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: GHN06 IBRD/IDA | Program-for-Results Financing | FY 2019 | Team Leader(s): Rifat Afifa Hasan Seq No: 1 | ARCHIVED on 27-Jun-2019 | ISR36571 | Created by: Rifat Afifa Hasan on 05-Apr-2019 | Modified by: Rahul Pandey on 26-Jun-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 Overall Implementation Progress (IP) -- Satisfactory Implementation Status and Key Decisions The Tamil Nadu Health System Reform Program (TNHSRP) – scheduled to be implemented between 2019 and 2014 – was approved by the World Bank Board of Directors on March 19, 2019. The Loan Agreement and Program Agreement were signed by the Government of India, Government of Tamil Nadu and World Bank on June 4, 2019. The TNHSRP is expected to be declared effective in July 2019 following the issuance of the legal opinion, after which disbursements can begin. Since the TNHSRP uses a Program-for-Results (PforR) instrument, it is imperative that implementation begins promptly to ensure that timebound disbursement-linked results (DLRs) are met so that the associated financing is not forfeited. The PforR is a new approach that pays for results rather than inputs and will require a mindset change among implementers to maintain focus on achieving the results. The priorities at this stage are to ensure that (i) institutional mechanisms are immediately put in place and administrative actions taken to enable prompt implementation, and (ii) develop roll-out plans for implementation of year 1 activities. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Not P166373 IBRD-89340 USD 287.00 287.00 0.00 0.00 287.00 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P166373 IBRD-89340 19-Mar-2019 04-Jun-2019 -- 31-May-2024 31-May-2024 Effective 6/27/2019 Page 1 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Program Action Plan Increase bidder participation: (i) establish procurement complaint redressal system; and (ii) organize annual supplier Action Description forum/conferences Source DLI# Responsibility Timing Timing Value Status TNMSC, ELCOT, Fiduciary Systems Recurrent Continuous Not Yet Due PWD Completion (i) procurement complaint redressal system established; (ii) annual supplier forum/conferences organized Measurement Comments Strengthen FM capacity in NHM: (i) assessment to identify gaps in staffing and policies; (ii) training programs for Action Description accounting staff; (iii) greater use of expenditure module of PFMS; (iv) strengthen concurrent audit system. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems NHM Society Recurrent Continuous Not Yet Due Completion (i) gap assessment report; (ii) training programs organized; (iii) PFMS usage report; and (iv) concurrent audit report Measurement Comments Enhance transparency: (i) publicly disclose contract awards of value greater than INR 20 Million (approx. US$ Action Description 285,720); and (ii) collate 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 Not Yet Due DOHFW Completion (i) report on disclosure by the procurement agencies; and (ii) quarterly report on fraud and corruption-related Measurement complaints Comments 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 Annual performance audit conducted and reports publicly disclosed by the competent authority Measurement 6/27/2019 Page 2 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) 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 Not Yet Due Systems DME Completion New refresher training course rolled out for healthcare staff across all healthcare facilities Measurement Comments 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 Moderate -- Moderate Technical Design of Project or Program Moderate -- Moderate Institutional Capacity for Implementation and Sustainability Low -- Low Fiduciary Moderate -- Moderate Environment and Social Moderate -- Moderate Stakeholders Low -- Low Other Low -- Low Overall Moderate -- Moderate Results PDO Indicators by Objectives / Outcomes Improved Quality of Care and Reduced Equity Gaps in Reproductive and Child Health IN00688526 ►Increased number of public facilities with quality certification (primary, secondary, and tertiary) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/27/2019 Page 3 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (i) Tertiary facilities with entry level NABH (i) Tertiary (i) Tertiary facilities certification: 7 facilities with entry level with entry level NABH (ii) Secondary facilities NABH accreditation: 0 accreditation: 0 with NQAS (ii) Secondary (ii) Secondary certification: 70 of facilities with NQAS Value facilities with NQAS -- which 14 are in the certification: 3 certification: 3 priority districts (iii) Primary (iii) Primary facilities (iii) Primary facilities facilities with NQAS with NQAS certification: 4 with NQAS certification: 4 certification: 300 of which 60 are in the priority districts Date 01-Nov-2018 -- 14-Jun-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 Comments NQAS certification; • number of CHCs and PHCs (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, IN00688531 Tirunelveli, Tiruvannamalai, Virudhunagar. Tertiary facilities with entry level NABH certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 7.00 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688535 Secondary facilities with NQAS certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 70 of which 14 are in Value 3.00 -- 3.00 the priority districts Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688540 Primary facilities with NQAS certification (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 300 of which 60 are in Value 4.00 -- 4.00 the priority districts Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 Improved Quality of Care IN00688527 ►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 Value quality dashboard is -- quality dashboard is To be established established established Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 A quality dashboard will be developed for primary, secondary, and tertiary level facilities in Year 1. This Comments indicator will track 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. 6/27/2019 Page 4 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Strengthened Management of Non-Communicable Diseases and Injuries IN00688530 ►Increased screening in public sector facilities for cervical and breast cancers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Cervical cancer: 15.8% Cervical cancer: 15.8% Cervical cancer: 30% Value -- Breast cancer: 19.5% Breast cancer: 19.5% Breast cancer: 30% Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 % of women age 30+ screened for cervical and breast cancer in public sector facilities Numerator: number Comments of women age 30+ screened for cervical/breast cancers in public sector facilities Denominator: number of IN00688532 women age 30+ Cervical cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 15.80 -- 15.80 30.00 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688536 Breast cancer (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 19.50 -- 19.50 30.00 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 Improved Quality of Care and Strengthened Management of Non-Communicable Diseases and Injuries IN00688528 ►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 increase from NA - to be established to be measured after baseline Value after STEPS is -- STEPS is implemented Diabetes under implemented in 2019 control: 6 percentage point increase from baseline Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 (i) % of individuals age 30+ with hypertension whose blood pressure is under control;(ii) % of individuals age Comments 30+ with diabetes whose blood glucose level is under control. Numerators and denominators specified in IN00688534 the DLI verification protocol. Hypertension under control (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target NA - to best established to be measured after 3 percentage point Value after STEPS is -- STEPS is implemented increase from baseline implemented in 2019 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688538 Diabetes under control (Text, Custom Breakdown) 6/27/2019 Page 5 of 15 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 to be measured after 6 percentage point Value after STEPS is -- STEPS is implemented increase from baseline implemented in 2019 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688539 ►Improved provision of quality trauma care services (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) # of trauma centers (i) # of trauma centers (i) # of trauma centers using trauma registry: using trauma registry: 0 using trauma registry: 0 54 (ii) % of surgical ED (ii) % of surgical ED (ii) % of surgical ED Value admissions: 6.7% -- admissions: 6.7% admissions: 15% (iii) % of IFT calls as a % (iii) % of IFT calls as a (iii) % of IFT calls as a of total 108 system calls: % of total 108 system % of total 108 system 41.1% calls: 41.1% calls: 30% Date 01-Nov-2018 -- 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 Comments in the DLI verification protocol. *Group 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 IN00688542 % of total 108 system calls Numerator and denominator specified in the DLI verification protocol. # of trauma centers using trauma registry (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 54.00 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688543 % of surgical ED admissions (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 6.7% -- 6.7% 15% Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688544 % of IFT calls as % of total 108 system calls (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 41.1% -- 41.1% 30% Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 Reduced Equity Gaps in Reproductive and Child Health IN00688529 ►Increased utilization of reproductive and child health services in priority districts (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) Full ANC: 28.8% (i) Full ANC: 28.8% (i) Full ANC: 41.3% (ii) Fully immunized: (ii) Fully immunized: (ii) Fully immunized: Value -- 57.9% 57.9% 70.4% (iii) mCPR: 38.5% (iii) mCPR: 38.5% (iii) mCPR: 43.5% 6/27/2019 Page 6 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Date 01-Nov-2018 -- 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 Comments (ANC): Pregnant women receiving at least four 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 IN00688533 standard days method, the lactational amenorrhoea method, and emergency contraception. Full ANC (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 28.80 -- 28.80 41.30 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688537 Fully immunized (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 57.90 -- 57.90 70.40 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688541 mCPR (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 38.50 -- 38.50 43.50 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 Intermediate Results Indicators by Results Areas Result #1: Improved Quality of Care IN00688545 ►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 secondary, and tertiary secondary, and tertiary facilities implementing level facilities level facilities at least 1 endorsed implementing at least 1 implementing at least 1 quality improvement endorsed quality endorsed quality initiative from the list of improvement initiative improvement initiative evidence-based Value from the list of evidence- -- from the list of interventions specified based interventions evidence-based in the QoC Strategy: specified in the QoC interventions specified Primary: 570 and Strategy: 0 ………….. (ii) in the QoC Strategy: 0 Secondary and Number of primary, ………….. (ii) Number tertiary:248 ………….. secondary, and tertiary of primary, secondary, (ii) Number of facilities reporting on and tertiary facilities facilities reporting on 6/27/2019 Page 7 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) quality dashboard reporting on quality quality dashboard quarterly: 0 dashboard quarterly: 0 quarterly: Primary: 570 and Secondary and tertiary: 248 Date 01-Nov-2018 -- 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 indicators to measure quality of care along the three dimensions Comments 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. IN00688548 ►Piloting of patient experience questionnaire for secondary & tertiary care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 10.00 Date 01-Nov-2018 -- 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 Comments track the % of secondary & 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 IN00688549 ►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 40.00 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 This indicator measures the % of primary & secondary facilities with at least one staff trained on mental Comments health. Numerator: 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. IN00688551 ►Establishment of suicide hotline (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2021 TN has a functional toll-free number (104) for counselling on health issues and grievances related to health Comments services. Under the Program, a hotline linked to the 104 health helpline will be developed for counselling related to suicide contemplation and attempts. IN00688553 ►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 6/27/2019 Page 8 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Value 64.00 -- 64.00 164.00 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 Comments Number of ATLS ambulances providing Level 1 care during the year. IN00688555 ►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; Level 3: Nurses - 165; Level 3: Nurses - Doctors - 100. Doctors - 100. 9000; Doctors - 6000. Value -- Level 4: Nurses - 0; Level 4: Nurses - 0; Level 4: Nurses - 900; Doctors - 0. Doctors - 0. Doctors - 600. Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 This indicator measures the number of emergency department providers that received Level 3 (BTLS) and Comments Level 4 training (ATLS) during the year. Result #3: Reduced Equity Gaps in Reproductive and Child Health IN00688547 ►Implementation of updated social and behavior change communication (SBCC) strategy (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 This indicator tracks progress on the implementation of annual workplans developed as part of a Comments comprehensive SBCC Strategy. The SBCC strategy will include messages on NCDs and their risk factors (including mental health), road safety, and RCH in priority districts IN00724522 ►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 3,600,000.00 Date 29-Mar-2019 -- 29-Mar-2019 01-Jul-2024 This indicator tracks number of children who have received immunization services in the state. Comments IN00724524 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 3,600,000.00 Date 29-Mar-2019 -- 29-Mar-2019 01-Jul-2024 Cross-Cutting Results IN00688546 ►Strengthened content, quality, accessibility, and use of data for decision making (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/27/2019 Page 9 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Conceptual Model and Conceptual Model and Operational Plan for a Operational Plan for a Integrated system strengthened and strengthened and implemented in all the Value -- integrated Health integrated Health health facilities in 9 Management Management Information districts: Yes Information System System (HMIS) : No (HMIS) : No Date 01-Nov-2018 -- 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 Comments contract will be awarded for development of integrated HMIS, and 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. IN00688550 ►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 (ii) Development & adoption of performance-based incentive strategy for PHCs: Yes. Date 01-Nov-2018 -- 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 Comments research proposals issued and selected 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. IN00688552 ►Increased transparency and accountability through citizen engagement (voice, agency, and social accountability) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Districts conducting Districts conducting Districts conducting Health Health Assembly: Health Assembly: 0%. Value Assembly: 0%. -- 60%. State Health Assembly: State Health Assembly: 0 State Health 0 Assembly: 1 Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 Year 2 onward, the indicator will monitor the share of districts conducting health assemblies/forums and Comments whether an annual 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. IN00688554 Districts conducting Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0% -- 0% 60% 6/27/2019 Page 10 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Date 01-Nov-2018 -- 14-Jun-2019 01-Jul-2024 IN00688556 State Health Assembly (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1.00 Date 01-Nov-2018 -- 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 in the QoC Strategy: US$20,000 for each primary care facility up to 143 facilities and US$30,000 for each secondary and tertiary care facility Ad hoc implementation of Ad hoc implementation of up to 62 Value quality improvement -- quality improvement facilities...….(ii) At initiatives by hospitals initiatives by hospitals least 1 health facility 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 -- Comments ►DLI 2 Increased number of public facilities with quality certification (primary, secondary and tertiary) (Outcome, 38,200,000.00, 0%) 6/27/2019 Page 11 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Baseline Actual (Previous) Actual (Current) Year 5 (i) US$850,000 for every tertiary care facility certified (up to 2 such facilities)…………...( ii) US$160,0 00 for every (i) Tertiary: 0 additional secondary (i) Tertiary: 0 (ii) Secondary: 3 care facility certified (ii) Secondary: 3 (iii) Primary: 4 (up to 21 facilities), (iii) Primary: 4 Tertiary = medical with an additional Tertiary = medical colleges colleges US$75,000 for each Value -- Secondary = district, taluk, Secondary = district, taluk, of the first 2 that are and non-taluk hospitals and non-taluk hospitals in the priority Primary = PHCs and CHCs Primary = PHCs and districts...……...(iii) CHCs US$37,00 0 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 -- 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%) Baseline Actual (Previous) Actual (Current) Year 5 Value Baseline to be established -- Baseline to be established (i) The percentage after STEPS is after STEPS is point increase in the implemented in 2019 implemented in 2019 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 increase ……………………… (ii) The percentage point increase in the share of diabetic adults whose blood glucose is under control over the previous survey 6/27/2019 Page 12 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (with statistical significance) up to 3 percentage points increase - US$3 million for every percentage point increase Date -- -- 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 (i) Increase in the number of trauma centers where the trauma registry is in use - US$35,000 for each additional trauma center from the previous year operating a trauma registry up to 14 (i) # of trauma centers trauma centers (i) # of trauma centers using trauma registry: 0 ………….. (ii) using trauma registry: 0 ……………….(ii) % of Percentage point ……………….(ii) % of surgical emergency increase in surgical surgical emergency department admissions in emergency department admissions in Group A and B facilities department Group A and B facilities who received surgery admissions in Group Value who received surgery within -- within 6 hours of A and B facilities 6 hours of admission in the admission in the same who received same institution: 6.7% institution: 6.7% surgery within 6 ……………….(iii) % of IFT ……………….(iii) % of IFT hours of admission - calls as a % of total 108 calls as a % of total 108 US$600,000 for system calls: 41.1% system calls: 41.1% 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 -- 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 6/27/2019 Page 13 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) (i) Percentage point increase in women receiving full ANC compared to the previous survey (with statistical significance) - US$1,600,000 for every percentage point increase from baseline up to 5 (i) Women receiving full percentage points ANC: 28.8% ……………… ……………………… (ii) Children 12–23 months .. (ii) Percentage fully immunized: 57.9% point increase in full …………….. (iii) Modern immunization of contraception prev. rate: children 12–23 38.5% (i) Women receiving full months compared to ANC: 28.8% ……………… the previous survey Definitions: (a) Full ANC (ii) Children 12–23 months (with statistical means at least four ANC fully immunized: 57.9% Value -- significance) - visits, at least one tetanus …………….. (iii) Modern US$1,600,000 for toxoid injection, and having contraception prev. rate: every percentage taken IFA tablets or syrup 38.5% point increase from for 100 or more days. (b) baseline up to 5 Full immunization means percentage points vaccinations against ……………………… tuberculosis, diphtheria, ….. (iii) Percentage pertussis, tetanus, polio, point increase in and measles modern contraceptive 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 -- 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 least 1 HMIS in place but HMIS in place but additional district of Value fragmented across data -- fragmented across data Tamil Nadu - streams/ databases streams/ databases US$1,000,000 per district up to a maximum of 8 districts Date -- -- 14-Jun-2019 -- 6/27/2019 Page 14 of 15 The World Bank Implementation Status & Results Report Tamil Nadu Health System Reform Program (P166373) Comments ►DLI 7 Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results (Process, 30,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 5 Annual call for research proposals Value NA -- NA issued and selected proposal awarded - US$ 3,000,000 Date -- -- 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 (i) At least 40% of all districts conducted health assembly during the year - US$3,000,000 Value NO -- No ………….. (ii) Tamil Nadu conducted state health assembly during the year - US$250,000 Date -- -- 14-Jun-2019 -- Comments 6/27/2019 Page 15 of 15