Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Kyrgyz Health Results Based Financing (P120435) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Specific Investment Loan | FY 2013 | Seq No: 6 | ARCHIVED on 04-Nov-2015 | ISR21340 | Implementing Agencies: Mandatory Health Insurance Fund, Ministry of Health Key Dates Key Project Dates Bank Approval Date:18-Apr-2013 Effectiveness Date:29-Jul-2014 Planned Mid Term Review Date:22-May-2016 Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2017 Revised Closing Date:30-Jun-2017 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to (1) pilot performance-based payments and/or enhanced supervision for quality of maternal and neonatal care in randomly selected rayon hospitals; and (2) strengthen the Government’s and providers’ capacity in performance-based contracting and monitoring and evaluating for results. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Care:(Cost $9.59 M) Component 2: Strengthen the Government's and Providers' Capacity in Performance-Based Payment Reform and Monitoring and Evaluation f or Results:(Cost $1.41 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  High  High 11/4/2015 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Implementation Status and Key Decisions The Government remains committed to the project implementation. Implementation of pilot project was successfully scaled up to all 42 hospitals since the project effectiveness on July 30, 2014. That included five rounds of quarterly peer verifications and two rounds of semiannual counter verification. It has created an interest among providers beyond the pilot hospitals. Ongoing finalization of the Kyrgyz Open RBF portal and the mobile data collection tool development (ICT system) is expected to contribute to improved transparency and accountability of health providers as well as to having a benchmarking tool of hospitals performance. Implementation of the pilot KG HRBF project activities: Hospitals performance has improved in average from 9% to 63,6% (Arm 1) and 54,5% (Arm2) between July 2015 baseline survey and July-August 2015 rounds of peer verification. However, the improvements in quality scores have started to level off. Counter verifications conducted in10 randomly selected hospitals (5 in each Arm) in March and September 2015 showed difference in scores below the acceptable threshold of 10%. Patient satisfaction levels have shown a consistent improvement in both groups of hospitals since the start of the project. While hospitals have done remarkably well in improving the structural aspects of quality, the clinical processes and content of care are yet to see significant improvements. To address this shortcoming the team has discussed and agreed with the MOH to use clinical vignettes to test providers' knowledge during the quarterly peer verification process. In addition it has been agreed to conduct a knowledge, attitude and practice (KAP )survey to assess the extent of lack of clinical skills, attitude of young doctors and bottlenecks to improving the situation. A model for the pilot PHC PBF scheme was developed after several consultations with all relevant stakeholders, including the MOH, MHIF, development partners, Family Group Practice (FGP) Association and presented at the SWAp-2's September 2015 Thematic Meeting. The proposed model will add on a bundled care payment when the earning through three bundled services will be adjusted based on the global quality score. Upon the MHIF's recommendation, it was agreed to have one unified PHC PBF model which should integrate also the PBF indicators developed under WHO pilot project and proposals made for PHC PBF pilots under the Swiss Provider Autonomy and GAVI projects. Implementation of the rural pilot PBF PHC scheme, funded from KG HRBF is scheduled to start in January-April 2016. There is a potential for two other pilots in urban area and hard to reach area to be financed from GAVI project subject to confirmation of availability of GAVI funds by the end of the CY 2015 after completion of the consultancy financed from the GAVI EFO. It has been agreed with the MOH and MHIF to have the Mid-term review of the project scheduled for the last week of May 2016. 11/4/2015 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Substantial  Substantial Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  High  High Fiduciary  --  Substantial  Substantial 11/4/2015 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Environment and Social  --  High  High Stakeholders  --  Substantial  Substantial Other  --  --  -- Overall  --  High  High Results Project Development Objective Indicators PHINDPDOTBL  Proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals submitted to MHIF within one week after the end of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date -- 13-May-2015 13-May-2015 30-Jun-2017 Comments Off track. RBF Secretariat indicates that this indicator is not achievable and will need to be modified. A feasible deadline is 20 working days versus the current one week after the end of each quarter. PHINDPDOTBL  Proportion of eligible rayon hospitals that received the authorized performance-based payments within two weeks after the MHIF’s receipt of payment invoices (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date -- -- -- 13-May-2015 Comments Off track. RBF Secretariat indicates that this indicator is not achievable and will need to be modified. A feasible deadline is 20 working days versus the current two weeks after the MHIF's receipt of payment invoices. PHINDPDOTBL  Number of counter-verification carried out for a subset of Group 1 rayon hospitals and Group 2 rayon hospitals every six months (Number, Custom) 11/4/2015 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 8.00 Date -- 13-May-2015 30-Oct-2015 31-Dec-2015 PHINDPDOTBL  Impact Evaluation Surveys completed on schedule to generate evidence for policy (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Impact Evaluation Impact Evaluation At least 2 round baseline survey baseline survey of serveys completed before start completed before start Value No surveys implmented by of pilot of pilot the end of the project Date -- 11-May-2015 11-May-2015 30-Jun-2017 Overall Comments On track. Baseline IE survey was completed in 2012. Midline IE survey is being scheduled for the summer-fall 2016 Intermediate Results Indicators PHINDIRITBL  Performance Contracts signed with the Group 1 rayon hospitals (20) and updated annually based on any modifications introduced to the Balanced Scorecard (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 20.00 Date -- 25-Sep-2014 02-Nov-2014 31-Dec-2015 PHINDIRITBL  Proportion of Group 1 rayon hospitals (20) that received quarterly performance-based payments in accordance to their level of performance as per agreed Performance Contracts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date -- 20-Dec-2015 30-Oct-2015 31-Dec-2015 Comments For the payment quarter completed in June 2015 payments were made based on results of July-August quarterly peer verification. For the 11/4/2015 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) payment quarter completed in September the payment will be made based on results of the ongoing October-November 2015 quarterly perr verification PHINDIRITBL  MOH/MHIF produce quarterly monitoring reports within 2 weeks after the end of each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date -- 13-May-2015 14-Aug-2015 31-Dec-2015 Comments off track. MOH indicates that quarterly monitoring reports are feasible to be produced after 45 days vs the currently set 2 weeks. PHINDIRITBL  National RBF Steering Committee meets at least twice a year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 2.00 Date -- 13-May-2015 14-Aug-2015 31-Dec-2015 Comments Members of the NSC have been identified, TOR is available. However meetings haven't been taken place yet due to changes in the management of the MOH PHINDIRITBL  Extended RBF team meets at least every 2 months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6.00 6.00 6.00 Date -- 13-May-2015 13-May-2015 31-Dec-2015 Comments The Extended RBF team has held regular meetings (at least every 2 months) 11/4/2015 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P120435 TF-13310 Effective USD 11.00 11.00 0.00 2.22 8.78 20% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P120435 TF-13310 Effective 30-Dec-2013 30-Dec-2013 29-Jul-2014 30-Jun-2017 30-Jun-2017 Cumulative Disbursements 11/4/2015 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 11/4/2015 Page 8 of 8 Public Disclosure Copy