The World Bank Report No: ISR9692 Implementation Status & Results Romania Health Sector Reform 2 Project (APL #2) (P078971) Public Disclosure Copy Operation Name: Health Sector Reform 2 Project (APL #2) (P078971) Project Stage: Implementation Seq.No: 16 Status: ARCHIVED Archive Date: 29-May-2013 Country: Romania Approval FY: 2005 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Key Dates Board Approval Date 16-Dec-2004 Original Closing Date 31-Dec-2009 Planned Mid Term Review Date 26-Sep-2007 Last Archived ISR Date 29-Dec-2012 Effectiveness Date 27-Jun-2005 Revised Closing Date 31-Dec-2013 Actual Mid Term Review Date 26-Sep-2007 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the overall APL Program are as follows: (a) improve efficiency and equity in the planning and regulation of the health service delivery system; (b) reduce preventable deaths among emergency medical cases; (c) improve access and quality health care in poor and remote areas; and (d) help the Romanian health sector to better focus on priority public health problems, thereby reducing preventable illness and deaths. The specific objectives of Phase 2 are as follows: (i) Provide more accessible services, of increased quality and with improved health outcomes for those requiring maternity and newborn care and emergency medical care; and (ii) Provide support for the preparation of the primary health care strategy. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost MATERNITY AND NEONATAL CARE 104.87 EMERGENCY CARE SERVICES 47.23 NATIONAL HEALTH ACCOUNTS AND PLANNING 0.52 Public Disclosure Copy PROJECT MANAGEMENT 3.85 PRIMARY HEALTH CARE 3.00 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview Page 1 of 6 The World Bank Report No: ISR9692 A fifth extension of the closing date from March 15, 2013 to December 31, 2013, was granted to allow the completion of a financial impact assessment and enable the undertaking of some technical assistance activities in support of the preparation of a proposed newoperation in the health sector. The total level of payments under the project has reached EUR 61.5 million (approx 94.5 % of the total loan funds). The Project is expected to be fully disbursed by its new closing date. Public Disclosure Copy Overall progress towards achieving the Project Development Objectives remains satisfactory. Though the targets for PDOs and Intermediate Indicators have been exceeded in several areas, sole attribution to the Project should be read with caution since the civil works for the rehabilitation of maternities under the Project has been delayed. The great majority of these works (almost 90%) is being co-financed by the European Investment Bank (EIB). Besides the delays in the rehabilitation works caused by the revision of the architectural designs, their implementation is also hampered by the lack of adequate counterpart funds affecting the disbursements of the EIB financed loan. With the support of the activities developed under Component 1 of the Project (Maternity and Neonatal Care), the Ministry of Health has developed maternal and neonatal referral system which ensures that women and newborns have access to appropriate levels of care complexity. Thus, with the support of the medical equipment purchased under the Project, the system now can provide an effective integrated modern prenatal, delivery and postpartum care, to both low and high risk pregnant women as well as high quality neonatal care. The implementation of the Integrated Emergency Health Care System supported by the Project became a best practice in the region, and several other countries are currently learning from this experience. The second major PDO, namely the preparation of the strategy for the development and provision of primary health care services in under-served areas, has also been completed. The strategy is expected to be approved by the Government shortly. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Maternal Mortality (MM) and Rate (MMR) Text Value MM: 52 MM: 8 20% decrease MMR: (NEW) MMR: 0.24/1000 MMR: 0.053/1000 0.19/1000 Date 31-Dec-2004 25-Feb-2013 15-Mar-2013 Comments Target exceeded in 2012. Target exceeded during the Data for 2012 available for all project life. The MM at nation 12 months but not yet wide decreased by 85 %. validated by the NSI. Public Disclosure Copy Neonatal deaths and rate Text Value Deaths: 2068 Deaths: 673 25% decrease from baseline Rate: 9.6/1000 Rate: 4.5/1000 Deaths: 1551 Rate: 7.2/1000 Date 31-Dec-2004 25-Feb-2013 15-Mar-2013 Comments Target exceeded in 2012. The neonatal deaths Data for 2012 available for all decreased from 2004 to 2012 12 months but not yet by 67,5%. Target exceeded validated by the NSI. during the project life. Page 2 of 6 The World Bank Report No: ISR9692 Post-neonatal deaths and rate Text Value Deaths: 1573 Deaths: 634 25% decrease from baseline Rate: 7.3/1000 Rate: 4.2/1000 Deaths: 1180 Rate: 5.5/1000 Public Disclosure Copy Date 31-Dec-2004 25-Feb-2013 15-Mar-2013 Comments Target exceeded in 2012. The post-neonatal deaths Data for 2012 available for all decreased from 2004 to 2012 12 months but not yet by 60%. Target exceeded validated by the NSI. during the project life. 24-hour death rate among patients treated in Text Value 5.78% (for 6 ICUs) 4.16% (for 6 ICUs) 15% decrease 4.91% (for 6 the ER, then admitted to ICU in that hospital ICUs). (NEW) Date 30-Dec-2007 25-Feb-2013 15-Mar-2013 Comments ICU equipment was received Data for 2012 available for the The 24-hour deaths rate by 6 of 63 hospitals which all 12 months. reduced from 2007 to 2012 by report on this indicator. 28%. Sample size too small Others will receive a small for result to be significant. amount in late 2010. The Target value is revised to series only report for 6 ICUs comply with the Amendment dated December 15, 2011 Primary health care strategy approved Yes/No Value No No Yes Date 15-Oct-2008 25-Feb-2013 15-Mar-2013 Comments In 2008, at the The strategy was elaborated The strategy need to be MidTermReview, there was and internally approved by the formally approved by the no strategy for the PHC in MoH. MoH. place. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target A1. Neonatal Mortality by level of MCH facilities Text Value Level 1: 1.14/1000 Level 1: 2.76/1000 Level 1: 10% decrease 3.7 (NEW) Level 2: 8.40/1000 Level 2: 5.01/1000 Level 2: 10% decrease: 7.6 Level 3: 10.60/1000 Level 3: 6.58/1000 Level 3: 5% decrease: 9.6 Date 31-Dec-2006 25-Feb-2013 15-Mar-2013 Public Disclosure Copy Comments Level 1 value revised to Target exceeded in 2012. The neonatal mortality rate reflect MoH request for the Data for 2012 available for all decreased of 32%, 40% and Amendment no 5/December 12 months. 36% by level of MCH facilities 15, 2011. from 2006 to 2012. Target exceeded at the end of the project. Page 3 of 6 The World Bank Report No: ISR9692 A2. Maternal Mortality by level of MCH Text Value Level 1: 0.09/1000 Level 1: 0.06/1000 Level 1: 10% decrease facilities (NEW) Level 2: 0.07/1000 Level 2: 0.05/1000 Level 2: 10% decrease Level 3: 0.17/1000 Level 3: 0.05/1000 Level 3: 3.5% decrease Public Disclosure Copy Date 31-Dec-2006 25-Feb-2013 15-Mar-2013 Comments Data for 2012 available for the Target value is revised to first 6 months.Target comply with the Amendment exceeded. dated December 15, 2011. The maternal mortality rate decreased by 33%, 28,5% and 70% by level of MCH facilities from 2006 to 2012. Target exceeded at the end of the project. A3. Patient satisfaction with maternity/neonatal Text Value Level 1: 109/140 Level 1: 127/140 Level 1: 10% improvement services Level 2: 110/140 Level 2: 121/140 Level 2: 10% improvement Level 3: 109/140 Level 3: 119/140 Level 3: 3.5% improvement Date 31-Dec-2008 25-Feb-2013 15-Mar-2013 Comments Survey completed and index The final survey to be Target value is revised to computed conducted by Dec 2013. comply with the Amendment dated December 15, 2011 At the end of the project the patient satisfaction values have improved by 16,5%, 10% and 9,2% by each level of maternities. B1. Response times fpr emergency services Text Value Urban: R&Y-18min 25sec, Urban: R&Y-17min23sec, Urban: R&Y - 15 min by urgency category and urban/rural areas Green-52min 33sec. Green-51min30sec. Green - 8% less than baseline (NEW) Rural - R&Y: 24min 43sec Rural - R&Y: 25min47sec Rural: R&Y -20 min; Green - 36min 2sec Green - 50min14sec Green: 8% less than baseline Date 31-Dec-2007 25-Feb-2013 15-Mar-2013 Comments Data for 2012 available for all Target not achieved. 12 months. However, at the national level Public Disclosure Copy the average time response for all emergency services (including ambulances and integrated services SMURD) has been improved. B2. Death Rate in Emergency Departments Text Value 0.079% 0.066% 20% less than baseline: (dead patients/total alive presentations) 0.064% (NEW) Date 31-Dec-2007 25-Feb-2013 15-Mar-2013 Comments Data for 2012 available for all Target very closed to 12 months. achieved. Page 4 of 6 The World Bank Report No: ISR9692 B5. Fatality rate for patients treated in small Text Value 0.040% 0.042% 5% less than baseline ERs (NEW) Date 31-Dec-2008 25-Feb-2013 31-Dec-2011 Comments Data for 2012 available for all Revised target at Public Disclosure Copy 12 months. restructuring. B6. Fatality rate after 24 hours from admission Text Value 2.84% 2.76% 5% less than baseline of patients treated in hospital ICUs (NEW) Date 31-Dec-2007 25-Feb-2013 15-Mar-2013 Comments Revised as the Restructuring Data for 2011 available for all Target closed to achieved. Amendment on December 12 months. Only reported for 2011. the 6 ICUs, which received equipment D!. (Health Accounts) Appropriate regulations Text Value No The report covering all the 3 of the 3 approved issued with respect to three main areas:(i) three agreed areas was internationally comparable Romanian matrixes: completed, and accepeted by (ii) institutional responsibilities: and (iii) the MOH. timeframe for Date 31-Dec-2005 25-Feb-2013 15-Mar-2013 Comments The enabling legal framework for the internalization of the detailed new NHA still not in place D3. Average lag time implementing project Text Value NA On time. Lag less that 3 months activities beyong critical dates agreed in the Date 31-Dec-2005 25-Feb-2013 15-Mar-2013 MTR (NEW) Comments Target achieved. D4. Timely submission of project progress Text Value On time On time. On time (twice a year) reports Date 31-Dec-2005 25-Feb-2013 15-Mar-2013 Comments Target achieved. Data on Financial Performance (as of 18-Mar-2013) Financial Agreement(s) Key Dates Public Disclosure Copy Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P078971 IBRD-47600 Effective 16-Dec-2004 28-Jan-2005 27-Jun-2005 31-Dec-2009 31-Dec-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P078971 IBRD-47600 Effective USD 80.00 80.00 0.00 84.05 6.01 105.00 Disbursement Graph Page 5 of 6 The World Bank Report No: ISR9692 Public Disclosure Copy Key Decisions Regarding Implementation N/A Restructuring History There has been no restructuring to date., Level two Approved on 17-Dec-2010, Level two Approved on 16-Feb-2011, Level two Approved on 14-Dec-2011, Level two Approved on 21-Nov-2012, Level two Approved on 14-Mar-2013 Related Projects There are no related projects. Public Disclosure Copy Page 6 of 6