The World Bank Report No: ISR10361 Implementation Status & Results Kazakhstan Health Sector Technology Transfer and Institutional Reform (P101928) Public Disclosure Copy Operation Name: Health Sector Technology Transfer and Institutional Reform Project Stage: Implementation Seq.No: 9 Status: ARCHIVED Archive Date: 25-Jun-2013 (P101928) Country: Kazakhstan Approval FY: 2008 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 15-Jan-2008 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 31-Oct-2011 Last Archived ISR Date 03-Jan-2013 Effectiveness Date 15-Dec-2008 Revised Closing Date 31-Dec-2015 Actual Mid Term Review Date 31-Oct-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To introduce international standards and build long-term institutional capacity in MOH and related healthcare institutions in support of key health sector reforms pursued by the Government of Kazakhstan in the context of the State Health Care Reform and Development Program. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component A: Health Financing and Management 20.20 Component B: Health Care Quality Improvement 59.90 Component C: Reform of Medical Education and Medical Science 9.40 Component D: Health Information System Development 188.60 Component E: Pharmaceutical Policy Reform 4.20 Public Disclosure Copy Component F: Food Safety and WTO Accession 8.70 Component G: Project Management 4.60 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Page 1 of 7 The World Bank Report No: ISR10361 Implementation Status Overview The Project has been restructured, including: (1) a revision of the results framework; and (2) an extension of the closing date to December 31, 2015. Despite of good progress under majority of components, disbursement rates are still slow. The main reason forslow disbursement is due to component D - Information technology. Public Disclosure Copy Transition from old to new eHealth Concept which is open to ICT industry is taking long time. However, this transition had to be made gradually and carefully to prevent existing system from collapsing. Significant progress and a breakthrough has been made on the development of the new ICT eHealth Concept under Component D which has the largest amount of funding allocated compared to all other components. With the finalization of the eHealth Concept and its implementation plan (which is expected to be officially accepted in June 2013), Component D is exiting the transitional phase. There is also significant progress made in almost all other components. Outstanding progress has particularly been achieved under Component F (Food Safety). Institutions created and strengthened under the project are in fact instrumental in the reform process in the country. The Minister of Health has also emphasized that the project is actually supporting all major reforms. In that regard, she was very pleased to inform that an additional six months is being added on a yearly basis to life expectancy of the population of Kazakhstan due to the recent reforms. To ensure sustainability of reforms, institutionalization needs to be further pursued. Locations Country First Administrative Division Location Planned Actual Kazakhstan Not Entered Shyghys Qazaqstan Oblysy Kazakhstan Not Entered Pavlodar Oblysy Kazakhstan Not Entered Qaraghandy Oblysy Kazakhstan Not Entered Astana Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased funding for Primary Health Care Percentage Value 16.00 20.90 30.00 Date 31-Dec-2011 01-Jan-2013 31-Dec-2015 Comments On track. PHC expenditures Public Disclosure Copy for 2012 on target. Expenditures for 2013 to be calculated in 2014. Budget for PHC for 2014 under revision. Improved financial risk protection as defined by Percentage Value 32.90 31.40 30.00 reduced share of household health spending in Date 31-Dec-2010 31-Dec-2012 31-Dec-2015 total health expenditures Comments On track. Previous data were not accurate. new data obtained for 2012 based on Page 2 of 7 The World Bank Report No: ISR10361 household survey and national health accounts. Master plans for capital investments, Number Value 0.00 1.00 4.00 developed based on international best practice, Public Disclosure Copy Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 used as a basis for capital investment Comments Implementation based on new allocations in at least 4 oblasts master plans approved in one oblast. At least two evidence-based disease Number Value 0.00 0.00 2.00 management programs, which include Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 incentives for health care providers and Comments in progress. preparation for patients, developedand endorsed by the Ministry of Health limited implementation based on pilots in progress. Number of public health facilities accredited by Number Value 20.00 20.00 40.00 national accreditation body in accordance with Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 international standards Comments On track. Previous figure was wrong. It is expected that other facilities will be accredited to meet the target. ICT standards, which conform with Text Value No standards New e Health Concept TBD international standards and include addopted allowing new interoperability standards, are endorsed by standards to be finalized as Health ICT Regulatory Body and published basis for new system Date 31-Dec-2011 07-Apr-2013 31-Dec-2015 Comments Slightly delayed due to Target values to be unsuccessful contract determined based on negotiations with first-ranked international expert's candidate. Contract has been recommendations to be concluded with next-in- received by the end of 2012. ranking candidate and work started. Public Disclosure Copy Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased capacity for health policy analysis Number Value 0.00 2.00 4.00 (as measured by number of national analytical Date 31-Dec-2011 10-Dec-2012 31-Dec-2015 reports produced annually) Comments slightly delayed but 3 reports are under preparation. Page 3 of 7 The World Bank Report No: ISR10361 NHA reports produced annually, disaggregated Yes/No Value Yes Yes Yes by national and sub-national levels, and Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 disseminated among key stakeholders Comments NHA 2010 aggregated at On track: NHA 2012 Four NHA reports to be Public Disclosure Copy national level aggregated at national level; prepared by 2015. disaggregation by sub- national levels to be completed in Q3 New network planning tools and new facility Text Value New hospital planning tools in progress New tools and standards for standards formally adopted by the Ministry of and standards developed planning hospitals, laboratory Health and PHC facilities formally adopted Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments New hospital planning tools and standards formally adopted. New tools and standards for planning laboratory and PHC facilities developed but not formally adopted. Master plans for capital investments developed Number Value 5.00 16.00 16.00 for 16 regions based on international best Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 practice Comments On track. Oblast-level health network master plans Number Value 0.00 1.00 4.00 endorsed for at least 4 oblasts Date 31-Dec-2011 10-Dec-2012 31-Dec-2015 Comments On track. First oblast level master plan adopted in November 2012 (East- Kazakhstan oblast). Other 2 Oblasts are on track to approvemaster plans. Evidence-based incentives for providers in Text Value No evidence-based incentives No evidence-based incentives Optimized set of evidence- Public Disclosure Copy disease management programs implemented for providers for provider for disease based incentives and pay-for- management performance mechanisms for providers implemented Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments in preparation. Incentives introduced, including revision of co- Text Value No incentives for patients No incentives for patients Optimized set of incentives for payments, for patients to comply with diseases patients implemented management programs Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments in preparation Page 4 of 7 The World Bank Report No: ISR10361 Criteria, procedures and standards for Text Value Health facility accreditation on track. Accreditation criteria, accreditation of health facilities developed, standards developed procedures and standards adopted and implemented in line with renewed international practice Public Disclosure Copy Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments implementation started last year with 20 organizations accredited. In 2013 additional five planned. Beta testing of standards for blood services done. Evidence-based CPGs for selected disease Text Value No CPGs for disease in preparation. CPGs for disease management programs developed management programs management programs implemented Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments Preparation for CPG with partnership to be implemented in 2 pilot regions Increase in share of voluntary blood donations Percentage Value 83.00 84.00 88.00 by 2015 Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments Seriously delayed. no programs for voluntary blood donations supported under the project. Decrease in absolute number of paid donations Number Value 38800.00 45077.00 33400.00 by 2015 Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments Not in compliance. Year-end value for 2012 was 48217. Criteria, procedures and standards for Text Value No educational programs No educational programs Educational programs for accreditation of basic medical education accredited accredited “General Medicine� of two programs developed, adopted and medical universities implemented in linewith international practice accredited Public Disclosure Copy Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments Delayed. IT-infrastructure for deployment of UHMIS in Text Value IT infrastructure developed in new eHealth concept IT infrastructure developed in selected oblasts developed by the Ministry of 140 health organizations developed. 2,000 health organizations Health Date 31-Dec-2011 10-Dec-2012 31-Dec-2015 Comments On track infrastructure to be done in parallel with other activities nation wide. Page 5 of 7 The World Bank Report No: ISR10361 Functional ICT standards in line with major Text Value No functional ICT standards in progress TBD international functional standards developed by Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Health ICT Regulatory Body Comments on track. Standards expected Standards developed and Public Disclosure Copy by September 2013. published and used for market. Drug price reference system for drugs included Text Value Ceiling prices for drugs set in progress. Reference drug prices refined in the National Formulary Book developed and based on implementation adopted by the Ministry of Health experience Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 Comments review planned in May 2013 with Bank support Legal and regulatory documents related to Text Value Recommendations on On track. HACCP system post-processing food standards revised in revision of 26 food safety implementation in food accordance with international standards norms and rules, 25 technical industry expanded regulations, and on amendments to the Law on Food Safety developed Date 31-Dec-2011 10-Dec-2012 31-Dec-2015 Comments Technical standards approved. legislation pending. All food safety regulations adopted expecting formal approval for Customs Union in July 2013 Project work plans, procurement plans, and Yes/No Value Yes No Yes budget produced and approved on an annual Date 31-Dec-2011 01-Apr-2013 31-Dec-2015 basis as described in the Project Operational Comments delayed . Expected to be Manual submitted by May 1 2013. Health personnel receiving training (number) Number Value 10720.00 72253.00 63066.00 Date 31-Dec-2011 10-Dec-2012 31-Dec-2015 Public Disclosure Copy Comments Health facilities constructed, renovated, and/or Number Value 160.00 312.00 2058.00 equipped (number) Date 31-Dec-2011 10-Dec-2012 31-Dec-2015 Comments On track. Data on Financial Performance (as of 03-May-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date Page 6 of 7 The World Bank Report No: ISR10361 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101928 IBRD-48830 Effective 15-Jan-2008 02-Feb-2008 15-Dec-2008 30-Jun-2013 31-Dec-2015 Disbursements (in Millions) Public Disclosure Copy Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101928 IBRD-48830 Effective USD 117.70 117.70 0.00 46.28 71.42 39.00 Disbursement Graph Key Decisions Regarding Implementation N/A Public Disclosure Copy Restructuring History Level two Approved on 12-Oct-2012 Related Projects There are no related projects. Page 7 of 7