OFFICIAL 3- DOCUMENTS Supplemental Letter No. 2 REPUBLIC OF TURKEY Qpke30 ,2015 International Bank for Reconstruction and Development 1818 H Street, N.W. Washington, D.C. 20433 United States of America Re: Loan No. 8531-TR (Health System Strengthening and Support Project) Performance Monitoring Indicators Dear Sirs and Mesdames: This refers to the provisions of paragraph I of Section II.A. of Schedule 2 to the Loan Agreement of even date between the International Bank for Reconstruction and Development (the Bank) and the Republic of Turkey (the Borrower) for the above- captioned Project. The Borrower hereby confirms to the Bank that the indicators set forth in the attachment to this letter shall serve as basis for the Borrower to monitor and evaluate the progress of the Project and the achievement of the objectives thereof. Very truly yours, REPUBLIC OF TURKEY By: A th"ri ed epresentati Attachment 9 Act Deputy IDI Genera Attachment to Supplemental Letter No. 2 RESULT FRAMEWORK AND MONITORING INDICATORS HEALTH SYSTEM STRENGTHENING AND SUPPORT PROJECT (P152799) Project Development Objective: To improve primary and secondary prevention of selected NCDs, increase the efficiency of public hospital management, and enhance the capacity of the MoH for evidence-based policy-making These results are at Project Level Indicator Name Unit of Baseline' Cumulative Tar et Values Frequenc Data Source/ Responsibility Measure YR1 YR2 YR3 YR4 YR5 y Methodology for Data 2016 2017 2018 2019 2020 Collection End Target PROJECT DEVELOPMENT OBJECTIVE INDICATORS PDO Indicator 1: Percent A: 10 A: 10.2 No A: 10.8 A: 11 No survey Three Household NCD & Cancer Percent of households that M: 7 M: 7.3 survey M: 7.8 M: 8 times Health Survey VP/PHel, receive from health workers F: 13 F: 13.4 F: 14.5 F: 15 during Report PHC VP/PHeI counselling or education related implemen to healthy living2 (by-gender) tation PDO Indicator 2: Percent 0 10 20 30 40 50' Annual HLC PHC VP/PHel Percent change of target information population using services of system, HLC Healthy Living Centers (by surveys province, age, gender, education, health status, and by type of services provided) PDO Indicator 3: Percent (a) 25 (a) 30 (a) 35 (a) 40 (a) 45 (a) 50 Annual Cancer records NCD & Cancer Early detection of (a) cervical (b) 40 (b) 45 (b) 50 (b) 55 (b) 60 (b) 65 data VP/PHeI and (b) breast cancer4 (by province and age) PDO Indicator 4: Percenta 0 0 0 1 4 10 Annual Reporting from VP of Increase in average composite ge points PHol M&E Monitoring, productivity index for all public system Measurement, hospitals' Baseline is indicated for 2012 2 Healthy nutrition, weight reduction, smoking cessation, or physical activity Size of target population for the HLCs (denominator) will be identified once locations of HLCs within the selected provinces are determined 4Defined as (a) number of cases detected at stages 0 and I divided by number of cases detected at all stages (0-V), b) number of cases detected at stages 0, I, and II divided by number of cases detected at all stages (0-IV) The index is an average value of selected productivity indicators for Clinical Engineering Management, Public Hospital Pharmacy Management, Inventory/Stock Management models 2 and Evaluation/PHol PDO Indicator 5: Percent 0 0 0 0 10 70-80 Annual HMIS generated GDHIS/MoH Percent of policy and decision reports, annual makers' that use HMIS survey of regularly (on a monthly basis) targeted users INTERMEDIATE RESULTS INDICATORS. Component 1: Strengthening Public Health and Primary Care Intermediate Result Indicator Percent TBD TBD No 3 4 No survey Three Household NCD & Cancer 1: during survey times Health Survey VP/PHeI, Percent of general population Yrl during PHC VP/PHel who can state two or more implemen negative health impacts of tation selected risk factors of non- communicable diseases and substance use (by province, age, and gender) Intermediate Result Indicator Percent 0 10 20 50 75 90 Annual HLC PHC VP/PHel 2: information Percent of target population in system, HLC 8 provinces' covered by newly surveys established Healthy Living Centers (by province) Intermediate Result Indicator 3: Number 90 1,000 2,400 3,900 5,900 8,400 Annual Administrative NCD & Cancer Number of individuals in 5 records, Project VP/PHel project provinces who visit (2015) monitoring Substance Use Treatment reports Centers to receive patient- specific counselling (new and returning visitors) Intermediate Result Indicator 4: Percent (a) 509 (a) 55 (a) 60 (a) 65 (a) 70 (a) 70 Annual Cancer NCD & Cancer Percent of target population (b) 3010 (b) 35 (b) 40 (b) 45 (b) 50 (b) 70 screening VP/PHel screened for 3 types of cancer' (c) 20" (c) 25 (c) 30 (c) 35 (c) 40 (c) 50 records (by province, age, gender [for colorectal], and cancer type) (2014) 6 The targeted users (the denominator) will be specified following the first phase of the activity (the identification of users) One Healthy Living Center in each of 8 identified provinces. Size of target population for the HLCs (denominator) will be identified once locations of HLCs within the selected provinces are determined Types and target age brackets: (a) cervical: 30-65; (b) breast: 40-69; (c) colorectal: 50-69 1,678,500 of targeted female population were screened in 2014 o 1,650,000 of targeted female population were screened in 2014 A total of 1,290,000 targeted individuals were screened in 2014 (1,032,000 male and 258,000 female) 3 Intermediate Result Indicator Percent (a) 60 (a) 60 (a) 65 (a) 70 (a) 75 (a) 80 Annual Project PHC VP/PHel 5: (b) 0 (b) 5 (b) 10 (b) 15 (b) 25 (b) 30 monitoring Percent of PHC-level staff who reports have satisfactorily completed (2015) standardized training modules required by the staff's job profile: (a) distance learning and (b) face-to-face 12 INTERMEDIATE RESULTS INDICATORS. Component 2: Improving Management of Selected Public Hospital Resources Intermediate Result Indicator Number 0 0 0 3 15 8914 Annual PHol reports, VP of 6: Project Monitoring, Number of Public Hospital monitoring Measurement, Unions where newly developed reports and hospital management models" Assessment/PHo implemented I Intermediate Result Indicator Standard No Guideline Standard Drafts of Standard Annual Project GDHI/MoH 7: documen standard s in 4 contract updated guidelines monitoring Standard guidelines and tation document areas with regulations and reports, standard templates for PPP transactions ation annexes to enact templates guidelines and developed" guidelines for PPP templates for and transaction PPP transactions templates s in place INTERMEDIATE RESULTS INDICATORS. Component 3: Enhancing Evidence-Based Decision-Making Capacity of the Minist y of Health Intermediate Result Indicator Yes/No Latest in Yes Yes Yes Yes Yes Annual NHSA report, GDHR/MoH 8: 2011 Project National-level Health System monitoring Assessment conducted annually reports and published Intermediate Result Indicator Number None of 5 15 20 20 20 Annual Draft regulations GDHIS/MoH 9: of planned containing Key information technology standards 20 developed standards developed and standards standards, but Project Minimum monitoring Health reports Data Sets. 2 Denominators for (a) and (b) include all PHC-level staff in family health centers and community health centers whose job profiles require distance-learning and/or face-to-face training " Management models for non-clinical resources to be monitored include Clinical Engineering Management, Public Hospital Pharmacy Management, and Inventory/Stock Management. '4 Out of a total of 89 Public Hospital Unions Guidelines, at least, for (i) health facility design, (ii) feasibility study preparation, (iii) financial mechanisms, (iv) health facility management; (v) standard templates of PPP contract with technical annexes. 4 integrated into updated draft National regulations16 Health Data Dictionar y, Health Coding Reference Glossary, and HL7 standards Intermediate Result Indicator Percent (a) 1.517 (a) 20 (a) 50 (a) 80 (a) 80 (a) 100 Annual Project GDHIS/MoH 10: (b) 018 (b) 20 (b) 50 (b) 80 (b) 80 (b) 100 monitoring Percent of health facilities that (c) 0 (c) 10 (c) 30 (c) 50 (c) 50 (c) 60'9 reports, HMIS share data to HMS ((a) public generated hospitals, (b) reports family/community health centers, and (c) private hospitals) Intermediate Result Indicator Percent 70 70 95 96 97 97 Annual GDHR reports, GDHR/MoH 11: Health.Net, Percent of health indicators on WHO, OECD, Health.Net that meet Eurostat international standards databases Intermediate Result Indicator Strategy 4 HTA New HTA 3 reports 6 reports 9 reports 12 reports Annual New HTA GDHR/MoH, 12: and reports strategy strategy, At least 12 Health Technology number prepared/ developed published HTA Assessments on prioritized of HTA published reports topics prepared in line with reports (2012- new HTA strategy and 2015) published INTERMEDIATE RESULTS INDICATORS. Core Sector and Citizen Engagement Indicators Intermediate Result Indicator Number/ 0 and 0 4,434,773 9,214,80 14,942,1 20,728,023 26,787,691 Annual Project PMSU 13: percent and 72 7 and 65 06 and and 66 and 66 monitoring Direct project beneficiaries 66 reports (number), of which female (percentage) 16 A total of 20 key standards for (a) producing, processing, storing and sharing electronic health data (target: 5); (b) health informatics and management (target: 7); (c) organizations that produce and manage electronic health data (target: 4); (d) training and awareness activities for current and potential users of health informatics products and services (target: 4) 17 Out of 1,100 hospitals and dental health centers, pilot is currently being implemented in 16 hospitals in Istanbul 18 Out of 6,800 family health centers and 970 community health centers "' The targeted number of private hospitals (the denominator) will be specified following the first phase of the activity (the identification of system scope) 5 Intermediate Result Indicator Number 0 19,372 24,832 29,670 35,248 40,953 Annual Project PMSU 14: monitoring Health personnel receiving reports training Intermediate Result Indicator Number 0 15 25 32 44 50 Annual Project PMSU 15: monitoring Health facilities constructed, reports renovated, and/or equipped Intermediate Result Indicator Percent 0 50 55 60 65 70-80 Annual Project PHC VP 16: monitoring /PHel Percent of users of Healthy reports, HLC Living Centers satisfied with information ease of access to Healthy system Living Centers and/or responsiveness of services to users' individual needs 6