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Comprehensive Approach to Health System Strengthening

Abstract*

The development objectives of Comprehensive Approach to Health System Strengthening Project for Comoros are: (i) To improve utilization of quality PHC; and (ii) strengthen capacity of institutions which are critical to quality PHC. This project has four components.1) The first component, Improving PHC infrastructure, workforce, and service delivery platforms, has the following subcomponents: (i) Supporting the rehabilitation of PHC facilities (district... Show More

Development Objective

(i) To improve utilization of quality PHC, (ii) to strengthen capacity of institutions which are critical to quality PHC and (iii) to provide immediate and effective response to an Eligible Crisis or Emergency

Key Details

Project Details

Project ID
P166013
Status
Active
Team Leader
Cedric Ndizeye
Borrower 2
UNION OF COMOROS

Country
Comoros
Disclosure Date
September 4, 2018
Approval Date
(as of board presentation)
July 2, 2019
Effective Date
April 17, 2020

Total Project Cost 1
US$ 30.00 million
Implementing Agency
MINISTRY OF HEALTH, SOLIDARITY, SOCIAL PROTECTION AND GENDER PROMOTION
Region
Eastern and Southern Africa
Fiscal Year 3
2020

Commitment Amount
US$ 30.00 million
Environmental Category
B
Environmental and Social Risk
Not Applicable
Closing Date
June 30, 2026

Consultant Services required
Yes
Last Stage Reached
BANK APPROVED
Last Update Date
May 20, 2024

Associated Projects
P174227

Notes
1. Total project cost includes funding from World Bank and non-bank sources in US$ millions. Active and Closed projects show current commitments. Proposed (pipeline) and dropped projects show the forecast amount. The commitment amount for projects in the pipeline is indicative and may be modified during the project preparation.
2. Borrower refers to the Borrower of a Loan or Recipient of a Grant.
3. ”Fiscal Year” is the fiscal year in which the project was approved (or dropped if the status is dropped). The World Bank's fiscal year is from July 1 - June 30. For example, a fiscal year of 1996 corresponds to July 1, 1995 - June 30, 1996.

Sectors

Themes

FY17 - Environment and Natural Resource Management

FY17 - Climate change6%
- FY17 - Adaptation4%
- FY17 - Mitigation2%

FY17 - Human Development and Gender

FY17 - Disease Control54%
- FY17 - Non-communicable diseases38%
- FY17 - Pandemic Response1%
FY17 - Health Systems and Policies98%
- FY17 - Health Finance38%
- FY17 - Health Service Delivery25%
- FY17 - Health System Strengthening69%
FY17 - Nutrition and Food Security22%
- FY17 - Nutrition22%

FY17 - Social Development and Protection

FY17 - Social Inclusion10%
- FY17 - Participation and Civic Engagement10%
FY17 - Social Protection22%
- FY17 - Social Safety Nets22%

Project Map

Interactive Map

Finances

Financing Plan (US$ Millions)

Financier	Commitments
IDA Credit	15.00
IDA Grant	15.00

Total Project Financing (US$ Millions)

Product Line	IBRD/IDA
IBRD Commitment	N/A
IDA Commitment	30.00
IBRD + IDA Commitment	30.00

Lending Instrument
Grant Amount	N/A
Total Project Cost**	30.00

Summary Status of World Bank Financing (US$ Millions) as of September 30, 2025

No data available.

Detailed Financial Activity as of September 30, 2025

Download:

Period	Financier	Transaction Type	Amount (US$)
Aug 29, 2023	IDA-64670	Loan Disb	456,624.60
Sep 21, 2023	IDA-64670	Loan Disb	109,556.34
Jun 23, 2023	IDA-64670	Loan Disb	359,232.94
Sep 14, 2023	IDA-64670	Loan Disb	43,994.30
Feb 2, 2021	IDA-64670	Loan Disb	21,068.94
Dec 3, 2020	IDA-64670	Loan Disb	117,234.41
Oct 15, 2021	IDA-64670	Int Charges	70.18
Apr 28, 2021	IDA-64670	Loan Disb	20,082.43
Apr 28, 2021	IDA-64670	Loan Disb	215,686.92
Jul 2, 2021	IDA-64670	Loan Disb	71,836.64
Apr 28, 2021	IDA-64670	Int Charges	130.22
Apr 28, 2021	IDA-64670	Int Charges	130.22
Apr 28, 2021	IDA-64670	Int Charges	12,314.70
Apr 28, 2021	IDA-64670	Int Charges	12,314.70
Apr 19, 2021	IDA-64670	Loan Disb	62,974.96
Jun 2, 2021	IDA-64670	Loan Disb	25,008.63
Apr 30, 2021	IDA-64670	Loan Disb	-2,378.06
Apr 1, 2021	IDA-64670	Loan Disb	64,589.26
Jul 1, 2021	IDA-64670	Loan Disb	12,131.90
Dec 2, 2021	IDA-64670	Loan Disb	30,207.88
Nov 10, 2021	IDA-64670	Loan Disb	9,930.31
Nov 10, 2021	IDA-64670	Loan Disb	350,708.30
Oct 15, 2021	IDA-64670	Int Charges	70.18
Oct 15, 2021	IDA-64670	Int Charges	14,112.42
Oct 15, 2021	IDA-64670	Int Charges	14,112.42
Apr 15, 2022	IDA-64670	Int Charges	14,667.92
Apr 15, 2022	IDA-64670	Int Charges	14,667.92
Apr 8, 2022	IDA-64670	Loan Disb	441,870.78
Jan 11, 2022	IDA-64670	Loan Disb	83,233.80
Oct 15, 2022	IDA-64670	Int Charges	57.62
Oct 15, 2022	IDA-64670	Int Charges	57.62
Nov 6, 2020	IDA-64670	Int Charges	6,326.29
Nov 6, 2020	IDA-64670	Int Charges	6,326.29
Jun 30, 2020	IDA-64670	Loan Disb	64,983.12
Jul 23, 2020	IDA-64670	Loan Disb	134,792.22
May 27, 2020	IDA-64670	Loan Disb	1,263,649.20
May 27, 2020	IDA-64670	Loan Disb	447,874.00
Nov 20, 2020	IDA-64670	Loan Disb	147,448.30
Jul 6, 2020	IDA-64670	Loan Disb	292,653.00
Oct 5, 2020	IDA-64670	Loan Disb	608,744.90
Apr 13, 2023	IDA-D5050	Loan Disb	876,979.00
Feb 3, 2023	IDA-D5050	Loan Disb	180,266.11
Apr 3, 2023	IDA-D5050	Loan Disb	-1,325,694.00
Apr 3, 2023	IDA-D5050	Loan Disb	1,325,694.00
Jan 3, 2023	IDA-D5050	Loan Disb	-1,083,020.40
Sep 19, 2022	IDA-D5050	Loan Disb	171,348.70
Nov 7, 2022	IDA-D5050	Loan Disb	595,150.80
Oct 31, 2022	IDA-D5050	Loan Disb	178,631.12
Nov 21, 2022	IDA-D5050	Loan Disb	338,292.90
Oct 12, 2022	IDA-D5050	Loan Disb	247,088.97
Dec 28, 2022	IDA-D5050	Loan Disb	308,209.34
Dec 19, 2022	IDA-D5050	Loan Disb	157,092.98
Dec 1, 2022	IDA-D5050	Loan Disb	413,522.62
Aug 30, 2022	IDA-D5050	Loan Disb	267,047.22
Jun 28, 2022	IDA-D5050	Loan Disb	322,536.00
Feb 11, 2022	IDA-D5050	Loan Disb	176,885.10
Jun 8, 2022	IDA-D5050	Loan Disb	137,638.84
Mar 4, 2022	IDA-D5050	Loan Disb	282,424.90
Sep 14, 2023	IDA-D5050	Loan Disb	27,109.88
Jun 28, 2023	IDA-D5050	Loan Disb	75,061.63
Aug 17, 2023	IDA-D5050	Loan Disb	13,147.91
Aug 8, 2023	IDA-D5050	Loan Disb	277,088.78
Jul 24, 2023	IDA-D5050	Loan Disb	75,436.23
Jun 21, 2023	IDA-D5050	Loan Disb	44,367.28
Jan 19, 2023	IDA-D5050	Loan Disb	487,494.16
Apr 24, 2023	IDA-D5050	Loan Disb	129,511.45
Mar 31, 2023	IDA-D5050	Loan Disb	403,945.94
May 15, 2023	IDA-D5050	Loan Disb	275,276.25
Dec 30, 2022	IDA-D5050	Loan Disb	-10,939.60
Mar 2, 2023	IDA-D5050	Loan Disb	164,551.34
Jun 12, 2023	IDA-D5050	Loan Disb	365,947.06
Jun 2, 2023	IDA-D5050	Loan Disb	182,155.81
Aug 6, 2020	IDA-67550	Loan Commitment	2,500,000.00
Aug 6, 2020	IDA-D7030	Loan Commitment	2,500,000.00
Jul 2, 2019	IDA-64670	Loan Commitment	15,000,000.00
Jul 2, 2019	IDA-D5050	Loan Commitment	15,000,000.00
Mar 19, 2021	IDA-D5050	Loan Disb	301,942.28
Jan 8, 2021	IDA-D5050	Loan Disb	91,154.99
Jun 30, 2021	IDA-D5050	Loan Disb	72,119.07
Jun 16, 2021	IDA-D5050	Loan Disb	12,172.28
Apr 6, 2021	IDA-D5050	Loan Disb	81,596.98
Aug 6, 2020	IDA-D5050	Loan Disb	96,753.11
Mar 17, 2021	IDA-D5050	Loan Disb	97,522.49
Jan 25, 2021	IDA-D5050	Loan Disb	21,245.00
Mar 19, 2021	IDA-64670	Loan Disb	97,514.31
Jan 12, 2021	IDA-64670	Loan Disb	90,422.07
Sep 11, 2020	IDA-D5050	Loan Disb	21,522.00
Dec 23, 2020	IDA-D5050	Loan Disb	142,213.16
May 21, 2020	IDA-D5050	Loan Disb	1,250,000.00
May 21, 2020	IDA-D5050	Loan Disb	434,630.80
Jun 30, 2020	IDA-D5050	Loan Disb	290,261.75
Jul 20, 2020	IDA-D5050	Loan Disb	289,972.28
Oct 13, 2020	IDA-D5050	Loan Disb	64,565.00
May 27, 2020	IDA-D5050	Loan Disb	447,874.00
Jun 25, 2020	IDA-D5050	Loan Disb	65,015.01
Jul 28, 2020	IDA-D5050	Loan Disb	952,928.60
Oct 1, 2020	IDA-D5050	Loan Disb	289,753.88
Mar 4, 2022	IDA-D5050	Loan Disb	296,469.00
Mar 10, 2022	IDA-D5050	Loan Disb	82,987.89
May 24, 2022	IDA-D5050	Loan Disb	374,082.88
Jun 9, 2022	IDA-D5050	Loan Disb	309,178.94
Apr 8, 2022	IDA-D5050	Loan Disb	24,238.52
Mar 18, 2022	IDA-D5050	Loan Disb	177,568.80
Jul 1, 2022	IDA-D5050	Loan Disb	186,318.23
Nov 2, 2021	IDA-D5050	Loan Disb	133,051.10
Nov 8, 2021	IDA-D5050	Loan Disb	351,391.56
Nov 8, 2021	IDA-D5050	Loan Disb	9,949.65
Nov 29, 2021	IDA-D5050	Loan Disb	30,245.17
Dec 2, 2021	IDA-D5050	Loan Disb	54,027.82
Jun 10, 2021	IDA-D5050	Loan Disb	47,455.29
Sep 24, 2021	IDA-D5050	Loan Disb	282,995.47
Apr 28, 2021	IDA-D5050	Loan Disb	44,844.79
Mar 30, 2021	IDA-D5050	Loan Disb	64,564.50
Mar 30, 2021	IDA-D5050	Loan Disb	62,555.06
Mar 31, 2021	IDA-D5050	Loan Disb	20,146.50
Apr 30, 2021	IDA-D5050	Loan Disb	-5,255.42
May 28, 2021	IDA-D5050	Loan Disb	25,013.75
Jul 1, 2021	IDA-D5050	Loan Disb	188,899.95
Jun 18, 2021	IDA-D5050	Loan Disb	183,940.52
Apr 27, 2021	IDA-D5050	Loan Disb	216,375.05
Jan 19, 2021	IDA-D5050	Loan Disb	55,164.63
Dec 2, 2020	IDA-D5050	Loan Disb	497,525.53
Mar 28, 2024	IDA-64670	Loan Disb	95,407.97
Jul 17, 2024	IDA-64670	Loan Disb	86,613.07
Feb 28, 2024	IDA-64670	Loan Disb	59,939.14
Oct 26, 2023	IDA-64670	Loan Disb	57,965.16
Nov 30, 2023	IDA-64670	Loan Disb	74,752.54
Nov 13, 2023	IDA-64670	Loan Disb	266,683.20
Dec 20, 2023	IDA-64670	Loan Disb	111,254.98
Oct 15, 2023	IDA-64670	Int Charges	734.89
Oct 15, 2023	IDA-64670	Int Charges	734.89
Oct 15, 2023	IDA-64670	Int Charges	12,294.84
Oct 15, 2023	IDA-64670	Int Charges	12,294.84
Mar 15, 2024	IDA-64670	Loan Disb	217,104.39
Apr 15, 2024	IDA-64670	Int Charges	615.74
Apr 15, 2024	IDA-64670	Int Charges	615.74
Apr 15, 2024	IDA-64670	Int Charges	20,017.51
Apr 15, 2024	IDA-64670	Int Charges	20,017.51
Oct 13, 2023	IDA-64670	Loan Disb	291,662.72
Jan 25, 2024	IDA-64670	Loan Disb	426,116.66
Jun 26, 2024	IDA-64670	Loan Disb	372,693.47
Aug 22, 2024	IDA-64670	Loan Disb	185,756.42
Aug 15, 2024	IDA-64670	Loan Disb	133,635.27
Jun 3, 2024	IDA-64670	Loan Disb	157,723.70
Jun 27, 2024	IDA-64670	Loan Disb	365,801.22
Feb 8, 2024	IDA-64670	Loan Disb	330,049.60
May 9, 2024	IDA-64670	Loan Disb	247,698.80
Apr 17, 2024	IDA-64670	Loan Disb	422,856.88
Jun 13, 2024	IDA-64670	Loan Disb	156,016.38
Oct 15, 2022	IDA-64670	Int Charges	14,609.24
Oct 15, 2022	IDA-64670	Int Charges	14,609.24
Apr 15, 2023	IDA-64670	Int Charges	-14,665.15
Apr 15, 2023	IDA-64670	Int Charges	-14,665.15
Jan 24, 2023	IDA-64670	Loan Disb	-1,225.66
Dec 30, 2022	IDA-64670	Loan Disb	-10,884.54
Apr 15, 2023	IDA-64670	Int Charges	14,665.15
Apr 15, 2023	IDA-64670	Int Charges	14,665.15
Jan 3, 2023	IDA-64670	Loan Disb	-1,053,795.60
Nov 9, 2022	IDA-64670	Int Charges	407.71
Nov 9, 2022	IDA-64670	Int Charges	407.71
Apr 15, 2023	IDA-64670	Int Charges	14,665.15
Apr 15, 2023	IDA-64670	Int Charges	14,665.15
Aug 18, 2023	IDA-64670	Loan Disb	76,287.38

Footnotes

Ratings

IMPLEMENTATION RATINGS

Name	Review	Date
Procurement	Moderately Satisfactory	2025-05-21
Project Management	Satisfactory	2025-05-21
Progress towards achievement of PDO	Satisfactory	2025-05-21
Financial Management	Moderately Satisfactory	2025-05-21
Monitoring and Evaluation	Satisfactory	2025-05-21
Overall Implementation Progress (IP)	Moderately Satisfactory	2025-05-21

COMPLETION RATINGS

No data available.

INDEPENDENT EVALUATION RATINGS

No data available.

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

PHC facilities with accreditation level 2 above as per the quality assurance program Value 0.00 0.00 40.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Percentage of identified close contacts of confirmed COVID-19 cases investigated based on national guidelines Value 0.00 100.00 80.00
Date May 15, 2020 December 1, 2023 December 31, 2022
Comment

PHC facilities participating in the PBF scheme supported by the project which reimburses for both quantity and quality of service	Value	0.00	64.00	80.00
	Date	December 31, 2017	December 1, 2023	September 30, 2025
	Comment

People who have received essential health, nutrition, and population (HNP) services Value 0.00 140119.00 199263.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Of which female Value 0.00 114481.00 161029.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Number of children immunized Value 0.00 51733.00 70263.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Number of women and children who have received basic nutrition services Value 0.00 36370.00 59000.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Number of deliveries attended by skilled health personnel Value 0.00 52016.00 70000.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Functional community health sites Value 69.00 173.00 172.00
Date October 31, 2019 December 1, 2023 September 30, 2025
Comment

INTERMEDIATE RESULTS INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

PHC facilities renovated (minor renovations) and/or equipped among the PHC structures in need of these renovations and/or equipment (percentage)	Value	0.00	90.00	100.00
	Date	December 31, 2019	December 1, 2023	September 30, 2025
	Comment

Emergency Action Plan validated Value Emergency Action Plan prepared Yes Yes
Date December 31, 2019 May 11, 2022 June 30, 2020
Comment
National Health Strategies and Plans adopted (Quality of Care, NCDs, Human Resources for Health) (number) Value 0.00 3.00 3.00
Date June 30, 2019 December 1, 2023 September 30, 2025
Comment
Operational hotline for patient complaints and feedbacks Value No Yes Yes
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Number of PHC health workers receiving annual CME Value 0.00 244.00 500.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Number of designated GeneXpert center with SARS-CoV-2 diagnostic capacity Value 0.00 3.00 2.00
Date May 15, 2020 May 11, 2022 December 31, 2022
Comment
PHC health workers benefiting from annual clinical mentorship and/or coaching Value 53.00 64.00 100.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Patient associations/support groups established (diabetes, hypertension, chronic lung diseases, cancer) Value 0.00 1.00 4.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Of which female Value 0.00 162.00 332.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Number of designated health facilities with COVID-19 case management capacity Value 0.00 3.00 3.00
Date May 15, 2020 May 11, 2022 December 31, 2022
Comment
PHC facilities self-monitoring a set of quality of care indicator quarterly for quality improvement Value 0.00 0.00 50.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Nationally representative patient experience surveys conducted Value 0.00 1.00 2.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Revision of the pre-service nurse training curriculum to make it competency-based Value No No Yes
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Complaints for grievances timely addressed Value 0.00 100.00 75.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Membership of health professional associations Value 0.00 310.00 100.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment
Primary health care facilities submitting monthly report according to national guidelines Value 0.00 42.00 70.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment

Recipients of scholarships for pre-service training in selected clinical disciplines, public health and health management	Value	0.00	33.00	35.00
	Date	December 31, 2019	December 1, 2023	September 30, 2025
	Comment

Annual District and National Health Assemblies Value 0.00 50.00 86.00
Date October 31, 2019 December 1, 2023 September 30, 2025
Comment
Community health workers trained to provide health and nutrition services Value 0.00 305.00 516.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Of which female Value 0.00 197.00 333.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
PHC facilities with at least one quality improvement initiative with the team based problem solving approach Value 0.00 0.00 60.00
Date December 31, 2019 December 1, 2023 September 30, 2025
Comment
Functional Emergency Medical Transportation with a dedicated hotline on each island Value 0.00 0.00 5.00
Date December 31, 2017 December 1, 2023 September 30, 2025
Comment

Of which female	Value	0.00	114481.00	161029.00
	Date	December 31, 2017	December 1, 2023	September 30, 2025
	Comment

Number of children immunized	Value	0.00	51733.00	70263.00
	Date	December 31, 2017	December 1, 2023	September 30, 2025
	Comment

Functional community health sites	Value	69.00	173.00	172.00
	Date	October 31, 2019	December 1, 2023	September 30, 2025
	Comment

Emergency Action Plan validated	Value	Emergency Action Plan prepared	Yes	Yes
	Date	December 31, 2019	May 11, 2022	June 30, 2020
	Comment

PHC health workers benefiting from annual clinical mentorship and/or coaching	Value	53.00	64.00	100.00
	Date	December 31, 2019	December 1, 2023	September 30, 2025
	Comment

Patient associations/support groups established (diabetes, hypertension, chronic lung diseases, cancer)	Value	0.00	1.00	4.00
	Date	December 31, 2019	December 1, 2023	September 30, 2025
	Comment

Comprehensive Approach to Health System Strengthening

Abstract*

Development Objective

Key Details

Project Details

Sectors

Themes

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Project Map

Finances

Financing Plan (US$ Millions)

Total Project Financing (US$ Millions)

Summary Status of World Bank Financing (US$ Millions) as of September 30, 2025

Detailed Financial Activity as of September 30, 2025

Ratings

IMPLEMENTATION RATINGS

COMPLETION RATINGS

INDEPENDENT EVALUATION RATINGS

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INTERMEDIATE RESULTS INDICATORS