The World Bank Report No: ISR10694 Implementation Status & Results Ghana Health Insurance Project (P101852) Public Disclosure Copy Operation Name: Health Insurance Project (P101852) Project Stage: Implementation Seq.No: 14 Status: ARCHIVED Archive Date: 18-Jun-2013 Country: Ghana Approval FY: 2008 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 03-Jul-2007 Original Closing Date 31-Dec-2012 Planned Mid Term Review Date Last Archived ISR Date 03-Nov-2012 Effectiveness Date 10-Dec-2007 Revised Closing Date 30-Jun-2013 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to strengthen the financial and operational management of the National Health Insurance Scheme by improving: (i) the policy adaptation and implementation capacity of the National Health Insurance Council in addressing ongoing core policy issues related to contribution collection, risk equalization, and provider payment mechanisms; and (ii) the purchasing function of the District Mutual Health Insurance Schemes, and the billing function of the Providers. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Streamlined Purchasing Policies and Mechanisms 2.05 Strengthening Integrated Claims Management Systems 8.60 Project Management 0.00 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview This an update based on the Bank's supervision mission in February 2013, and a May 2013 pre-appraisal mission of the Health Systems Strengthening Project (HSSP) with a component to continue to support the health insurance system in Ghana. Page 1 of 6 The World Bank Report No: ISR10694 The likelihood of achieving the Project Development Objective is downgraded to Moderately Satisfactory as only two outcome indicators out of four have met their target. The Implementation Progress (IP) is maintained at Satisfactory. The Government has requested for a nine month extension to complete key project activities. There are encouraging results of Health Insurance Project (HIP) implementation with two of the four PDO indicators having met their end of project targets. The two outcome Public Disclosure Copy indicators that have met their targets are (i) proportion of total claims submitted by providers to NHIS (District Mutual Health Insurance Scheme or Claims Processing Center) for processing that passed the initial screening; and (ii) proportion of total “clean� claims that are reimbursed by payers (NHIS) to providers within 60 days of claims receipt. Actions are being taken to ensure that the target on electronic claims (eclaims) management system and the coverage of the poor will be met by end of the extended period. Since the eclaims management system went live on April 1 2013, it has now been rolled out to 20 facilities out of the target 47, and 51697 claims have been submitted, vetted and paid through the system as at May 28, 2013. While this number is increasing as and when additional facilities become operational the target will not be met by the current closing date. It will only be met by the extended project closing in March, 2014. In the case of the indicator on coverage of the poor, the National Health Insurance Authority (NHIA) is working closely with the relevant stakeholders, especially the Ministry of Gender, Children and Social Protection and the Livelihood Empowerment Against Poverty Program (LEAP) and the Ministry of Health in a nationwide exercise to increase the number of poor persons enrolled into the National Health Insurance Scheme (NHIS). The target will be close to being met by the current closing date of June 30, 2013. It will only be met fully by the extended project closing. The procurement plan was also updated, showing actual dates for completed activities, with only minimal deviation between planned dates and actuals achieved; The capitation pilot was completed and reviewed; accreditation of providers, gate keeper and referral policy training have all been completed under Component A - Streamlined Purchasing Policies and Mechanisms. Under Component B - Strengthening Integrated Claims Management Systems, the Health Dictionary Data (HDD) is completed and efforts are underway for the hosting. The project continues to be relevant as the objective of strengthening the financial and operational management of the Ghana National Health Insurance System is still one of the priorities of Government as these are the issues raised for consideration in the Health Financing Report completed by the World Bank in 2011. As such the Government has requested for continuous support for it. Even though there were delays in project implementation activities, there has not been price escalations and therefore there were no adverse effect on the efficiency of the project. While the country in the recent period has experienced power cuts that could have affected the health facilities' and District Health Insurance Schemes' ability to submit electronic claims, measures were put in place to minimize the effects. Inverters were procured for all the facilities and the Claims Processing Center (CPC) to ensure constant power supply. Thus power cuts will not affect their operations and there would be full utilization of the computerized claims management system that is being put in place under the project. Already the beneficiaries have said that claims submission has become faster in the facilities that are already using the eclaims system and it has become paperless making it more efficient. Locations Country First Administrative Division Location Planned Actual Ghana Ashanti Region Ashanti Region Public Disclosure Copy Results Project Development Objective Indicators Page 2 of 6 The World Bank Report No: ISR10694 Indicator Name Core Unit of Measure Baseline Current End Target # of total claims received electronically by Number Value 19537.00 43000.00 2500000.00 processors (NHIS) from provider Date 31-Dec-2010 10-May-2013 28-Jun-2013 Public Disclosure Copy Comments NHIC M&E system Source: NHIA M&E system. The eclaims management system became operational at end April 2013 after a long delay. The target is not going to be met by the current closing date but is expected to be met or surpassed by the proposed extended end date of March 30, 2014 . % of total claims submitted by providers to Percentage Value 45.00 98.00 59.00 NHIS (DMHIS or CPC) for processing that Date 31-Dec-2010 29-Mar-2013 31-Dec-2012 passed the initial screening (i.e. not rejectedby Comments NHIC M&E system Source NHIA M&E system. first electronic/manual review) % of total "clean" claims that are reimbursed by Percentage Value 0.03 100.00 70.00 payers (NHIS) to providers within 60 days of Date 31-Dec-2010 29-Mar-2013 31-Dec-2012 claims receipt Comments NHIC M&E system Source: NHIA M&E system. % of population in the lowest quintile (20% of Percentage Value 14.00 29.00 40.00 the index of socio-economic status) registered Date 31-Dec-2008 31-Dec-2008 31-Dec-2012 under the NHIS with a valid card Comments Source: 2008 Ghana DHS Source: Administrative Project Data using the common targeting mechanism means testing. Efforts are being made to further improve coverage of the poor and the target is expected to be close to being met by the current closing date of June 30, 2013 Public Disclosure Copy and fully met or surpassed by the extended project closing date of March 30, 2014. Intermediate Results Indicators Page 3 of 6 The World Bank Report No: ISR10694 Indicator Name Core Unit of Measure Baseline Current End Target HR Strategy approved by Management (MoH/ Text Value None Yes Yes IASC/NHIC Board) Date 31-Dec-2010 30-Mar-2012 31-Dec-2012 Public Disclosure Copy Comments NHIC Source: NHIA Target has been met. HMIS Master Plan for 2011-2016 (including Text Value No Yes Yes implementation plan and cost estimates for Sub Type hardware, software, training and maintenance) Supplemental approved by Management (MoH/IASC) NHIS population exemption policy (with Text Value No Yes Yes implementation plan and cost projections) for Date 31-Dec-2010 29-Mar-2013 28-Mar-2014 the enrollment of the poor approved by Comments NHIC Source: NHIC Management (MoH/IASC/NHIC Board) Common Targeting Mechanism (CTM) being used to enroll the poor Provider payment policy, implementation Text Value No Yes Yes strategy, guidelines and tools for NHIS Date 31-Dec-2010 31-Oct-2011 31-Dec-2010 approved by Management (MoH/IASC/NHIC Comments NHIC Source: NHIA This target has been met. Board) This is included in the 2011-2012 Strategic Plan Financial sustainability strategy for NHIS Text Value No Yes Yes approved by Management (MoH/iasc/NHIC) Date 31-Dec-2010 30-Mar-2012 31-Dec-2012 Comments NHIC Source: NHIA Project Unit This target has been met. Included in the 2011-2012 Strategic Plan Health personnel receiving training (number) Number Value 60.00 5877.00 1486.00 Date 31-Dec-2010 29-Mar-2013 31-Dec-2012 Comments NHIC Source: NHIA Project Unit Public Disclosure Copy Target surpassed Health Data Dictionary approved Text Value No Yes Yes Date 31-Dec-2011 29-Mar-2013 31-Dec-2012 Comments NHIC Source: NHIA Project Unit HMIS Master Plan for 2011 - 2016 (including Text Value No Draft being reviewed based Yes implementation plan and cost estimates for on comments from hardware, software, training and maintenance) stakeholders. approved by Management (MoH/IASC) Date 31-Dec-2010 29-Mar-2013 31-Dec-2012 Page 4 of 6 The World Bank Report No: ISR10694 Comments NHIC Source: NHIA. This is an ICT Master Plan and not HMIS as stated in the indicator name. Public Disclosure Copy CPC has "gone live" with its first electronic Text Value No Yes Yes claim automatically vetted and paid Date 31-Dec-2010 31-Dec-2012 31-Dec-2012 Comments NHIC Source: NHIA First call received through the NHIA call Center Text Value No Yes Yes and successfully responded Date 31-Dec-2010 29-Mar-2013 31-Dec-2012 Comments NHIC Source NHIA Strategy Department NHIA funded this activity from own source. % of total claims that are submitted by Percentage Value 64.00 100.00 75.00 providers to NHIS (CPC or DMHIS) within 60 Date 31-Dec-2010 29-Mar-2013 31-Dec-2012 days of service provision Comments HIP Implementation Unit Source: HIP Implementation Unit. Health facilities constructed, renovated, and/or Number Value 0.00 9.00 47.00 equipped (number) Date 01-Feb-2013 21-May-2013 Comments HIP Implementation Unit Source: Project M&E System Project M&E System This indicator is now being added to comply with the new guidelines. Data on Financial Performance (as of 10-May-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101852 IDA-43450 Effective 03-Jul-2007 08-Aug-2007 10-Dec-2007 31-Dec-2012 30-Jun-2013 Disbursements (in Millions) Public Disclosure Copy Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101852 IDA-43450 Effective XDR 10.00 10.00 0.00 8.33 1.67 83.00 Disbursement Graph Page 5 of 6 The World Bank Report No: ISR10694 Public Disclosure Copy Key Decisions Regarding Implementation Bank Management is considering the nine month extension request positively to provide additional time and allow for completion of key project activities and meet targets. Restructuring History Level two Approved on 25-Apr-2011, Level two Approved on 24-Jun-2011, Level two Approved on 03-Dec-2012 Related Projects There are no related projects. Public Disclosure Copy Page 6 of 6