The World Bank Report No: ISR14664 Implementation Status & Results Vietnam Central North Region Health Support Project (P095275) Public Disclosure Copy Operation Name: Central North Region Health Support Project (P095275) Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive Date: 19-Jul-2014 Country: Vietnam Approval FY: 2010 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 06-Apr-2010 Original Closing Date 31-Aug-2016 Planned Mid Term Review Date 23-Sep-2013 Last Archived ISR Date 06-Feb-2014 Effectiveness Date 23-Aug-2010 Revised Closing Date 31-Aug-2016 Actual Mid Term Review Date 23-Sep-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project development objective is to strengthen district-level curative and preventive health services and improving their accessibility for the economically vulnerable population in the Central North Provinces. Intermediate objectives are: Increasing health insurance coverage among the near-poor population; Upgrading capacities of district hospitals and District Preventive Health Centers; Improving supply and quality of health care personnel. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Supporting health insurance for the near poor population 9.11 Public Disclosure Copy Strengthening district health services 32.20 Improving supply and quality of human resources for health 15.99 Project management, monitoring and evaluation 7.71 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Page 1 of 8 The World Bank Report No: ISR14664 Implementation Status Overview The project is in progress to meet the Development Objectives. By mission, the project has disbursed almost 48% of the Credit, slightly behind the originally planned disbursement schedule. The main areas of progress are: (i) insurance coverage of the near poor has reached 82% in the region by end of 2013, (including those who received 100% covered by the Government budget), in which, the project could support 65% of the near poor to buy HI with 78% of the enrollees bought for the whole family ; and (b) over archived long term Public Disclosure Copy training for both under-graduate and post graduate. Locations Country First Administrative Division Location Planned Actual Vietnam Tinh Nghe An Tinh Nghe An Vietnam Tinh Thua Thien-Hue Tinh Thua Thien-Hue Vietnam Tinh Thanh Hoa Tinh Thanh Hoa Vietnam Tinh Quang Tri Tinh Quang Tri Vietnam Tinh Quang Binh Tinh Quang Binh Vietnam Tinh Ha Tinh Tinh Ha Tinh Vietnam Tinh Nghe An Huyen Nam Dan Vietnam Tinh Nghe An Huyen Nghi Loc Vietnam Tinh Nghe An Huyen Dien Chau Vietnam Tinh Nghe An Huyen Yen Thanh Vietnam Tinh Nghe An Huyen Thanh Chuong Vietnam Tinh Nghe An Huyen Quynh Luu Vietnam Tinh Nghe An Huyen Nghia Dan Vietnam Tinh Nghe An Huyen Que Phong Public Disclosure Copy Vietnam Tinh Nghe An Huyen Tuong Duong Vietnam Tinh Nghe An Huyen Ky Son Vietnam Tinh Thanh Hoa Huyen Tinh Gia Vietnam Tinh Thanh Hoa Huyen Nhu Xuan Vietnam Tinh Thanh Hoa Huyen Hoang Hoa Vietnam Tinh Thanh Hoa Huyen Thuong Xuan Page 2 of 8 The World Bank Report No: ISR14664 Country First Administrative Division Location Planned Actual Vietnam Tinh Thanh Hoa Huyen Ngoc Lac Public Disclosure Copy Vietnam Tinh Thanh Hoa Huyen Lang Chanh Vietnam Tinh Thanh Hoa Huyen Cam Thuy Vietnam Tinh Thanh Hoa Huyen Hau Loc Vietnam Tinh Thanh Hoa Huyen Ba Thuoc Vietnam Tinh Thanh Hoa Huyen Quan Son Vietnam Tinh Thanh Hoa Huyen Quan Hoa Vietnam Tinh Thanh Hoa Huyen Muong Lat Vietnam Tinh Quang Tri Huyen Hai Lang Vietnam Tinh Quang Tri Huyen Gio Linh Vietnam Tinh Quang Tri Huyen Vinh Linh Vietnam Tinh Quang Binh Huyen Le Thuy Vietnam Tinh Quang Binh Huyen Bo Trach Vietnam Tinh Quang Binh Huyen Quang Trach Vietnam Tinh Quang Binh Huyen Tuyen Hoa Vietnam Tinh Quang Binh Huyen Minh Hoa Vietnam Tinh Ha Tinh Huyen Cam Xuyen Vietnam Tinh Ha Tinh Huyen Ky Anh Public Disclosure Copy Vietnam Tinh Ha Tinh Huyen Huong Khe Vietnam Tinh Ha Tinh Huyen Nghi Xuan Vietnam Tinh Ha Tinh Huyen Duc Tho Vietnam Tinh Ha Tinh Huyen Huong Son Vietnam Tinh Thua Thien-Hue Thanh Pho Hue Vietnam Tinh Thua Thien-Hue Huyen Phu Vang Vietnam Tinh Thua Thien-Hue Huyen Phong Dien Page 3 of 8 The World Bank Report No: ISR14664 Vietnam Tinh Thua Thien-Hue Huyen Huong Tra Vietnam Tinh Thua Thien-Hue Huyen Phu Loc Public Disclosure Copy Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target 10% increase in the utilization of inpatient and Text Value inpatient - 5.6/100 inpatient - 6.9/100 inpatient - 6.2/100 outpatient services by the poor outpatient - 11/100 outpatient - 12.8/100 outpatient - 12.1/100 Date 31-Dec-2010 31-Dec-2013 28-Feb-2016 Comments VLSS 2010 VLSS 2012 VLSS 2014 10% increase in the utilization of inpatient and Text Value inpatient – 5.1/100 inpatient - 10.1/100 inpatient - 5.6/100 outpatient services by the near-poor Sub Type outpatient - 11.6/100 outpatient - 11/100 outpatient - 12.8/100 Breakdown Date 31-Dec-2010 31-Dec-2013 28-Feb-2016 Comments VLSS 2010 VLSS 2012 VLSS 2014 Average number of new technical services that Number Value 0.00 15.00 20.00 a district hospital (among 30 projet district Date 31-Dec-2010 31-Dec-2013 28-Feb-2016 hospitals) can perform with project intervention Comments The technical service is identified based on the list by the MOH on the required services to be performed by each level of hospital. Health facilities constructed, renovated, and/or Number Value 0.00 30.00 67.00 equipped (number) Date 31-Dec-2010 31-Aug-2013 26-Feb-2016 Comments This indicator is strictly In progress. 30 district health The indicator includes 30 referencing the 30 district centers were built. district health centers, 30 health centers being Procurement of equipment is district hospitals and 1 constructed and equipped in progress provincial hospital, and 5 Public Disclosure Copy under the Project . An medical colleges and NgheAn additional 32 health facilities Medical University. are being equipped 20 new District Preventive Health Centers Number Value 0.00 30.00 20.00 constructed with adequate facilities and Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 equipment to provide the full range of Comments The indicator also monitors preventive health services accordingto the government norms the capacity of health centers to provide full range of services according to the government norm. By the Page 4 of 8 The World Bank Report No: ISR14664 mid-term, only construction of 30 centers is completed. Significant support on equipment is not yet Public Disclosure Copy implemented. The indicator will be monitored in the next year. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target 40% of the near poor are covered by the health Percentage Value 10.00 65.40 40.00 insurance program Date 31-Dec-2010 31-Dec-2013 28-Feb-2016 Comments The indicator directly reflects the project support to HI premium. In general, the project contributed to bring up the HI coveragefor the near poor to 82%. People with access to a basic package of Number Value 420000.00 913011.00 600000.00 health, nutrition, or reproductive health services Date 31-Dec-2010 30-Jun-2012 28-Feb-2016 (number) Comments The actual indicator is 40% of 60.7%. 347,086 cards have 40%. End target the near poor are covered by been issued with project conservatively set assuming the health insurance program. support since this year, plus (i) baseline was 10% of the The baseline was estimated 565,925 near poor people target population; and (ii) low to be 10% or 150,000. already covered by the take-up considering Government support. The experience in the Mekong It was estimated that 10% of data will be updated when Region. the near poor were covered provinces finalize the new by health insurance. Once project beneficiaries the Project identified the 1.5 according to new Government million near poor, 28% or Policy 420,000 were identified as Public Disclosure Copy beingcovered by health insurance through another progress group. The share of near-poor households spending Percentage Value 18.40 16.00 12.00 25% of more of their non-food consumption on Date 31-Dec-2010 31-Dec-2013 28-Feb-2016 health is reduced to 12% or less Comments The baseline information was VLSS 2012 updated by the baseline survey in 2012. Page 5 of 8 The World Bank Report No: ISR14664 The share of district hosptials in claims Percentage Value 47.90 50.50 50.00 reimbursed by health insurance (VSS) is 50% Date 31-Dec-2010 31-Mar-2014 28-Feb-2016 or more Comments The baseline information was Data updated by March 31, Public Disclosure Copy updated by the baseline 2014 survey in 2012. 50% of patients satisfied with (a) overall quality Text Value (a) 35% (a) 50% of care at district hospitals, (b) reduction of (b) 35% (b) 50% waiting time, and (c) availability of services and (c) 32% (c) 50% diagnostic facilities Date 31-Dec-2010 10-May-2014 28-Feb-2016 Comments The indicators are very questionable. It is related to the method of data collection. The survey was self-reported by patients right after they discharged from the hospitals. However, the survey was not closely and independently supervised by consultants. The team recommend to have the survey with sound method by end of project evaluation or update by a separate patient satisfaction survey. Lecturers of Vinh Medical University trained for Text Value Nil 44 50 post-graduate degrees Date 31-Dec-2010 31-Mar-2014 28-Feb-2016 Comments This is a new indicator to better reflect the project support to improve Vinh Medical University's teaching capacity Health personnel receiving training (number) Number Value 0.00 1192.00 854.00 Public Disclosure Copy Date 31-Dec-2010 31-Mar-2014 28-Feb-2016 Comments This includes training of 175 In progress and will exceed MD: 680 Doctors in Level 1 Specialty. the original targets. 804 Specialist level 1: 174 and Training of 680 Assistant Assistant Doctors are under Doctors as full fledged training to be full fledge doctors. doctors. 288 staff are taking Specialist level 1 training. Page 6 of 8 The World Bank Report No: ISR14664 175 Doctors from District Hospitals trained for Number Value 0.00 1192.00 854.00 Level 1 specialization and at least 680 health Date 31-Dec-2010 31-Mar-2014 28-Feb-2016 professionals trained for MD degree Comments In progress and will exceed MD: 680 Public Disclosure Copy the original targets. 804 Specialist level 1: 174 Assistant Doctors are under training to be full fledge doctors. 288 staff are taking Specialist level 1 training. 80% of medical professional return to their Percentage Value 99.30 80.00 original place of work/residence after long-term Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 training supported by the project Comments Since the training is still on- going, the indicator will be monitored closely through out the project implementation. Data on Financial Performance (as of 25-Jun-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P095275 IDA-46880 Effective 06-Apr-2010 25-May-2010 23-Aug-2010 31-Aug-2016 31-Aug-2016 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095275 IDA-46880 Effective XDR 41.50 41.50 0.00 22.62 18.88 55.00 Disbursement Graph Public Disclosure Copy Page 7 of 8 The World Bank Report No: ISR14664 Public Disclosure Copy Key Decisions Regarding Implementation During the Mid term review, the Bank team and the Central Project Management Unit discussed on a restructuring proposal including (i) reallocation of resources to increase the amount allocated for the Near Poor Health Insurance Premium and using savings from the Training and Medical Equipment Procurement; and (ii) revision of the Results Framework. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 8 of 8