Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Kyrgyz Health Results Based Financing (P120435) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Specific Investment Loan | FY 2013 | Seq No: 9 | ARCHIVED on 08-May-2017 | ISR25783 | Implementing Agencies: Key Dates Key Project Dates Bank Approval Date:18-Apr-2013 Effectiveness Date:29-Jul-2014 Planned Mid Term Review Date:26-Sep-2016 Actual Mid-Term Review Date:26-Sep-2016 Original Closing Date:30-Jun-2017 Revised Closing Date:30-Jun-2017 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to (1) pilot performance-based payments and/or enhanced supervision for quality of maternal and neonatal care in randomly selected rayon hospitals; and (2) strengthen the Government’s and providers’ capacity in performance-based contracting and monitoring and evaluating for results. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Care:(Cost $9.59 M) Component 2: Strengthen the Government's and Providers' Capacity in Performance-Based Payment Reform and Monitoring and Evaluation f or Results:(Cost $1.41 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Satisfactory  Moderately Satisfactory Overall Risk Rating  High  High Implementation Status and Key Decisions 5/8/2017 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) The Project Mid-term Review was completed in Sept-Nov 2016. Based on that a proposed restructuring is intended to better demonstrate project achievements, give a sufficient time for institutionalization of hospitals RBF, its scale up to all rayon hospitals and to implement PHC RBF/PBF model. Results over a two-year period showed impressive improvements in both intervention arms whereas the control arm remained the same. The project mid-term review (MTR) that took place in MTR in September-October 2016 has confirmed that significant progress was achieved in terms of: (i) roll-out of the results-based financing (RBF) scheme to 42 hospitals (RBF hospitals) and effect of the RBF scheme since the project effectiveness on July 29, 2014, particularly showing a remarkable improvement in quality of services in pilot RBF hospitals from the baseline of 9% in July 2014 to 61-80% in April 2017 in patients’ satisfaction as compared to the control group, which has remained the same; (ii) improved accountability for results and stewardship of financial resources at the hospital level; (iii) contribution to development of Health Management Information System (HMIS) by establishing a web-based platform and tablet-based data collection tool to collect, store, manage and display RBF results. Other than injecting additional resources in the health system (Group 1/RBF hospitals), RBF is contributing to: (i) building capacity in decentralized decision making, empowering hospital managers and core management team to plan for improvements towards improving hospitals services in hospitals; (ii) creating a results-based monitoring and a supportive supervision culture; (iii) promoting team work; (iv) motivating health workers; and (v) holding providers accountable for their results. The RBF scheme has created an interest among providers beyond RBF pilot hospitals. While hospitals have done remarkably well in improving the structural aspects of the quality of services, the clinical processes and content of care are yet to see significant improvements. The project has identified a need for considerable investment in building knowledge, skills and capacity of frontline workers to improve clinical processes and content of care. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Substantial  Substantial Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  High  High Fiduciary  --  Substantial  Substantial Environment and Social  --  High  High Stakeholders  --  Substantial  Substantial Other  --  Low  Low Overall  --  High  High Results Project Development Objective Indicators PHINDPDOTBL  Proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals submitted to MHIF within one week after the end of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/8/2017 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Value 0.00 42.00 42.00 42.00 Date 25-Aug-2014 31-Oct-2016 01-May-2017 30-Jun-2017 Comments Achieved. Proposed modification from "within 2 weeks after the MHIF's receipt of payment invoices to" .. "within 2 weeks after the MHIF's receipt of RBF payments to their bank accounts" to reflect more accurately existing public financial management arrangements PHINDPDOTBL  Proportion of eligible rayon hospitals that received the authorized performance-based payments within two weeks after the MHIF’s receipt of payment invoices (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 22.00 Date 25-Aug-2014 31-Oct-2016 01-May-2017 30-Jun-2017 Comments Achieved. The time period for submission to MHIF is proposed to be modified from 1 week to 30 working days taking into account the country's procedures. As the GOK made a request to include control group of hospitals into the project, it will increase the time needed for completing verifications PHINDPDOTBL  Number of counter-verification carried out for a subset of Group 1 rayon hospitals and Group 2 rayon hospitals every six months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 8.00 Date 25-Aug-2014 31-Oct-2016 01-May-2017 31-Dec-2015 Comments Achieved PHINDPDOTBL  Impact Evaluation Surveys completed on schedule to generate evidence for policy (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/8/2017 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Impact Evaluation Impact Evaluation At least 2 round baseline survey baseline survey of serveys completed before start completed before start Value No surveys implmented by of pilot of pilot the end of the project Date 25-Aug-2014 31-Oct-2016 01-May-2017 30-Jun-2017 PHINDPDOTBL  Average quarterly quality score of Group 1 hospitals (percentage) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9.00 -- 70.00 TBD Date 20-Aug-2014 -- 01-May-2017 30-Jun-2017 Comments Target value TBD after specifying details of scale up of the RBF scheme to all 63 hospitals covering current control group of hospitals (21) Overall Comments Baseline IE survey was completed before start of pilot. There is ongoing data collection for midline IE study which is scheduled to be completed by June 2017 Intermediate Results Indicators PHINDIRITBL  Performance Contracts signed with the Group 1 rayon hospitals (20) and updated annually based on any modifications introduced to the Balanced Scorecard (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 20.00 Date 25-Aug-2014 02-Nov-2014 01-May-2017 30-Jun-2017 Comments Achieved. # of hospitals modified to 22 as the pre-pilot Chui hospital is also in Gr 1 making it 22 in all 5/8/2017 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDIRITBL  Proportion of Group 1 rayon hospitals (20) that received quarterly performance-based payments in accordance to their level of performance as per agreed Performance Contracts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 25-Aug-2014 30-Oct-2015 01-May-2017 30-Jun-2017 Comments Achieved. Slight modification proposed as part of restructuring by correcting # of hospitals from 20 to 22 (increase) PHINDIRITBL  MOH/MHIF produce quarterly monitoring reports within 2 weeks after the end of each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 25-Aug-2014 31-Oct-2016 01-May-2017 30-Jun-2017 Comments Achieved, Slight modification is proposed by changing 2 weeks to 3 weeks as it is not feasible to produce it given the existing budget payment cycle PHINDIRITBL  National RBF Steering Committee meets at least twice a year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 2.00 Date 25-Aug-2014 31-Oct-2016 01-May-2017 30-Jun-2017 Comments Achieved. 5/8/2017 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDIRITBL  Extended RBF team meets at least every 2 months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6.00 6.00 6.00 Date 25-Aug-2014 31-Oct-2016 01-May-2017 30-Jun-2017 Comments Achieved, modification proposed : from once every 2 months to once every 4 months PHINDIRITBL  Average % score BSC indicator 1.7 Red Blood Cell Availability ( GR of hospitals with payment) (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 -- 73.00 75.00 Date 20-Aug-2014 -- 01-May-2017 30-Jun-2017 PHINDIRITBL  Average % score for Category 6 Maternity Department (Group of hospitals with payment) (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 -- 75.00 85.00 Date 20-Aug-2014 -- 01-May-2017 30-Jun-2017 PHINDIRITBL  Average % score for Category 7 Pediatric/Neonatal Department (Group of hospitals with payment) (Amount(USD), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.30 -- 83.00 80.00 Date 20-Aug-2014 -- 01-May-2017 30-Jun-2017 Overall Comments 5/8/2017 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) end targets are determined taking into account potential switch of different groups of hospitals after completion of midline IE Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P120435 TF-13310 Effective USD 11.00 11.00 0.00 5.66 5.34 51% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P120435 TF-13310 Effective 30-Dec-2013 30-Dec-2013 29-Jul-2014 30-Jun-2017 30-Jun-2017 Cumulative Disbursements Restructuring History There has been no restructuring to date. 5/8/2017 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Related Project(s) There are no related projects. 5/8/2017 Page 8 of 8 Public Disclosure Copy