The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Emergency Tuberculosis Project (P160947) EAST ASIA AND PACIFIC | Papua New Guinea | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 6 | ARCHIVED on 04-Nov-2019 | ISR38615 | Public Disclosure Authorized Implementing Agencies: Department of Treasury, National Department of Health Key Dates Key Project Dates Bank Approval Date: 31-May-2017 Effectiveness Date: 25-Sep-2017 Planned Mid Term Review Date: 19-Nov-2019 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2022 pdoTable Public Disclosure Authorized Project Development Objectives Project Development Objective (from Project Appraisal Document) To Improve the quality and expand the coverage and utilization of health services to control the spread of tuberculosis in targeted areas of Papua New Guinea by strengthening programmatic management of tuberculosis. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Early detection of active tuberculosis patients:(Cost $3.55 M) Public Disclosure Authorized Effective treatment of drug-susceptible and drug-resistant tuberculosis patients:(Cost $7.70 M) Strengthening government systems for managing its health services delivery and tuberculosis response:(Cost $3.75 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions Implementation continues to progress well on all Project components: Following the completion of the systemic population screening of the Public Disclosure Authorized population for TB in Daru island, Western Province, the mop-up screening for TB in Daru, intended to screen eligible individuals who previously refused to be screened, was completed by the end of March 2019. All the TB cases identified through the screening have been placed on treatment. A final report will be completed by the end of calendar year 2019. Lessons learned from the systematic screening for TB in Daru island will inform a systematic TB screening exercise in the National Capital District (NCD) to be implemented early in calendar year 2020. In addition to procuring two ‘find and treat’ mobile vans equipped with digital X-rays to enable systematic TB screening in NCD, the Project has also procured 14 GeneXpert machines for TB diagnostics in NCD and is financing two laboratory personnel to build in-country diagnostic capacity in the Central Public Health 11/4/2019 Page 1 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Laboratory, the national reference laboratory. Technical support provided with Project financing in partnership with WHO has included updates to TB treatment guidelines as well as monitoring and technical supportive supervision to Basic Management Units in NCD and Western Province. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Low Low Low Institutional Capacity for Implementation and Sustainability High High High Fiduciary High High High Environment and Social Low Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- High High Overall High High High Results PDO Indicators by Objectives / Outcomes To Improve the quality and expand the coverage and utilization of health services to control the spr IN00745949 ►Number of people receiving tuberculosis treatment in accordance with the national guidelines (NCD) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6,169.00 6,783.00 6,783.00 7,100.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 In Q1-Q2 2019, a total of 3,607 TB patients (3,399 DS-TB and 208 DR-TB) enrolled in treatment in and all 14 BMUs reported during the period. It is expected that the number of new TB cases identified will Comments: increase in Q3-4 2019, following the procurement of additional GeneXpert machines planned for distribution in NCD. IN00745950 ►Number of people receiving tuberculosis treatment in accordance with the national guidelines (Daru/South Fly District, Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/4/2019 Page 2 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 1,659.00 551.00 551.00 1,900.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Baseline value does not match case notification rate of 480 in 2016 TB case notification report. A total of 551 TB cases (438 DS and 113 DR) were enrolled in treatment in Daru in 2018. Daru is the only BMU in South Fly District. Note: It is not clear how the original baseline for Daru was determined. It could have been a typo? (1,659 instead of 659?). The total number of TB patients registered in Daru did not exceed 661 in any given year Comments: since 2012 (513 (2012), 601 (2013), 661 (2014), 498 (2015): 480 (2016). The proposed baseline of 480 TB cases is derived from 2016 case notification reports after the national emergency was declared in 2014. The proposed target for 2022 would be 612 with the assumption that the TB prevalence in Daru is 3% in a population of 18,854 (SSI, 2018) with an annual population growth is 2%. NB: different methods can be used to estimate the target IN00745981 ►The proportion of TB patients who have received drug-sensitivity testing (DST) (NCD) for Longer regime (LR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 23.00 23.00 80.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 In Q1-2 2019, 27% of DR-TB patients (shorter regimen) received DST and 69% (longer regimen) received DST. data needs to be verified. Comments: IN00745982 ►The proportion of TB patients who have received DST (Daru/South Fly District,Western Province) for Shorter regime (SR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 71.00 71.00 80.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The current indicator is no longer routinely reported, and has be obtained from the DR TB Register. The most up-to-date WHO guidance states that all presumptive TB patients should be tested with GeneXpert, Comments: which assesses Rifampicin resistance. IN00745983 ►TB treatment success rate for DS TB (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 56.00 78.00 78.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Treatment success rate (cured & treatment completed) is 82% in Q1 2019 and 87% in Q2 2019 for DS-TB pts (2017 cohort). Q2 2019 treatment success rate exceeded the WHO recommendation of 85%. Data Comments: needs to be verified IN00745984 ►TB treatment success rate for DS TB (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/4/2019 Page 3 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 71.00 86.00 86.00 85.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The treatment success rate for DS TB for the Q3+4 cohort of 2017 was 85.5%. For the Q1+2 cohort of 2018, preliminary treatment success rate is 84.2% (some patients still on treatment). Data needs to be Comments: verified IN00745985 ►TB treatment success rate for DR TB (NCD) for Shorter regime ( SR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 44.00 64.00 64.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Treatment success rate for DR-TB is 49% (30/62) - 2017 cohort on shorter regimen. Comments: Treatment success rate for DR-TB is 62% (70/113) - 2016 cohort on longer regimen. IN00745986 ►TB treatment success rate for DR TB for females (NCD) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 61.00 61.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 31-Dec-2021 Data for indicator POI 4b is not routinely collected and has to be collected separately from the TB Register Comments: at the facilities registering DR TB patients. Efforts are currently underway to disintegrate data by gender.. IN00745987 ►TB treatment success rate for DR TB (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 49.00 87.00 87.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 The treatment success rate for the Q1-2 cohort of 2017 was 94.6%, compared to 92% for the Q3+4 cohort Comments: of 2016. IN00745988 ►TB treatment success rate for DR TB for females (Daru/South Fly District,Western Province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 71.40 0.00 0.00 75.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 Data for indicator POI 4b is not routinely collected and has to be collected separately from the TB Register at the facilities registering DR TB patients. Efforts are currently underway to disintegrate data by gender. Comments: Data is not available at the moment .. IN00745989 ►Number of BMUs where all clinical staff have been trained/ retrained on TB and DR TB (NCD & Western Province) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/4/2019 Page 4 of 10 The World Bank Implementation Status & Results Report Emergency Tuberculosis Project (P160947) Value 0.00 16.00 16.00 20.00 Date 31-Aug-2016 31-Dec-2018 31-Dec-2018 30-Jun-2022 A total of 54 health workers trained/retrained on TB management from 14 BMUs in NCD including staff Comments: members of NCD Health.