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: 14 | ARCHIVED on 22-Oct-2019 | ISR38774 | 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 Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions An implementation support visit took place from October 7 to 11, 2019 to review the implementation progress of the project. Progress toward achievement of Project Development Objective (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) has been achieved. The intermediate results indicators have also largely achieved or exceeded their 2019 target values. More details on project components are provided below. 10/22/2019 Page 1 of 6 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Overall implementation progress Component 1: Performance-based financing (PBF) scheme to improve Maternal and Child Health (MCH) and Non-Communicable Diseases (NCD) services in primary health care (PHC) facilities. Between January 2018 and September 2019, PHC facilities performed a total of 92,004 cervical cancer screens, 249,513 diabetes mellitus screens, 478,467 hypertension screens, and 31,346 screens of antenatal clients for key risk factors, surpassing all end-of-project target values for the screening-related PDO indicators. Facility reports of screening coverage continue be verified by review of a sub-sample of medical cards and phone calls to recipients of care, without prior notice. Less than 2% of the sub-sample of facilities visited were classified as risky, due to absent medical records or non-confirmation by reported service recipients of diabetes mellitus screens. Following a process evaluation of previous iterations of the public awareness campaign to increase demand for screening, the final phase of the campaign has been launched. The fieldwork for the impact evaluation of demand-side incentives to increase the uptake of screenings for diabetes and hypertension was launched in July 2019 and will end in December 2019. Component 2: Improving efficiency and quality of selected hospitals. The completed design documents for the construction of Martuni and Vayots Dzor Medical Centers (MCs) were submitted for approval by the relevant government agencies. The two new hospitals are based on a new prototype with one-floor, higher total square meters (to accommodate a blood bank and dialysis unit), and higher construction costs. The construction, projected to start in April 2020, will take about 27 months, extending beyond the current closing date of the project, by 15 months to September 30, 2022. However, availability of project funds can only accommodate one hospital, thus the Ministry of Health will decide on the selected hospital by November 29, 2019. 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 IN00750190 10/22/2019 Page 2 of 6 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) ►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 85.00 89.70 85.00 Date 23-Jan-2013 09-Apr-2019 30-Sep-2019 30-Jun-2021 The 2021 end-of-project target value has been met. Comments: IN00750277 ►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)122.6% b)84.7% a) 76% b) 55% Date 31-Dec-2013 09-Apr-2019 30-Sep-2019 30-Jun-2021 The 2021 end-of-project target value has been met. Values exceeding 100% point to duplications owing to Comments: entry errors in e-health system. IN00750278 ►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% a)76.0% b)48.1% b)7.5% b) 36% Date 31-Dec-2013 09-Apr-2019 30-Sep-2019 30-Jun-2021 The 2021 end-of-project target value has been met. Comments: IN00750279 ►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 35.40 40.90 35.00 Date 23-Jan-2013 09-Apr-2019 30-Sep-2019 30-Jun-2021 The 2021 end-of-project target value has been met. Comments: To improve the efficiency and quality of selected hospitals in Armenia IN00750276 ►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% a)69.0% b)51.8% Value a) 64% b) 51% a) 70% b) 70% Date 23-Jan-2013 09-Apr-2019 30-Sep-2019 30-Jun-2021 The 2019 target values have been met. Comments: 10/22/2019 Page 3 of 6 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) Intermediate Results Indicators by Components Performance-based incentives to improve MCH and NCD services in Primary care facilities IN00750280 ►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 09-Apr-2019 30-Sep-2019 30-Jun-2021 The 2019 target value for this indicator has been achieved. Comments: IN00750282 ►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-Jun-2021 Actual values for this indicator to be updated following completion of next Health System Performance Assessment, scheduled to align with the Project closing date. Comments: Improving efficiency and quality of selected hospitals IN00750281 ►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 09-Apr-2019 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: IN00750283 ►% 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 26.00 33.30 25.00 Date 23-Jan-2013 09-Apr-2019 30-Sep-2019 30-Jun-2021 Outside the initial construction and equipment, the project does not provide direct support to the Comments: management of the center, which suggests this indicator may not be an appropriate measure of results attributable to the project. 10/22/2019 Page 4 of 6 The World Bank Implementation Status & Results Report Disease Prevention and Control Project (P128442) IN00750284 ►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 0.00 316.00 300.00 Date 23-Jan-2013 09-Apr-2019 30-Sep-2019 30-Jun-2021 The 2021 end-of-project values have been achieved. Comments: IN00750285 ►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. a) Operational. b) Operational. b) Operational. c) Civil works not All four Medical Value No c) Civil works not started. started. Centers operational d) Civil works not started. d) Civil works not started. Date 23-Jan-2013 09-Apr-2019 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: 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 27.70 4.46 86% P128442 TF-14138 Effective 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-Jun-2021 P128442 TF-14138 Effective 11-Jul-2013 27-Sep-2013 27-Sep-2013 31-Dec-2018 31-Dec-2019 Cumulative Disbursements 10/22/2019 Page 5 of 6 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. 10/22/2019 Page 6 of 6