The World Bank Report No: ISR16298 Implementation Status & Results Bosnia and Herzegovina Health Sector Enhancement Project (P088663) Public Disclosure Copy Operation Name: Health Sector Enhancement Project (P088663) Project Stage: Implementation Seq.No: 19 Status: ARCHIVED Archive Date: 18-Oct-2014 Country: Bosnia and Herzegovina Approval FY: 2005 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): FBiH Ministry of Health, Ministry of Health and Social Protection of RS Key Dates Board Approval Date 31-Mar-2005 Original Closing Date 15-Dec-2010 Planned Mid Term Review Date 15-Sep-2008 Last Archived ISR Date 30-Mar-2014 Effectiveness Date 03-Apr-2006 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 15-Sep-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of the Project are to (i) expand and enhance the family medicine model of primary health care; (ii) build managementcapacity in the sector; and (iii) strengthen the policy making process through the development and implementation of a system for monitoring and evaluating sector performance. Has the Project Development Objective been changed since Board Approval of the Project? ● Yes No Component(s) Component Name Component Cost Primary Health Care Restructuring 29.00 Improvement of Health Sector Management Capacity 3.00 Health Policy Formulation and Project Support 8.00 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Low Low Implementation Status Overview All activities planned under the Additional Financing (AF) have been completed or are currently being implemented by both entities. Progress toward achieving the Project Development Objectives indicators indicates that 4 out of 5 indicators have been achieved and 1 partially achieved. In addition, most of the intermediate outcome indicators are also achieved or on track to be achieved. The four pilots to promote preventive services for Non-Communicable Diseases by introducing pay-for-performance have been implemented during the period January – December, Page 1 of 8 The World Bank Report No: ISR16298 2013. The final report was submitted to the Bank. The main finding shows a significant greater performance of the 50 teams receiving the payment incentives. The reporting system developed for the pilots has been adopted as standard reporting system. This new reporting system (and software) was very well accepted by the Family Medicine (FM) teams because it allows the teams to analyze their own performance and also to better report their activities. In addition, one of the Cantonal health insurance funds is analyzing the possibility of including similar incentive in the new contract with FM teams. Public Disclosure Copy In addition to the planned activities, the Project financed additional works and medical equipment to repair some health facilities that were damaged during the natural disaster that affected BiH in May and June 2014. The Project also financed some supplies needed for sanitation and outbreak control activities. The IDA portion of the Project is ending in December 31, 2014, but additional activities financed under CEB funds will continue. Locations Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Visegrad Bosnia and Herz Republika Srpska Trebinje Bosnia and Herz Republika Srpska Sreflije Bosnia and Herz Republika Srpska Srbac Bosnia and Herz Republika Srpska Sokolac Bosnia and Herz Republika Srpska Sipovo Bosnia and Herz Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herz Republika Srpska Prnjavor Bosnia and Herz Republika Srpska Prijedor Bosnia and Herz Republika Srpska Podgrab Bosnia and Herz Republika Srpska Pale Bosnia and Herz Federation of Bosnia and Herzegovina Novi Grad Bosnia and Herz Republika Srpska Mokro Public Disclosure Copy Bosnia and Herz Republika Srpska Modrica Bosnia and Herz Republika Srpska Milici Bosnia and Herz Republika Srpska Ljubinje Bosnia and Herz Republika Srpska Krupa na Vrbasu Bosnia and Herz Republika Srpska Gornji Ribnik Bosnia and Herz Republika Srpska Foca Page 2 of 8 The World Bank Report No: ISR16298 Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Branesci Donji Public Disclosure Copy Bosnia and Herz Republika Srpska Bosanski Samac Bosnia and Herz Republika Srpska Bosanska Gradiska Bosnia and Herz Republika Srpska Bocac Bosnia and Herz Republika Srpska Bijeljina Bosnia and Herz Republika Srpska Berkovici Bosnia and Herz Republika Srpska Banja Luka Bosnia and Herz Republika Srpska Demirovac Bosnia and Herz Republika Srpska Strojice Bosnia and Herz Republika Srpska Gornji Seher Bosnia and Herz Republika Srpska Celinac Bosnia and Herz Republika Srpska Laus Bosnia and Herz Republika Srpska Ugljevik Bosnia and Herz Republika Srpska Tilava Bosnia and Herz Republika Srpska Miljevina Bosnia and Herz Republika Srpska Dubrava Stara Bosnia and Herz Republika Srpska Lazarevo Results Public Disclosure Copy Project Development Objective Indicators Page 3 of 8 The World Bank Report No: ISR16298 Indicator Name Core Unit of Measure Baseline Current End Target Coverage of population through family Text Value About 58% of pop.; FBH: FBiH: 1,586,000 (69.0%) About 70% of pop.; FBH medicine teams 1,000,000 (2009); RS: RS: 1,193,230 (95.5%) 1,500,000; RS: 1,250,000 Public Disclosure Copy 1,200,147 The census was conducted FBiH: 2.3 M RS: 1.2M Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved The census was conducted FBiH: 2.3 M RS: 1.2M Number of FM teams and health centers in the Text Value RS: 60/650 or about 9% and FBiH: N/A RS: 260 or 40% of FM team RS meeting rigorous accreditation standards 0 health centers RS: 131 accredited plus 70 to meting accreditation be completed by the end of standards; and 35% of health the project centers to meet safety standards Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Final number would be about 200. Below the 260 Systemic implementation of selected Text Value No standard set of preventive FBiH: RBF 4 pilots completed. Active selected preventive preventive services (i.e., hypertension, breast services except for special New report system and services implemented cancer, prostate enlargement, smoking, etc.) annual programs software adopted systemically by all FM teams inat least 2 major FBiH cantons in at least two major cantons RS: N/A Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Health management center operational with Text Value Health management center FBiH: The Health Health management center annual budget and regular work plan not fully operational Management Center operational developed as a unit within the Public Disclosure Copy Federation PH institute. FPHI signed MOU with the School of Economy – fully operational RS: The Health Management Center fully operational Date 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Page 4 of 8 The World Bank Report No: ISR16298 RS and FBiH primary health care strategy Text Value First version completed and FBiH: Operation Plan for 2014 FBH operational plan for PHC operational plan are updated based on adopted updated and adopted reform for 2014 adopted by evidence of sector performance and include FBiH MoH based on evidence consultative process with stakeholders and RS: The RS Primary Health Public Disclosure Copy between entities Care Strategy was updated, and being implemented but not formally approved by Parliament Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of teams operating in family medicine Text Value FBH: 652; RS: 649 FBiH: 793 FBH: 900; RS: 650 RS: 685 Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Partially achieved Number of doctors in operating FM teams who Text Value FBH: 383; RS: 191 FBiH: 436 FBH: 523 specializations in completed specialization 354 working in FM FM; RS: 250 spec. in FM RS: 227 20 specialist are not working as FM Date 22-Mar-2011 19-Sep-2014 Comments New since March 2011 Partially achieved Number of FM doctors in operating FM teams Text Value FBH: 740; RS: 342 FBiH: 986 FBH: 940; RS: 342-no further who completed PAT RS: 148 PAT doctor training in RS Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 FBiH surpassed RS: not achieved Public Disclosure Copy RS: Drs. Moved to other works Number of nurses in operating FM teams that Text Value FBH: 1437; RS: 1031 FBiH: 2070 FBH: 1900; RS: 1300 completed PAT RS: 1273 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 Achieved Page 5 of 8 The World Bank Report No: ISR16298 Number of FM educators (Cathedra Faculty of Text Value FBH: 27; RS: 5 FBiH: 34 FBH: 35; RS: 10 Education Center trainers) with a higher education (masters or PhD) in FM RS: 6 Public Disclosure Copy Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Partially achieved Number of health personnel receiving training Text Value FBH: 3853; RS 2055 FBiH: 4587 FBH: 4000; RS: 3196 RS: 3425 Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Health buildings (physical sites) constructed, Text Value FBH: 79; RS: 56 FBiH:385 FBH: 129; RS: 110 reconstructed, or renovated RS: 409 Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved FM ambulantas constructed, reconstructed or Text Value FBH: 335; RS: 146 FBiH: 455 FBH: 385; RS: 275 renovated (several ambulantas per DZ) RS: 213 Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Family Medicine Offices / ambulantas equipped Text Value FBH: 376; RS: 320 FBiH: 488 FBiH 410; RS 400 with medical equipment and or furniture RS: 409 Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Family Medicine Offices / ambulantas equipped Text Value FBH: 3 DZ (education centers FBiH: Sarajevo and Mostar FBH: ambulantas of 3 with IT and belonging ambulata); RS: completed (300 offices -79 municipalities; RS: 510 510 municipalities RS: 157/201 (510/622) Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Public Disclosure Copy Comments Achieved 12Performance Based contracts signed with Text Value FBH: 0 FBiH: 100 Contracts signed FBH: 100 FM teams (directly or through DZs) in the and implemented Federation RS: N/A Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Page 6 of 8 The World Bank Report No: ISR16298 Development of Federation level rules for the Text Value 0 FBiH: Rules completed FBH rules for HIS health information standards (HIS) RS: N/A Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Public Disclosure Copy Comments New since March 2011 Achieved Support the implementation of PHC information Text Value 0 FBiH: 18 municipalities 3 municipalities systems in about 3 municipalities (Federation) RS: N/A Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 Achieved Development of programs and monitoring tools Text Value 0 FBiH: SW application Programs completed for targeted non-communicable disease operational on pilot sites in 4 preventive programs (Federation) cantons RS: N/A Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments New since March 2011 Achieved Number of trained and equipped community Text Value 0 FBiH: This activity was moved 300 nurses to support FM teams (Federation) to a different project RS: N/A Date 22-Mar-2011 19-Sep-2014 Comments New since March 2011 Number of clinical guidelines developed and Text Value 31 FBiH: N/A 51 disseminated according to needs of FM RS: 31 practitioners (RS) Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments Not achieved Public Health Grants for Innovative Service Text Value FBH: 40 40 + 17 during Additional FBH:55 Delivery (Federation) Financing Date 22-Mar-2011 19-Sep-2014 31-Dec-2014 Comments Achieved Public Disclosure Copy Data on Financial Performance (as of 12-Sep-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P088663 IDA-40470 Closed 31-Mar-2005 05-Sep-2005 03-Apr-2006 15-Dec-2010 31-Dec-2011 P088663 IDA-49120 Effective 22-Mar-2011 05-Jul-2011 27-Dec-2011 31-Dec-2014 31-Dec-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Page 7 of 8 The World Bank Report No: ISR16298 P088663 IDA-40470 Closed XDR 11.20 11.13 0.07 11.13 0.00 100.00 P088663 IDA-49120 Effective XDR 6.50 6.50 0.00 5.65 0.85 87.00 Public Disclosure Copy Disbursement Graph Key Decisions Regarding Implementation not applicable Restructuring History CD Approved on 05-Jun-2009, Level two Approved on 17-Nov-2010 Related Projects Public Disclosure Copy P120285-Health Sector Enhancement Project Additional Financing Page 8 of 8