BLANK TEMPLATE FOR SIMPLE RESTRUCTURING



Document ofThe World BankFOR OFFICIAL USE ONLYReport No: 89788-INRestructuring PAPERON APROPOSED Project restructuring of TAMIL NADU HEALTH SYSTEMS PROJECTcREDIT 4756-inAPRIL 29, 2010TOiNDIAAUGUST 2, 2014india country management unitsouth asia regionThis 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.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 ACRONYMSCEmONCComprehensive Emergency Obstetric and Neonatal Care CentersCMSCollege Management SystemDMEDepartment of Medical EducationEmONCEmergency Obstetric and Neonatal Care CenterGoTNGovernment of Tamil NaduHMISHealth Management Information SystemHMSHospital Management SystemITInformation TechnologyNCDNon-Communicable DiseasePDOProject Development ObjectivePHCPrimary Health CenterTNHSPTamil Nadu Health System ProjectUASUniversity Automation SystemRegional Vice President:Philippe H. Le HouerouCountry Director:Onno RuhlPractice Manager/Manager:Julie McLaughlinTask Team Leader:Bushra Binte AlamINDIATAMIL NADU HEALTH SYSTEMS PROJECTContentsA.SUMMARY5B.PROJECT STATUS 5C.PROPOSED CHANGES6ANNEX 1: RESULTS FRAMEWORK AND MONITORING7DATA SHEETIndiaIndia: Tamil Nadu Health Systems Project (P075058)SOUTH ASIA0000009074.Report No:89788-IN.Basic InformationProject ID: P075058Lending Instrument: Specific Investment LoanRegional Vice President: Philippe H. Le HouerouOriginal EA Category: Partial Assessment (B)Country Director: Onno RuhlCurrent EA Category: Partial Assessment (B)Senior Global Practice Director: Timothy Grant EvansOriginal Approval Date: 29-Apr-2010Practice Manager/Manager: Julie McLaughlinCurrent Closing Date: 30-Sep-2014Team 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 FormDecision Authority: Country DirectorRestructuring Level:Level 2Explanation of Approval Authority:.Financing ( as of 30-Jun-2014 )Key DatesProjectLn/Cr/TFStatusApproval DateSigning DateEffectiveness DateOriginal Closing DateRevised Closing DateP075058IDA-40180Closed16-Dec-200405-Jan-200527-Jan-200531-Mar-201030-Sep-2010P075058IDA-47560Effective29-Apr-201006-Jul-201006-Aug-201030-Sep-201330-Sep-2014Disbursements (in Millions)ProjectLn/Cr/TFStatusCurrencyOriginalRevisedCancelledDisbursedUndisbursed% DisbursedP075058IDA-40180ClosedXDR73.9060.6413.2660.640.00100P075058IDA-47560EffectiveXDR77.6077.600.0060.7116.8978.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..C. Proposed Changes.FinancingChange in Loan Closing Date(s): ExplanationThe 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/TFStatusOriginal Closing DateCurrent Closing DateProposed Closing DatePrevious Closing Date(s)IDA-40180Closed31-Mar-201030-Sep-2010 31-Mar-2010IDA-47560Effective30-Sep-201330-Sep-201430-Sep-201530-Sep-2013Project Name:Tamil Nadu Health Systems ProjectProject Stage: :RestructuringStatus :SupervisionTeam Leader:Bushra Binte AlamRequesting Unit:GHNDRCreated by:Sangeeta Carol PintoProduct Line:Investment Project FinancingResponsible Unit:GHNDRModified by:Sangeeta Carol PintoCountry:IndiaApproval FY:2010Region:South AsiaLending 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 ApplicableResultsCore sector indicators are considered: YesResults reporting level:ProjectProject Development Objective IndicatorsStatusIndicator NameCoreUnit of MeasureBaselineActual(Current)End TargetDroppedIndicator OneAt least 23% of complicated maternal admissions at certified project CEmONCs (state-wide) will be for SC/ST patientsPercentageValue23%34.5%23%Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator TwoEffective functioning of CEmONCs (state-wide) as measured by % of complicated maternal admissionsPercentageValue35%71.9%35%Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator ThreeEffective functioning of CEmONCs (state-wide) as measured by risk adjusted maternal case fatality rateNumberValue13.336.1713.33Sub TypeDateNovember 31, 2009March 31, 2014September 30, 2014CommentsDroppedIndicator FourEffective functioning of CEmONCs (state-wide) as measured by risk adjusted neonatal case fatality rateNumberValue4.083.984.08Sub TypeDateNovember 31, 2009March 31, 2014September 30, 2014CommentsDroppedIndicator Seven: Improved efficiency of services as measured by Bed Occupancy RatePercentageValue81%81%81%Sub TypeDateSeptember 30, 2009March 31, 2014September 30, 2014CommentsDroppedIndicator Seven:Improved efficiency of services as measured by number of diagnostic services performedNumberValue11,967,68337,615,86012,000,000Sub Type: SupplementalDateSeptember 30, 2009March 31, 2014September 30, 2014CommentsDroppedIndicator Seven:Number of night time Caesarians at CEmONCsNumberValue4,65622,5308,500Sub Type: SupplementalDateSeptember 30, 2009March 31, 2014September 30, 2014CommentsDroppedIndicator Nine: Strengthened state level capacity of pharmaceuticals and medical supplies procurement, repair and maintenance of medical equipmentTextValueCurrently TNMSC is responsible for procurement and AMCs of medical equipment49 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 repairSub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsNo changeCurrent 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 pilotsTextValueCervical cancer screening operational in Theni and Thanjavur; interventions for cardio-vascular disease prevention and control operational in Sivagangai and VirudhunagarCervical cancer screening and interventions for cardio-vascular disease prevention and control scaled up to entire stateScale-up on basis of pilot evaluationSub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsNo changeCurrent Indicator Six and Proposed Indicator Three: Improved access to health care, as measured by inpatient utilization of services by the poorest 40% of population: Proportion of population (per 1000) reporting ailment in last 15 days NumberValue36.7Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsData collection ongoingIncreased utilization rate by the poorest as measured by an asset indexNo changeCurrent Indicator Six and Proposed Indicator Three: Percentage of those who accessed any form of carePercentageValue82.8%Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsData collection ongoingNo changeCurrent Indicator Six and Proposed Indicator Three: Number of hospitalization cases (per 1000)NumberValue32.1Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsData collection ongoingNo changeCurrent Indicator Eight and Proposed Indicator Four: Patient Satisfaction (perceived quality of care) as measured by overall satisfaction scoreNumber Value3.963.96Sub TypeDate2006March 31, 2014September 30, 2014CommentsData collection ongoingNo changeCurrent Indicator Eight and Proposed Indicator Four: Patient Satisfaction (perceived quality of care) as measured by overall inpatient scoreNumberValue3.993.99Sub Type: SupplementalDate2006March 31, 2014September 30, 2014CommentsData collection ongoingNo changeCurrent Indicator Eight and Proposed Indicator Four: Patient Satisfaction (perceived quality of care) as measured by overall outpatient scoreNumberValue3.953.95Sub Type: SupplementalDate2006March 31, 2014September 30, 2014CommentsData collection ongoingNewProposed Indicator One: Proportion of C-sec deliveries amongst SC/ST mothers at secondary level CEmONCsPercentageValue28.11%46.59%43%Sub TypeDateMarch 31, 2008March 31, 2014September 30, 2015CommentsNewProposed Indicator Five: No: of public hospitals accredited by the National Board of Accreditation of HospitalsNumberValue0312Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2015CommentsIntermediate Results IndicatorsStatusIndicator NameCoreUnit of MeasureBaselineActual(Current)End TargetDroppedIndicator One: Health personnel receiving training: Doctors (OBGYN and pediatricians), medical officers of 1st referral units and nursesXNumberValue047612402Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Two: Number of health facilities constructed, renovated, equipped: Maternity wings construction and equipment at selected medical collegesXNumberValue078Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Three: Staffing according to agreed norms (2OBGYN, 2 pediatricians and 1 anesthetist) in Phase I CEmONCsPercentageValue77%100%85%Sub TypeDateNovember 31, 2009March 31, 2014September 30, 2014CommentsDroppedIndicator Three: Staffing according to agreed norms (2OBGYN, 2 pediatricians and 1 anesthetist) in Phase II CEmONCsPercentageValue38%42%85%Sub Type: SupplementalDateNovember 31, 2009March 31, 2014September 30, 2014CommentsDroppedIndicator Four: Increased provision of health services to the tribal population through mobile outreach servicesNumber Value121920Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Four: Increased provision of health services to the tribal population through NGO hospitals providing bed grantsNumberValue244Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Four: Increased provision of health services to the tribal population through NGO hospitals providing testing, counseling and treatment services for sickle cell anemiaNumberValue233Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Four: Increased provision of health services to the tribal population through 32 patient counselors at primary and secondary health facilities in tribal areasNumberValue324232Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Five: Increased emergency transport services by way of vehicles provided by projectNumberValue385638585Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Five: Increased emergency transport services by way of number of calls responded toNumberValue113,570397,919Sub Type: SupplementalDate2008-09March 31, 2014September 30, 2014CommentsDroppedIndicator Five: Increased emergency transport services by way of percentage of pregnant womenPercentageValue26.8%26%Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Five: Increased emergency transport services by way of percentage of road accidentsPercentageValue30.9%20%Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Six: Support services (laundry, cleaning, security and food distribution) provided NumberValue04820Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Seven: Health promotion for prevention of CVD among children carried out in schoolsNumberValue50163695000Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Eight: Percentage of women in target age group (30-60) screened for cervical cancer implementation districtsPercentageValue85%33.5%50%Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Nine: Health facilities constructed, renovated and/or equipped: cancer cervix screeningXNumberValue02,1431,710Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Ten: Health personnel receiving training: cancer cervix screeningXNumberValue07,041424,000Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Eleven: CVD screening and management operational in districtsNumberValue23216Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Twelve: Health facilities constructed, renovated and/or equipped: CVD screening and controlXNumberValue02,1431,670Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Thirteen: Health personnel receiving training: CVD screening and controlXNumberValue070,41415,360Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Fourteen: Health facilities constructed, renovated and/or equipped: Operational HMSXNumberValue38267270Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Fifteen: Operational HMS being used for management decision making in hospitalsNumberValue38267270Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Sixteen: Operational HMIS across the stateTextValueNot operationalOperational across stateOperational across stateSub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Seventeen: Maintain hospital based quality circles of excellence, as measured by submission of monthly reportsNumberValue80267270Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Eighteen: Health personnel receiving training to improve quality of care, in hospital managementXNumberValue3551,1721,000Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Eighteen: Health personnel receiving training to improve quality of care, in rational use of drugsXNumberValue05,528900Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Eighteen: Health personnel receiving training to improve quality of care, in skill based trainingXNumberValue037,468Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Nineteen: Health facilities constructed, renovated and/or equipped: accreditationXNumberValue01212Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Twenty: Hospitals accredited (including provision of civil works, equipment, training)NumberValue0312Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Twenty Two: Health personnel receiving training: retraining provided to staff of health care facilities across state (PHCs, secondary and tertiary)XNumberValue44,00058,29444,000Sub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Twenty Three: Fully operational Project Management Unit (PMU) integrated into the Department of HealthTextValuePMU operationalPMU operationalPMU integratedSub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Twenty Four: Mechanism established for planning and implementing IEC activities in the health sectorTextValueNoneMechanism establishedSupport NRHM for establishment of a coordination unit in the Directorate of Health for all health communication activities in stateSub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Twenty Four: Mechanism established for monitoring of PPP activitiesTextValueNoneMechanism establishedSupport NRHM for establishment of a coordination unit in the Directorate of Health for monitoring PPP activitiesSub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedIndicator Twenty Five: Establish a health data resource center in the TNTextValueNoneSHDRC being establishedHealth data resource center establishedSub Type: DateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedName 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 normsXNumberValue03232Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedName Twenty Seven: TNMSC strengthened as per planTextValueNoneBiomedical engineers mainstreamed. TNMSC being strengthened with state fundsTNMSC strengthened as per agreed plan including mainstreaming of biomedical engineersSub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsDroppedName Twenty Eight: Supporting additional contractual staff at 270 project hospitals in accordance with agreed normsTextValue0562 staff nurses for CEmONCS being financed by GoTN1,132 NCD staff nurses for Phase I districts supported by GoTN1,212 NCD staff nurses contracted for Phase II districts supported by TNHSPAdditional staff at 270 hospitals as agreedSub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsNewProposed Indicator One: Number of health personnel receiving training:XNumberValue0143,487105,000Sub TypeDateMarch 31, 2014March 31, 2014September 30, 2015CommentsNewProposed Indicator Two: Number of health facilities constructed, renovated and/or equippedXNumberValue02,1832,228Sub TypeDateMarch 31, 2014March 31, 2014September 30, 2015CommentsNewProposed 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)NumberValue35,15653,60666,000Sub TypeDate2007-08March 31, 2014September 30, 2015CommentsNewProposed Indicator Four: Number of tribal patients provided outpatient care through Mobile Outreach VansNumberValue137,543174,683200,000Sub TypeDate2007-08March 31, 2014September 30, 2015CommentsNewProposed Indicator Five: Percentage of calls made by pregnant women attended to by 108 servicesPercentageValue90.396.896.8Sub TypeDate2009-10March 31, 2014September 30, 2015CommentsNewProposed Indicator Five: Percentage of calls made for Road Traffic Accident victims attended by 108 servicesPercentageValue66.179.479.4Sub Type: SupplementalDate2009-10March 31, 2014September 30, 2015CommentsNewProposed Indicator Six: Number of performance based contracts delivering health care services through TNHSP in Tamil NaduNumberValue099Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2015CommentsNewProposed Indicator Seven: Number of schools where health promotion activities for prevention of cardiovascular diseases is undertakenNumberValue5016,36916,369Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2015CommentsNewProposed Indicator Eight: Percentage of eligible women in age group 30-60 years screened for Cancer CervixPercentageValue3.4%33.5%40%Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2015Comments(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)= 4,844,988NewProposed Indicator Eight: Percentage of eligible persons (both men and women) in age group >30years screened for hypertensionPercentageValue3.4%37.2%50%Sub Type: SupplementalDateMarch 31, 2010March 31, 2014September 30, 2015Comments1,231,259 (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) = 13,314,231NewProposed Indicator Nine: Number of health facilities where HMIS is used to submit monthly reportsNumberValue02,1832,228Sub Type: Date2009-10March 31, 2014September 30, 2015CommentsGH-274PHC-1889MC-20GH-274PHC-1889MC-65RevisedCurrent: Indicator Twenty One: Integrated health care waste management plan implemented in all project facilitiesNumberValue270449270Sub TypeDateMarch 31, 2010March 31, 2014September 30, 2014CommentsProposed Indicator Ten: Number of public health facilities implementing integrated health care waste management planNumberValue267449449Sub TypeDate2007-08March 31, 2014September 30, 2015Comments ................
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