The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Second Serbia Health Project (P129539) EUROPE AND CENTRAL ASIA | Serbia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 11 | ARCHIVED on 26-Mar-2019 | ISR36252 | Implementing Agencies: Ministry of Health, Ministry of Finance Key Dates Key Project Dates Bank Approval Date: 25-Feb-2014 Effectiveness Date: 08-May-2015 Planned Mid Term Review Date: 14-Feb-2018 Actual Mid-Term Review Date: 29-Jan-2018 Original Closing Date: 30-Sep-2019 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to contribute to improving the efficiency and quality of the public health system of the Republic of Serbia through the strengthening of: (i) health financing, purchasing, and maintenance systems; and (ii) quality improvement systems and management of selected priority non- communicable diseases. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improvement of Health Financing:(Cost $11.20 M) Improve Access to Quality Health Care:(Cost $8.90 M) Strengthening Quality of Service Delivery:(Cost $46.00 M) Monitoring and Evaluation and Project Management:(Cost $4.90 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions In November 2018, all 5 project development objectives indicators had met their 2017 annual target values. All values for 2018 should all become available by June 2019. There has been progress in the implementation of the activities under all components since the last implementation support visit. Specifically: Component 1 - Improvement of Health Financing. Payments to hospitals based on DRGs started on January 1, 2019. Improved formula for the variable part of salary at the primary health care level started on January 1, 2019. The operations manual for primary health care quality improvement grants was developed. 3/26/2019 Page 1 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Component 2 - Improve Access to Quality Health Care. The Ministry of Health has continued to implement multiple activities for the rational use of antibiotics, e.g. the development of guidelines, the delivery of training and the national campaign, capacity building of microbiology laboratories. The implementation of all activities related to e-prescription are completed. On health technology assessment, a situation analysis and an action plan have been developed. The development of medical equipment maintenance systems has been initiated through the consolidation of databases on medical equipment. Component 3 - Strengthen Quality of Service Delivery. A new set of quality indicators are being elaborated by the Institute of Public Health and are expected to be adopted by end of June 2019. Three clinical pathways on cancer-related cases have been developed in accordance with international standards. All six linear accelerators planned under the parent project are in operation. The Government and the World Bank team agreed to intensify efforts to accelerate project implementation, including to meet all project development objectives. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Moderate Moderate Fiduciary -- Moderate Moderate Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- Moderate Moderate Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes To contribute to improving the efficiency and quality of the public health system of Serbia IN00678143 ►Percentage of total acute care hospitalization cases in public hospitals reported accurately based on DRGs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 70.00 95.00 95.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678144 ►Percent reduction in average unit price relative to baseline for the 50 most frequently dispensed multi-source pharmaceuticals that are procured through centralized framework contracts (Percentage, Custom) 3/26/2019 Page 2 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 27.00 27.00 27.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678145 ►Percentage of patients starting radiotherapy treatment at public hospitals within 28 days between the date of issuance of treatment protocol and the first radiotherapy session for a) breast, b) cervic (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Monitoring system in No monitoring system in Monitoring system in place to measure the Value place to report on the -- place to measure the indicator, baseline and indicator indicator target values defined Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678146 ►Percentage of registered adult patients in Dom Zdravljas with recorded blood pressure value, BMI, smoking status and recommended tips for healthy behavior in the preceding 12 months in their med recor (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 32.00 33.25 45.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678147 ►Percentage of registered insured persons covered by the targeted examination for early detection of a) breast (age 50-69 in the past two years), b) cervical (age 25-64 in the past three years) and c) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target a) 6%; a) 6%; a) 25%; Value b) 27%; -- b) 27%; b) 35%; c) 10% c) 10% c) 35% Date 30-Nov-2017 27-Jul-2018 19-Mar-2019 31-Dec-2021 Screening is done once every two or three years. The data for this indicator is reported on an annual basis Comments: by the Institute of Public Health. The 2018 value should be available by June 2019. Intermediate Results Indicators by Components 1. Improvement of Health Financing IN00678148 ►Percentage of pilot Dom Zdravljas who meet grant agreement performance criteria in the preceding one year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678151 ►DRGs payment system developed and financing for a portion of acute hospital care based on DRGs initiated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes 3/26/2019 Page 3 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678154 ►Number of health workers receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 500.00 11,251.00 13,152.00 13,000.00 Date 16-Jan-2014 27-Jul-2018 19-Mar-2019 31-Dec-2021 This indicator is mapped to all three components Comments: 2. Improve Access to Quality Health Care IN00678149 ►Number of pharmaceuticals and health products that are procured through centralized framework contracts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,421.00 700.00 700.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678152 ►Percentage of a) Dom Zdravljas and b) pharmacies implementing e-prescription system (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DZs - 0 DZs - 100%; DZs - 90% Value -- Pharm - 0 Pharm - 100% Pharm - 90% Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678155 ►Reduction in the total consumption of antibiotics for systemic use (J01) DDD/1000 person/per day (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18.00 32.80 22.00 Date 30-Nov-2017 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678157 ►Strengthen systems for Health Technology Assessment (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The linkage between national clinical practice guidelines and basic benefit package Situation analysis Limited institutional well established and completed. Roadmap efficiency related to the functional. The new, document with detailed Value decision making process -- robust and plan of activities for in the area of drug transparent, system of HTA system reimbursement evidence based establishment drafted supported decision making process fully established and functional 3/26/2019 Page 4 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Date 30-Nov-2017 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678159 ►Strengthen systems for medical equipment maintenance (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No national systems or Budget allocated to Medical equipment policies in place, Medical expand maintenance Value -- registry set up within equipment database in system. National IHIS the IPH system(s) in use Date 16-Jan-2014 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678161 ►Annual training organized for health Roma mediators (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 4.00 Date 30-Nov-2017 27-Jul-2018 19-Mar-2019 31-Dec-2021 3. Strengthen Quality of Service Delivery IN00678150 ►Number of clinical pathways developed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 14.00 32.00 35.00 48.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678153 ►Number of health care institutions that have completed staff training on priority clinical pathways (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 64.00 77.00 160.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678156 ►Ranking of health institutions according to quality criteria in place based on quality indicators in health care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Ranking of health Improved quality institutions according Value Existing quality indicators -- indicators under to quality criteria based discussion/no ranking on data from previous year/Yes Date 16-Jan-2014 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678158 ►Number of new linear accelerators installed at national level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6.00 6.00 8.00 3/26/2019 Page 5 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 IN00678160 ►Percentage of adult diabetic patients in Dom Zdravljas with at least one determined value of glycosylated hemoglobin (HbA1c) in the last year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 39.30 40.90 50.00 Date 16-Oct-2013 27-Jul-2018 19-Mar-2019 31-Dec-2021 This indicator is mapped to components 2 and 3 Comments: IN00678162 ►Percentage of registered adult patients in DZs with hypertension under treatment whom in the last recorded blood pressure (measured in the preceding one year) is ≤ 140/90 mm Hg (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 50.00 50.00 70.00 Date 16-Jan-2014 27-Jul-2018 19-Mar-2019 31-Dec-2021 This indicator is mapped to components 2 and 3 Comments: IN00678163 ►Percentage of patients satisfied with the quality of care in PHC facilities (CE) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 78.00 78.00 80.00 Date 30-Nov-2017 27-Jul-2018 19-Mar-2019 31-Dec-2021 Indicator is reported by the IPH. The data is reported annually. Data for 2018 is not yet available, but it is Comments: expected to be available by June 2019. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P129539 IBRD-83380 Effective USD 40.00 40.00 0.00 27.66 8.10 77% P129539 IBRD-88300 Effective USD 31.10 31.10 0.00 2.35 28.53 7.6% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P129539 IBRD-83380 Effective 25-Feb-2014 10-Jul-2014 08-May-2015 30-Sep-2019 31-Dec-2021 P129539 IBRD-88300 Effective 20-Mar-2018 21-Mar-2018 24-Jul-2018 31-Dec-2021 31-Dec-2021 3/26/2019 Page 6 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Cumulative Disbursements Restructuring History Level 2 Approved on 14-Sep-2015 Related Project(s) P166025-Additional Financing for Second Serbia Health Project 3/26/2019 Page 7 of 7