Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Health System Strengthening and Support Project (P152799) EUROPE AND CENTRAL ASIA | Turkey | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 6 | ARCHIVED on 10-May-2018 | ISR32356 | Implementing Agencies: Ministry of Health, Undersecretariat of Treasury Key Dates Key Project Dates Bank Approval Date:21-Sep-2015 Effectiveness Date:26-Nov-2015 Planned Mid Term Review Date:23-Feb-2018 Actual Mid-Term Review Date:13-Apr-2018 Original Closing Date:31-May-2020 Revised Closing Date:31-May-2020 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) of the HSSSP is to improve primary and secondary prevention of selected NCDs, increase the efficiency of hospital management, and enhance the capacity of the MoH for evidence-based policy making. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Primary and Secondary Prevention:(Cost $44.03 M) Increasing Efficiency of Hospital Management and Operations:(Cost $47.65 M) Improving the Effectiveness of Overall Health Sector Administration:(Cost $44.30 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Unsatisfactory  Moderately Unsatisfactory Overall Implementation Progress (IP)  Moderately Unsatisfactory  Moderately Unsatisfactory Overall Risk Rating  Substantial  Substantial 5/10/2018 Page 1 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Implementation Status and Key Decisions This ISR reflects the outcomes of the Mid-term Review (MTR) that took place during the period February 19 to April 13, 2018. A thorough assessment of progress towards achievement of the project development objectives (PDO) in relation to agreed key performance indicators was carried out during the MTR. The MTR confirms the continued relevance of the PDO, but agreed that some of the PDO and intermediate results indicators would require adjustment in (a) their formulation; (b) their target values to reflect progress and challenges; and (c) their definition or content. The following informs on the key activities in support of the PDO implemented at the time of the MTR. -MoH will make 100 Healthy Living Centers (HLCs) fully operational in May 2018, and use Project funds for technical refurbishment of HLCs, staff recruitment, staff training and HLC launch events. HLC physicians, dentists, psychologists, social workers, dietitians, and child development experts will work on changing behavior with regard to the risk factors of chronic disease and addiction. -MoH has so far developed the risk evaluation guidelines for hypertension (HT) and cardiovascular diseases (CVD) and currently works on developing a software and a database for HLC and family medicine staff to track NCDs. -MoH completed several surveys and studies that will help to collect reliable, nationally representative, and internationally comparable data on obesity, diabetes mellitus, nutritional and healthy eating habits to inform policy and develop/adopt campaign messages as well monitor results (i.e. Childhood Obesity Survey - COSI 2016, Turkey Nutrition and Health Survey - 2017) - MoH is conducting various training activities to ensure effective screening for the early detection of cancer. MoH is procuring mammography devices to be placed in the new HLCs or in Cancer Screening Units (KETEMs) to improve the screening coverage. -Concerning the development of hospital management models, a pilot implementation has been done in Istanbul Umraniye district. The findings of the pilot, which are based on the lean management 5S technique will be used to develop guidelines on 5S inventory standards and the model will be expanded to other hospitals. MoH will develop and implement the relevant legislation which will speed up the supply chain processes and increase health facilities’ access to the medical supplies and materials. -MoH has been developing and adopting national e-health standards and legislation to improve the quality of health data and ensure the interoperability of health information systems nationwide and internationally. 12 standards have been adopted in 2017, and 4 more standards will be adopted in 2018. In the remaining duration of the project, GDHIS will be expanding the team of consultants, develop a Requirements Management Software, procure technical hardware and licensing for storage and servers and conduct workshops. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  Substantial  Substantial  High Macroeconomic  Moderate  Moderate  Moderate Sector Strategies and Policies  Low  Moderate  Moderate Technical Design of Project or Program  Moderate  Substantial  Substantial Institutional Capacity for Implementation and Sustainability  Substantial  Substantial  Substantial Fiduciary  Substantial  Substantial  Substantial Environment and Social  Low  Low  Low Stakeholders  Low  Low  Low Other  --  --  -- Overall  Moderate  Substantial  Substantial 5/10/2018 Page 2 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Results Project Development Objective Indicators PHINDPDOTBL  Percent of households that receive from health workers counselling or education related to healthy living (by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 10.00 40.50 11.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDPDOTBL  Percent change of target population using services of Healthy Living Centers (by province, age, gender, education, health status, and by type of services provided) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDPDOTBL  Early detection of (a) cervical (by province and age) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 25.00 26.00 50.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDPDOTBL  Early detection of (b) breast cancer (by province and age) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 43.00 44.00 65.00 5/10/2018 Page 3 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDPDOTBL  Increase in average composite productivity index for all public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDPDOTBL  Percent of policy and decision makers that regularly use HMIS (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 3.00 80.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 Overall Comments Intermediate Results Indicators PHINDIRITBL  Percent of general population who can state two or more negative health impacts of selected risk factors of non-communicable diseases and substance use (by province, age, and gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 5/10/2018 Page 4 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Percent of target population in 8 provinces covered by newly established Healthy Living Centers (by province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Number of individuals in 5 project provinces who visit Substance Use Treatment Centers to receive patient-specific counselling (new and returning visitors) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 90.00 90.00 7,292.00 8,400.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Percent of target population screened for 3 types of cancer: (a) by province (for colorectal and cancer type) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 83.70 81.30 70.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Percent of target population screened for 3 types of cancer : (b) by age (for colorectal and cancer type) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 30.00 30.90 35.60 70.00 5/10/2018 Page 5 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Percent of target population screened for 3 types of cancer: (c) by gender (for colorectal and cancer type) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 22.60 25.70 50.00 PHINDIRITBL  Percent of PHC-level staff who have satisfactorily completed standardized training modules required by the staff’s job profile: (a)distance learning (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 80.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Percent of PHC-level staff who have satisfactorily completed standardized training modules required by the staff's job profile: (b)face-to-face (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 30.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2015 PHINDIRITBL  Number of Public Hospital Unions where newly developed hospital management models implemented (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 89.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 5/10/2018 Page 6 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Standard guidelines and templates for PPP transactions developed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Standard guidelines and No standard No standard No standard templates for Value documentation documentation documentation PPP transactions in place Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  National-level Health System Assessment conducted annually and published (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Y N N Y Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Key information technology standards developed and integrated into updated draft regulations (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 12.00 20.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Percent of health facilities that share data to HMS (a) public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 39.30 55.00 100.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 5/10/2018 Page 7 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Percent of health facilities that share data to HMS (b) family/community health centers (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 57.00 66.00 100.00 PHINDIRITBL  Percent of health facilities that share data to HMS (c) private hospitals (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9.20 14.00 60.00 PHINDIRITBL  Percent of health indicators on Health.Net that meet international standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 70.00 70.00 97.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  At least 12 Health Technology Assessments on prioritized topics prepared in line with new HTA strategy and published (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 4.00 3.00 3.00 12.00 Date 20-Apr-2015 19-Jun-2017 13-Apr-2018 30-Jun-2020 5/10/2018 Page 8 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Direct project beneficiaries (number), of which female (percentage) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 11,411,083.00 2,678,769.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,450.00 3,450.00 40,953.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 3.00 50.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 PHINDIRITBL  Percent of users of Healthy Living Centers satisfied with ease of access to Healthy Living Centers and/or responsiveness of services to users’ individual needs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 20-Apr-2015 19-Oct-2017 13-Apr-2018 30-Jun-2020 Overall Comments 5/10/2018 Page 9 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P152799 IBRD-85310 Effective USD 134.30 134.30 0.00 20.53 113.74 15% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P152799 IBRD-85310 Effective 21-Sep-2015 30-Sep-2015 26-Nov-2015 31-May-2020 31-May-2020 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) 5/10/2018 Page 10 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) There are no related projects. 5/10/2018 Page 11 of 11 Public Disclosure Copy