The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Sri Lanka: Primary Health Care System Strengthening Project (P163721) SOUTH ASIA | Sri Lanka | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2018 | Seq No: 3 | ARCHIVED on 18-Aug-2019 | ISR38139 | Implementing Agencies: Ministry of Health, Nutrition and Indigenous Medicine, Democratic Socialist Republic of Sri Lanka Key Dates Key Project Dates Bank Approval Date: 27-Jun-2018 Effectiveness Date: 23-Jan-2019 Planned Mid Term Review Date: 17-May-2021 Actual Mid-Term Review Date: -- Original Closing Date: 31-Dec-2023 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to increase the utilization and quality of primary health care services, with an emphasis on detection and management of non-communicable diseases in high-risk population groups, in selected areas of the country. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Implementation of the PHC System Reorganization and Strengthening Strategies:(Cost $4404.00 M) Project Implementation Support and Innovation Grants:(Cost $14.22 M) Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Ministry of Health met all disbursement linked results due to be completed prior to June 30, 2019, which provided the basic policy and operational guidance necessary for the PHC reorganization and strengthening activities supported, in part, by the Project. These included important policy decisions endorsing the Essential Service Package to be provided by primary health care facilities, the process of empaneling and registering the population to a specific primary health care provider, clinical protocols for quality non-communicable disease detection and management, and community engagement guidelines. Given this progress in the first year of project implementation, the project is rated as satisfactory. 8/18/2019 Page 1 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability Moderate Moderate Moderate Fiduciary Moderate Moderate Moderate Environment and Social Low Low Low Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Increase utlization of PHC services, particularly prevention/management of NCDs in high-risk groups IN00731507 ►Number of women at age 35 and at age 45 years who are screened for cervical cancer at a network of public health facilities (DLI 8) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 107,551.00 161,344.00 161,344.00 213,000.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 This reflects the number reported for calendar year 2018. The report for 2019 is not yet available. Comments: IN00731509 ►Percentage of screened adults with high risk for non-communicable diseases who are registered and actively followed-up at primary medical care institutions (DLI 9) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 29-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 Information system to track this indicator is not yet available. Comments: IN00731510 Male (Percentage, Custom Breakdown) 8/18/2019 Page 2 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 IN00731511 Female (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 30-Dec-2022 Increase in the quality of PHC services, in selected areas of the country IN00731508 ►The number of primary medical care institutions that have the required capabilities for providing comprehensive and quality care. (DLI 3) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 550.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 Of the 5 capabilities defined in the indicator, the status is as follows: - Approximately 5% registered and screened adult population in the defined empaneled area for all 50 phase 1 target PMCIs Comments: - Operational definitions for essential training of MOs and Nurses, equipment, drugs and lab tests are pending - Quality supportive supervision visits have just started in all 50 phase 1 target PMCIs Intermediate Results Indicators by Components Implementation of the PHC System Reorganization and Strengthening Strategies IN00731513 ►MoH and Provinces endorse policies and standards for reorganizing PHC (DLI 1) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target MoH and Provinces MoH and Provinces Policies and standards endorse the package endorse the package sufficient to guide PHC of circulars and of circulars and Value Same as baseline. Reorganization do not guidelines necessary guidelines necessary exist for PHC model for PHC model implementation. implementation Date 03-Sep-2018 28-Feb-2019 30-Jun-2019 30-Jun-2019 IN00731515 ►MoH adopts and updates clinical protocols for selected health conditions (DLI 2) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No clinical protocols Package of protocols Package of protocols targeted for the PHC adopted for defined adopted for defined Value Same as baseline. level exist for the defined selected health selected health tracer conditions conditions. conditions 8/18/2019 Page 3 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Date 03-Sep-2018 28-Feb-2019 30-Jun-2019 23-Jun-2023 IN00731516 ►Number of annual progress reviews on MoH Action Plan, including Project Results Indicators at the central MoH (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3.00 Date 03-Sep-2018 28-Feb-2019 30-Jun-2019 31-Dec-2022 This is planned in the month of August by the Planning unit Comments: IN00731517 ►Number of patient-friendly services provided on the basis of 4 types of services at the PMCIs (DLI 4) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 550.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 Progress on the 4 types of patient friendly service is outlined below: - The list of tracer drugs to be given in blister yet to be defined. Some drugs are currently being issued in blister pack in all 50 phase 1 PMCIs. Comments: - PPP has not yet been established for pharmacy and lab services. - Online appointment systems are being encouraged in some PMCIs, but not yet established. IN00731518 ►Percentage of Medical Officers (both Medical Officers of Health in the Public Health stream and Medical Officers at PMCIs) trained on essential service package on NCDs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 01-Jul-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 Distance learning program for MOs to be initiated by early October Comments: IN00731519 ►Percentage of PMCIs with transport facilities for dispatching the samples for investigations to apex laboratories (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 5.00 55.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 These are available in all 50 phase 1 PMCIs Comments: IN00731520 ►Percentage of PMCIs with capability for primary detection and management of dengue (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 55.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 Status report on the same currently not available. To be taken from Dengue Control Unit, Ministry of Comments: Health 8/18/2019 Page 4 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) IN00731521 ►Percentage of PMCIs providing a standard primary oral health care package (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 55.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 The PHC oral package has been included in the essential services package (ESP) and the DDG-DS has Comments: taken initiatives to achieve the target IN00731522 ►Percentages of PMCIs with basic emergency care facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 0.00 0.00 50.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 30-Dec-2022 Status report from DDG-MS II and provinces not yet available. Comments: IN00731523 ►Percentage of Medical Officer of Health areas offering mental health services in at least one PMCI (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 35.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 Status report from D/Mental Health not yet available. Comments: IN00731524 ►Percentage of PMCIs with capability for TB screening and referral (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 45.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 Status report D/TB control programme not yet available. Comments: IN00731525 ►Percentage of Medical Officer of Health areas with at least one PMCI providing routine nutrition counseling services, particularly for identified high-risk population, by qualified nutritionist (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 35.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 Cadre approval is pending from the DMS. Status report from the D/Nutrition not yet available. Comments: IN00731526 ►Percentage of public sector schools implementing health promoting programs (health promoting schools) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 8/18/2019 Page 5 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Value 31.00 31.00 31.00 45.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 30-Dec-2022 Status report from the D/FHB not yet available. Baseline value retained. Comments: IN00731527 ►Percentage of food business operators inspected and classified as satisfactory according to the healthy food standard (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 51.00 51.00 75.00 Date 29-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 Status report from the DDG-E&OH not yet available. Baseline value retained. Comments: IN00731528 ►Number of PMCIs that use personal health records to coordinate patient care over time and through the referral chain (DLI 5) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 50.00 550.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 IN00731529 ►Number of PMCIs connected to and using the Medical Supplies Management Information System (DLR 6.1) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 550.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 Procurement procedures underway to extend the system. Comments: IN00731530 ►Percentage of annual procurement by MSD that is less than or equal to defined performance benchmarks (DLR 6.3) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 50.00 50.00 70.00 Date 31-Dec-2016 31-Dec-2018 30-Jun-2019 31-Dec-2022 IN00731531 ►The use of the urgent procurement procedure as a percent of total medical supplies procurement that is reduced from the established baseline (DLR 6.5) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 IN00731532 ►Community Engagement Mechanism for health sector operational, including grievance redressal mechanism (DLI 7) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 8/18/2019 Page 6 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) An operational An operational community community There is no operational engagement and engagement and community engagement Value Same as baseline. citizen feedback citizen feedback and grievance redressal mechanism in place, mechanism in place, mechanism especially for users of especially for users of PMCIs. PMCIs. Date 03-Sep-2018 28-Feb-2019 30-Jun-2019 30-Jun-2023 IN00731533 ►Number of PMCIs with active community engagement committees (DLR 7.5) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 550.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 30-Dec-2022 Initiatives have been taken to establish committees . Status is yet to be assessed after the piloting of the Comments: community engagement guideline in PMCIs. IN00731534 ►Adequate and timely release of treasury funds requested to health sector program (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 75.00 75.00 75.00 85.00 Date 31-Dec-2017 31-Dec-2018 30-Jun-2019 31-Dec-2022 Baseline data has been retained. Comments: Project Implementation Support and Innovation Grants IN00731512 ►Percentage of MoH and district training/capacity building plans developed and monitored (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2022 - A consultant is to be hired to facilitate the development of capacity building plan. Comments: - 1 MoH and district level foreign capacity building programme on NCD was completed. IN00731514 ►Number of innovative subprojects supported, evaluated and disseminated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 03-Sep-2018 31-Dec-2018 30-Jun-2019 31-Dec-2023 1 innovation project has been awarded. 23 innovation projects were sent for independent review and are Comments: pending project review committee recommendations. 8/18/2019 Page 7 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P163721 IBRD-88780 Effective USD 200.00 200.00 0.00 24.77 175.23 12% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P163721 IBRD-88780 Effective 27-Jun-2018 23-Jan-2019 23-Jan-2019 31-Dec-2023 31-Dec-2023 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) 8/18/2019 Page 8 of 9 The World Bank Implementation Status & Results Report Sri Lanka: Primary Health Care System Strengthening Project (P163721) There are no related projects. 8/18/2019 Page 9 of 9