Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Kyrgyz Health Results Based Financing (P120435) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition and Population Global Practice | Recipient Executed Activities | Specific Investment Loan | FY 2013 | Seq No: 5 | ARCHIVED on 11-Jun-2015 | ISR19203 | Implementing Agencies: Mandatory Health Insurance Fund, Ministry of Health Key Dates Key Project Dates Board Approval date:18-Apr-2013 Effectiveness Date:29-Jul-2014 Planned Mid Term Review Date:20-Jan-2016 Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2017 Revised Closing Date:30-Jun-2017 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to (1) pilot performance-based payments and/or enhanced supervision for quality of maternal and neonatal care in randomly selected rayon hospitals; and (2) strengthen the Government’s and providers’ capacity in performance-based contracting and monitoring and evaluating for results. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Care:(Cost $9.59 M) Component 2: Strengthen the Government's and Providers' Capacity in Performance-Based Payment Reform and Monitoring and Evaluation f or Results:(Cost $1.41 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Overall Risk Rating  --  High 6/11/2015 Page 1 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Implementation Status and Key Decisions The Government remains committed to the project implementation. Pilot project has been successfully scaled up to all 42 hospitals since the project effectiveness on July 30, 2014. That included four rounds of quarterly peer verifications and one round of semiannual counterverification. Close attention needs to be paid to (i) timely design of an open-source information and communication technology (ICT) system for the RBF program and (ii) technical assistance (TA) for capacity building of providers' knowledge and skills. Both should contribute to improvement of quality of care. Implementation of the pilot KG HRBF project activities: The scale up of the pilot project since project effectiveness demonstrates promising results - the hospitals performance has improved in average from 9% to 33,8%, 42,3% and 53,6% between July 2015 baseline survey and follow up October 2014, January and April 2015 rounds of peer verification. All 42 hospitals have prepared hospitals development plans to address identified issues, focusing on quality improvement measures. Counterverification conducted in10 randomly selected hospitals (5 in each Arm) in March 2015 showed difference in scores below the acceptable threshold of 10%.Structural measures of quality have shown striking improvement, for instance, with the availability of blood transfusion services increasing to near-universal availability from baseline across both Arms. Overall, first year implementation has created an interest among providers across all three Arms and at the oblast level of health care. It has been also agreed that preparation of the pilot PHC PBF scheme needs to be accelerated, focusing on all key needs/issues identified at the PHC level and on the entire PHC network, including stand-alone Family Groups Practices/FGPs and remote small PHC facilities/FAPs. 6/11/2015 Page 2 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  --  High Macroeconomic  --  --  Substantial Sector Strategies and Policies  --  --  Substantial Technical Design of Project or Program  --  --  Moderate Institutional Capacity for Implementation and Sustainability  --  --  High Fiduciary  --  --  Substantial Environment and Social  --  --  High Stakeholders  --  --  Substantial Other  --  --  -- Overall  --  --  High Results Project Development Objective Indicators PHINDPDOTBL  Proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals submitted to MHIF within one week after the end of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date -- -- 13-May-2015 30-Jun-2017 Comments Off track. RBF Secretariat indicates that this indicator is not achievable and will need to be modified. A feasible deadline is 20 working days after end of the quarter. 6/11/2015 Page 3 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDPDOTBL  Proportion of eligible rayon hospitals that received the authorized performance-based payments within two weeks after the MHIF’s receipt of payment invoices (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date -- -- -- 13-May-2015 Comments Off track. RBF Secretariat indicates that this indicator is not achievable and will need to be modified. A feasible deadline is 20 working days after the MHIF’s receipt of payment invoices. PHINDPDOTBL  Number of counter-verification carried out for a subset of Group 1 rayon hospitals and Group 2 rayon hospitals every six months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 10.00 8.00 Date -- -- 13-May-2015 31-Dec-2015 Comments 10 hospitals were randomly selected (5 in each arm) PHINDPDOTBL  Impact Evaluation Surveys completed on schedule to generate evidence for policy (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Impact Evaluation At least 2 round baseline survey of serveys completed before start Value No surveys -- implmented by of pilot the end of the project Date -- -- 11-May-2015 30-Jun-2017 Comments Indicator target met. Impact Evaluation baseline survey completed before start of pilot.Follow up survey to be completed before end of Project Overall Comments First two PDO level indicators need to be modified as they are not achievable as the timeline for both (i) submission of peerverification 6/11/2015 Page 4 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) records within one week after the end of the quarter and (ii) payments received within two weeks after the receipt of invoices were defined wrongly during the preparation of the project. Team is looking into options available to address this Intermediate Results Indicators PHINDIRITBL  Performance Contracts signed with the Group 1 rayon hospitals (20) and updated annually based on any modifications introduced to the Balanced Scorecard (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 22.00 20.00 Date -- -- 25-Sep-2014 31-Dec-2015 Comments Number of hospitals should be modified to 22. Contracts renewed and adjusted as needed. PHINDIRITBL  Proportion of Group 1 rayon hospitals (20) that received quarterly performance-based payments in accordance to their level of performance as per agreed Performance Contracts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 100.00 100.00 Date -- -- 20-Dec-2015 31-Dec-2015 Comments On track. For the payment quarter completed in September 2014, all 22 participating hospitals have received quarterly performance-based payments in accordance with their BSC scores. PHINDIRITBL  MOH/MHIF produce quarterly monitoring reports within 2 weeks after the end of each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 4.00 Date -- -- 13-May-2015 31-Dec-2015 Comments Off track. The RBF Secretariat indicates that it is not feasible to produce monitoring reports within 2 weeks after the peer review. 45 working days will be needed. Last peer review was completed by the end of April 2015 6/11/2015 Page 5 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDIRITBL  National RBF Steering Committee meets at least twice a year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 2.00 2.00 Date -- -- 13-May-2015 31-Dec-2015 Comments On track. Members of the Committee have been identified and a Terms of Reference for the committee was finalized prior the project effectiveness PHINDIRITBL  Extended RBF team meets at least every 2 months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 6.00 6.00 Date -- -- 13-May-2015 31-Dec-2015 Comments On track .The Extended RBF Team has held three meetings in 2014: on June 8, September 25 and December 17. Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P120435 TF-13310 Effective USD 11.00 11.00 0.00 1.66 9.34 15% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P120435 TF-13310 Effective 30-Dec-2013 30-Dec-2013 29-Jul-2014 30-Jun-2017 30-Jun-2017 Cumulative Disbursements 6/11/2015 Page 6 of 7 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 6/11/2015 Page 7 of 7 Public Disclosure Copy