Djibouti - Renforcement des Competences dans le Secteur de la Sante - EER Avril 2024

Implementation progress and results report ipr a. report summary and proposed actions report data project name: renforcement des competences dans le secteur de la sante project code: p-dj-ke0-001 country djibouti sector: infrastructure environmental categorization 3-low es risks and report type: date of report: 25.06.2024 mission: field mission 4 from: 22.04.2024 to: 24.04.2024 prepared by task manager: nadege kiswensida balima alternate task manager : division manager : doroba chalwe hendrina ahhd1 project data project financing in uac financing sourceinstrument foreign currency local currency totala.d.f. project 4.945.,00 1.055.,00 6..,00a.d.f. projcyclegrant 257.,00 50.,00 307.,00government projcyclegrant 0,00 2.080.,00 2.080.,00t o t a l 5.202.,00 3.185.,00 8.387.,00processing milestones bank approved financing only loan number date approved date signed date of entry into force date effective for first disbursement disbursement deadline 2100150036493 05.12.2016 06.02.2017 26.07.2017 26.07.2017 30.06.2026 2100155033667 05.12.2016 06.02.2017 06.02.2017 05.07.2017 30.06.2026 loan amount in uac loan number net loan approved uac signed uac cancelled uac net loan uac 2100150036493 6..,00 6..,00 6..,00 0,00 6..,00 2100155033667 307.,00 307.,00 307.,00 0,00 307.,00 t o t a l 6.307.,00 6.307.,00 0,00 6.307.,00 disbursment status at supervision date in uac loan number disbursed to date disbursed to date uac disbursed to date undisbursed to date in uac undisbursed to date 2100150036493 2.644.084,90 2.644.084,90 44,07 3.355.915,10 55,93 2100155033667 128.968,94 128.968,94 42,01 178.031,06 57,99 t o t a l 2.773.053,84 43,97 3.533.946,16 56,03 executing and implementation agencies borrower gouverment de djibouti ministere de l'econ. des fin. et de la planificationguarantor gouverment de djibouti ministere de l'econ. des fin. et de la planificationexecuting agency gouverment de djibouti ministere de l'econ. des fin. et de la planificationperformance status progress towards development objective performance rating summary of key findings rating on development objective do current previous the project's general objective is to back the government's efforts to improve access to quality and affordable health care by the people of djibouti. the specific objectives are to: i develop human resources for health medical specialists, paramedics, managers, and maintenance specialists and place a wide range of medical specialties at the disposal of the population; ii reduce the cost of evacuating patients abroad for specialized medical care; and enable the functioning of health facilities. in terms of developing human resources for the health sector, the project is on track. since the last supervision mission in october 2023, implementation continues to progress as: i courses continue to be provided by the higher institute of health scie nces i of djibouti for the training of paramedical staff, including i 63 in initial training to become state -certified nurses 31 in the first year and 32 in the second year ; ii 18 in in initial training as anesthesiologist nurses all in the se cond year; 11 in continuing education as operating theater nurses; iv 20 in continuous education to become emergency doctors; and v 15 in continuous education receiving healthcare management training. on doctors being trained abroad in specific specialization trainings, out of the 27 doctors in cohort 1 who went abroad in 2021, 14 have returned since 2022 and 8 others have returned in 2023. twenty 20 doctors out the second cohort went abroad in 2022 and 2 doctors of the third cohort went to st art their training in june 2023. one doctor in the third cohort is still awaiting registration and the two others from the ministry of health from the 5 initially planned in the third cohort have dropped out. the fifth cohort 3 doctors will not be abl e to be trained as part of the project as the cnss cannot avail more doctors without affecting its operations. it should be noted that from the second and third cohort, 15 doctors will not finish their training until after the closing date of the project, which is scheduled for december 31, 2026. the executing agency has formally committed to covering all fees and costs related to these 15 doctors until the end of their training. on the issue of gender balance in the number of trainees in i and doctor s in specific specialization trainings abroad, the bank is working on arranging a workshop to be held with the gender department to help the project improve the targets related to gender parity following recommendations from the midterm review. the proce ss of 1 purchasing two 2 ambulances for the new cnss hospital including the construction financed by the islamic development bank - idb and 2 the recruitment of the consulting firm for the design of the amu digitalization system were concluded. the two ambulances were delivered in q3 2023. both will supportimprove health facilities' function. satisfactory satisfactory implementation progress rating on implementation progress ip performance rating summary of key findings current previous overall, project implementation is satisfactory. the main activity of the project is training, which is on track - doctors who are to be trained abroad for their specialization are being trained abroad and will meet the target. th training provided by the higher institute of health sciences i is on track. in terms of goods to be acquire the hospital management system and related equipment for the hospital, has been launched in q1 2024 in anticipation of the completion of the works for the hospital now scheduled for q3 2024. the firm who will be managing the hospital has been recruited and has finalized preparation of the list of furniture and equipment. satisfactory satisfactory it should be noted that the project was initially to support the it equipment of the new hospital. since funds were planned as part of the hospital construction project to supply it equipment amongst other equipment in the lot, mtr of this project conclude d that it would be more effective to procure the hospital management system and related it equipment as part of this project instead. the mission of the consultant supporting the operationalization of universal health coverage uhc, medical standards an d quality standards was concluded in april 2023. the procurement process for the technical assistance activities planned for the digitalization of the uhc was concluded and the contract should be signed by q2 2024. overall project performance classification overall project performance pp, or n performance rating summary of key findings current previous the overall project classification is rated as n. despite the project being flagged for not being at 50 disbursement after 6 years 44.07 disbursement on the loan instrument and 42.01 on the grant instrument, it can only be classified as n as all activities are on track and the design of the project and its core activitiesexpense types are what has led to the flags. loan: scholarships and school fees which make up the bulk of the instrument's expected disbursements are paid out quarterly and sal aries for 9 replacement doctors are paid out monthly. grant: piu staff and the 10th replacement doctor salaries are paid out monthly from the special account which cannot disburse more than 6 months in advance. non potentialy problematic project non potentialy problematic project issues, risks and actions for management consideration issues affecting project implementation key issues corrective actions responsible deadline status timely submission of error -free disbursement requests. meeting with piu to review workload distribution and quality control measures in place. afdb and piu 30.06.2024 completedmain risks and mitigation risks mitigation measures applied or proposed responsible deadline non return of medical staff sent abroad for training risk of medical staff trained abroad and not returning to their job to serve. close follow -up while in country and ensure enforceability of signed commitment to return to country. cnss 31.12.2024 further delay in end of construction of cnss hospital risk of delays in finalization of the construction and equipment of the hospital which would have an impact on the delivery timleine of the his which requires the hospital and it equipment to be in place. the end date for the construction of the cnss hospital was further delayed by another 6 months to october 2024. in order to minimize the risk of delayed delivery of the hospital management system which will need adaptation from software engineers based on the tors identified, the procurement process was initiated in february 2024 and should be concluded by 30 august 2024. cnss 30.08.2024 b. results reporting and assessment progress towards development objective project purpose state the project development objective usually the project purpose as set out in the results -based logframe and assess progress the project's general objective is to back the government's efforts to improve access to quality and affordable health care b y the people of djibouti. the specific objectives are to: i develop human resources for health medical specialists, paramedi cs, managers and maintenance specialists and place a wide range of medical specialties at the disposal of the population; ii reduce the cost of evacuating patients abroad for specialized medical care; and enable the functioning of health facili ties. outcome reporting outcome indicators as per rlf baseline value most recent value end target progress toward endtarget assesment improved access to nursing care services coverage rate of nurses 1, 1, 1,250 0,00 achievedlikely to be achieved this indicator is not measurable yet until the nurses have completed their training. however, training provided by the higher institute of health sciences i is on track.coverage rate of specialists 0,400 0,400 0,800 0,00 achievedlikely to be achieved this indicator is not measurable yet: only 14 doctors out of the 50 have returned from their specialization training abroad.decrease in evacuation costs for patients seeking specialised care abroad cost of medical evacuations mi 6, 6, 2, 0,00 likely to be achieved with correctives actions this indicator is not measurable yet as only 14 doctors have returned from training, the cnss hospital funded by isdb is still under construction. this indicator may need to be revised as it is becoming clearer that this may not be measurable by the end of the project.improvement in universal medical coverage people coverage by universal medical coverage nbr 282., 282., 332., 0,00 achievedlikely to be achieved this indicator is not measurable yet as only 13 of technical assistance activities planned for this outcome have been completed - that of the work of the individual consultant. procurement is underway for the technical design and processes 23 and softw are purchase 33 for the activities related to this outcome to be completed.job creation jobs created nbr 0, 0, 300, 0,00 achievedlikely to be achieved this indicator is not measurable yet as the isdb cnss hospital is still under construction and is not expected to be operational before q1 2025.outcome rating rating on project outcomes performance rating summary of key findings current previous 3 3 there has been progress in capacity building of medical staff to improve and increase the quality of services. 22 doctors out of the 50 have returned from their specialization training, while the remaining 26 are still carrying out their trainings. the training provided by the higher institute of health sciences i is on t rack. output reporting output indicators most recent value annual target end target progress towards annual target progress towards end of project target assessment training of paramedics paramedics trained nbr 137, 196,00 196, 69,90 69,90 on track the training provided by the higher institute of health sciences i is ongoing and on track. trainings started in 2022. out of the 196 expected to be trained, 135 are currently still in training. disaggregated figures for female paramedics are yet to be shared. [women] -paramedics trained 0, 40,00 40, 0,00 0,00 on track numbers disaggregated by gender is has not yet been made available. training of specialist doctors specialists trained nbr 22, 28,00 53, 78,57 41,51 on track 22 doctors out of the 47 have returned from their specialization training - they are from cohort 1 27 doctors. while the remaining 25 are still carrying out their trainings and 3 others cohort 3 went abroad at the end of june 2023 and 2 dropped out. however, based on discussions with the piu, the 50 target will not be met as doctors to be sent for training are selected mainly on merit. [women] -specialists trained 0, 50,00 50, 0,00 0,00 on track number disaggregated by gender has not yet been made available. universal medical coverage is operational management of and accounting of umc is digitalized nbr 0, 1,00 1, 0,00 0,00 on track this indicator is not measurable yet as pre -requisite this output. procurement has just been concluded for the technical design and processes and software purchase for the activities related to this output. capacity of the maintenance of equipment and infrastructure enhanced maintenance center equipped and operating nbr 1, 1,00 1, 100,00 100,00 on track this activity is complete. biomedical engineers trained nbr 0, 0,00 5, 0,00 0,00 not on track this indicator is not measurable yet as the training of the biomedical engineers and maintenance technicians has not started yet. this target may need to be revised as it may not be achievable in the remaining timeline. maintenance technicians trained nbr 0, 0,00 10, 0,00 0,00 not on track this indicator is not measurable yet as the training of the biomedical engineers and maintenance technicians has not started yet. this target may need to be revised as it may not be achievable in the remaining timeline. output rating rating on project outputs performance rating summary of key findings current previous the project output rating is quite satisfactory. the umc individual consultant has finished their assignment. procurement has been concluded for the technical design and processes and software purchase for the digitalization of the umc. the training provi ded by the higher institute of health sciences i is on track and 22 doctors out of the 47 have returned from their specialization training, while the remaining 25 are still carrying out their trainings, with 2 more expected who went abroad for traini ng in june 2023 and one awaiting registration to be finalized by june 2024 2 having dropped out from doctors sent by the ministry. 3 3 development objective do rating progress towards development objective rating on development objective do performance rating summary of key findings current previous the project's general objective is to back the government's efforts to improve access to quality and affordable health care by the people of djibouti. the specific objectives are to: i develop human resources for health medical specialists, paramedics, managers, and maintenance specialists and place a wide range of medical specialties at the disposal of the population; ii reduce the cost of evacuating patients abroad for specialized medical care; and enable the functioning of health facilities. in terms of developing human resources for the health sector, the project is on track. since the last supervision mission in october 2023, implementation continues to progress as: i courses continue to be provided by the higher institute of health sciences i of djibouti for the training of paramedical staff, including i 63 in initial training to become state -certified nurses 31 in the first year and 32 in the second year ; ii 18 in in initial training as anesthesiologist nurses all in the se cond year; 11 in continuing education as operating theater nurses; iv 20 in continuous education to become emergency doctors; and v 15 in continuous education receiving healthcare management training. on doctors being trained abroad in specific specialization trainings, out of the 27 doctors in cohort 1 who went abroad in 2021, 14 have returned since 2022 and 8 others have returned in 2023. twenty 20 doctors out the second cohort went abroad in 2022 and 2 doctors of the third cohort went to st art their training in june 2023. one doctor in the third cohort is still awaiting registration and the two others from the ministry of health from the 5 initially planned in the third cohort have dropped out. satisfactory satisfactory the fifth cohort 3 doctors will not be able to be trained as part of the project as the cnss cannot avail more doctors without affecting its operations. it should be noted that from the second and third cohort, 15 doctors will not finish their training until after the closing date of the project, which is scheduled for december 31, 2026. the executing agency has formally committed to covering all fees and costs related to these 15 doctors until the end of their training. on the issue of gender balance in the number of trainees in i and doctors in specific specialization trainings abroad, the bank is working on arranging a workshop to be held with the gender department to help the project improve the targets related to gender parity following recommen dations from the midterm review. the process of 1 purchasing two 2 ambulances for the new cnss hospital including the construction financed by the islamic development bank - idb and 2 the recruitment of the consulting firm for the design of the amu digitalization system were concluded. the two ambulances were delivered in q3 2023. both will supportimprove health facilities' function. additional andor unanticipated outcomesoutputs optional indicator baseline end target most recent value

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