The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Serving People, Improving Health Project (P144893) EUROPE AND CENTRAL ASIA | Ukraine | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 8 | ARCHIVED on 24-Sep-2018 | ISR33404 | Implementing Agencies: Government of Ukraine, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 04-Mar-2015 Effectiveness Date: 15-Jun-2015 Planned Mid Term Review Date: 30-Mar-2018 Actual Mid-Term Review Date: 12-Mar-2018 Original Closing Date: 30-Sep-2020 Revised Closing Date: 30-Sep-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed “Serving People, Improving Health” Project seeks to improve the quality of health services in selected Oblasts, with special focus on primary and secondary prevention of cardiovascular diseases and cancer, and to enhance efficiency of the health caresystem. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improving Service delivery at the local level:(Cost $189.53 M) Strengthen Ministry of Health Governance:(Cost $20.20 M) Project Implementation support and monitoring and evaluation:(Cost $4.46 M) Commission 0.25%:(Cost $0.54 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project remains as a priority for the health sector and overall health reform agenda. The Mid-term Review (MTR) has identified areas that require revisions and therefore a project restructuring is in progress to be better aligned with the ongoing health reform and modernization of health care delivery. The project restructuring is expected to be completed by the end of 2018 calendar year. The Ministry of Health and Project Oblasts are implementing actions to accelerate project implementation. Overall progress has been made over the last 6 months, and the available data show that the Project Development Objective (PDO) indicators are moving in the right direction. 9/24/2018 Page 1 of 7 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- High High Sector Strategies and Policies -- Substantial Substantial Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improved quality of health services in selected Oblasts, with special focus on CVDs and cancer IN00619845 ►PDO Indicator 1: Early detection of cervical and breast cancer as measured: a) Ratio of new in situ to new invasive cervical cancer (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.79 0.58 0.70 0.88 Date 01-Jan-2014 07-Mar-2018 14-Sep-2018 31-Dec-2017 IN00619853 b) Share of new breast cancer detected at stage I (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 21.80 21.50 30.10 30.00 IN00619844 ►PDO Indicator 2: High blood pressure under control as measured by the share of patients aged 40-60 achieving target level of blood pressure (measure is 140/90mmHg) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.40 16.50 16.50 19.00 Date 01-Jan-2014 04-Mar-2016 04-Mar-2016 31-May-2020 9/24/2018 Page 2 of 7 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) The indicator will be measured as part of the ongoing survey of medical records Comments: IN00619847 ►PDO Indicator 3: Improved quality management (prevention, early diagnosis and treatment) of CVDs at primary and secondary care measured as: a) reduction of hypertension-related hospitalization (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.80 5.32 2.38 4.80 Date 01-Jan-2014 07-Mar-2018 14-Sep-2018 31-May-2020 A positive tendency is reported towards the achievement of the target (the indicator value decreased from 5.3 in the first half of 2017 to 2.38 in the reporting period) due to improved quality of primary hypertension Comments: management through controlled treatment. Supplies of equipment for diagnosis and treatment of CVDs, starting in 2017, have had a positive effect on achievement of the above indicator. IN00619854 b) number of patients who received stenting for acute myocardial infarction with ST segment elevation (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 93.60 174.40 174.40 193.70 Enhanced efficiency of the health care system IN00619843 ►PDO Indicator 4: Average in-patient length of stay in hospitals (Days, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11.70 11.00 11.00 9.50 Date 01-Jan-2014 07-Mar-2018 07-Mar-2018 31-May-2020 Measured annually Comments: Intermediate Results Indicators by Components Improving Service delivery at the local level IN00619849 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 23.00 23.00 260.00 Date 01-Jan-2015 07-Mar-2018 07-Mar-2018 31-May-2020 The reconstruction works are ongoing in 4 project regions and the number will be updated. Comments: IN00619850 ►7. % of primary health care facilities meeting the equipment norms for improved management of CVD (according to an explicit list) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/24/2018 Page 3 of 7 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Value 31.00 10.40 20.80 55.00 Date 01-Jan-2014 07-Mar-2018 14-Sep-2018 31-May-2020 There is a positive tendency towards increasing the number of primary medical care facilities that meet the standards for improvement for the treatment of CVDs. The total number of outpatient clinics meeting Comments: fit-out standards for improved CVD management as of 30 June 2018 is 415 units or 20.8% (as compared to 31 December 2017 – 206 units or 10.4%). IN00619832 ►8. Number of cancer screening procedures performed: a) cervical cancer tests (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 709,184.00 784,341.00 784,341.00 830,000.00 Date 01-Jan-2014 07-Mar-2018 07-Mar-2018 31-May-2018 The current reported number of cervical tests is 267,339 and 57,982 mammograms, which is reported for Comments: the semi-annual period. To update the trend, the numbers will be added in the next ISR. IN00619852 b) mammograms (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 20,893.00 67,740.00 67,740.00 150,000.00 IN00619848 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5,805.00 8,037.00 24,937.00 Date 01-Jan-2015 07-Mar-2018 14-Sep-2018 31-May-2020 The indicator is increasing to catch up with the original projection. The major increases are expected from Comments: the full scale implementation of the capacity building activities of the central level components. IN00619833 ►9. Share of acute myocardial infarction with ST segment elevation diagnoses confirmed according to appropriate protocols in the previous 12 months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 -- 0.00 78.00 Date 01-Jan-2014 11-Mar-2016 14-Sep-2018 31-May-2020 The actual number for the indicator is expected from the ongoing survey of medical records (data will be Comments: available in December 2019 and reported in the next ISR) IN00619834 ►10. Share of primary care centers which have structured schools of health or similar initiatives working on educational group activities related to main NCDs’ risk factors (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 25.50 44.70 50.00 Date 01-Jan-2014 07-Mar-2018 14-Sep-2018 31-May-2020 Comments: The target indicator has been achieved. In the reporting period, 987 Schools of Health (45% of the total number of outpatient clinics) in various areas of NCDs operated in seven Project oblasts; about 9 9/24/2018 Page 4 of 7 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) thousand sessions were held, in which more than 42 thousand persons took part. The remaining Rivne oblast, which is behind the other seven is being actively supported by the PIU and MOH. Strengthen Ministry of Health Governance IN00619842 ►11. Critical e-Health standards approved by MoH (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jan-2014 17-Jul-2017 14-Sep-2018 31-May-2017 The contract with SMIS International, which is expected to contribute to the achievement of the indicator is ongoing, but performance is problematic. The MoH is working with the bank team to negotiate an Comments: appropriate plan to address the bottlenecks. IN00619846 ►12. Communication campaign designed and implemented at central level (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jan-2014 07-Sep-2017 14-Sep-2018 31-May-2020 The ToR for the communication campaign has been prepared by the MoH team and reviewed by the Bank. Upon agreements on the implementation of the campaign, the procurement of the services will be Comments: launched (expected in September 2018) IN00619835 ►13. Availability of hospital beds (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 880.00 742.80 738.00 650.00 Date 01-Jan-2014 24-Jul-2017 14-Sep-2018 31-May-2020 The indicator was determined on the data basis from 8 Project oblasts, and may be adjusted as soon as the national level indicator is officially reported by the Statistics office. Compared to 2017, a positive Comments: tendency is reported towards reducing the number of in-patient hospital beds per 100 000 population; 1483 hospital beds were reduced in the Project oblasts during the first half of 2018. IN00619841 ►14. Number of Oblasts that in any given year have implemented at least one productivity enhancing reform (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 8.00 Date 01-Jan-2014 07-Mar-2018 07-Mar-2018 31-May-2020 The indicator will be updated in the next ISR as evaluation of progress is done on annual basis Comments: Project Implementation support and monitoring and evaluation IN00619851 9/24/2018 Page 5 of 7 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) ►15. Share of beneficiaries in participating oblasts reporting improvement in the access and quality of the targeted healthcare services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 14.20 20.00 Date 01-Jan-2014 30-Aug-2017 30-Aug-2017 31-May-2020 The indicator captures 2017 data for now. The data from 2018 survey is being processed and the indicator Comments: will be updated in the next ISR. Overall Comments IR The indicators are updated where possible. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P144893 IBRD-84750 Effective USD 214.73 214.73 0.00 56.87 157.86 26% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P144893 IBRD-84750 Effective 04-Mar-2015 19-Mar-2015 15-Jun-2015 30-Sep-2020 30-Sep-2020 Cumulative Disbursements 9/24/2018 Page 6 of 7 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 9/24/2018 Page 7 of 7