The World Bank Report No: ISR14206 Implementation Status & Results Timor-Leste Health Sector Strategic Plan Support Project (P104794) Public Disclosure Copy Operation Name: Health Sector Strategic Plan Support Project (P104794) Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive Date: 31-Aug-2014 Country: Timor-Leste Approval FY: 2008 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 13-Dec-2007 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 18-Jul-2010 Last Archived ISR Date 14-Mar-2014 Effectiveness Date 17-Jun-2008 Revised Closing Date 15-Jun-2015 Actual Mid Term Review Date 18-Jul-2010 Project Development Objectives Health Sector Strategic Plan Support Project (P104794) Project Development Objective (from Project Appraisal Document) The revised PDO is to support Government of Timor-Leste to get more resources to where they are needed most to improve the deliveryof health services in districts and subdistricts. Has the Project Development Objective been changed since Board Approval of the Program? ● Yes No Component(s) Component Name Component Cost Health Service Delivery (to close out given restructured components below) 9.00 Support Services (to close out given restructured components below) 9.00 Coordination, Planning & monitoring (to close out given restructured components below) 1.70 Innovation and Program Development (to close out given restructured components below) 1.30 New per PP Jan2013: Improving Public Financial Management and Fund Flows for Health Service 12.20 Public Disclosure Copy Delivery New per PP Jan2013: Strengthening Pharmaceutical and Medical Supplies Management 1.60 NEW per PP Jan2013: Improving Evidence-Informed Decision Making and Health Sector 3.90 Coordination Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Page 1 of 5 The World Bank Report No: ISR14206 Previous Rating Current Rating Overall Risk Rating Substantial Substantial Public Disclosure Copy Implementation Status Overview The April-May mission found promising progress. Public Financial Management (PFM) has now a detailed implementation roadmap for the coming year and certain activities have progressed, with Ministry of Health taking PFM as a priority to link budget planning and execution with outcomes. The human resource functional analysis for the Ministry of Health is underway, with analysis completed for the National Hospital. The pharmaceutical sector, though still challenged by capacity constraints, has some progress to note (key pharmacists in place, piloting of stockbook, plans for revision to the Essential Drug List (EDL) and the Standard Treatment Guidelines (STG), and a pharmaceutical registration system to be put in place in the coming months). The logistical management system for the pharmaceutical warehouse is being reinforced with a long-term technical assistance. The M&E framework dissemination and implementation is ongoing, and on the National Health Institute, key training programs have been completed for staff and a limited amount of research topics identified (though capacity remains a challenge to carry out research activities). Legacy issues such as delivery and installation of biomedical equipment has also been completed (though some issues remain to ensure full functionality of the equipment and training of staff on use and maintenance). Project indicators will also need to be revised to accurately assess progress, and revision to both the activity plan and indicators will be undertaken in the coming weeks to reflect certain changes in the scope of the project. Locations Country First Administrative Division Location Planned Actual Timor-Leste Not Entered Democratic Republic of Timor-Leste ✔ Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of districts that receive recurrent Number Value 0.00 0.00 8.00 expenditures consistent (+/- 20%) with the Date 31-Dec-2012 31-May-2014 15-Jun-2015 NHSSP MTEF and approved budget Comments No MTEF for NHSSP MTEF has not been launched, available but is planned for 2017. Concentration is on PFM. Number of districts that report expenditure Number Value 0.00 0.00 8.00 against the approved plan/budget on time Date 31-Dec-2012 08-May-2014 15-Jun-2015 Public Disclosure Copy Comments Reporting & management has Ongoing process to put in been done centrally place structure/system under PFM. Percentage of stock-outs of tracer essential Percentage Value 40.00 29.60 30.00 drugs at health facilities Date 31-Dec-2012 31-Dec-2013 15-Jun-2015 Comments Proxy data from 3 districts Avg from March 2013 to Dec survey in 2011 2013. There is no accurate way to measure stockouts which differs between SAMES and Dept of Pharmacy; the Page 2 of 5 The World Bank Report No: ISR14206 warehouse is stocked and distribution being made. System being built up to better manage planning, Public Disclosure Copy forecasting, ordering, distribution, and monitoring. Joint annual sector review and planning Text Value No Yes Yes meetings held as planned (at least 1/year) Date 31-Dec-2012 08-May-2014 15-Jun-2015 Comments Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of formal MOH-private sector/NGO Text Value 0 - project 1 - total 6 10 contracts signed Date 30-Dec-2006 30-May-2014 30-Jun-2013 Comments 6 contracts signed; All NGO contract ended in June 2012. This indicator will be removed during restructuring. Health MTEF prepared based on costing of Text Value METF based on the new No Available and updated strategic plan strategic plan (i.e., NHSSP) not available Date 31-Dec-2012 30-May-2014 15-Jun-2015 Comments Planned for 2017. Number of districts that submit annual district Number Value 0.00 13.00 9.00 plan/budget to the Central MoH for approval on Date 31-Dec-2012 30-May-2014 15-Jun-2015 time Comments All districts required to prepare plans however, process needs to be improved at national level with regard to budget preparation. Public Disclosure Copy Number of structured sector coordination Number Value 0.00 1.00 2.00 meetings held to progress toward one plan, Date 31-Dec-2012 30-May-2014 15-Jun-2015 one budget, and one sector M&E framework Comments Percentage of targeted staff who pass Percentage Value 0.00 0.00 60.00 competency test in financial management, Date 31-Dec-2012 30-May-2014 15-Jun-2015 procurement, and/or management Comments Being planned in coming year. Percentage of stock-outs of tracer essential Percentage Value 19.00 29.60 15.00 drugs at SAMES Date 31-Dec-2012 30-May-2014 15-Jun-2015 Page 3 of 5 The World Bank Report No: ISR14206 Comments Avg in last 9 months. Uneven with some tracer drugs pushed to district level, making stock outs at SAMES Public Disclosure Copy higher, though districts report no stock outs as they receive their allocations. However, emergency procurement continues to be a modus operandi. Percentage of SAMES’ procurement activities Percentage Value 47.00 0.00 30.00 using direct contracting (emergency order, in $ Date 31-Dec-2012 30-May-2014 15-Jun-2015 value) Comments Procurement is now being undertaken by MOH, and emergency procurement being undertaken but data difficult to obtain. transparent. Number of targeted places (13 districts and 6 Number Value 0.00 0.00 11.00 hospitals) with functional National Logistics Date 31-Dec-2012 31-May-2013 15-Jun-2015 Management Information System Comments Not available at this time. A computerized drug registration system Text Value No computerized system no Functional system available available Date 31-Dec-2012 30-May-2014 15-Jun-2015 Comments Planned for Sept. 2014 Percentage of research projects approved by Percentage Value 0.00 4.00 60.00 the research cabinet that responds to the Date 31-Dec-2012 30-May-2014 15-Jun-2015 national research priorities defined by the MoH Comments N/A Not yet approved by MOH. Data on Financial Performance (as of 10-Jul-2014) Financial Agreement(s) Key Dates Public Disclosure Copy Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P104794 IDA-H3430 Effective 13-Dec-2007 16-Apr-2008 17-Jun-2008 30-Jun-2013 15-Jun-2015 P104794 TF-91653 Effective 25-Mar-2008 25-Mar-2008 25-Mar-2008 30-Jun-2013 15-Jun-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P104794 IDA-H3430 Effective USD 1.00 1.00 0.00 0.99 0.00 99.00 P104794 TF-91653 Effective USD 34.20 34.20 0.00 20.35 13.85 59.00 Page 4 of 5 The World Bank Report No: ISR14206 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Revision to both the activity plan and indicators will be undertaken in the coming weeks with project restructuring and reduced scope of the project. Restructuring History Level two Approved on 05-Mar-2012 Related Projects P144520-Health Sector Strategic Plan Support Additional Financing Public Disclosure Copy Page 5 of 5