Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) EUROPE AND CENTRAL ASIA | Kazakhstan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 4 | ARCHIVED on 10-Jan-2018 | ISR31114 | Implementing Agencies: Ministry of Health, Ministry of Health, Ministry of Finance Key Dates Key Project Dates Bank Approval Date:27-Apr-2016 Effectiveness Date:27-Jun-2017 Planned Mid Term Review Date:11-Nov-2019 Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2021 Revised Closing Date:30-Jun-2021 Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed Project Development Objective is to improve accessibility, quality, and efficiency of health service delivery, and reduce financial risks to the population that are caused by serious health problems. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1. Supporting implementation of the national mandatory Social Health Insurance system:(Cost $16.63 M) Component 2. Strengthening of health service delivery to support implementation of the national mandatory Social Health Insurance system:(Cost $62.94 M) Component 3. Project management, monitoring and evaluation, and communications strategy:(Cost $10.43 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Satisfactory  Moderately Satisfactory Overall Risk Rating  Substantial  Substantial 1/10/2018 Page 1 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Implementation Status and Key Decisions This Project was approved by the World Bank Board of Executive Directors on April 27, 2016. Following the signing of the Loan Agreement on November 1, 2016, it was ratified by the Parliament on May 11, 2017, with the ratification Law signed by the President on May 30, 2017. Following the fulfillment by the Government of Kazakhstan of all the required legal conditions stipulated in the Loan Agreement, the Loan was declared effective on June 27, 2017. After some delays in launching the envisaged technical activities, the pace of Project implementation is accelerating with various Project activities being at different stages of procurement processes. In terms of the implementation of the Mandatory Social Health Insurance (MSHI) system, which the Project was designed to support, the country leadership took the decision to postpone the full-fledged implementation of the MSHI system by two years to January 2020. This period is considered necessary to fully prepare for the MSHI implementation. Given the postponement of the MSHI implementation, the Ministry of Health and the Bank team agreed to restructure the Project in order to adjust the target values of the Project monitoring indicators to the new timeline of the MSHI implementation. At the same time, the opportunity could be taken to critically review definitions and targets of all the Project indicators as well as the scope and timeline of technical activities. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  Moderate  Moderate  Moderate Macroeconomic  Substantial  Substantial  Substantial Sector Strategies and Policies  Substantial  Substantial  Substantial 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  Substantial  Substantial  Substantial Overall  Substantial  Substantial  Substantial Results Project Development Objective Indicators PHINDPDOTBL  Increase public expenditure share for PHC + consultation and diagnostic care + outpatient drugs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 35.00 36.28 40.00 1/10/2018 Page 2 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Date 18-Sep-2015 -- 15-Dec-2017 30-Jun-2021 PHINDPDOTBL  Percent of all surgeries included in the “outpatient elective surgeries” list performed as outpatient surgeries in project- supported hospitals and outpatient facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 5.00 5.00 50.00 Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDPDOTBL  Percent of all contracted inpatient services subject to technical audit (annually) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 20.00 20.00 40.00 Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDPDOTBL  SHIF is fully functional based on predefined criteria (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDPDOTBL  Decline in the proportion of the bottom 40% of households incurring out-of-pocket expenditures on health that exceed 10% of total non-food related household spending over a 12-month period (Percentage, Custom) 1/10/2018 Page 3 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Baseline Actual (Previous) Actual (Current) End Target Value 9.30 9.30 9.30 6.50 Date 31-Dec-2013 -- 15-Dec-2017 30-Jun-2021 Overall Comments No changes in the values of PDO indicators given (i) the delays in technical activities and (ii) the decision to postpone MSHI implementation, with the latter requiring a Project restructuring. Intermediate Results Indicators PHINDIRITBL  Percent of population for whom SHIF received SHI contributions/subsidies and people with access to an insurance package of health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDIRITBL  People with access to an insurance package of health services (Number (Thousand), Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10,500.00 PHINDIRITBL  Achievement of key benchmarks for functioning social health insurance system (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 1/10/2018 Page 4 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) PHINDIRITBL  Key adjustments in the contracting methods are adopted to include incentives for providers to improve quality (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N -- N Y Date 18-Sep-2015 -- 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Number of fully functional regional PHC excellence centers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 16.00 Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Number of regions implementing disease management programs with evidence-based effectiveness, including incentives for health providers and patients (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 7.00 7.00 16.00 Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Percent of health facilities meeting International Patient Safety Goals (minimum 5 points) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 10.00 10.00 50.00 Date 31-Dec-2014 09-Jun-2017 15-Dec-2017 30-Jun-2021 1/10/2018 Page 5 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) PHINDIRITBL  Number of educational programs developed and implemented in medical education institutions based on competence-based approach and professional standards through strategic partnerships (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 5.00 Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Unified register of human resources for health implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10,000.00 Date 18-Sep-2015 09-Jun-2017 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 52.00 1/10/2018 Page 6 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) PHINDIRITBL  Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 3,400.00 Date 18-Sep-2015 -- 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 50.00 Date 18-Sep-2015 -- 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Percentage of patients reporting improved health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 50.00 70.00 Date 18-Sep-2015 -- 15-Dec-2017 30-Jun-2021 PHINDIRITBL  Increase in transparency, credibility, and effectiveness of the complaints handling system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 60.00 Date 18-Sep-2015 -- 15-Dec-2017 30-Jun-2021 Overall Comments No changes in the values of Intermediate Results indicators given (i) the delays in technical activities and (ii) the decision to postpone MSHI implementation, with the latter requiring a Project restructuring. 1/10/2018 Page 7 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P152625 IBRD-86170 Effective USD 80.00 80.00 0.00 0.17 79.83 0.2% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P152625 IBRD-86170 Effective 27-Apr-2016 01-Nov-2016 27-Jun-2017 30-Jun-2021 30-Jun-2021 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) 1/10/2018 Page 8 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) There are no related projects. 1/10/2018 Page 9 of 9 Public Disclosure Copy