Healthcare Action Through Rapid Infrastructure Improvements (“HARI'I”) Project

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The proposed Timor-Leste Healthcare Action through Rapid Infrastructure Improvements (“HARI’I” ) Project, in the amount of IDA Credit US$50 million, will contribute to establishing a functioning health referral system in Timor-Leste through strengthening supply-side readiness from the PHC level to secondary care in three project municipalities selected by MoH based on the National Health Sector Strategic Plan (NHSSP) and up to tertiary care level in the capital, Dili. It will also support efforts to improve the overall performance and efficiency of health service delivery systems in Timor-Leste from the perspective of data management, financing, and human resources for health through (i) strengthening the current health information systems setup by establishing connectivity between the DHIS2, Sauda Na Familia/RESTL, and mSupply into the integrated national Timor-Leste Health Information System (TLHIS); (ii) providing facility management cost to improve service readiness, including operation and maintenance of health facilities and equipment of some basic health services; and (iii) ensuring the provision of basic clinical in-service and Public Financial Management (PFM) training needed to manage and operate health care infrastructure, data, and strengthen financial accountability at municipal level in collaboration with Development Partners. The project is expected to involve small to medium-scale civil work activities and limited procurement of medical equipment as part of the Component 1. The sub-component 1.1. of the Project will finance the construction of new municipal hospital in Gleno (Ermera) and Lospalos (Lautem) and the expansion of existing Community Health Center (CHC) in Viqueque Vila (Viqueque) to become a municipal hospital as well as provide funds for the upgrading/rehabilitating and equipping of all CHCs and Health Posts in the same three municipalities in line with the TL MOH’s Essential Service Package (ESP) for Primary Health Care facilities. The sub-component 1.2 will support limited procurement of medical equipment in two national hospitals including for expansion of the Hospital National Guido Valadares (HNGV) & new cardiac ward at Lahane Hospital. Both hospitals are already operating and will be upgraded through the national government budget. The sub-component 1.3 will support preparation of Detailed Engineering Design (DED) for the HNGV expansion and new/upgrade of municipal hospitals. The DED support will ensure the infrastructure development work to be financed under the Project will be in compliance with the WB ESF and all ESSs requirements to be met prior to the commencement of civil work activities. The project will also support the management cost of CHC and HP and the associated PFM capacity building on staff in 3 municipalities to appropriately manage funds (Component 2) and Project Management and Monitoring & Evaluation (Component 3).Additionally, the project will also include a Contingent Emergency Response Component (CERC) to provide health-related support in the event of disasters. A CERC Operations Manual will be prepared as an annex to the Project’s Operation Manual outlining triggers for its activation and detailing fiduciary and environmental and social requirements, and any other necessary implementation arrangements.Moreover, MoH agreed to supply the required human resources for health (HRH) and funding for hospital infrastructure and equipment operation and maintenance. This joint and coordinated efforts will be critical in building the country’s health care referral system. The multifunctional ambulances and operational vehicles procured under the World Bank’s HEPR-TF project will also enable appropriate transportation as part of creating this functional referral system. The World Bank will support the development of protocols and, if necessary, decree laws to substantiate the functioning of the referral system, underpinned by analytical and advisory work and other development partners’ contributions and achievements. The proposed Project is closely aligned with the current Country Partnership Framework (FY2020–24) and its Focus Area 2, invest in human capital and service delivery, and its associated Objective 4: strengthen human capital and promote gender equity. The low levels of access to and use of health services of rural populations stand out as a key challenge to be addressed, in light of natural hazards and climate change, affecting health, lives, and livelihoods.