Lebanon Health Resilience Project

Project Implementation Status

 

Fourth Project Restructuring: The project underwent a fourth restructuring in November 2024 based on the MoPH request. The restructuring consisted of: (a) using of funds under Component 2.1 to reach poor and vulnerable people in Lebanon that require emergency health services from October 1, 2024 as a result of the conflict and provision of emergency secondary-level healthcare services in public hospitals for internally displaced (IDP) Lebanese due to the conflict; (b) extending the closing date by 12 months, from March 31, 2025 to March 31, 2026; and (c) revising the results framework (RF). The activities benefiting refugees were not affected by this restructuring.

 

Progress Updates: The progress towards achievement of the PDO is rated as Moderately Satisfactory:

• Component 1: Scaling up the Scope and the Capacity of the Primary health care (PHC) Universal Health Coverage (UHC) program: The implementation of the PHC pilot is making steady progress. On September 5, MoPH sent SMSs to 210,000 beneficiaries selected from the Emergency Social Safety Net (ESSN) database, inviting them to enroll in the PHC pilot. As of January 21, 2025 around 25k beneficiaries have been enrolled in PHC centers and started receiving services. During the last year, the MoPH has been preparing for the launch of the pilot. MoPH already completed the identification of PHC centers, their readiness assessment, trained the PHC centers personnel, developed the provider payment mechanism, contracted a Third-Party Agent (TPA), contracted a call center firm, conducted security test to ensure confidentiality of ESSN data, signed contracts with PHC centers, and transferred readiness grants to the PHC centers. A communication plan to complement the activities of the pilot has been completed and communication materials were delivered to participating PHC centers.
• So far, 48 PHC centers have been contracted by MoPH under this pilot. These centers received a readiness grant (up to US$10,000 per center) to procure the required equipment (such as EKG, ultrasound, IT equipment) and recruit the needed staff (nurse, HIS officer, etc.) to be able to implement the PHC packages. Training activities have been provided to personnel at these centers as well. Training activities covered the design of the packages and the provider payment method, financial management procedures, procurement arrangements, environmental and social risks and mitigation measures, as well as using the electronic system for data entry. This has improved the technical and managerial capacities of these centers, improving their capacity to deliver quality PHC services and benefiting both Lebanese and displaced persons.
• Implementation of the PHC pilot has been delayed due to the outbreak and escalation of the conflict in Lebanon since 2023, which; In addition, due to the financial crisis, country instability and multiple shocks, the capacity of MoPH and the Project Management Unit (PMU) has been limited; mainly by workforce absenteeism (caused by the socioeconomic crisis) and vacancies in key PMU positions. To speed up the implementation of the PHC pilot, the WB requested to MoPH to prepare an action plan with the actions that could be taken to increase disbursement.
• Component 2: Provision of Health Care Services in Public Hospitals: The Project financed 127,000 non-COVID-19 hospitalization claims. This component is also designed to finance secondary care for vulnerable population. The MoPH is planning to start the design the secondary care model and the referral mechanism. The Terms of Reference (TOR) for this consultant are under discussion between WB and MoPH.
• Component 3: Strengthening Project Management and Monitoring: The Project Operations Manual (POM) was revised to include the activities that will be financed as per the latest restructuring. The TPA is currently working as per TORs and signed contract.
• Component 4: Strengthen the Government’s Capacity to Respond to COVID 19: The project contributed to strengthening the capacity of the Government of Lebanon (GoL) to respond to the COVID-19 pandemic through (i) COVID-19 prevention awareness campaigns and community engagement; (ii) procurement of 3.25 million doses of Pfizer vaccine; (iii) procurement of Polymerase Chain Reaction machines and their kits, personal protective equipment, medical equipment for hospitals, and regular and Intensive Care Unit (ICU) beds; (iv) maintenance of COVID-19 related equipment at hospitals; (v) installation of negative pressure system; (vi) coverage of 17,660 COVID-19 hospital claims; and (vii) supporting the pharmacovigilance program at the MoPH.

 

PMU Staffing: The procurement officer, financial officer, financial assistant and monitoring and evaluation officer are on board. Due to the war situation, the project manager resigned from her position end of September 2024. The selection of the new project manager is ongoing and is expected to be on board by end of January 2025. The recruitment of environment and social officer and the administrative assistant is underway.

 

Disbursement: US$30.47 million is undisbursed. It is anticipated that disbursement will accelerate in calendar year 2025, through the PHC capitation payments. Simultaneously, financing of secondary care services and additional investments for system strengthening (improvements in the information system, procurement of equipment, etc.) are expected to take place in the third and fourth quarters of 2025. The WB requested the MoPH to prepare a disbursement plan to show how the remaining funds will be disbursed before the closing date of the project.