The World Bank Public Disclosure Copy Overview and Performance Operation Name:: Health System Quality and Efficiency Improvement Project Stage:: Implementation Seq No. 1 Status: ARCHIVED (P144871) Team Leader: Carlos Marcelo Bortman Requesting Unit: ECCU5 Created by: Johanne Angers on 30-Jun-2014 Product Line: IBRD/IDA Responsible Unit: GHNDR Modified by: Carlos Marcelo Bortman on 18- Jul-2014 Country: Croatia 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 Program will contribute to (a) improving the health care delivery system in order to provide more equitable quality and sustainable health services to the population; (b) rationalizing the hospital network in order to streamline health care services to the population; (c) strengthening Government's capacity to develop and monitor effective health sector policies in the area of health financing, resource allocation, and provider payments; and (d) promoting effective public health interventions. 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 Public Disclosure Copy Implementation Status Overview The Program was approved by the World Bank’s Board of Executive Directors on May 8, 2014. This program supports the Republic of Croatia in its efforts to implement a comprehensive health sector reform that addresses the emerging health care needs of the Croatian population and addresses the need for greater cost effectiveness. The Program supports the Government of Croatia’s 2012-2020 National Health Care Strategy, which identifies the strategic problems and reform priorities for the health care sector. These are: (i) poor connectivity and insufficient continuity of health care across all levels of the system (primary, secondary, and tertiary); (ii) uneven quality of care; (iii) inadequate efficiency and Page 1 of 7 The World Bank Public Disclosure Copy effectiveness of the health care system; (iv) poor and uneven availability of health care across regions; and (v) relatively poor health indicators, particularly Key Decisions forrelated those to risk factor and health behaviors. Disclosure Not applicable Financing ( as of 12-Jun-2014 ) Key Dates Effectiveness Program Loans Status Approval Date Signing Date Closing Date Date P144871 IBRD-83650 Not Effective 08-May-2014 10-Jun-2014 30-Jun-2018 Disbursements (in Millions) Program Loans Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P144871 IBRD-83650 Not Effective USD 103.50 103.50 0.00 0.00 103.50 0.00 DLIs Disbursement Linked Indicators (DLI) DLI Scalable Unit of Measure DLI Baseline Actual(Previous) Actual(Current) Disbursement 1. Total number of hospital beds in Number Value 15930.00 15930.00 Rationalized Hospitals classified as Sub Type Date 31-Dec-2012 31-Dec-2012 Acute Care Beds. Comments 2. Number of “hospital reshaping Number Value 0.00 0.00 Public Disclosure Copy scheme” projects implemented Sub Type Date 31-Dec-2012 16-Jul-2014 Comments 3. Percentage of rationalized hospitals Percentage Value 0.00 0.00 without arrears incurred during the Sub Type Date 31-Dec-2012 16-Jul-2014 preceding calendar year. Comments Page 2 of 7 The World Bank Public Disclosure Copy 4. Percentage of all surgeries included Percentage Value 5.00 5.00 in the elective surgeries list performed Sub Type Date 31-Dec-2012 16-Jul-2014 as outpatient surgeries in the preceding six months. . Comments 5. Percentage of best-performing Percentage Value 0.00 0.00 rationalized hospitals which are Sub Type Date 31-Dec-2012 16-Jul-2014 publicly disclosed (including results) based on the technical audit in the Comments preceding 12 months. 6. Percentage of Rationalized Percentage Value 0.00 0.00 Hospitals accredited by AQAHS Sub Type Date 31-Dec-2012 16-Jul-2014 through the Acceptable Accreditation Process Comments 7. Percentage of identified doctors Percentage Value 20.00 20.00 with whom corrective course of action Sub Type Date 31-Dec-2012 16-Jul-2014 has been discussed on a person-to- person basis in the preceding six Comments months. 8. Percentage of total public spending Percentage Value 0.00 0.00 per fiscal year on medical Sub Type Date 31-Dec-2012 16-Jul-2014 consumables, drugs, and devices for hospital (in and outpatient) services Comments made through centralized procurement and disclosed 9. Percentage of primary health care Percentage Value 0.00 0.00 doctors in the Republic of Croatia Sub Type Date 31-Dec-2012 16-Jul-2014 working in group practices Public Disclosure Copy Comments 10. Percentage of hospitals with Percentage Value 0.00 0.00 surgery wards that have established Sub Type Date 31-Dec-2012 16-Jul-2014 quality- and safety-related sentinel surveillance schemes thatare reporting Comments the rates of specific events Results Page 3 of 7 The World Bank Public Disclosure Copy Program Development Objectives Indicators Indicator Name Key DLI Unit of Measure Baseline Actual (Previous) Actual (Current) End Target First phase of the hospital Number Value 15930.00 12800.00 master plan achieved: Date 31-Dec-2012 31-Dec-2017 Total number of hospital beds in Rationalized Comments Hospitals a classified as acute care beds First phase of the hospital Percentage Value 0.00 80.00 master plan achieved: Date 31-Dec-2012 31-Dec-2017 Percentage of rationalized hospitals without arrears Comments incurred during the preceding calendar year Quality control Percentage Value 0.00 40.00 procedures in place: Date 31-Dec-2012 31-Dec-2017 Percentage of best- performing rationalized Comments hospitals which are publicly disclosed (including results) based on the technical audit in the preceding 12 months Quality control Percentage Value 0.00 50.00 procedures in place: Date 31-Dec-2012 31-Dec-2017 Percentage of Rationalized Hospitals Comments Public Disclosure Copy accredited by AQAHS through the Acceptable Accreditation Process Intermediate Results Indicators (a) improving the health care delivery system in order to provide more equitable quality and sustainable health services to the popu lation Page 4 of 7 The World Bank Public Disclosure Copy Indicator Name Key DLI Unit of Measure Baseline Actual (Previous) Actual (Current) End Target 1. Ratio between primary Text Value Ratio 58 / 18 / 1 90 / 19 / 1 health care/secondary Date 31-Dec-2012 30-Dec-2017 outpatient care/ and hospital inpatient care Comments services 4.Number of clinical Number Value 0.00 20.00 guidelines with specific Date 31-Dec-2012 24-Dec-2017 protocols for most prevalent NCDs Comments (including care pathways). 6. Percentage of primary Percentage Value 0.00 50.00 health care doctors Date working in group practices Comments 7. Percentage of Primary Percentage Value 0.00 60.00 Health Care group Date practices achieving performance indicators Comments and accessing to payment incentives. 8. Percentage of identified Percentage Value 20.00 90.00 doctors a with whom Date corrective course of action has been discussed Comments on a person-to-person basis in the preceding six Public Disclosure Copy months. 10. Number of counties Number Value 1.00 15.00 implementing specialized Date services on palliative care. Comments 12. Percentage of Percentage Value 0.00 30.00 Nosocomial Infections Date Surveillance system in Comments Page 5 of 7 The World Bank Public Disclosure Copy place in tertiary hospitals and secondary hospitals. 13. Percentage of Percentage Value 0.00 60.00 hospitals with surgery Date wards that have established quality-and Comments safety-related sentinel surveillance schemes that are reporting the rates of specific events. 14. Percentage of Percentage Value 38.00 75.00 patients’ satisfaction by a Date perception of increased responsiveness. Comments (b) rationalizing the hospital network in order to streamline health care services to the population Indicator Name Key DLI Unit of Measure Baseline Actual (Previous) Actual (Current) End Target 2. Number of “hospital Number Value 0.00 2.00 reshaping scheme” Date 31-Dec-2012 31-Dec-2017 projects implemented Comments 3. Percentage of all Percentage Value 5.00 60.00 surgeries included in the Date 31-Dec-2012 31-Dec-2017 elective surgeries list performed as outpatient Comments surgeries in the preceding six months. (c) promoting effective public health interventions Public Disclosure Copy Indicator Name Key DLI Unit of Measure Baseline Actual (Previous) Actual (Current) End Target 5. Number of Primary Number Value 0.00 4000.00 Health Care doctors re- Date trained in updated clinical protocols Comments Page 6 of 7 The World Bank Public Disclosure Copy 9. Percentage of total Percentage Value 0.00 60.00 public spending per fiscal Date year on medical consumables, drugs, and Comments devices for hospital (inpatient and outpatient) services made through centralized procurement/ framework contr 11. Number of proposals Number Value 0.00 8.00 for EU structural funds Date accepted by the relevant authority after being Comments correctly submitted. Organizations Organization Name Type Contact Title Office Phone Email Ministry of Health and Implementing Agency Antoaneta Bilic Project Coodinator Antoaneta. Social Welfare Bilic@mzss.hr Government of Croatia Borrower/Recipient Public Disclosure Copy Page 7 of 7