and Conceptual Model and Operational Plan for a Operational Plan for a Operational Plan for a Integrated system strengthened and integrated strengthened and integrated strengthened and integrated implemented in all the Value Health Management Health Management Health Management health facilities in 9 Information System (HMIS) : Information System (HMIS) : Information System districts: Yes No No (HMIS) : No Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 A Conceptual Model and Operational Plan for a strengthened Health Management Information System (HMIS) covering all data sources, data users and data channels including integration with electronic medical records and patient tracking for NCDs will be developed in Year 1. In Year 2, a detailed model and detailed design specifications will be completed based on the Conceptual Model and Operational Plan. In Year 3, a contract will be awarded for development of integrated HMIS, and Comments key modules (electronic health record and reporting) will be piloted in at least 1 primary, 1 secondary, and 1 tertiary facility in a district. In Year 4, the indicator will monitor the implementation of an integrated system in all the health facilities of at least one district (as determined by a GoTN order). In Year 5, the integrated system will be implemented in all the health facilities of up to an additional 8 districts of Tamil Nadu. IN00743688 ►Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) 1 annual call for research proposals issued and selected proposal awarded. Value Policies/Strategies: No Policies/Strategies: No Policies/Strategies: No (ii) Development & adoption of performance- based incentive strategy for PHCs: Yes. Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 This indicator tracks development and adoption of the following policies, strategies, and activities. Year 1: • TN Health Policy/ Strategy for Vision 2030; • Development and adoption of an Environment Strategy for the Health Sector in Tamil Nadu. Year 2: • Launch of the operational research program with 1 annual call for research proposals issued and selected Comments proposal awarded. • Deploying e-procurement system in TNMSC and 20% of value of total contracts of TNMSC under the Program done through e-procurement. Year 5: • Development and adoption of performance-based incentive strategy for PHCs. Year 3-5: One annual call for research proposals issues and selected proposals awarded. 10/11/2019 Page 11 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) IN00743691 ►Increased transparency and accountability through citizen engagement (voice, agency, and social accountability) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Districts conducting Health Districts conducting Health Districts conducting Health Districts conducting Value Assembly: 0%. Assembly: 0%. Assembly: 0%. Health Assembly: 60%. State Health Assembly: 0 State Health Assembly: 0 State Health Assembly: 0 State Health Assembly: 1 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 Year 2 onward, the indicator will monitor the share of districts conducting health assemblies/forums and whether an annual Comments State Health Assembly was convened. District health assemblies are expected to occur before the State Health Assembly. Numerator and denominator specified in the DLI verification protocol. IN00743694 ►Districts conducting Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0% 0% 0% 60% Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 IN00743697 ►State Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 01-Nov-2018 14-Jun-2019 14-Jun-2019 01-Jul-2024 Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities (Output, 43,732,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) At least 1 health facility implementing at least 1 endorsed quality improvement initiative from the list of evidence-based interventions specified Ad hoc implementation of Ad hoc implementation of Ad hoc implementation of in the QoC Strategy: Value quality improvement initiatives quality improvement quality improvement US$20,000 for each by hospitals initiatives by hospitals initiatives by hospitals primary care facility up to 143 facilities and US$30,000 for each secondary and tertiary care facility up to 62 facilities...….(ii) At least 1 health facility 10/11/2019 Page 12 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) reporting on quality dashboard during each quarter of the reporting year: US$14,800 for each additional primary care facility up to 190 facilities and US$22,000 for each additional secondary and tertiary care facility up to 82 facilities from the previous year Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 2 Increased number of public facilities with quality certification (primary, secondary and tertiary) (Outcome, 38,200,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 (i) US$850,000 for every tertiary care facility certified (up to 2 such facilities)…………...(ii) US$160,000 for every additional secondary care facility (i) Tertiary: 0 (i) Tertiary: 0 (i) Tertiary: 0 certified (up to 21 (ii) Secondary: 3 (ii) Secondary: 3 (ii) Secondary: 3 facilities), with an (iii) Primary: 4 (iii) Primary: 4 (iii) Primary: 4 additional US$75,000 Tertiary = medical colleges Tertiary = medical colleges Tertiary = medical colleges Value for each of the first 2 Secondary = district, taluk, and Secondary = district, taluk, Secondary = district, taluk, that are in the priority non-taluk hospitals and non-taluk hospitals and non-taluk hospitals districts...……...(iii) Primary = PHCs and CHCs Primary = PHCs and CHCs Primary = PHCs and CHCs US$37,000 for every additional primary care facility certified (up to 79 facilities), with an additional US$15,000 for each of the first 10 that are in the priority districts Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 3 Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control (Outcome, 48,885,500.00, 0%) 10/11/2019 Page 13 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) Year 5 (i) The percentage point increase in the share of hypertensive adults whose blood pressure is under control over the previous survey (with statistical significance) up to 1.5 percentage points increase - US$7.3 million for every percentage point Baseline to be established Baseline to be established after increase Baseline to be established after Value after STEPS is implemented STEPS is implemented in ……………………… (ii) STEPS is implemented in 2019 in 2019 2019 The percentage point increase in the share of diabetic adults whose blood glucose is under control over the previous survey (with statistical significance) up to 3 percentage points increase - US$3 million for every percentage point increase Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 4 Improved provision of quality trauma care services (Outcome, 17,715,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value (i) # of trauma centers using (i) # of trauma centers using (i) # of trauma centers using (i) Increase in the trauma registry: 0 ……………….(ii) trauma registry: 0 trauma registry: 0 number of trauma % of surgical emergency ……………….(ii) % of surgical ……………….(ii) % of surgical centers where the department admissions in emergency department emergency department trauma registry is in use Group A and B facilities who admissions in Group A and B admissions in Group A and B - US$35,000 for each received surgery within 6 hours facilities who received facilities who received surgery additional trauma of admission in the same surgery within 6 hours of within 6 hours of admission in center from the institution: 6.7% ……………….(iii) admission in the same the same institution: 6.7% previous year operating % of IFT calls as a % of total 108 institution: 6.7% ……………….(iii) % of IFT calls a trauma registry up to system calls: 41.1% ……………….(iii) % of IFT calls as a % of total 108 system calls: 14 trauma centers as a % of total 108 system 41.1% ………….. (ii) Percentage calls: 41.1% point increase in surgical emergency department admissions in Group A and B 10/11/2019 Page 14 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) facilities who received surgery within 6 hours of admission - US$600,000 for every percentage point increase up to 3 percentage points ……………. (iii) Percentage point decrease in IFT calls as a percent of total 108 system calls - US$800,000 for every percentage point decrease up to 2 percentage points Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 5 Increased utilization of reproductive and child health services in priority districts (Outcome, 56,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Value (i) Women receiving full ANC: (i) Women receiving full (i) Women receiving full (i) Percentage point 28.8% ……………… (ii) Children ANC: 28.8% ……………… (ii) ANC: 28.8% ……………… (ii) increase in women 12–23 months fully immunized: Children 12–23 months fully Children 12–23 months fully receiving full ANC 57.9% …………….. (iii) Modern immunized: 57.9% …………….. immunized: 57.9% …………….. compared to the contraception prev. rate: 38.5% (iii) Modern contraception (iii) Modern contraception previous survey (with prev. rate: 38.5% prev. rate: 38.5% statistical significance) - Definitions: (a) Full ANC US$1,600,000 for means at least four ANC visits, every percentage point at least one tetanus toxoid increase from baseline injection, and having taken IFA up to 5 percentage tablets or syrup for 100 or more points ……………………….. days. (b) Full immunization (ii) Percentage point means vaccinations against increase in full tuberculosis, diphtheria, immunization of pertussis, tetanus, polio, and children 12–23 months measles compared to the previous survey (with statistical significance) - US$1,600,000 for every percentage point increase from baseline up to 5 percentage points ………………………….. (iii) Percentage point increase in modern contraceptive 10/11/2019 Page 15 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) prevalence rate compared to the previous survey (with statistical significance) - US$3,300,000 for every percentage point increase from baseline up to 2 percentage points Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 6 Strengthened content, quality, accessibility, and use of data for decision-making (Output, 36,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Integrated HMIS implemented in all the health facilities in at HMIS in place but HMIS in place but HMIS in place but fragmented least 1 additional Value fragmented across data fragmented across data across data streams/ databases district of Tamil Nadu - streams/ databases streams/ databases US$1,000,000 per district up to a maximum of 8 districts Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 7 Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results (Process, 30,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Annual call for research proposals issued and Value NA NA NA selected proposal awarded - US$ 3,000,000 Date -- 14-Jun-2019 14-Jun-2019 -- Comments ►DLI 8 Increased transparency and accountability through citizen engagement (voice, agency, and social accountability) (Output, 14,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 10/11/2019 Page 16 of 17 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (i) At least 40% of all districts conducted health assembly during the year - Value NO No No US$3,000,000 ………….. (ii) Tamil Nadu conducted state health assembly during the year - US$250,000 Date -- 14-Jun-2019 14-Jun-2019 -- Comments 10/11/2019 Page 17 of 17