The World Bank Report No: ISR16017 Implementation Status & Results Kazakhstan Health Sector Technology Transfer and Institutional Reform (P101928) Public Disclosure Copy Operation Name: Health Sector Technology Transfer and Institutional Reform Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive Date: 18-Oct-2014 (P101928) Country: Kazakhstan Approval FY: 2008 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 15-Jan-2008 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 31-Oct-2011 Last Archived ISR Date 06-Mar-2014 Effectiveness Date 15-Dec-2008 Revised Closing Date 31-Dec-2015 Actual Mid Term Review Date 31-Oct-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To introduce international standards and build long-term institutional capacity in MOH and related healthcare institutions in support of key health sector reforms pursued by the Government of Kazakhstan in the context of the State Health Care Reform and Development Program. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component A: Health Financing and Management 20.20 Component B: Health Care Quality Improvement 59.90 Component C: Reform of Medical Education and Medical Science 9.40 Component D: Health Information System Development 188.60 Component E: Pharmaceutical Policy Reform 4.20 Public Disclosure Copy Component F: Food Safety and WTO Accession 8.70 Component G: Project Management 4.60 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Page 1 of 10 The World Bank Report No: ISR16017 Implementation Status Overview Project continues to demonstrate good achievements and progress towards PDO. However, there are still several tasks that need to be completed as soon as possible. Public Disclosure Copy Locations Country First Administrative Division Location Planned Actual Kazakhstan Not Entered Shyghys Qazaqstan Oblysy Kazakhstan Not Entered Pavlodar Oblysy Kazakhstan Not Entered Qaraghandy Oblysy Kazakhstan Not Entered Astana Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased funding for Primary Health Care Percentage Value 16.00 26.40 30.00 Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments On track, based on 6 months of 2014. This share increased as a result of significant supplementation and equalization of PHC per capita rate by regions as of January 2014. Improved financial risk protection as defined by Percentage Value 32.90 27.30 30.00 reduced share of household health spending in Date 31-Dec-2010 15-Aug-2014 31-Dec-2015 total health expenditures Comments Exceeded, based on data from NHA report for 2013. Public Disclosure Copy Master plans for capital investments, Number Value 0.00 11.00 4.00 developed based on international best practice, Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 used as a basis for capital investment Comments On track, to be exceeded allocations in at least 4 oblasts covering all 16 regions. Prospective Plans for Oblast Health Infrastructure Development for 2015-2025 already developed and approved by 11 oblasts and will be used as bases for all Page 2 of 10 The World Bank Report No: ISR16017 capital investment allocations for all oblasts starting in 2015. At least two evidence-based disease Number Value 0.00 0.00 2.00 management programs, which include Public Disclosure Copy Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 incentives for health care providers and Comments Delayed. Contract patients, developedand endorsed by the Ministry of Health negotiations with consulting firm (CSIH) selected on SSS basis were terminated due to disagreement on firm's financial proposal. The MOH is preparing to advertise the assignment for competitive selection. Number of public health facilities accredited by Number Value 20.00 127.00 40.00 national accreditation body in accordance with Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 international standards Comments Exceeded. 115 public and 12 private PHC health facilities accredited by national accreditation body in 2013 based on new accreditation standards for outpatient care endorsed by ISQua. 226 health facilities (incl. 179 public) are on list subject to accreditation in 2014. ICT standards, which conform with Text Value No standards 12 25 international standards and include Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 interoperability standards, are endorsed by Comments On track. 12 standards Health ICT Regulatory Body and published endorsed and published on MOH's website. Development of 3 more standards is underway to be approved and Public Disclosure Copy published by end-2014. Intermediate Results Indicators Page 3 of 10 The World Bank Report No: ISR16017 Indicator Name Core Unit of Measure Baseline Current End Target Increased capacity for health policy analysis Number Value 0.00 4.00 4.00 (as measured by number of national analytical Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Public Disclosure Copy reports produced annually) Comments On track, to be fully achieved by end-2014. 4th analytical report on health system financing and performance (based on all past NHA reports brought in consistency with SHA-2 and using disaggregated indicators and OECD standards) to be completed by end-2014. NHA reports produced annually, disaggregated Yes/No Value Yes Yes Yes by national and sub-national levels, and Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 disseminated among key stakeholders Comments NHA 2010 aggregated at On track: NHA 2013 with data Four NHA reports to be national level disaggregated at oblast level prepared by 2015. and compliant with SHA-2 to be completed in Q4. New network planning tools and new facility Text Value New hospital planning tools New network planning tools New tools and standards for standards formally adopted by the Ministry of and standards developed and standards for laboratories planning hospitals, laboratory Health and PHC facilities reflected in and PHC facilities formally the new state standard of adopted health facilitynetwork (GoK decree #114 dated Feb.19, 2014). Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Achieved. Master plans for capital investments developed Number Value 5.00 16.00 16.00 for 16 regions based on international best Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 practice Comments Achieved. All 16 master plans Public Disclosure Copy developed, now in addition to hospitals also including PHC facility, and lab networks. Oblast-level health network master plans Number Value 0.00 11.00 4.00 endorsed for at least 4 oblasts Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Exceeded, to be endorsed for all 16 regions. Recommendations from master plans for hospitals, Page 4 of 10 The World Bank Report No: ISR16017 PHC facilities, and laboratories developed for all 16 regions provided the bases for Prospective Plans for Public Disclosure Copy Oblast Health Infrastructure Development for 2015-2025, 11 of which were approved by oblasts. Evidence-based incentives for providers in Text Value No evidence-based incentives Evidence-based incentives for Optimized set of evidence- disease management programs implemented for providers providers not yet implemented based incentives and pay-for- in practice. performance mechanisms for providers implemented Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Delayed. Contract negotiations with consulting firm (CSIH) selected on SSS basis were terminated due to disagreement on firm's financial proposal. The MOH is preparing to advertise the assignment for competitive selection. Incentives introduced, including revision of co- Text Value No incentives for patients Incentives for patients not yet Optimized set of incentives for payments, for patients to comply with diseases implemented in practice. patients implemented management programs Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments Delayed. Contract negotiations with consulting firm (CSIH) selected on SSS basis were terminated due to disagreement on firm's financial proposal. The MOH is preparing to advertise the assignment for competitive Public Disclosure Copy selection. Criteria, procedures and standards for Text Value Health facility accreditation Criteria, procedures and Accreditation criteria, accreditation of health facilities developed, standards developed standards for accreditation of procedures and standards adopted and implemented in line with health facilities implemented renewed international practice in line with international practice through annual accreditation process. Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments On track. 115 public and 12 private PHC health facilities Page 5 of 10 The World Bank Report No: ISR16017 accredited by national accreditation body in 2013 based on new accreditation standards for outpatient care Public Disclosure Copy endorsed by ISQua. 226 in- and outpatient health facilities (incl. 179 public) are on list subject to accreditation in 2014. Evidence-based CPGs for selected disease Text Value No CPGs for disease 3 CPGs for selected disease CPGs for disease management programs developed management programs management programs management programs developed/adapted. implemented Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments On track. CPG for diabetes adapted and piloted; CPGs for hypertension and chronic heart insufficiency adapted (three CPGs correspond to three selected disease management programs. Increase in share of voluntary blood donations Percentage Value 83.00 87.00 88.00 by 2015 Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments 2014 target of 86% achieved, based on 6 months of 2014. Decrease in absolute number of paid donations Number Value 38800.00 19819.00 33400.00 by 2015 Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments The target of 37,700 for 2013 was not achieved (actual value for 2013 was 41,931). Although there is a decreasing trend for the past few years, the 2014 target of Public Disclosure Copy 35,600 is also unlikely to be achieved because of inaccurate initial baseline and targets (actual baseline in 2011 was 48,217 instead of 38,800 reported at restructuring). Slow progress due to delayed engagement of international TA. Page 6 of 10 The World Bank Report No: ISR16017 Criteria, procedures and standards for Text Value No educational programs Developed draft documents Educational programs for accreditation of basic medical education accredited for institutional accreditation “General Medicine” of two programs developed, adopted and of medical universities and medical universities implemented in linewith international practice specialized accreditation of accredited Public Disclosure Copy General Medicineeducational program are being reconciled with Ministry of Education and Science. Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Delayed due to late engagement of international IT (RFP re-advertised in July due to only one, unresponsive technical proposal in first round). IT-infrastructure for deployment of UHMIS in Text Value IT infrastructure developed in IT infrastructure developed in IT infrastructure developed in selected oblasts developed by the Ministry of 140 health organizations 290 health organizations 2,000 health organizations Health Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Change in approach. As part of new e-Health Concept, only central level e-Health infrastructure (Interoperability Platform and DataProcessing Centers) and decentralized MIS in 10 pilot health facilities are to be developed under the project. Given the "critical elements first" approach under the e-Health Road Map and potentially reduced counterpart funding allocation for 2015, deployment of IT infrastructure to health Public Disclosure Copy facilities country-wide is to be done through the MOH's own designated budget program. Functional ICT standards in line with major Text Value No functional ICT standards 2 functional ICT standards in 25 functional ICT standards international functional standards developed by place (Electronic Health Health ICT Regulatory Body Record and Electronic Medical Record) Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments On track. 2 out of 3 functional Standards developed and standards planned for 2014 Page 7 of 10 The World Bank Report No: ISR16017 developed; development of 3 published and used for more functional standards is market. underway (drugprescriptions, exchange of diagnostic study Public Disclosure Copy results, and e-prophylactics) to be completed by end-2014 (actual value in previous ISRand end target were indicated by mistake since not all ICT standards being developed are functional standards - correct values: 3 functional standards in 2014, 5 functional standards in 2015). Drug price reference system for drugs included Text Value Ceiling prices for drugs set Drug price reference system Reference drug prices refined in the National Formulary Book developed and not yet in place based on implementation adopted by the Ministry of Health experience Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Delayed. Additional activities on drug price reference system through collaboration with PPRI, capacity building, and creation of a dedicated pricing unit were included in the TA firm's contract in February 2014, with grounds for implementation to be in place byend-2014. Legal and regulatory documents related to Text Value Recommendations on Tehnical activities to initiate HACCP system post-processing food standards revised in revision of 26 food safety implementation of HACCP implementation in food accordance with international standards norms and rules, 25 technical system to start in September industry expanded regulations, and on 2014. amendments to the Law on Public Disclosure Copy Food Safety developed Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments On track. Two int'l TA contracts for introduction of HACCP system (national- level regulation and piloting at food industry level) concluded, with experts' first Page 8 of 10 The World Bank Report No: ISR16017 visit planned starting September 1. Project work plans, procurement plans, and Yes/No Value Yes Yes Yes budget produced and approved on an annual Public Disclosure Copy Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 basis as described in the Project Operational Comments On track after a long delay. Manual Procurement Plan cleared by Bank in January 2014, with two amendments cleared in February and June 2014. About KZT 3 bln of counterpart funding from approved project budget for 2014 (KZT 7.3 bln) will be returned due to delays with disbursing these funds to e- Health systems procurement. Health personnel receiving training (number) Number Value 10720.00 92293.00 63066.00 Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Exceeded. Health facilities constructed, renovated, and/or Number Value 160.00 305.00 2058.00 equipped (number) Date 31-Dec-2011 15-Aug-2014 31-Dec-2015 Comments Target of 1,058 for 2014 unlikely to be achieved due to deployment of IT infrastructure to health facilities country-wide will likely be done through the MOH's own designated budget program Data on Financial Performance (as of 11-Sep-2014) Public Disclosure Copy Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101928 IBRD-48830 Effective 15-Jan-2008 02-Feb-2008 15-Dec-2008 30-Jun-2013 31-Dec-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101928 IBRD-48830 Effective USD 117.70 117.70 0.00 55.19 62.51 47.00 Disbursement Graph Page 9 of 10 The World Bank Report No: ISR16017 Public Disclosure Copy Key Decisions Regarding Implementation After adopting ICt strategy based on international best practice, Ministry of Health merged with Ministry of Social affairs and Labor indicating strong orientation towards comprehensive approach towards social sectors. Further, after top level policy discussion and intense research, the Government decided to start preparation for introduction of purchasing function while sustaining universal coverage. Restructuring History Level two Approved on 12-Oct-2012 Related Projects There are no related projects. Public Disclosure Copy Page 10 of 10