The World Bank Implement participatory social accountability for better health in Moldova (P150873) REPORT NO.: RES38727 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF IMPLEMENT PARTICIPATORY SOCIAL ACCOUNTABILITY FOR BETTER HEALTH IN MOLDOVA APPROVED ON NOVEMBER 19, 2014 TO CENTER FOR HEALTH POLICIES AND STUDIES OCTOBER 15, 2019 HEALTH, NUTRITION & POPULATION EUROPE AND CENTRAL ASIA Regional Vice President: Cyril E Muller Country Director: Satu Kristiina J. Kahkonen Global Director: Muhammad Ali Pate Practice Manager/Manager: Tania Dmytraczenko Task Team Leader: Volkan Cetinkaya The World Bank Implement participatory social accountability for better health in Moldova (P150873) ABBREVIATIONS AND ACRONYMS HPRC Hospital Performance Report Card PAS Centrul Pentru Politici Și Analize În Sănătate PDO Project Development Objection PHC-PIA Primary Health Care Performance-Based Incentives Audit POP Public Opinion Pool The World Bank Implement participatory social accountability for better health in Moldova (P150873) BASIC DATA Product Information Project ID Financing Instrument Investment Project Financing Original EA Category Current EA Category Not Required (C) Not Required (C) Approval Date Current Closing Date 19-Nov-2014 19-Nov-2019 Organizations Borrower Responsible Agency Center for Health Policies and Studies Center for Health Policies and Studies Financing (in USD Million) FIN_SUMM_PUB_TBL SUMMARY Total Project Cost .73 Total Financing .73 Financing Gap 0 DETAILS -NewFin3 Project Development Objective (PDO) Original PDO The project proposes a holistic approach that links national planning, monitoring and execution systems with service deliveryperformance in the health sector. More specifically, the project aims to empower civil society organizations and citizens with theskills and knowledge to monitor performance of service providers which is expected to assist the The World Bank Implement participatory social accountability for better health in Moldova (P150873) Ministry of Health develop astronger oversight capacity that will complement and strengthen the existing planning, monitoring and evaluation processes. TheProject is designed to be implemented over a five-year period to include 70 hospitals and a representative sample (120) of primaryhealthcare facilities. The applied results of social accountability tools will serve as guidance to provide stronger evidence-basedsupport to thereforms promoted by the Ministry of Health. In order to achieve the above the project implementation will consists offour main components: (1) Promoting citizen monitoring of hospital performance; (2) Strengthening performance based incentiveprogram in family medicine through social audits of primary healthcare institution; (3) Creating an enabling environment forinformed public dialogue in health; and (4) Knowledge and learning and project management. Current PDO The Revised Project Development Objective is to inform users of health services in selected rayons about the performance, quality, and efficiency of hospitals and primary care clinics within a certain radius of their residence in order to improve service delivery. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net TF Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed TF-18162 19-Nov-2014 19-Nov-2014 19-Nov-2014 19-Nov-2019 .73 .67 .06 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Progress towards achievement of PDO 1. There has been good progress in all activities supporting the achievement of the Project Development Objection (PDO). Four out of 5 PDO indicators have been surpassed and 1 will be achieved by the proposed Closing Date of January 31, 2020. In addition, 6 out of 8 Intermediate Results Indicators have surpassed their target values. The remaining 2 are expected to be achieved by the proposed Closing Date. 2. The following progress has been achieved by each component: 3. Component 1. Promoting citizen monitoring of hospital performance a. Development and implementation of Hospital Performance Report Card (HPRC). The data on the HPRC indicators for the 55 targeted public hospitals was collected and processed, and benchmarks for each The World Bank Implement participatory social accountability for better health in Moldova () reference group were determined. In order to improve the quality of HPRC and the Primary Health Care Performance-Based Incentives Audit (PHC-PIA) tools, a focus group meeting with citizens from different organizations and from different background were conducted in April 2018, recommendations on how to improve and make the content of HPRC and PHC PIA more understandable were collected. These recommendations have been taken into account when generating hospital report cards for 9 districts. Performance measurement results are available for 55 hospitals on the transparency portal hospital.md. Paper based HPRC version for dissemination door to door as part of policy experiment on citizen engagement in 9 selected districts (treatment) was developed in Romanian and Russian languages. The dissemination was completed in August-October 2018. b. Patient exit survey. The patient exit survey in all 55 public hospitals as part of the policy experiment exercise on citizens’ engagement was conducted in March-April 2018. The results of the survey were presented during a meeting in December 2018 with the participation of representatives from the Government. 4. Component 2. Strengthening performance-based incentive program in family medicine through social audits of primary healthcare institutions a. Development of Primary Health Care Performance-Based Incentives Audit (PHC-PIA) tool. Taking in consideration that the Ministry of Health, Labor, and Social Protection changed the list of pay for performance indicators in 2018, the trust fund recipient, Centrul Pentru Politici Și Analize În Sănătate (PAS), in coordination with the Family Doctors Association changed the approach of PHC-PIA tool. Similar to HPRC, paper-based PHC- PIA tool version for dissemination door to door as part of the policy experiment on citizen engagement in 9 selected rayons was developed in Romanian and Russian languages. The dissemination was completed in August-October 2018. 5. Component 3. Creating an enabling environment for informed public dialogue in health a. Public Opinion Pool (POP). In line with project implementation schedule and succession of activities, the work under this component was conducted between April and May 2018. The report has been developed and preliminary discussion took place with the Ministry of Health, Labor, and Social Protection and the World Bank. The report will be translated in English. Due to parliamentary election in February 2019, public presentation of the report only took place in September 2019. 6. Component 4. Facilitating knowledge and learning to enhance effectiveness of social accountability interventions a. Build sustainable information-communication platform for disseminating and using health systems data and project results. With the aim to facilitate knowledge on social accountability exchange and learning uptake to enhance the effectiveness of social accountability interventions, the PAS Center has improved the development of transparency platform, spitale.md, for disseminating and using health systems’ data and project results, for feedback collection, promotion and monitoring of social accountability tools in healthcare. An information technology company was contracted on April 3, 2018 to develop a mobile compatible interactive map for displaying hospitals in the Republic of Moldova registered in the spitale.md portal. The HPRC are disseminated on the online platform for the 55 public hospitals and aimed to improve information flow about hospitals performance and leverage participatory monitoring and evaluation. The development of information-communication and promotional materials was completed, and the materials were developed, printed and distributed. 7. As a response to the Bank team’s recommendations, the recipient added a number of activities and updated the workplan which was approved on July 23, 2019. These recommendations include 3 trainings in social accountability tools, policy dialogues at the local level in 9 districts in order to promote and discuss the project outcomes and final evaluation of the grant. The bid for proposals for program evaluation was announced on July 26, but due to the low The World Bank Implement participatory social accountability for better health in Moldova () number of bids (3 bids), it has been re-advertised on September 27, 2019 with the bid opening planned for October 21, 2019. 8. In addition, parliamentary elections in February 2019 resulted in stalemate, with no clear winner emerging among political parties. After the elections, it took nearly 4 months for a new coalition government to be established. A number of planned activities have been delayed as a result of political instability related to elections and establishing a new Government. 9. Disbursement. The Grant will be fully disbursed by the proposed Closing Date with only US$62,000 remaining as of today. 10. The project financial management systems are satisfactory. The semi-annual financial reports and project audits are up to date. The audit opinions have been always unqualified. There are no issues which would affect the FM performance. II. DESCRIPTION OF PROPOSED CHANGES A. Extension of the Project Closing Date 11. By letter of October 7, 2019, the recipient requested an extension on the Closing Date from November 19, 2019 to January 31, 2020 to allow the completion of the remaining activities pertaining to trainings in social accountability tools, which involve the participation of national central authorities, and to achieve the PDO. III. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Implementing Agency ✔ Project's Development Objectives ✔ Results Framework ✔ Components and Cost ✔ Cancellations Proposed ✔ Additional Financing Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Change in Overall Risk Rating ✔ The World Bank Implement participatory social accountability for better health in Moldova () Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline TF Status Closing Closing(s) Closing for Withdrawal Applications TF-18162 Effective 19-Nov-2019 31-Jan-2020 29-May-2020