The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Kyrgyz Second Health and Social Protection Project (P126278) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2013 | Seq No: 15 | ARCHIVED on 30-Dec-2019 | ISR39197 | Implementing Agencies: Kyrgyz Republic, Ministry of Health, Ministry of Labor and Social Development Key Dates Key Project Dates Bank Approval Date: 03-May-2013 Effectiveness Date: 11-Jul-2014 Planned Mid Term Review Date: 20-Jun-2016 Actual Mid-Term Review Date: 15-Jun-2016 Original Closing Date: 31-Dec-2018 Revised Closing Date: 31-Dec-2019 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed PDO is to: (i) improve health outcomes in four health priority areas in support of the “Den Sooluk” National Health Reform Program 2012-2016; and (ii) enable the Government's efforts to enhance effectiveness and targeting performance of social assistance and services Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The proposed new PDO is to contribute to improving delivery of quality maternal and child health care services within the “Den Sooluk” National Health Reform Program. Components Table Name Component 1 – Strengthening the delivery of quality MCH care services within eh "Den Sooluk" National Health Reform Program:(Cost $13.50 M) Component 2 – Strenghtening Health System within teh "Den Sooluk" National Health Reform Program:(Cost $3.00 M) Component 3: Contingency Emergency Response (no funds allocated) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions 12/30/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Progress toward achievement of Project Development Objective (PDO) remains as Satisfactory. All five PDO indicators have been achieved compared to the end-of Project target of December 2018, before the extension of the closing date. Specifically, the estimated percentage of normal deliveries in rayon hospitals following clinical protocol was averaged at 84.1%, against the end target of 58% for 2018. For complicated deliveries, the estimate was 42.9%, against the end target of 43%. Nearly 937,000 births were attended by a skilled professional by the end of 2018, compared to the target of 916,000. The proportion of children under 5 with diarrhea being treated with oral rehydration therapy reached 82%, against the target of 80%. Finally, the share of government expenditure for health in 2018 has been confirmed at 13.1%, against the yearly target of 13%. Project closing. The project is now fully disbursed and will close on December 31, 2019. The Project’s Implementation Completion and Results Report, which includes the World Bank’s evaluation of the performance and development outcomes of the project and the Government’s own assessment is under preparation. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- High High Technical Design of Project or Program -- High High Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- High High Environment and Social -- Low Low Stakeholders -- Substantial Substantial Other -- Substantial Substantial Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To contribute to improving delivery of quality maternal and child health care services. IN00763384 ►Proportion of normal deliveries in district (rayon) hospitals that received services following clinical protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.70 91.60 84.10 58.00 Date 01-Jul-2014 31-Dec-2018 30-Jun-2018 31-Dec-2018 Comments on all PDO indicators are provided as an overall comment Comments: 12/30/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) IN00763385 ►Proportion of complicated deliveries in district (rayon) hospitals that received services following clinical protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.50 68.30 42.90 43.00 Date 01-Jul-2014 31-Dec-2018 30-Jun-2018 31-Dec-2018 IN00763391 ►Births (deliveries) attended by skilled health personnel (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 150,000.00 936,943.00 936,943.00 916,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2018 IN00763392 ►Diarrhea treatment with oral rehydration therapy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.00 81.90 81.90 80.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2018 IN00763393 ►Government health expenditure as % of total government expenditure (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.70 13.10 13.10 13.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2018 Overall Comments PDO For the first 2 indicators, the numbers reported for 2019 (which are partial), as well as those which will be available for the ICR, are not comparable with those reported in previous years. The computation method used for 2019 would – for the same data - lead to lower numbers. For technical reasons (including the necessity to review files which are not available at the central level any more and the fact that the RBF unit in moH was dissolved), recomputing a 2019 figure comparable with the 2018 number is not feasible, nor can the 2019 indicator be “retro- extrapolated” to assess, even crudely, whether the data series using the two definitions of the indicators are parallel. It is possible that the trend in performance changed slightly in 2019 though. At the beginning of the year, the Balance-Score Card approach to rewarding performance was embedded into the Government system – whereas before it was managed under the Kyrgyz Health Results Based Financing (RBF) Project. In this process, the level of payment linked to performance was decreased, and verification of the results became less frequent. These both could have affected providers performance and data reporting but not to a considerable extent in the first six months of the project. For the 3 following indicators, results are only available annually and will be updated in the ICR Intermediate Results Indicators by Components Component 1. Strengthening the delivery of quality MCH care services within "Den Sooluk" National IN00763394 ►Number of facilities adequately equipped to provide emergency obstetric and neonatal care (cumulative) (Text, Custom) 12/30/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 10.00 Date 31-Dec-2013 31-Dec-2018 20-Dec-2019 31-Dec-2019 IN00763396 ►Number of pregnant women receiving any antenatal care (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 148,000.00 919,415.00 919,415.00 909,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 IN00763398 ►Number of providers trained in postnatal and postabortal IUD insertion and removal (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 435.00 691.00 200.00 Date 31-Dec-2013 31-Dec-2018 30-Jun-2019 31-Dec-2019 IN00763400 ►Children immunized (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 850,940.00 850,940.00 837,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 These data is reported only yearly. Data for the year 2019 will be available by the end of March 2020. Comments: ICR report will take them into account IN00763403 Children immunized - under 12 months against DTP3 (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 838,848.00 943,651.00 837,000.00 Date 31-Dec-2012 31-Dec-2018 30-Sep-2019 31-Dec-2019 IN00763405 Children immunized - under 12 months against Polio (number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 135,000.00 838,646.00 942,218.00 837,000.00 Date 31-Dec-2013 31-Dec-2018 30-Sep-2019 31-Dec-2019 IN00763406 ►Number of children treated with ORS for diarrhea or with antibiotic for pneumonia (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 53,000.00 163,897.00 163,897.00 177,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 12/30/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) the target was set unrealistically high based on a wrong baseline value, recorded at 53,000 instead of the correct value of 33,000. Therefore, this indicator can be considered achieved in 2018 even though the Comments: actual number is slightly lower than the target (163,897 versus 177,000 respectively). Component 2. Strenghtening Health System within the "Den Sooluk" National Health Reform Program IN00763395 ►Proportion of HIV infected pregnant women that received antiretroviral drugs to reduce risk of mother-to-child transmission (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 96.10 97.70 97.70 95.00 Date 31-Dec-2013 31-Dec-2018 30-Sep-2019 31-Dec-2019 IN00763397 ►Number of family doctors, feldshers, TB doctors and nurses trained on TB clinical protocols and guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8,830.00 12,460.00 3,300.00 Date 31-Dec-2013 31-Dec-2018 30-Nov-2019 31-Dec-2019 IN00763399 ►Number of family doctors, feldshers and nurses trained on CVD (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,451.00 8,038.00 4,500.00 Date 31-Dec-2013 31-Dec-2018 30-Nov-2019 31-Dec-2019 IN00763401 ►Percentage of negative deviations of the executed health budget from the initially approved budget and quarterly allocations and execution of the health budget (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 4.40 4.40 5.00 Date 31-Dec-2012 31-Dec-2018 31-Dec-2018 31-Dec-2019 IN00763402 ►Submission of IFRs satisfactory to IDA within due dates according to Financing Agreement (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2012 31-Dec-2018 30-Nov-2019 31-Dec-2019 IN00763404 ►Proportion of electronically registered families with children receiving social assistance (MBPF) who are electronically registered (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 IN00763407 12/30/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) ►Number of districts where the Social Registry Information System has been fully rolled out (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 54.00 54.00 54.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 The last of the remote districts was connected on-line to the new MIS system, reaching the target of connecting all the districts in the country. Comments: the total number of districts is reduced from 57 to 54 due to recent administrative consolidation.The work on fully paperless operation is ongoing. IN00763408 ►Roadmap to reform disability service developed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2012 31-Dec-2018 31-Dec-2018 31-Dec-2019 Roadmap on the optimization of the system of disability assessment and rehabilitation of people with Comments: disabilties has been prepared, agreed with key stakeholders and is pending endorsement by MLSD. IN00763409 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,921,207.00 1,921,207.00 1,816,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 This indicator is the sum of two sub CRIs: (1) number of children immunized; and (2) number of births delivered by a skilled health personnel. The number of children immunized (children under 5) was not included in the original result framework. Other Corporate Result Indicators are not supported by the Comments: project. IN00763410 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 984,264.00 984,264.00 900,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 IN00763411 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 936,943.00 936,943.00 916,000.00 Date 31-Dec-2013 31-Dec-2018 31-Dec-2018 31-Dec-2019 Overall Comments IR 12/30/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) The most recent data availabe is systematically reported here. For those numbers which will only be available in March 2020, the latest numbers are those reported in December 2018. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P126278 IDA-52350 Effective USD 9.07 9.07 0.00 8.24 0.00 100% P126278 IDA-H8390 Closed USD 7.43 7.43 0.00 6.85 0.00 100% P126278 TF-15135 Closed USD 11.96 11.96 0.00 11.96 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P126278 IDA-52350 Effective 03-May-2013 16-Dec-2013 11-Jul-2014 31-Dec-2018 31-Dec-2019 P126278 IDA-H8390 Closed 03-May-2013 16-Dec-2013 11-Jul-2014 31-Dec-2018 31-Dec-2018 P126278 TF-15135 Closed 05-Feb-2014 28-May-2014 11-Jul-2014 30-Jun-2016 31-Dec-2018 Cumulative Disbursements 12/30/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Kyrgyz Second Health and Social Protection Project (P126278) Restructuring History Level 2 Approved on 16-Nov-2015 ,Level 1 Approved on 07-Mar-2017 ,Level 2 Approved on 07-Apr-2017 ,Level 2 Approved on 17-Sep-2018 Related Project(s) There are no related projects. 12/30/2019 Page 8 of 8