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 | Investment Project Financing | FY 2013 | Seq No: 11 | ARCHIVED on 18-May-2018 | ISR32323 | Implementing Agencies: Mandatory Health Insurance Fund, Ministry of Health, KYRGYZ REPUBLIC Key Dates Key Project Dates Bank Approval Date:18-Apr-2013 Effectiveness Date:29-Jul-2014 Planned Mid Term Review Date:26-Sep-2016 Actual Mid-Term Review Date:26-Sep-2016 Original Closing Date:30-Jun-2017 Revised Closing Date:31-Dec-2018 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  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  High  High Implementation Status and Key Decisions 5/18/2018 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) The project continues to show strong progress toward achieving its Project Development Objective (PDO). The project activities have been scaled up to all 64 rayon and small town hospitals since July 2017. Pilot Primary Health Care PBF scheme in Chui rayon has had four rounds of quarterly verification so far. The Ministry of Health (MoH) and Mandatory Health Insurance Fund (MHIF) have taken a note of the preliminary results of the Impact Evaluation of the Health RBF project and decided to create a fiscal space for “positive incentives” based on a quality score by setting aside 5% budget and developing “positive incentives” scheme across the health sector at all levels. The MHIF has requested to assist in creating such a quality index for various types of health facilities at the national, oblast, rayon hospital and PHC levels. It is expected that the project will fully achieve its development objective. 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 Environment and Social  --  Moderate  Moderate Stakeholders  --  Substantial  Substantial Other  --  Low  Low Overall  --  High  High Results Project Development Objective Indicators PHINDPDOTBL  Proportion of eligible rayon hospitals that received the authorized performance-based payments within two weeks after the MHIF’s receipt of RBF payment to their bank account (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 22.00 Date 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments Achieved 5/18/2018 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDPDOTBL  Proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals submitted to MHIF within 30 working days after the end of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 42.00 42.00 42.00 Date 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments Achieved. Verification records for QIV 2017 and for QI 2018 were submitted on Jan 30, 2018 and Apr 26, 2018. These records were submitted for 64 hospitals given the scale up of the project from 42 hospitals to 64 hospitals 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) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 8.00 Date 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments Achieved. The 7th round of counter verifications was completed on March 4-8.2018 in 10 hospitals 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 Value No surveys completed before start completed before start implmented by of pilot of pilot the end of the project 5/18/2018 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Date 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments Target is met as two rounds of IE surveys ( quantitative study) was completed. PHINDPDOTBL  Average quarterly quality score of Group 1 hospitals (percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9.30 71.10 77.00 75.00 Date 29-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments QI 2018 score is 77% which exceeds the target of 75% Overall Comments 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-Aug-2014 30-Jun-2017 15-May-2018 31-Dec-2018 Comments Achieved. Contracts w participating providers are signed on annual basis. Performance contracts with all 22 hospitals (Group 1) were signed in Dec 2017 for the year 2018 5/18/2018 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) 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 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments Achieved. All 22 hospitals (Group I) received performance based payments in accordance w their BSC scores PHINDIRITBL  MOH/MHIF produce quarterly monitoring reports within 3 weeks after the end of each quarter (Weeks, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 4.00 Date 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments Achieved. Verifications for QIV 2017 and QI 2018 were completed on Jan 30, 2018 and Apr 21, 2018 and quarterly monitoring reports were submitted on Feb 8, 2018 and April 27, 2018 within 1 week 5/18/2018 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) 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 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments Achieved. National RBF Steering Committee met on Nov 9, 2017 and Dec 1, 2017. Next meeting is scheduled for early June 2018 PHINDIRITBL  Extended RBF team meets at least every 4 months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 3.00 Date 25-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments On track. The RBF Extended team met 6 times during the 2017 on March 3, may 26, Aug 14, Oct 20, Nov 1, Dec 8, 2017. It met on March 23, 2018 in 2018. Next meeting is scheduled prior the June-July 2018 quarterly verification PHINDIRITBL  Average % score Balance Score Card (BSC) indicator 1.7 Red Blood Cell Availability (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 68.00 73.00 75.00 Date 20-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments On track 5/18/2018 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDIRITBL  Average % score for Category 6 Maternity Department (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 61.70 72.50 85.00 Date 20-Aug-2014 03-Nov-2017 03-Nov-2017 31-Dec-2018 Comments There has been a significant increase from the baseline of 5% in July 2014 to 72,5% in April 2018. If this score would have been calculated as per the initial calculation (given the below mentioned changes) it would be 79.3%. However the end target of 85% has been set too ambitious. It is unlikely to be met in the remaining three quarters. There was decrease from 75% (2016) to 72,5% in 2018 due to changes made in the BSC in 2017: (i) a new indicator on differential diagnosis was added to make the BSC more difficult for providers to achieve; (ii) competency test from Cat 1 of the BSC was moved to Cat 6 thus affecting this indicator too. In addition there was an increase in # of hospitals which had zero cases of pathological deliveries due to referral of the high risk pregnancies to higher level hospitals. This has affected denominator. PHINDIRITBL  Average % score for Category 7 Pediatric/Neonatal Department (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.30 77.60 80.00 80.00 Date 20-Aug-2014 03-Nov-2017 15-May-2018 31-Dec-2018 Comments On track 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 8.45 2.55 77% 5/18/2018 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) 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 31-Dec-2018 Cumulative Disbursements Restructuring History Level 2 Approved on 21-Jun-2017 Related Project(s) There are no related projects. 5/18/2018 Page 8 of 8 Public Disclosure Copy