The World Bank’s Board of Directors approved the Comprehensive Approach to Health System Strengthening Project (COMPASS), financed by $30 million from the International Development Association (IDA), of which $15 million as a grant and $15 million as a credit.
The objective of COMPASS is to improve utilization of quality Primary Health Care (PHC) and to strengthen capacity of institutions which are critical to quality PHC in Comoros. The entire population of Comoros, particularly children under five, women, adolescents, patients with non-communicable disease will benefit from the project.
The Human Capital Index for Comoros is 0.41 in 2017. This means that children born today in Comoros would be 41 percent more productive as workers in the future if they enjoyed complete education and full health.
Not only is this index lower than the average for lower-middle-income countries, it also places Comoros at the lower end of the global distribution (122nd ranking out of 157 countries).
Despite the progress in some key health outcomes since 2000, Comoros, as a country affected by fragility, conflict and violence performs worse than Sub-Saharan Africa averages in various health indicators, including infant mortality, neonatal mortality and severe wasting rates.
Quality primary health care in Comoros is hindered by major constraints in financing, governance, capacity and institutions. Less than half (48.9 percent) of pregnant women receive full antenatal care.
Only 38.1 percent of children under 5 with suspected pneumonia are taken to an appropriate health facility or provider and only 37.5 percent of children with diarrhea receive appropriate treatment.
Regarding the workforce, 60 percent of staff in public facilities are volunteers, which is an anomaly not only in the region but also globally. In response, the Government of Comoros has made health prominent in the its Accelerated Growth and Development Strategy (SCA2D) 2018-2021. It has recently made a commitment to Universal Health Coverage.
“The World Bank is committed to further assist the Government of Comoros in implementing its 2018-2021 SCA2D. In order to have inclusive and sustainable growth, we must first and foremost ensure that people have good health,” said Rasit Pertev, World Bank Resident Representative in Comoros.
To bring quality care closer to the population, the project will support the strengthening of the foundational elements of a quality primary health care system: infrastructure, workforce, service delivery platforms, governance, institutions for quality, and citizen engagement.
It will include rehabilitation of district centers and health posts, provision of equipment and vehicles; training for selected health cadres as well as recruitment of health workers; and scale-up of the community health and nutrition platform piloted under the Comoros Social Safety Net Project. This project will also aim at strengthening institutions which are critical to ensure quality primary health care and timely response to disease outbreaks.
“This project will contribute to support a “whole system” approach to primary health care strengthening of Comoros health care system, both by addressing the needs of population and by increasing the national institutions capacity to deliver quality health care,” said Voahirana Rajoela, World Bank Task Team Leader for the operation.
The project will build on existing support the health system is receiving, including from the WHO, UNICEF, UNFPA and PASCO, the AFD-supported performance-based financing project.