The World Bank Implementation Status & Results Report Health System Improvement Project (P144688) Health System Improvement Project (P144688) EUROPE AND CENTRAL ASIA | Albania | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 11 | ARCHIVED on 21-Nov-2019 | ISR39120 | Implementing Agencies: Ministry of Health, Ministry of Finance Key Dates Key Project Dates Bank Approval Date: 27-Feb-2015 Effectiveness Date: 28-Aug-2015 Planned Mid Term Review Date: 16-Jul-2018 Actual Mid-Term Review Date: 16-Jul-2018 Original Closing Date: 28-Feb-2021 Revised Closing Date: 28-Feb-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project PDO is to contribute to improving the efficiency of care in selected hospitals in Albania, improving the management of information in the health system, and increasing financial access to health services. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) To contribute to the modernization of selected pubic hospital services Components Table Name Improving Hospital Services:(Cost $21.50 M) Expanding Health Management Information System:(Cost $16.20 M) Monitoring and Evaluation, and Project Management:(Cost $1.20 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Overall, good progress is noted in the implementation of key activities, especially under project component 1, including: (a) contracting the civil works for the physical rehabilitation of the Pediatric Hospital under the University Hospital Center (QSUT), (ii) contracting the international consultancy firm to support the MHSP in updating the Hospital Rationalization Plan; (iii) launching of the procurement process for the physical rehabilitation of Kukes regional hospital, etc. Meanwhile, the procurement of the regional Hospital Information System is at evaluation stage, with 11/21/2019 Page 1 of 6 The World Bank Implementation Status & Results Report Health System Improvement Project (P144688) contract expected to be in place by December, 2019. Agreement was reached with the MHSP management to further strengthen their efforts in following up with the implementation of key activities under this component, considering the limited timing until project closure. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Substantial Substantial Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Moderate Moderate Environment and Social -- Low Low Stakeholders -- Substantial Substantial Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To contribute to the modernization of selected public hospital services IN00761176 ►Total number of hospitals in the selected region that have launched the implementation of the hospital master plan recommendations (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 3 hospitals have Value 0.00 0.00 0.00 developed plan of actions Date 18-Sep-2014 30-May-2019 30-Oct-2019 28-Feb-2021 Currently the international consultancy firm to support the MHSP in updating the hospital rationalization plan has been contracted and started work. The work is expected to be finalized by end of first quarter Comments: 2020, hence ensuring completion of this indicator within project closure. IN00761177 ►Number of regional hospitals with Hospital Information System (HIS) established and functional (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/21/2019 Page 2 of 6 The World Bank Implementation Status & Results Report Health System Improvement Project (P144688) 4 HIS are established Value 0.00 0.00 0.00 and functional Date 27-Jul-2018 30-May-2019 30-Oct-2019 28-Feb-2021 The procurement process for the HIS is launched, as agreed, and contract is expected to be in place by Comments: end of December, 2019. IN00761178 ►Number of regional hospitals meeting the minimum requirements of the accreditaton agency (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 4.00 3.00 Date 27-Jul-2018 30-May-2019 30-Oct-2019 28-Feb-2021 The indicator has been achieved. Regional hospitals of Elbasan, Lezha, Durres and Vlora have met the Comments: minimum requirements, as confirmed by the Accreditation Agency. Intermediate Results Indicators by Components Improving Public Hospital Sector Management and Infrastructure IN00761180 ►Number of regional hospitals with social accountability mechanisms in place (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 18-Sep-2014 30-May-2019 30-Oct-2019 28-Feb-2021 Social accountability mechanisms for citizen engagement - the mechanisms (supported under the project) are expected to be in place towards project closure, when the HIS will be established. However, based on existing mechanisms established by the MHSP, data suggest that all hospitals have some social accountability mechanisms in place. They collect patient feedback and over 50% of the patients use the Comments: mechanisms. Feedback from the patients/citizens has resulted in MOHSP decentralization of services near to the place of residence (for example, offering of the perinatal dialysis in some regional hospitals while previously this service was offered only to QSUT). IN00761181 ►Medical equipment management and maintenance revised strategy and plans adopted (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Strategy updated and Value No No No plans adopted by MoHSP Date 18-Sep-2014 30-May-2019 30-Oct-2019 28-Feb-2021 Update of the maintenance strategy is expected to take place by second quarter of 2020. Currently, the MHSP is working to hire an international TA to support them with the update. The selection process for Comments: the TA is expected to be completed by beginning of 2020. IN00761182 ►Number of clinical protocols and guidelines updated and implemented for management of five main chronic diseases (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/21/2019 Page 3 of 6 The World Bank Implementation Status & Results Report Health System Improvement Project (P144688) 5 guidelines and protocols implemented Value 0.00 0.00 0.00 and monitored in all regional hospitals Date 18-Sep-2014 30-May-2019 30-Oct-2019 28-Feb-2021 Clinical guideline is a set of systematically developed statements involving through evaluation of evidence, to assist clinicians and patients to make decision about appropriate health care for specific clinical circumstances. The implementation of clinical guidelines allows a better management of resources, improves quality in treatment and will improve the utilization of the referral system. They will be monitored Comments: at facility level and HIF. Currently, the MHSP has established a working group which is analyzing the existing protocols and will come up (within November, 2019) with proposed ToRs for hiring an international TA to support the ministry in updating and implementing the agreed guidelines. IN00761184 ►HIF experts and selected health personnel receiving training (disaggregated by gender) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Total: 434; (287 Value 0.00 0.00 55 females; 45 males Females; 146 Male) Date 18-Sep-2014 30-May-2019 30-Oct-2019 28-Feb-2021 Total number of experts (by area of training and disaggregated by gender) receiving training is 434 Comments: experts. Target achieved. IN00761185 ►Roadmap for hospital payment reforms adopted by HIF (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Roadmap adopted by Value No No Yes HIF Date 27-Jul-2018 30-May-2019 30-Oct-2019 28-Feb-2021 A Roadmap for the HIF organization has been already developed and adopted. Target is achieved Comments: IN00761186 ►Number of service payment packages (10 in total) using new platform processed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 27-Jul-2018 30-May-2019 30-Oct-2019 28-Feb-2021 This is a new indicator, introduced during project MTR. Currently the MHSP and HIF are working to finalize the selection of an international TA to support them with costing of packages in hospitals. The TA is expected to start work within December, 2019. In parallel, the MHSP is finalizing the revision of Health Comments: and Hospital law which will reflect the overall hospital reform. However, the previous delays may risk the achievement of this indicator. IN00761187 ►Number of facilities renovated and/or equipped (cumulative) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 11 regional hospitals 11 regional hospitals received medical equipped; 3 regional equipment. 3 main Value 0.00 0.00 hospitals renovated; 1 hospitals are under QSUT (Pediatric) rehabilitation. The renovated indicator is on track 11/21/2019 Page 4 of 6 The World Bank Implementation Status & Results Report Health System Improvement Project (P144688) Date 27-Jul-2018 30-May-2019 30-Oct-2019 28-Feb-2021 Currently, 11 regional hospitals equipped with medical equipment. Contract for physical renovation for the Pediatric Hospital already signed and work has started (expected to be completed by January 2021). Rehabilitation of Kukes regional hospital is initiated (contract expected to be in place by January, 2020). In Comments: parallel, BDs are prepared and procurement process will start for the rehabilitation of another regional hospital - in Pogradec. Improving Health Information Management for Hospital Services IN00761179 ►Master Plan for eHealth/HMIS activities developed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 18-Sep-2014 30-May-2019 30-Oct-2019 28-Feb-2021 The MHSP has currently finalized the evaluation process for selection of an international consultant to provide support for development of the e-health Master Plan. The contract is expected to be in place Comments: beginning of November, 2019; and the Master Plan will be developed by second quarter of 2020. IN00761183 ►Number of essential registries that are consolidated and available online (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 27-Jul-2018 30-May-2019 30-Oct-2019 28-Feb-2021 This indicator is newly introduced during project MTR. to be updated...……………? Comments: Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P144688 IBRD-84660 Effective USD 40.00 40.00 0.00 7.29 31.94 19% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P144688 IBRD-84660 Effective 27-Feb-2015 24-Mar-2015 28-Aug-2015 28-Feb-2021 28-Feb-2021 Cumulative Disbursements 11/21/2019 Page 5 of 6 The World Bank Implementation Status & Results Report Health System Improvement Project (P144688) Restructuring History Level 2 Approved on 14-Dec-2018 Related Project(s) There are no related projects. 11/21/2019 Page 6 of 6