The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Belarus Health System Modernization Project (P156778) EUROPE AND CENTRAL ASIA | Belarus | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 6 | ARCHIVED on 25-Jun-2019 | ISR37574 | Implementing Agencies: Ministry of Health, Republic of Belarus Key Dates Key Project Dates Bank Approval Date: 18-Nov-2016 Effectiveness Date: 19-May-2017 Planned Mid Term Review Date: 25-May-2020 Actual Mid-Term Review Date: -- Original Closing Date: 31-May-2022 Revised Closing Date: 31-May-2022 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project development objective (PDO) is to contribute to improving selected aspects of the quality of health care delivery in the Republic of Belarus. This PDO is expected to be achieved through the: (a) establishment of e-Health system and adoptionof ICT-based clinical decision-support tools for quality improvement; (b) improvement of clinical competencies of health care providers in non-communicable disease (NCD) management; and (c) modernization of neonatal care provision at the Republic Center of Mother and Child (RCMC). Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Establishment of E-Health and clinical decision support systems:(Cost $65.20 M) Improvement of clinical competencies of health care providers in NCD management:(Cost $46.20 M) Modernization of neonatal care at the RCMC:(Cost $11.60 M) Project management, monitoring and evaluation:(Cost $2.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Progress in Project implementation and the likelihood of achieving the Project development objectives are assessed as Satisfactory thanks to the strong commitment of the Ministry of Health (MoH); Republican Scientific and Practical Center for Medical Technologies, Informatization, Administration and Management in Health (RSPC MT); and other stakeholders involved. The following are key highlights describing Project implementation progress by components. 6/25/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Component 1: Establishment of e-Health and Clinical Decision-support Systems. The bidding document for the first stage of a two-stage bidding process for the procurement of an Electronic Human Resource System and central services (creation of the central software platform for the centralized e-Health system) was published on February 10, 2019 on the Ministry of Health (MoH) website as well as on international platform. The Central Software Platform for the Centralized e-Health System will be available for all health care institutions, including private health care providers. The selection of contractors for conducting design and survey work on the modernization (construction) of local computer networks in healthcare organizations (845 construction sites in 205 health organizations) is underway. Technical documentation has been developed for the system of inventory and monitoring of the program-technical infrastructure of the MoH, a tender has been held to select its developer. At present, the system of inventory and monitoring of the program-technical infrastructure of the MoH is at the stage of operational testing. A draft concept of information security in the healthcare industry has been developed. Requirements for the design and creation of the information protection system of the e-Health system, basic requirements for ensuring information security have been defined. Component 2: Improvement of Clinical Competencies of Health Care Providers in Non-Communicable Diseases Management. The Project Management Unit/RSPC MT, and beneficiary medical education institutions continue to make progress in the implementation of this component, including renovation of medical education facilities and work on simulation training programs for secondary special medical education institutions. Design documents for the construction of the Republican simulation center at BelMAPO are developed. The consultant has carried out engineering and geodetic surveys, architectural solutions were developed with floor plans and preliminary equipment placement; a draft design of the building was prepared. Renovation works in the skills laboratories of 15 medical colleges and Belarus State Medical University are completed. Design works for the Belarus State Medical College is underway. Component 3: Modernization of Neonatal Care at the Republican Center of Mother and Child (RCMC). Bid opening for the construction of the “Mother and Child” facility is planned for August 20, 2019. A clinical decision support system for neonatal intensive care units has been developed and is in the process of approval. The RSMC specialists visited the Russian Federation and the Kingdom of Sweden for training on “Practical issues of nursing in resuscitation and intensive care of newborns". Four anesthesiologists and resuscitation RSMC specialists visited Karolinsky Hospital in Stockholm to receive training on “Practical Aspects and Actual view on the organization of infection control, external support, family care and respiratory support in the conditions of the intensive care unit for newborns”. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Sustainability Substantial Substantial Substantial Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes 6/25/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Improvement of health care delivery quality through establishment of e-health IN00715093 ►Number of oblasts using e-prescription (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 7.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Per the PMU M&E report, e-prescription is already being used in all the seven regions albeit only in a Comments: few health facilities per region, except Minsk city where all facilities use e-prescription. IN00715116 ►Percentage of selected health facilities (PHC centers/ambulatories, polyclinics, hospitals, and diagnostic centers) that can electronically exchange patient summaries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Improvement of clinical competencies of health care providers in NCD management IN00715095 ►Percentage of trained PHC doctors in clinical skills at BelMapo Simulation Training Center and at Medical Universities skills labs according to standards (emergency services among others)-cumulative (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 97.27 50.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 IN00715117 ►Percentage of diabetes patients who received A1C blood sugar test once a year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 30.00 41.40 84.69 80.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 As of 30.01.2019, the total number of registered patients with diabetes is 316,845 people, who underwent Comments: analysis for determining the level of sugar in the blood (A1C) – 268,350 people. That is 84,69%. Modernization of neonatal care IN00715094 ►Percentage increase in survival rate of newborns at the Intensive Neonatal Department of the RCMC (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 78.00 78.00 86.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Intermediate Results Indicators by Components 6/25/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Establishment of E-Health and clinical decision support systems IN00715118 ►Establishment of CHIS implementation unit at the RSPC MT and fully functional (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 1.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Achieved one year earlier than the target year. CHIS implementation unit was established at the RSPC Comments: MT and staffed pursuant to the RSPC MT order No. 31 dated May 19, 2017 and is fully functional. IN00715122 ►Central database operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 IN00715125 ►Percentage of PHC doctors in selected health facilities using clinical decision making tools (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 IN00715128 ►Increase in patients' satisfaction with e-prescription (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 70.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 IN00715131 ►Percentage of PHC doctors in selected health facilities receiving patients' summaries from specialists after hospital discharge (report on all relevant health information sent from specialists to PHC) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Improvement of clinical competencies of health care providers in NCD management IN00715119 ►BelMapo Simulation Center constructed and equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 6/25/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 The indicator is on track: all preparatory activities (necessary permits, feasibility study, contracting of services for development of project and bidding documentation) are being implemented according to Comments: schedule. IN00715123 ►Percentage of participants in training institutions: BelMapo new Simulation Center, medical universities and medical colleges satisfied with the technical effectiveness and quality of training (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 IN00715126 ►Training modules for core specialties at BelMapo new Simulation Center developed and approved by MoH (GP, ER, surgery, obstetrics-gynecology, dentistry, anesthesiology, neonatal) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 7 approved and Value 0.00 11 approved 11 approved implemented Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 On track. Three modules -Surgery, Dentistry, Neonatology-developed in 2017 are approved by MoH on April 6 2018. Eight modules -anesthesiology and resuscitation, ob/gyn, emergency medical care, general Comments: practice, laparoscopy and thoracoscopy; angiosurgery, traumatology and orthopedics, ophthalmology- approved by the MOH on August 22 2018 IN00715129 ►Number of departments in each of the training institutions (BelMapo, medical universities and medical colleges) offering trainings on reproductive health (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 21.00 31.00 22.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 On track. Comments: IN00715132 ►Clinical skill labs in (a) Medical Universities; and (b) Colleges rehabilitated and equipped (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value a) 0; b) 0 a) 0; b) 15 a) 0; b) 0 a) 4; b) 17 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Renovation works completed in 15 medical colleges and BSMU. Comments: IN00715133 ►Number of health care specialists trained in emergency medical care at BelMapo, including using simulation equipment (cumulative) (disaggregated by gender) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,536.00 4,084.00 7,500.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Comments: 4.084 health care specialists were trained in emergency medical care at BelMAPO and other 4 medical universities in using existing simulation equipment 6/25/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Modernization of neonatal care at the RCMC IN00715120 ►Construction of a nursing and breast milk pumping room in the new neonatal department (y/n) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 On track. Preparatory activities are implemented according to schedule. Comments: IN00715124 ►Clinical decision making tool on quality of neonatal care developed and used (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Clinical decision making tool has been developed. The tool can be used once the e-Health system is Comments: operating. IN00715127 ►Neonatal department constructed and equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 On track. The tender for construction works was announced on May 17, 2019. Comments: IN00715130 ►Reduction in average length of stay of infants at the Intensive Neonatal Department (days) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11.50 11.50 11.50 10.00 Date 26-Oct-2016 17-Dec-2018 10-Jun-2019 31-May-2022 Project management, monitoring and evaluation IN00715121 ►Grievances registered related to delivery of project benefits addressed (%) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 26-Oct-2016 30-May-2018 10-Jun-2019 31-May-2022 6/25/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Given the multitude of organizations involved in Project implementation, the MoH coordinates all data collection and actions related to appeals and grievances related to the Project. According to the Comments: PMU/MoH annual Project Progress Report, not a single application has been received and registered in 2018 in relation to the Project implementation. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P156778 IBRD-86630 Effective USD 125.00 125.00 0.00 3.00 122.00 2.4% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P156778 IBRD-86630 Effective 18-Nov-2016 25-Nov-2016 19-May-2017 31-May-2022 31-May-2022 Cumulative Disbursements 6/25/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 6/25/2019 Page 8 of 8