The World Bank Report No: ISR4667 Implementation Status & Results India India: National Vector Borne Disease Control & Polio Eradication Support Project (P094360) Public Disclosure Copy Operation Name: India: National Vector Borne Disease Control & Polio Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: 28-Jun-2011 Eradication Support Project (P094360) Country: India Approval FY: 2009 Product Line: IBRD/IDA Region: SOUTH ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health and Family Welfare Key Dates Board Approval Date 31-Jul-2008 Original Closing Date 31-Dec-2013 Planned Mid Term Review Date 18-Apr-2011 Last Archived ISR Date 28-Jun-2011 Effectiveness Date 06-Mar-2009 Revised Closing Date 31-Dec-2013 Actual Mid Term Review Date 02-May-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) is to enhance the effectiveness of government response to control malaria, eliminate kala azar and eradicate polio. This will be achieved by an increase in the number of people benefiting from effective prevention, diagnosis and treatment services for malaria and kala azar, and vaccination against polio. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Improving access to and use of of services for control of malaria 146.50 Improving access to and use of services for kala azar elimination 51.40 Policy and strategy development and monitoring and evaluation 52.10 Supply of polio vaccine 271.00 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview There have been no reported cases of polio in India for over 12 months, which is a remarkable achievement, particularly given the situation just 3-4 years ago. Progress on the utilization of the polio component of this project has been satisfactory to date, with the project funds being used to maintain a consistent supply of oral polio vaccines for the national Page 1 of 12 The World Bank Report No: ISR4667 program. On malaria, there have been significant improvements in the availability of diagnostic kits and malaria treatments, in disease surveillance, and in the field-level implementation of BCC/IIEC activities and the development of environmental codes of practice. However, delays in the procurement and distribution of long-lasting insecticide treated bed-nets (LLINs) have hampered program implementation, and therefore the full achievement of results. Expediting the distribution of bed-nets and providing focused support to the states with weaker capacities will go a long way in bringing down the prevalence of malaria nationally. Some progress has also been made in the implementation of the kala azar (KA) Public Disclosure Copy component, particularly on State level supervision and ownership in Bihar, but more needs to be done if the elimination of the disease is to become a reality. Overall, implementation progress and progress towards the PDOS are both rated as moderately satisfactory, as: a) more work is required in the lagging states on capacity building and ensuring that the changes brought about by the project are institutionalized and sustained; b) the procurement and distribution of both malaria and kala azar related commodities needs to be expedited as a matter of priority and c) the national goal of kala azar elimination will require a faster and more far-reaching response in the affected states. Locations Country First Administrative Division Location Planned Actual India Bengal West Dinajpur India State of Andhra Pradesh Vishakhapatnam India State of Bihar Vaishali India State of Gujarat Vadodara India Bengal Twenty-four Parganas India State of Karnataka Tumkur India State of Maharashtra Thane India State of Chhattisgarh Surguja India State of Gujarat Surendranagar India State of Gujarat Surat India State of Orissa Sundargarh India State of Andhra Pradesh Srikakulam India State of Bihar Siwan Public Disclosure Copy India State of Bihar Sitamarhi India State of Jharkhand Pashchim Singhbhum India State of Madhya Pradesh Sidhi India State of Madhya Pradesh Shivpuri India State of Madhya Pradesh Shahdol India State of Madhya Pradesh Seoni Page 2 of 12 The World Bank Report No: ISR4667 Country First Administrative Division Location Planned Actual India State of Madhya Pradesh Satna Public Disclosure Copy India State of Bihar Saran India State of Orissa Sambalpur India State of Bihar Samastipur India State of Bihar Saharsa India State of Madhya Pradesh Sagar India State of Madhya Pradesh Ratlam India State of Jharkhand Ranchi India State of Gujarat Rajkot India State of Madhya Pradesh Rajgarh India State of Chhattisgarh Raipur India State of Chhattisgarh Raigarh India State of Karnataka Raichur India State of Bihar Purnia India State of Bihar Purba Champaran India State of Bihar Patna India State of Bihar Pashchim Champaran India State of Madhya Pradesh Panna Public Disclosure Copy India State of Bihar Nalanda India Bengal Nadia India Bengal Nadia India State of Bihar Muzaffarpur India State of Bihar Munger India State of Orissa Mayurbhanj India State of Madhya Pradesh Mandla Page 3 of 12 The World Bank Report No: ISR4667 India Bengal Maldah India State of Bihar Madhubani Public Disclosure Copy India State of Orissa Koraput India State of Karnataka Kolar India State of Gujarat Kheda India State of Andhra Pradesh Khammam India State of Orissa Keonjhar India State of Orissa Kalahandi India State of Gujarat Kachchh India State of Gujarat Junagadh India State of Gujarat Junagadh India State of Madhya Pradesh Jhabua India State of Madhya Pradesh Jabalpur India Bengal Hugli India State of Madhya Pradesh Guna India State of Maharashtra Greater Bombay India State of Bihar Gopalganj India State of Andhra Pradesh East Godavari India State of Chhattisgarh Durg Public Disclosure Copy India State of Madhya Pradesh Dhar India State of Jharkhand Dhanbad India Bengal Darjiling India State of Bihar Darbhanga India State of Karnataka Dakshin Kannad India State of Karnataka Chitradurga Page 4 of 12 The World Bank Report No: ISR4667 India State of Madhya Pradesh Chhindwara India State of Maharashtra Chandrapur Public Disclosure Copy India Bengal Birbhum India State of Chhattisgarh Bilaspur India State of Bihar Bhojpur India State of Bihar Bhagalpur India State of Madhya Pradesh Betul India State of Karnataka Belgaum India State of Bihar Begusarai India State of Chhattisgarh Bastar India Bengal Barddhaman India State of Madhya Pradesh Balaghat India Rajasthan Alwar India State of Gujarat Ahmadabad India State of Maharashtra Garhchiroli India State of Maharashtra Raigarh India State of Bihar Supaul India State of Bihar Araria India State of Andhra Pradesh Vizianagaram Public Disclosure Copy India State of Madhya Pradesh Korba India State of Madhya Pradesh Dhamtari India State of Madhya Pradesh Dantewada India State of Madhya Pradesh Kanker India State of Bihar Simdega India State of Bihar Godda Page 5 of 12 The World Bank Report No: ISR4667 India State of Bihar Dumka India State of Bihar Latehar Public Disclosure Copy India State of Bihar Lohardaga India State of Madhya Pradesh Dindori India State of Orissa Jharsuguda India State of Orissa Kandhamal India State of Orissa Malkangiri India State of Orissa Rayagada India State of Gujarat Anand India State of Bihar Jehanabad India State of Bihar Buxar India State of Madhya Pradesh Janjgir-Champa India State of Gujarat Dahod India State of Gujarat Godhra India State of Gujarat Godhra India State of Bihar Jamtara India State of Bihar Katihar India State of Madhya Pradesh Kawardha India State of Bihar Khagaria Public Disclosure Copy India State of Bihar Kishanganj India State of Karnataka Koppal India State of Bihar Lakhisarai India State of Madhya Pradesh Mahasamund India Bengal Murshidabad India State of Gujarat Patan Page 6 of 12 The World Bank Report No: ISR4667 India State of Bihar Sheohar India State of Madhya Pradesh Sheopur Public Disclosure Copy India State of Jharkhand Gumla India State of Madhya Pradesh Koriya India State of Madhya Pradesh Jashpur India State of Madhya Pradesh Raj Nandgaon India State of Bihar Saraikela India State of Bihar Sahibganj India State of Bihar Pakur India State of Bihar Garhwa India State of Bihar Sheikhpura Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target At least 80% of the households with eligible Text Value >80% (Threshold reached) >80% children covered during the national and sub- Date 31-Jan-2008 30-Apr-2011 29-Nov-2013 national immunization days in high risk districts Comments Based on routine national data. At least 50% of the sampled blocks which at Text Value 0% 50% baseline have not achieved the elimination goal Date 31-Oct-2008 24-May-2010 29-Nov-2013 of less than one kala azar case per 10,000 Comments No data available as a special persons, will achieve elimination goal by Public Disclosure Copy endline survey will need to be conducted to obtain this information - expected by early-2012. Percentage of individuals in project areas Text Value 0% (The Program has 50% belonging to eligible Long Lasting Insecticidal recently approved the policy Net (LLIN) target population who slept under for adopting LLINs) an LLIN during the previous night Date 30-Jan-2009 28-Feb-2011 29-Nov-2013 Comments 1. From program monitoring data collected by MTS in 34 Page 7 of 12 The World Bank Report No: ISR4667 project districts; population weighted summary estimate represents universe of blocks where program was Public Disclosure Copy implemented and data collected during Jan-Mar 2011 2. Not restricted to LLIN targeted population in current rounds of data collection, since LLIN has been distributed in only one state so far (Orissa) 3. Includes the use of impregnated bednets and any LLIN distributed by health programs using project or other resources. Percentage of fever cases in project districts Text Value 0% (The diagnostic tests 70% receiving a malaria test result no later than the supported by the Project have day after the first contact only been recently approved by the Program) Date 28-Feb-2011 Comments From program monitoring data collected by MTS in 34 project districts; population weighted summary estimate represents universe of blocks where program was implemented and data collected during Jan-Mar 2011 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy Health personnel receiving training Number Value 0.00 182.00 950.00 Date 06-Mar-2009 24-May-2010 31-Dec-2013 Comments Based on PIU reports. Total number of staff to be trained in new treatment guidelines as well as the induction training for the new staff and international fellowships Page 8 of 12 The World Bank Report No: ISR4667 Long-lasting insecticide-treated malaria nets Number Value 0.00 1800000.00 8350000.00 purchased and/or distributed Date 06-Mar-2009 02-May-2011 31-Dec-2013 Comments India started distributing the These LLINs were distributed Total number of LLINS Public Disclosure Copy LLINs with this project in 2 of the 5 project states proposed to be purchased (Orissa and Chhattisgarh). under the project Procurement of 5.18 million LLINs is underway. The supply of oral polio vaccines for Text Value No stockout No Stock out Supplemental Immunization Activities is Date 31-Jul-2008 11-May-2011 29-Nov-2013 sustained. Comments Based on MoHFW reports. Porportion of eligible districts meeting the Text Value 0% (These criteria are being 100% readiness criteria for each period of applied under the project) implementation. Date 31-Jul-2008 30-Dec-2009 29-Nov-2013 Comments Based on PIU reports. Percentage of planned additional staff who are Text Value 0 100% in position at central, state and district levels Date 31-Jan-2007 09-May-2011 29-Nov-2013 and received induction training. Comments Based on PIU reports. Percentage of facilities reporting no stock-outs Text Value 73% (For first-line medicines) 90% of rapid disgnostic test for kala azar and first Date 31-Jan-2007 24-May-2010 29-Nov-2013 line medicines. Comments Based on PIU reports. Needs to confirmed with a survey to be done in early -2012. Percentage of diagnosed kala azar cases Text Value 55% (Based on preliminary 80% completing the standard treatment as per the surveys) national guidelines. Date 31-Jan-2007 24-May-2010 29-Nov-2013 Comments No data available as a survey will need to be conducted to obtain this information - expected in early -2012. Public Disclosure Copy Percentage of designated providers of malaria Text Value 0% (ACT and RDK are being 90% diagnosis and treatment who have not had an introduced under the project) ACT or RDT stockout during last 3 months. Date 31-Jul-2008 28-Feb-2011 29-Nov-2013 Comments 1. From program monitoring data collected by MTS in 34 project districts; population weighted summary estimate represents universe of blocks where program was implemented and data Page 9 of 12 The World Bank Report No: ISR4667 collected during Jan-Mar 2011 2. As currently estimated, the indicator represents provider reports of not having been in Public Disclosure Copy a situation where they could not test or treat a patient for want of RDT or ACT in stock in the previous three months. 3. From current sources, separate estimates are available for RDT and ACT. The quoted figure is the lower of the two estimates. Percentage of Rapid Diagnostic Test (RDT) Text Value 0% (District-wide ACT 70% positive cases in project districts receiving introduction is being done Artemisinin-based Combination Therapy (ACT) under the project) no less than the day after the first contact Date 31-Jul-2008 28-Feb-2011 29-Nov-2013 Comments 1. From program monitoring data collected by MTS in 34 project districts; population weighted summary estimate represents universe of blocks where program was implemented and data collected during Jan-Mar 2011 2. As currently estimated, the interval is estimated from the day of the blood test rather than from the day of first contact. 3. The low value for the indicator is attributed to an artifact of the LQAS methodology that will be Public Disclosure Copy corrected after an ongoing data entry and analysis of the raw data. In a situation of lowRDT usage, there could be ASHAs who have not done a single RDT in the last three months, and thus would score 0 in the numerator, but would still be included in the denominator because in the Page 10 of 12 The World Bank Report No: ISR4667 hand tabulation for the LQAS the denominator cannot be less than 19 perblock. Also since the data was collected Public Disclosure Copy during the low malaria transmission season, the chances of positive RDTs are also low. Once the data is computerized, this indicator can be computed correctly, i. e. using only RDT positive cases as denominators. Data on Financial Performance (as of 09-Feb-2012) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P094360 IDA-44610 Effective 31-Jul-2008 13-Feb-2009 06-Mar-2009 31-Dec-2013 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P094360 IDA-44610 Effective XDR 319.90 319.90 0.00 104.78 215.12 33.00 Disbursement Graph Public Disclosure Copy Page 11 of 12 The World Bank Report No: ISR4667 Key Decisions Regarding Implementation Recent efforts by the government to control malaria and eradicate polio have yielded tangible results. There have been no new polio cased in India now for more than a year and it has been taken off the list of polio-endemic countries. The goal should now be to maintain effective vaccination until the disease is eradicated. Routine project monitoring data suggests that the support has led to an increase in the number of people benefiting from effective diagnosis and treatment services for malaria, but more needs to be done on Public Disclosure Copy prevention and vector control. Also, more support is needed in Jharkhand and Chhattisgarh for effective implementation of the program. The kala azar effort has also shown progress in recent months in all the three project states, but a much more vigorous effort is needed - especially in Bihar State where the bulk of the disease burden is present - in order to bring the elimination goal to fruition. Restructuring History Level two Approved on 16-Dec-2010 Related Projects There are no related projects. Public Disclosure Copy Page 12 of 12