The World Bank Public Disclosure Copy Overview and Performance Operation Name:: Moldova Health Transformation Project (P144892) Project Stage:: Implementation Seq No. 1 Status: ARCHIVED Team Leader: Son Nam Nguyen Requesting Unit: ECCU2 Created by: Johanne Angers on 30-Jun-2014 Product Line: IBRD/IDA Responsible Unit: GHNDR Modified by: Son Nam Nguyen on 21-Aug-2014 Country: Moldova Approval FY: 2014 Region: EUROPE AND CENTRAL ASIA Lending Instrument: Program-for-Results Program Development Objectives Program Development Objective (from Program-for-Results Appraisal Document) The proposed Program Development Objective is to contribute to reducing key risks for non-communicable diseases and improving efficiency of health services in Moldova. Summary Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Overall Implementation Progress (IP) Satisfactory Overall Risk Rating Moderate Program Status for Public Disclosure Implementation Status Overview This is the initial Implementation Status Report for the Moldova Health Transformation Operation which was approved by the World Bank’s Board of Executive Directors on May 22, 2014. The Legal Agreement was signed on July 11, 2014. Ratification of the Legal Agreement by the Public Disclosure Copy Parliament is pending. Project effectiveness is planned for October 2014. Key Decisions for Disclosure Not applicable Financing ( as of 15-Jul-2014 ) Key Dates Page 1 of 7 The World Bank Public Disclosure Copy Effectiveness Program Loans Status Approval Date Signing Date Closing Date Date P144892 IDA-54690 Not Effective 22-May-2014 11-Jul-2014 30-Mar-2019 P144892 IDA-54700 Not Effective 22-May-2014 11-Jul-2014 30-Mar-2019 Disbursements (in Millions) Program Loans Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P144892 IDA-54690 Not Effective XDR 18.60 18.60 0.00 0.00 18.60 0.00 P144892 IDA-54700 Not Effective XDR 1.40 1.40 0.00 0.00 1.40 0.00 DLIs Disbursement Linked Indicators (DLI) DLI Scalable Unit of Measure DLI Baseline Actual(Previous) Actual(Current) Disbursement Adult smoking prevalence Percentage Value 25.30 Sub Type Date 22-May-2014 Comments This is the latest data from the 2013 Moldova STEPS Survey Adults with hypertension under Percentage Value 4.10 control Sub Type Date 22-May-2014 Comments This is the latest data from the 2013 Moldova STEPS Survey Public Disclosure Copy Annual acute care hospital discharges Number Value 17.60 per 100 persons Sub Type Date 22-May-2014 Comments Acute care hospital beds Number Value 17586.00 Sub Type Date 22-May-2014 Comments Page 2 of 7 The World Bank Public Disclosure Copy Adoption of a revised outpatient drug Text Value Average reimbursement benefit package for anti-hypertensive Sub Type rate of generic, first line drugs medications for the three main categories of antihypertensive drugs in the drug benefit package has not been revised and currently stands at 50 percent Date 22-May-2014 Comments Revision and implementation of Text Value Revision of the performance-based incentive scheme Sub Type performance-based in primary care incentive scheme in primary care has not taken place. Date 22-May-2014 Comments Design, piloting, adoption and Text Value The performance-based implementation of a performance- Sub Type incentives to improve (i) based incentive scheme for hospitals efficiency and (ii) quality of care in hospitals do not exist Date 22-May-2014 Comments Implementaition and update of DRG Text Value DRG is used but prices for public acute care hospitals Sub Type accounts for less than Public Disclosure Copy 40% of total payment by CNAM to acute care public hospitals. DRG prices have not been updated. Date 22-May-2014 Comments Page 3 of 7 The World Bank Public Disclosure Copy Proportion of public hospitals in Percentage Value 0.00 Chisinau which are under common Sub Type Date 22-May-2014 management Comments Adoption of the revised National Text Value Strategy has not been Health System Development Strategy Sub Type revised and approved which includes hospital Date 22-May-2014 rationalization measures Comments Results Program Development Objectives Indicators Indicator Name Key DLI Unit of Measure Baseline Actual (Previous) Actual (Current) End Target PDO Indicator 1: Percentage Value 25.30 25.30 23.30 Smoking prevalence Date 27-May-2014 20-Aug-2014 30-Sep-2019 among adults Comments Latest data from Moldova 2013 STEPS Survey Smoking prevalence Percentage Value 43.60 43.60 39.80 among adults, Male Sub Type Date 27-May-2014 20-Aug-2014 30-Sep-2019 Breakdown Comments Latest data from Moldova 2013 STEPS Survey Smoking prevalence Percentage Value 5.60 5.60 5.10 among adults, Female Sub Type Date 27-May-2014 20-Aug-2014 30-Sep-2019 Breakdown Comments Public Disclosure Copy PDO Indicator 2: Adults Percentage Value 4.10 4.10 9.10 with hypertension whose Date 27-May-2014 20-Aug-2014 30-Sep-2019 blood pressure is under control Comments Latest data from Moldova 2013 STEPS Survey Page 4 of 7 The World Bank Public Disclosure Copy Adults with hypertension Percentage Value 6.00 6.00 11.30 whose blood pressure is Sub Type Date 27-May-2014 20-Aug-2014 30-Sep-2019 under control , Female Breakdown Comments Latest data from Moldova 2013 STEPS Survey Adults with hypertension Percentage Value 2.40 2.40 7.10 whose blood pressure is Sub Type Date 27-May-2014 20-Aug-2014 30-Sep-2019 under control , Male Breakdown Comments Latest data from Moldova 2013 STEPS Survey PDO Indicator 3:Annual Number Value 17.60 17.60 15.60 acute care hospital Date 27-May-2014 30-Sep-2019 discharges per 100 persons Comments PDO Indicator 4: Acute Number Value 17586.00 17586.00 15000.00 care hospital beds Date 27-May-2014 30-Sep-2019 Comments PDO Indicator 5: Average Days Value 8.00 8.00 7.20 length of stay in acute Date 27-May-2014 20-Aug-2014 30-Sep-2019 care hospitals Comments Intermediate Results Indicators Intermediate Results Area 1: Reducing NCD risks Indicator Name Key DLI Unit of Measure Baseline Actual (Previous) Actual (Current) End Target Public Disclosure Copy Intermediate Results Yes/No Value No No Yes Indicator 1: Approval of Date 27-May-2014 20-Aug-2014 30-Sep-2019 the new tobacco control legislation Comments Intermediate Results Yes/No Value No No Yes Indicator 2: Revision of Date 27-May-2014 20-Aug-2014 30-Sep-2019 the outpatient drug benefit package with regard to Comments antihypertensive drugs Page 5 of 7 The World Bank Public Disclosure Copy Intermediate Results Percentage Value 23.80 23.80 29.80 Indicator 3: Adults with Date 27-May-2014 20-Aug-2014 30-Sep-2019 hypertension receiving treatment Comments Adults with hypertension Percentage Value 15.90 15.90 23.00 receiving treatment, Male Sub Type Date 27-May-2014 20-Aug-2014 30-Sep-2019 Breakdown Comments Latest data from Moldova 2013 STEPS Survey Adults with hypertension Percentage Value 32.50 32.50 37.60 receiving treatment, Sub Type Date 27-May-2014 20-Aug-2014 30-Sep-2019 Female Breakdown Comments Latest data from Moldova 2013 STEPS Survey Intermediate Results Area 2: Improved efficiency of health services Indicator Name Key DLI Unit of Measure Baseline Actual (Previous) Actual (Current) End Target Intermediate Results Text Value No revision of No revision of Performance based Indicator 4: Revision and performance based performance based incentive implementation of the incentives in family incentives in family agreements signed with performance-based medicine all primary care centers incentive scheme in contracted by CNAM in family medicine Year 4 Date 27-May-2014 20-Aug-2014 30-Sep-2019 Comments Intermediate Results Text Value No performance based No performance based Performance based Public Disclosure Copy Indicator 5: Introduction incentives for hospitals incentives for hospitals incentive agreements of performance-based signed with all multiple incentives to improve (i) profile hospitals efficiency; and (ii) quality Date 27-May-2014 20-Aug-2014 30-Sep-2019 of care in hospitals Comments Intermediate Results Text Value DRG accounting for less DRG accounting for less DRG updated using Indicator 6: Use of than 40% of total than 40% of total country updated DRG prices for payment by CNAM to payment by CNAM to data payment by CNAM to Page 6 of 7 The World Bank Public Disclosure Copy acute care public hospitals acute care acute care Date public hospitals 27-May-2014 public hospitals 20-Aug-2014 30-Sep-2019 Comments Intermediate Results Yes/No Value No No Yes Indicator 7: Approval of Date 27-May-2014 20-Aug-2014 30-Sep-2019 the revised national health strategy which includes Comments hospital rationalization measures Intermediate Results Percentage Value 0.00 0.00 50.00 Indicator 8: Public Date 27-May-2014 30-Sep-2019 hospitals in Chisinau which are under common Comments management Intermediate Results Yes/No Value No No Yes Indicator 9: Establishment Date 27-May-2014 20-Aug-2014 30-Sep-2019 of university hospital Comments Intermediate Results Percentage Value 36.00 36.00 44.00 Indicator10: Annual Date 27-May-2014 20-Aug-2014 30-Sep-2019 hospitalizations through referrals by family Comments 2011 data 2011 data medicine providers Organizations Organization Name Type Contact Title Office Phone Email Public Disclosure Copy National Health Implementing Agency 373-2-222-3166 mbuga@cnam.md Insurance Company (CNAM) Ministry of Health Borrower/Recipient Mr. Andrei Usatii Minister of Health 373-2-226-8885 andrei.usatii@ms.gov. 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