The World Bank Report No: ISR9624 Implementation Status & Results India India: Tamil Nadu Health Systems Project (P075058) Public Disclosure Copy Operation Name: India: Tamil Nadu Health Systems Project (P075058) Project Stage: Implementation Seq.No: 16 Status: ARCHIVED Archive Date: 27-Apr-2013 Country: India Approval FY: 2005 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 16-Dec-2004 Original Closing Date 30-Sep-2010 Planned Mid Term Review Date 26-Nov-2007 Last Archived ISR Date 12-Sep-2012 Effectiveness Date 27-Jan-2005 Revised Closing Date 30-Sep-2013 Actual Mid Term Review Date 21-Nov-2007 Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to significantly improve the effectiveness of the health system in Tamil Nadu as measured by (i) increased access to and utilization of maternal and neo-natal care services, particularly by poor, disadvantaged and tribal groups; (ii) effective non-communicable disease interventions scaled-up throughout the state; (iii) improved health outcomes, access and quality of service delivery through strengthened oversight of the public sector health systems and greater engagement of the non- government sector; and (iv) increased effectiveness of public sector hospital services, primarily at district and sub-district levels. Has the Project Development Objective been changed since Board Approval of the Project? � Yes No Component(s) Component Name Component Cost Increasing access to and utilization of services 33.79 NCD Prevention and Control 5.65 Building capacity for oversight and management of the health system 25.61 Improving effectiveness and efficiency of the public sector to deliver essential services 40.90 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview TNHSP remains on track to achieving its development objectives. Implementation progress has accelerated in the last six months. The project has strengthened and consolidated a network of 75 Comprehensive Emergency Obstetric and Neonatal Centers (CEmONCs) and 50 Emergency Obstetric and Neonatal Centers (EmONCs) to offer a suite of services Page 1 of 5 The World Bank Report No: ISR9624 appropriate to the center within 30 minutes of traveltime from anywhere in the state. All tribal activities including the Mobile Health Clinics, bed grant scheme, tribal counselors and sickle cell anemia screening and treatment, hitherto supported by the project, have now been devolved to the National Rural Health Mission and the Directorate of Medical Services and are financially supported by them. The prevention, screening and treatment of non-communicable disease conditions of cancer of the cervix, breast cancer, diabetes and hypertension has been successfully scaled up to 16 districts of the state. Preparatory activities for the pending scale-up to the remaining 16 districts are in advanced stages of Public Disclosure Copy completion and a state-wide scale-up is anticipated by end March 2013. The Phase II scale-up of the IT-based Hospital Management System (HMS) and Health Management Information System (HMIS) is complete. While software development for the Phase III scale up of HMS/HMIS is on track, the hardware procurement through ELCOT is delayed. NABH accreditation of 5 hospitals (Padmanabhapuram, Arruppukkotai, Tirupur, Tambaram and Erode) is pending on account of final assessment by the Quality Council of India. Several consulting and non-consulting contracts for improved knowledge, health seeking behaviors, provision and quality of care at public health facilities have been awarded or are in advanced stages of award. Civil works supported by the project are on track to completion by June 30, 2013 and equipment maintenance and management at public health facilities, through a network of 49 bio-medical engineers, is satisfactory. Locations Country First Administrative Division Location Planned Actual India State of Tamil Nadu State of Tamil Nadu Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Risk adjusted maternal case fatality rate Number Value 13.33 7.82 13.33 Date 30-Nov-2009 30-Sep-2012 30-Sep-2013 Comments for Phase I CEmONCs For 35 identified, designated Maintain baseline rate or CEmONCs reduce it. Risk adjusted neonatal case fatality rate Number Value 4.08 3.70 4.08 Date 30-Nov-2009 30-Sep-2012 30-Sep-2013 Comments for Phase I CEmONCs for 35 identified, designated Maintain baseline rate or CEmONCs reduce it Improved efficiency of services as measured Percentage Value 81.00 76.60 81.00 by Bed occupancy rate Date 30-Sep-2009 30-Sep-2012 30-Sep-2013 Public Disclosure Copy Comments Maintain baseline rate or increase Improved patient satisfaction as shown by Text Value Overall satisfaction score is Not yet due Maintain or increase patient periodic surveys 3.96 satisfaction. Date 30-Sep-2006 30-Mar-2012 30-Sep-2013 Comments Endline survey report will be available in Sep-2013 Intermediate Results Indicators Page 2 of 5 The World Bank Report No: ISR9624 Indicator Name Core Unit of Measure Baseline Current End Target Health personnel receiving training (number) Number Value 0.00 42642.00 89537.00 Date 06-Aug-2010 30-Sep-2012 30-Sep-2013 Public Disclosure Copy Comments Effectiveness date of AF 42,642 health personnel CEmONCs: 3362; CaCx: phase of project trained, including 23770; CVD: 15360; HCWM: - 20,062 health 44000; others: 3045. personnel for NCD screening otherwise: 87717 with 2402 and treatment program; for CEmONCs; 24000 for - 286 hospital administrators CaCx; 15360 for CVD; 44000 trained; for HCWM and 1955 Others. - 1,692 trained in quality of care; - 462 specialists trained in CEmONC services; - 648 staff nurses and ANMs trained in CEmONC services; - 19,492 personnel trained in HCWM Health facilities constructed, renovated, and/or Number Value 0.00 1223.00 8.00 equipped (number) Date 06-Aug-2010 30-Sep-2012 30-Sep-2013 Comments Effectiveness date of AF The current value includes The target does not take phase of project renovations and provision of account of renovations, equipment and therefore is refurbishments and provision disproportionately higher than of equipment. It only refers to the target value.The current new construction of value of 1223 includes 8 CEmONCs at 8 medical Medical College CEmONCs + colleges. 938 NCD facilities with equipment + 265 facilities supported with HMS/HMIS + 12 hospitals for NABH accreditation. The project paper shows this core Public Disclosure Copy indicator dispersed across components, but for the ISR, they have been consolidated into one indicator Staffing of CEmONCs according to agreed Percentage Value 77.00 125.00 85.00 norms (2 OBGYN, 2 pediatricians, 1 Date 30-Nov-2009 30-Sep-2012 30-Sep-2013 anesthetist) in Phase I CEmONCs Comments 75 CemONCs with 4 Staffing according to norms OBGYNs, 2 pediatricians and Page 3 of 5 The World Bank Report No: ISR9624 2 anesthetists; 50 EmONCs maintained at least at 85% of with 2 OBGYNs, 1 the CEmONC centers pediatrician and 1 anesthetist Increased provision of health services to the Number Value 12.00 20.00 20.00 Public Disclosure Copy tribal population through mobile outreach vans Date 30-Nov-2009 30-Sep-2012 30-Sep-2013 Comments The number of mobile units Total no: of tribal outpatients 20 Mobile outreach services providing tribal outreach addressed: 287,003 (for services. October 2011-Sept 2012) Strengthen M&E with an operational HMS used Number Value 0.00 265.00 267.00 for management, decision making in 270 Date 30-Nov-2009 30-Sep-2012 30-Sep-2013 hospitals Comments HMS/HMIS operational in 265 facilities Data on Financial Performance (as of 22-Mar-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P075058 IDA-40180 Closed 16-Dec-2004 05-Jan-2005 27-Jan-2005 30-Sep-2010 30-Sep-2010 P075058 IDA-47560 Effective 29-Apr-2010 06-Jul-2010 06-Aug-2010 30-Sep-2013 30-Sep-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P075058 IDA-40180 Closed XDR 73.90 60.64 13.26 60.64 0.00 100.00 P075058 IDA-47560 Effective XDR 77.60 77.60 0.00 47.25 30.35 61.00 Disbursement Graph Public Disclosure Copy Page 4 of 5 The World Bank Report No: ISR9624 Public Disclosure Copy Key Decisions Regarding Implementation The piloting and scale-up of several innovations, including the NCD prevention, screening and treatment program; the HMS/HMIS interventions; Public Private Partnerships (PPPs); and quality of care interventions has been an intense preparatory and learning experience for the project. This and several factors beyond the control of the project, including the state and municipal elections, resulted in delayed implementation of planned activities. Given the six months remaining to project closure (September 30, 2013), the pioneering nature of work being undertaken by the project, and the need for stabilizing these programs and rigorously evaluating them, since they hold immense potential for replication or can inform similar national and state implemented programs, the Government of Tamil Nadu has requested a one year no-cost extension of the project untill September 30, 2014. In February 2013, a formal request to that effect was shared with the Department of Economic Affairs, Ministry of Finance through the Ministry of Health and Family Welfare, for World Bank consideration. DEA in its communication to the World Bank of March 19, 2013 has supported the extension of the project and requested World Bank to consider the proposal favorably. Restructuring History CD Approval on 28-Jun-2010 Public Disclosure Copy Related Projects P118830-Tamil Nadu Health Additional Financing Page 5 of 5