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 & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2013 | Seq No: 10 | ARCHIVED on 17-Nov-2017 | ISR30183 | Implementing Agencies: Mandatory Health Insurance Fund, Ministry of Health, KYRGYZ REPUBLIC Key Dates Key Project Dates Bank Approval Date:18-Apr-2013 Effectiveness Date:29-Jul-2014 Planned Mid Term Review Date:26-Sep-2016 Actual Mid-Term Review Date:26-Sep-2016 Original Closing Date:30-Jun-2017 Revised Closing Date:31-Dec-2018 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  Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Satisfactory Overall Risk Rating  High  High Implementation Status and Key Decisions 11/17/2017 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) The project restructuring was completed in June 2017. The amendment to the grant agreement was delivered to the Ministry of Finance on June 23, 2017. Extension of the project closing date to December 31, 2018 will give sufficient time for the institutionalization of the Results-Based Financing (RBF) scheme and scale up of project activities to all 64 rayon hospitals and Primary Health Care RBF/PBF model. The project continues to show strong progress toward achieving its Project Development Objective (PDO). Results over a three-year period continue to demonstrate impressive improvements in both intervention groups of hospitals. The project has identified a need for considerable investment in building knowledge, skills and capacity of frontline workers to improve clinical processes and content of care. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Substantial  Substantial Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  High  High Fiduciary  --  Substantial  Substantial Environment and Social  --  High  Moderate Stakeholders  --  Substantial  Substantial Other  --  Low  Low Overall  --  High  High Results Project Development Objective Indicators PHINDPDOTBL  Proportion of eligible rayon hospitals that received the authorized performance-based payments within two weeks after the MHIF’s receipt of RBF payment to their bank account (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 22.00 Date 25-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 11/17/2017 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Comments Incentive payments for the Q3- 2017 will be made by the end of November based on results of the last quarterly verification completed on October 28, 2017 upon submission and clearance of the revised Project Operations Manual (POM) to the Bank PHINDPDOTBL  Proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals submitted to MHIF within 30 working days after the end of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 42.00 42.00 42.00 Date 25-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments Quarterly verification for the quarter ending September 2017 was completed on October 28, 2017. Quarterly verification records for all 42 hospitals in Groups 1 and 2 and pre-pilot Chui hospital were submitted to the MHIF on October 30, 2017 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 10.00 8.00 Date 25-Aug-2014 01-May-2017 03-Nov-2017 31-Dec-2018 Comments This indicator is on track. The 6th round of counter-verification for the period Jan-Jul.2017 was carried out on September 5-15, 2017 in 4 rayon hospitals of Group 1, and in 4 rayon hospitals of Group 2 PHINDPDOTBL  Impact Evaluation Surveys completed on schedule to generate evidence for policy (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Impact Evaluation Impact Evaluation At least 2 round Value No surveys baseline survey baseline survey of serveys completed before start completed before start implmented by 11/17/2017 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) of pilot of pilot the end of the project Date 25-Aug-2014 01-May-2017 03-Nov-2017 31-Dec-2018 Comments This indicator is on track. Midline IE data collection has been completed. Preliminary results will be available by December 2017 PHINDPDOTBL  Average quarterly quality score of Group 1 hospitals (percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9.30 79.00 71.10 75.00 Date 29-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments This indicator is on track. RBF Secretariat was requested to monitor it taking into account the revised Balanced score card as per previous version of the BSC . Overall Comments 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 22.00 20.00 Date 25-Aug-2014 03-Nov-2014 30-Jun-2017 31-Dec-2018 11/17/2017 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Comments On track. Performance contracts with providers are renewed annually (and 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 0.00 100.00 100.00 100.00 Date 25-Aug-2014 30-Oct-2015 03-Nov-2017 31-Dec-2018 Comments On track, payment is done by the MHIF based on hospitals performance PHINDIRITBL  MOH/MHIF produce quarterly monitoring reports within 3 weeks after the end of each quarter (Weeks, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 4.00 3.00 Date 25-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments For the quarter ending September 2017, quarterly peer verification was completed on October 28, 2017 and monitoring reports have been submitted on November 03, 2017, within 4 weeks after the end of quarter 3. This is due to scale up of quarterly verification from 42 hospitals to 64 hospitals 11/17/2017 Page 5 of 8 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 2.00 Date 25-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments On track. Last meeting took place in February 2017. NSC had informal meeting during the SWAp-2 Joint Annual Review in June 2017 on the issues of RBF project extension and RBF flow of funds; the next meeting is scheduled for November 2017 PHINDIRITBL  Extended RBF team meets at least every 4 months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6.00 4.00 3.00 Date 25-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments On track. Extended RBF Team has met 4 times in 2017: (i) March 3; (ii) May 26; (iii) August 10 and (iv) November 1. PHINDIRITBL  Average % score Balance Score Card (BSC) indicator 1.7 Red Blood Cell Availability (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 73.00 68.00 75.00 Date 20-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments This indicator has decreased from 73% at the MTR to 68% due to unavailability of Red Blood Cell in one small hospital in which blood transfusion cannot be done due to absence of anesthesiologist and any surgical activity based on the MoH's Regulation. There is a need to review closely how such situations should be measured by the BSC as this is not related to the hospital performance 11/17/2017 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDIRITBL  Average % score for Category 6 Maternity Department (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 75.00 61.70 85.00 Date 20-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments This indicator has decreased from 75% at the MTR in Oct 2016 to 60.6% in July 2016 due to the revision of the BSC making it more complex for providers to achieve versus the original version of the BSC. Oct 2017 quarterly verification has shown upward improvement to 61.7%. RBF Secretariat has been recommended to monitor this indicator using both the previous version of the BSC and the revised one for consistency purposes. PHINDIRITBL  Average % score for Category 7 Pediatric/Neonatal Department (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.30 83.00 77.60 80.00 Date 20-Aug-2014 31-Oct-2016 03-Nov-2017 31-Dec-2018 Comments Same as above. This indicator has decreased from 83% at the MTR in Oct 2016 to 77.6% in July 2016 due to revision of the BSC making it more complex for providers to achieve versus the original version of the BSC. Oct 2017 quarterly verification has shown upward improvement to 61.7%. RBF Secretariat has been recommended to monitor this indicator using both the previous version of the BSC and the revised one for consistency purposes 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 6.54 4.46 59% 11/17/2017 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) 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 31-Dec-2018 Cumulative Disbursements Restructuring History Level 2 Approved on 21-Jun-2017 Related Project(s) There are no related projects. 11/17/2017 Page 8 of 8 Public Disclosure Copy