Document ofThe World Bank

FOR OFFICIAL USE ONLY

Report No: 89788-IN

RESTRUCTURING PAPER

ON A

PROPOSED PROJECT RESTRUCTURING OF

TAMIL NADU HEALTH SYSTEMS PROJECTCREDIT 4756-INAPRIL 29, 2010

TO

INDIA

AUGUST 2, 2014

INDIA COUNTRY MANAGEMENT UNITSOUTH ASIA REGION

This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.

ABBREVIATIONS AND ACRONYMS

CEmONC Comprehensive Emergency Obstetric and Neonatal Care CentersCMS College Management SystemDME Department of Medical EducationEmONC Emergency Obstetric and Neonatal Care CenterGoTN Government of Tamil NaduHMIS Health Management Information SystemHMS Hospital Management SystemIT Information TechnologyNCD Non-Communicable DiseasePDO Project Development ObjectivePHC Primary Health CenterTNHSP Tamil Nadu Health System ProjectUAS University Automation System

Regional Vice President: Philippe H. Le HouerouCountry Director: Onno Ruhl

Practice Manager/Manager: Julie McLaughlinTask Team Leader: Bushra Binte Alam

2

INDIATAMIL NADU HEALTH SYSTEMS PROJECT

CONTENTS

A. SUMMARY 5B. PROJECT STATUS 5C. PROPOSED CHANGES 6ANNEX 1: RESULTS FRAMEWORK AND MONITORING 7

3

DATA SHEETIndia

India: Tamil Nadu Health Systems Project (P075058)SOUTH ASIA0000009074

.

Report No: 89788-IN.

Basic InformationProject ID: P075058 Lending Instrument: Specific Investment Loan

Regional Vice President: Philippe H. Le Houerou Original EA Category: Partial Assessment (B)Country Director: Onno Ruhl Current EA Category: Partial Assessment (B)

Senior Global Practice Director: Timothy Grant Evans Original Approval Date: 29-Apr-2010

Practice Manager/Manager: Julie McLaughlin Current Closing Date: 30-Sep-2014

Team Leader: Bushra Binte Alam.

Borrower:

Responsible Agency:

Government of Tamil Nadu, Public Works Department (PWD), Tamil Nadu Medical Services Corporation Limited

.

Restructuring TypeForm Type: Short Form Decision Authority: Country DirectorRestructuring Level:

Level 2 Explanation of Approval Authority:

.

Financing ( as of 30-Jun-2014 )Key Dates

Project Ln/Cr/TF Status Approval Date Signing Date Effectiveness

DateOriginal Closing Date

Revised Closing Date

P075058 IDA-40180 Closed 16-Dec-2004 05-Jan-2005 27-Jan-2005 31-Mar-2010 30-Sep-2010

P075058 IDA-47560 Effective 29-Apr-2010 06-Jul-2010 06-Aug-2010 30-Sep-2013 30-Sep-2014

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

P075058 IDA-47560 Effective XDR 77.60 77.60 0.00 60.71 16.89 78.

4

Policy WaiversDoes the project depart from the CAS in content or in other significant respects? Yes [ ] No [ X ]

Does the project require any policy waiver(s)? Yes [ ] No [ X ].

A. Summary of Proposed ChangesThe closing date of the Tamil Nadu Health Systems Project (TNHSP) will be extended till September 15, 2015. The Results Framework with be rationalized to include sharper, more relevant, and reduced number of indicators, while reflecting the proposed extension. This will be the second extension of the Additional Financing of project, which was approved by the Board on April 29, 2010..

B. Project StatusMonthly data from 100 percent of 267 project-supported hospitals and performance data from project partners indicates that TNHSP is close to achieving its Development Objective. Several successful interventions initiated by the project have been taken over by the Directorate of Health and the National Rural Health Mission for budget, implementation and oversight support. These include establishment of Comprehensive Emergency Obstetric and Neonatal Care Centers (CEmONCs); implementation of tribal health activities; outsourcing of regional diagnostic labs and housekeeping services; the financing of human resources, drugs, reagents and consumables support to the non-communicable disease (NCD) screening and treatment program; and re-certification of accredited hospitals.

The implementation support mission of July 2014 assessed Implementation Progress to be 'Satisfactory'. Performance of 55 CEmONCs and 50 Emergency Obstetric and Neonatal Care Centers (EmONCs) and public-private partnerships indicate an increased access to and utilization of maternal and neonatal care services, particularly by poor, disadvantaged and tribal groups. The NCD prevention, screening and treatment program has been scaled up to all 32 districts of the state since April 2013. Operational challenges, in the last sixteen districts added to under the project scale-up, are being resolved, with TNHSP enhancing efforts to ensure quality outcomes. The Hospital Management System (HMS)/Health Management Information System (HMIS) have been scaled up to 1,889 Primary Health Centers (PHCs), 264 secondary health facilities and 20 medical colleges. Additionally, College Management System (CMS) and University Automation System (UAS) have been implemented in 20 medical colleges and Dr. MGR. Medical University. The Phase III scale-up of HMS to an additional 20 medical colleges and 45 Department of Medical Education (DME) institutions is, however, delayed due to exigencies beyond the control of the project. With deployment of all hardware by October 2014, it is anticipated that with supportive training, the entire value chain of HMS/HMIS/CMS and UAS within the state’s public health system will function seamlessly by June, 2015. Accreditation of seven large hospitals is likely to be achieved by March 31, 2015. Activities in support of (i) improved health outcomes, access and quality of service delivery through strengthened oversight of the public sector health systems and greater engagement of the non-governmental sector, and (ii) increased effectiveness of public sector hospital services at the district and sub-district levels, are already yielding good results.

Both environmental and social safeguards are in full compliance. There are no overdue audit reports for the project. The project ratings for implementation, financial management and procurement have all been rated as ‘Satisfactory’ over the last 12 month.

The project has disbursed 100 percent of the Original Credit (US$ 93.36 million) and 78 percent of the Additional Financing (US$ 117 million), as of July 30, 2014..

5

C. Proposed Changes.

FinancingChange in Loan Closing Date(s):

Explanation

The proposed restructuring entails an extension of the TNHSP AF Credit Closing Date till September 15, 2015.

Due to several exigencies, the project has been unable to fully leverage the one-year extension provided last year to firmly entrench its ambitious state-wide scale-up of the NCD screening and treatment program and expansion of the HMS/CMS and UAS to the public health system at the tertiary level in the state. The exigencies include: national elections of 2014, which limited the procurement time available to the project; repeated non-responsive tenders for medical equipment, consumables and reagents; contentious procurement of medical and IT equipment, resulting in uncharacteristic delays; and leadership changes in early 2014.

The proposed extension will help ensure the long-term sustainability of the scaled-up interventions, which are the first of their kind to be implemented at such scale in India. This will require well-established operations and capacities within the existing programs implemented by GoTN and its Directorate of Health to take over their financing, continued implementation and oversight. Findings from independent assessments will be integrated into capacity building and operations strengthening activities. Joint management over a period of six months will facilitate a complete handing over of the implementation of project activities--the NCD, CEmONCs and of IT initiatives, to assigned programs/departments. The end result should be improved health outcomes, effectiveness and efficiencies.

The existing Results Framework comprises 9 PDO indicators and 4 supplementary indicators and 28 intermediate results and 10 supplementary indicators. The Task Team proposes to rationalize the Results Framework of the project to make it easier to measure, with sharper, relevant and a reduced number of outcome and intermediate results indicators.

Ln/Cr/TF Status Original Closing Date

Current Closing Date

Proposed Closing Date

Previous Closing Date(s)

IDA-40180 Closed 31-Mar-2010 30-Sep-2010 31-Mar-2010

IDA-47560 Effective 30-Sep-2013 30-Sep-2014 30-Sep-2015 30-Sep-2013

6

Results Framework

Project Name: Tamil Nadu Health Systems Project Project Stage: :Restructuring Status :Supervision

Team Leader: Bushra Binte Alam Requesting Unit: GHNDR Created by: Sangeeta Carol Pinto

Product Line: Investment Project Financing Responsible Unit: GHNDR Modified by: Sangeeta Carol Pinto

Country: India Approval FY: 2010

Region: South Asia Lending Instrument: Specific Investment Loan

.

Project Development ObjectivesProject Development Objective for Additional Financing: To assist Tamil Nadu improve the effectiveness of its health system through: (i) increasing access to and utilization of maternal and neo-natal care services, particularly by poor, disadvantaged and tribal groups; (ii) effective scaling-up of non-communicable disease interventions throughout Tamil Nadu; (iii) improving 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) increasing effectiveness of service delivery in public sector hospitals at district and sub-district levels.

Current Project Development Objective:

Proposed Project Development Objective (from Restructuring Paper): Not Applicable

ResultsCore sector indicators are considered: Yes Results reporting level: Project

Project Development Objective IndicatorsStatus Indicator Name Core Unit of Measure Baseline Actual(Current) End Target

Dropped Indicator OneAt least 23% of complicated maternal admissions at certified project CEmONCs (state-

Percentage Value 23% 34.5% 23%

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

wide) will be for

Dropped

Indicator TwoEffective functioning of CEmONCs (state-wide) as measured by % of complicated maternal admissions

Percentage Value 35% 71.9% 35%

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator ThreeEffective functioning of CEmONCs (state-wide) as measured by risk adjusted maternal case fatality rate

Number Value 13.33 6.17 13.33

Sub Type Date November 31, 2009 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator FourEffective functioning of CEmONCs (state-wide) as measured by risk adjusted neonatal case fatality rate

Number Value 4.08 3.98 4.08

Sub Type Date November 31, 2009 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Seven: Improved efficiency of services as measured by Bed Occupancy Rate

Percentage Value 81% 81% 81%

Sub Type Date September 30, 2009 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Seven:Improved efficiency of services as measured by number of diagnostic services performed

Number Value 11,967,683 37,615,860 12,000,000

Sub Type: Supplemental

Date September 30, 2009 March 31, 2014 September 30, 2014

Comments

Dropped Indicator Seven:Number of night time

Number Value 4,656 22,530 8,500

Sub Type: Date September 30, 2009 March 31, 2014 September 30, 2014

8

Caesarians at CEmONCs

Supplemental

Comments

Dropped

Indicator Nine:Strengthened state level capacity of pharmaceuticals and medical supplies procurement, repair and maintenance of medical equipment

Text Value Currently TNMSC is responsible for procurement and AMCs of medical equipment

49 Bio-medical engineers supporting TNMSC in management and maintenance of medical equipment of public health facilities.

A comprehensive state wide system established for all medical equipment, procurement , maintenance and repair

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

No change

Current Indicator Five and Proposed Indicator Two: Scale up of cancer cervix screening and cardio-vascular prevention and control based on a comprehensive assessments of the pilots

Text Value Cervical cancer screening operational in Theni and Thanjavur; interventions for cardio-vascular disease prevention and control operational in Sivagangai and Virudhunagar

Cervical cancer screening and interventions for cardio-vascular disease prevention and control scaled up to entire state

Scale-up on basis of pilot evaluation

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

No change Current Indicator Six and Proposed Indicator Three: Improved access to health care, as measured by inpatient utilization of services

Number Value 36.7

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments Data collection ongoing

Increased utilization rate by the poorest as measured by an asset index

9

by the poorest 40% of population: Proportion of

No change

Current Indicator Six and Proposed Indicator Three: Percentage of those who accessed any form of care

Percentage Value 82.8%

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments Data collection ongoing

No change

Current Indicator Six and Proposed Indicator Three: Number of hospitalization cases (per 1000)

Number Value 32.1

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments Data collection ongoing

No change

Current Indicator Eight and Proposed Indicator Four: Patient Satisfaction (perceived quality of care) as measured by overall satisfaction score

Number Value 3.96 3.96

Sub Type Date 2006 March 31, 2014 September 30, 2014

Comments Data collection ongoing

No change

Current Indicator Eight and Proposed Indicator Four: Patient Satisfaction (perceived quality of care) as measured by overall inpatient score

Number Value 3.99 3.99

Sub Type: Supplemental

Date 2006 March 31, 2014 September 30, 2014

Comments Data collection ongoing

10

No change

Current Indicator Eight and Proposed Indicator Four: Patient Satisfaction (perceived quality of care) as measured by overall outpatient score

Number Value 3.95 3.95

Sub Type: Supplemental

Date 2006 March 31, 2014 September 30, 2014

Comments Data collection ongoing

New

Proposed Indicator One: Proportion of C-sec deliveries amongst SC/ST mothers at secondary level CEmONCs

Percentage Value 28.11% 46.59% 43%

Sub Type Date March 31, 2008 March 31, 2014 September 30, 2015

Comments

New

Proposed Indicator Five: No: of public hospitals accredited by the National Board of Accreditation of Hospitals

Number Value 0 3 12

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2015

Comments

Intermediate Results Indicators

Status Indicator Name Core Unit of Measure Baseline Actual(Current) End Target

Dropped

Indicator One: Health personnel receiving training: Doctors (OBGYN and pediatricians), medical officers of 1st

referral units and nurses

X Number Value 0 4761 2402

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped Indicator Two: Number of health

X Number Value 0 7 8

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

11

facilities constructed, renovated, equipped: Maternity wings

Comments

Dropped

Indicator Three: Staffing according to agreed norms (2OBGYN, 2 pediatricians and 1 anesthetist) in Phase I CEmONCs

Percentage Value 77% 100% 85%

Sub Type Date November 31, 2009 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Three: Staffing according to agreed norms (2OBGYN, 2 pediatricians and 1 anesthetist) in Phase II CEmONCs

Percentage Value 38% 42% 85%

Sub Type: Supplemental

Date November 31, 2009 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Four: Increased provision of health services to the tribal population through mobile outreach services

Number Value 12 19 20

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Four: Increased provision of health services to the tribal population through NGO hospitals providing bed grants

Number Value 2 4 4

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped Indicator Four: Number Value 2 3 3

12

Increased provision of health services to the tribal population through NGO hospitals providing testing, counseling and treatment services for sickle cell anemia

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Four: Increased provision of health services to the tribal population through 32 patient counselors at primary and secondary health facilities in tribal areas

Number Value 32 42 32

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Five: Increased emergency transport services by way of vehicles provided by project

Number Value 385 638 585

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Five: Increased emergency transport services by way of number of calls responded to

Number Value 113,570 397,919

Sub Type: Supplemental

Date 2008-09 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Five: Increased emergency transport services by way of percentage of pregnant women

Percentage Value 26.8% 26%

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped Indicator Five: Percentage Value 30.9% 20%

13

Increased emergency transport services by way of percentage of road accidents

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Six: Support services (laundry, cleaning, security and food distribution) provided

Number Value 0 48 20

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Seven: Health promotion for prevention of CVD among children carried out in schools

Number Value 50 16369 5000

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Eight: Percentage of women in target age group (30-60) screened for cervical cancer implementation districts

Percentage Value 85% 33.5% 50%

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Nine: Health facilities constructed, renovated and/or equipped: cancer cervix screening

X Number Value 0 2,143 1,710

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Ten: Health personnel receiving training: cancer cervix screening

X Number Value 0 7,0414 24,000

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped Indicator Eleven: Number Value 2 32 16

14

CVD screening and management operational in districts

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Twelve: Health facilities constructed, renovated and/or equipped: CVD screening and control

X Number Value 0 2,143 1,670

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Thirteen: Health personnel receiving training: CVD screening and control

X Number Value 0 70,414 15,360

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Fourteen: Health facilities constructed, renovated and/or equipped: Operational HMS

X Number Value 38 267 270

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Fifteen: Operational HMS being used for management decision making in hospitals

Number Value 38 267 270

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

DroppedIndicator Sixteen: Operational HMIS across the state

Text Value Not operational Operational across state

Operational across state

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped Indicator Seventeen: Maintain

Number Value 80 267 270

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

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hospital based quality circles of excellence, as measured by

Comments

Dropped

Indicator Eighteen: Health personnel receiving training to improve quality of care, in hospital management

X Number Value 355 1,172 1,000

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Eighteen: Health personnel receiving training to improve quality of care, in rational use of drugs

X Number Value 0 5,528 900

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Eighteen: Health personnel receiving training to improve quality of care, in skill based training

X Number Value 0 37,468

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Nineteen: Health facilities constructed, renovated and/or equipped: accreditation

X Number Value 0 12 12

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Twenty: Hospitals accredited (including provision of civil works, equipment, training)

Number Value 0 3 12

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

16

Dropped

Indicator Twenty Two: Health personnel receiving training: retraining provided to staff of health care facilities across state (PHCs, secondary and tertiary)

X Number Value 44,000 58,294 44,000

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Twenty Three: Fully operational Project Management Unit (PMU) integrated into the Department of Health

Text Value PMU operational PMU operational PMU integrated

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Indicator Twenty Four: Mechanism established for planning and implementing IEC activities in the health sector

Text Value None Mechanism established

Support NRHM for establishment of a coordination unit in the Directorate of Health for all health communication activities in state

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped Indicator Twenty Four: Mechanism established for monitoring of PPP activities

Text Value None Mechanism established

Support NRHM for establishment of a coordination unit in the Directorate of Health for monitoring PPP activities

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

17

Supplemental

Comments

Dropped

Indicator Twenty Five: Establish a health data resource center in the TN

Text Value None SHDRC being established

Health data resource center established

Sub Type: Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Name Twenty Six: Health facilities constructed, renovated and/or equipped: equipment provided to selected district hospitals in order to ensure the provision of full range of services as per agreed norms

X Number Value 0 32 32

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped

Name Twenty Seven: TNMSC strengthened as per plan

Text Value None Biomedical engineers mainstreamed. TNMSC being strengthened with state funds

TNMSC strengthened as per agreed plan including mainstreaming of biomedical engineers

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

Dropped Name Twenty Eight: Supporting additional contractual staff at 270 project hospitals in accordance with

Text Value 0 - 562 staff nurses for CEmONCS being financed by GoTN

- 1,132 NCD staff nurses for Phase I

Additional staff at 270 hospitals as agreed

18

agreed norms

districts supported by GoTN

- 1,212 NCD staff nurses contracted for Phase II districts supported by TNHSP

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

New

Proposed Indicator One: Number of health personnel receiving training:

X Number Value 0 143,487 105,000

Sub Type Date March 31, 2014 March 31, 2014 September 30, 2015

Comments

New

Proposed Indicator Two: Number of health facilities constructed, renovated and/or equipped

X Number Value 0 2,183 2,228

Sub Type Date March 31, 2014 March 31, 2014 September 30, 2015

Comments

New

Proposed Indicator Three: Total no: of complicated SC/ST maternal admissions at certified CEmONCs*

(* where CEmONCs are certified to have at least 2 OBGYNs/2 pediatricians and 1 anesthetist)

Number Value 35,156 53,606 66,000

Sub Type Date 2007-08 March 31, 2014 September 30, 2015

Comments

New Proposed Indicator Number Value 137,543 174,683 200,000

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Four: Number of tribal patients provided outpatient care through Mobile Outreach Vans

Sub Type Date 2007-08 March 31, 2014 September 30, 2015

Comments

New

Proposed Indicator Five: Percentage of calls made by pregnant women attended to by 108 services

Percentage Value 90.3 96.8 96.8

Sub Type Date 2009-10 March 31, 2014 September 30, 2015

Comments

New

Proposed Indicator Five: Percentage of calls made for Road Traffic Accident victims attended by 108 services

Percentage Value 66.1 79.4 79.4

Sub Type: Supplemental

Date 2009-10 March 31, 2014 September 30, 2015

Comments

New

Proposed Indicator Six: Number of performance based contracts delivering health care services through TNHSP in Tamil Nadu

Number Value 0 9 9

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2015

Comments

New

Proposed Indicator Seven: Number of schools where health promotion activities for prevention of cardiovascular diseases is undertaken

Number Value 50 16,369 16,369

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2015

Comments

20

New

Proposed Indicator Eight: Percentage of eligible women in age group 30-60 years screened for Cancer Cervix

Percentage Value 3.4% 33.5% 40%

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2015

Comments (488,084 Pilot phase)

488,084 (Pilot phase) + 83,029 (Yr 2 Phase I) + 1,907,628 (Yr 3 Phase I) + 2,366,247 (Year 4 for Phase I and II)= 4,844,988

New

Proposed Indicator Eight: Percentage of eligible persons (both men and women) in age group >30years screened for hypertension

Percentage Value 3.4% 37.2% 50%

Sub Type: Supplemental

Date March 31, 2010 March 31, 2014 September 30, 2015

Comments 1,231,259 (Pilot) 1,231,259 (Pilot) + 876,000 (Yr 2 Phase I) + 5,369,454 (Year 3 Phase I and II) + 5,837,518 (Year 4 Phase I and II) = 13,314,231

New

Proposed Indicator Nine: Number of health facilities where HMIS is used to submit monthly reports

Number Value 0 2,183 2,228

Sub Type: Date 2009-10 March 31, 2014 September 30, 2015

Comments GH-274PHC-1889MC-20

GH-274PHC-1889MC-65

Revised Current: Indicator Twenty One: Integrated health care waste management plan implemented in all project facilities

Number Value 270 449 270

Sub Type Date March 31, 2010 March 31, 2014 September 30, 2014

Comments

21

Proposed Indicator Ten: Number of public health facilities implementing integrated health care waste management plan

Number Value 267 449 449

Sub Type Date 2007-08 March 31, 2014 September 30, 2015

Comments

22