Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) EAST ASIA AND PACIFIC | Cambodia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 4 | ARCHIVED on 30-Jul-2018 | ISR32727 | Implementing Agencies: Ministry of Health, Kingdom of Cambodia, Ministry of Health Key Dates Key Project Dates Bank Approval Date:19-May-2016 Effectiveness Date:09-Nov-2016 Planned Mid Term Review Date:28-Sep-2018 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) To improve access to quality health services for the targeted population groups with protection against impoverishment due to the cost of health services in the Kingdom of Cambodia. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1: Strengthening Health Service Delivery:(Cost $74.20 M) Component 2: Improving Financial Protection and Equity:(Cost $70.00 M) Component 3: Ensuring Sustainable and Responsive Health Systems:(Cost $30.00 M) Component 4: Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Overall Risk Rating  Substantial  Substantial 7/30/2018 Page 1 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Implementation Status and Key Decisions Despite initial rollout delays, project implementation is now progressing well and has made considerable progress since project effectiveness on November 9, 2016. Lump sum grants financed by the Royal government of Cambodia are flowing to the health facilities on time, and these funds are now complemented by performance based grants for about one-third of the country. SDG phase 2 roll-out is expected to be in the fourth quarter of 2018, and with the recruitment of an ICT firm to support the Service Delivery Grants expected in July 2018, the SDG rollout should be nationwide by early 2019, fully using ICT tools. Payment of Health Equity Fund (HEF) is on time, and transition of HEF monitoring role to the Payment Certification Agency is on track. HEF was expanded to five national hospitals in April 2018, and the new Prakas on HEF benefit package was approved in May 2018. HEF Promoters to support the Post-Identification process and promoting HEF services are now on board in all six regions of the country. 7/30/2018 Page 2 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) 7/30/2018 Page 3 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) 7/30/2018 Page 4 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  Substantial  Substantial  Substantial Macroeconomic  Moderate  Substantial  Substantial Sector Strategies and Policies  Moderate  Substantial  Substantial Technical Design of Project or Program  Substantial  Substantial  Substantial Institutional Capacity for Implementation and Sustainability  Substantial  Substantial  Substantial Fiduciary  High  Substantial  Substantial Environment and Social  Moderate  Moderate  Moderate Stakeholders  Moderate  Substantial  Substantial Other  --  --  -- 7/30/2018 Page 5 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Overall  Substantial  Substantial  Substantial Results Project Development Objective Indicators PHINDPDOTBL  Increase in the number of health centers exceeding 60% score on the quality assessment of health facilities. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 49.00 46.00 392.00 300.00 Date 30-Apr-2016 05-Oct-2017 24-Apr-2018 30-Jun-2021 Comments Notes: Notes: Out of 1,191 targeted HCs, 453 HCs were assessed in Q1 2018 (Phase I). Among those assessed, 392 HCs (or 86.53%) exceeded 60% scores, and only 61 HCs got the scores below 60%. It should be noted that among 454 HCs assessed in 2017, one HC in Preah Vihear (Chom Ksan HC) was upgraded to CPA1-RH according to the MoH Prakas (Statement) issued on 27th Feb, 2018. Thus only 453 HCs were assessed in 2018. In addition, a new HC (Sen Sok Rong Roeung 5) was built and will be included in the next round (R4) quality assessment Source: MoH Service Delivery Grant disbursement for 3rd round assessment (Q1/2018). PHINDPDOTBL  Reduction in the share of households that experienced impoverishing health spending during the year. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.90 0.90 -- 0.70 Date 30-Oct-2015 05-Oct-2017 -- 30-Jun-2021 Comments Notes: Baseline is from Cambodia Socioeconomic Survey (CSES) 2014. The CSES 2016 report is still in the printing house as reported by the National Institute of Statistics/Ministry of Planning, and will be ready for distribution in few more weeks from now. The 2017 CSES report may be available around October or November 2018. Source: NIS focal person. PHINDPDOTBL  Reduction in out of pocket health expenditure as percentage of the total health expenditure. (Percentage, Custom) 7/30/2018 Page 6 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Baseline Actual (Previous) Actual (Current) End Target Value 62.30 -- -- 55.00 Date 30-Oct-2015 -- -- 30-Jun-2021 Comments Notes: Baseline from National Health Account (NHA) 2013, actual (previous) from NHA 2014. The 2016 NHA was already submitted by WHO to MoH (early April 2018) for approval, and it is expected to be disseminated in July 2018. PHINDPDOTBL  Increase in the utilization of health services by HEF beneficiaries. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 -- -- 81.00 Date 30-Oct-2015 -- -- 30-Jun-2021 Comments Note: The National Health Congress (NHC) only recorded number of cases and not individual HEF users who utilized OPD services at HC and hospitals. This indicator will be replaced by “Increase in the number of outpatient services (episodes) covered by HEF” in the upcoming Additional Financing/Restructuring. Overall Comments Intermediate Results Indicators PHINDIRITBL  Percentage of health centers having stock-outs of 14 essential medicines. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 4.73 -- -- 5.00 Date 30-Oct-2015 05-Oct-2017 -- 30-Jun-2021 Comments 7/30/2018 Page 7 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Note: The 2018 NHC report did not include this indicator and despite all efforts by the team to obtain this from MOH it has not been possible until now. It has thus been agreed to drop this indicator from the project. However, given the importance of monitoring this indicator, it will be monitored through the results of quality scorecards under the National Quality Enhancement Monitoring Process which also report on drug availability. PHINDIRITBL  Proportion of health centers with functioning health center management committees. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64% -- 75% Baseline + 25% Date 24-Mar-2017 05-Oct-2017 24-Apr-2018 30-Jun-2021 Comments Note: This data is from the 2018 NHC, p175. It is still below the target of 85% in 2017. PHINDIRITBL  Percentage of health center, CPA-1, CPA-2, and CPA-3 facilities that receive payments based on performance that includes quality scores within 90 days of the end of the quarter. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 30-Oct-2015 05-Oct-2017 24-Apr-2018 30-Jun-2021 Comments all assessed health facilities already received this payment around 28-30 March (DBF released this payment on 23rd March). Source: DBF focal person. 7/30/2018 Page 8 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) PHINDIRITBL  Reduction in the variance in score on Health Center quality assessment. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 43 percentage Value 53 percentage points -- 60.65% points Date 30-Oct-2015 -- 24-Apr-2018 30-Jun-2021 Comments Notes: The highest score was 97.20% and the lowest score was 36.55%. Thus, the variance range is: 97.20% - 36.55% = 60.65% The lowest score of the ex-ante assessment at HC level was increased from 8.13% in May 2017 to 36.55% in Jan 2018 after 2 rounds of coaching by OD assessors to help the poorly performing facilities. The variance is expected to become lower when MOH/QAO share a standard coaching guideline which will improve the coaching quality. Source: MoH Service Delivery Grant disbursement for 3rd round assessment (Q1/2018). PHINDIRITBL  Percentage of CPA-1, CPA-2 and CPA-3 facilities having a 60% quality score in the previous quality assessments. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Not yet available Value -- 59.5% Baseline +50% Date 30-Oct-2015 05-Oct-2017 24-Apr-2018 30-Jun-2021 Comments All 42 CPA1, CPA2 and CPA3 Hospitals (including 29 district RH and 13 Provincial RHs) were assessed in Q1, 2018. Twenty-five hospitals (or 59.5%) have 60% scores in the Q3 quality assessment. Source: MoH 3rd round assessment results (Q1/2018). PHINDIRITBL  Outpatient Department (OPD) consultations (new cases only) per person per year. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.59 -- 0.71 0.95 Date 30-Oct-2015 -- 24-Apr-2018 30-Jun-2021 Comments Notes: OPD new case per person/year is 0.71 in 2017 (from both public and private health facilities). 7/30/2018 Page 9 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) PHINDIRITBL  Number of University of Health Sciences courses that adopt competency-based curricula with trained faculty and use of skills laboratory (DLI 1). (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 25.00 Date 30-Jul-2016 05-Oct-2017 01-Jul-2018 30-Jun-2021 Comments No further increases have been possible so far- this is expected to progress rapidly in the near future with the UHS receiving its DLI funds now. Source: MoH Submission letter to WB dated Jan 30, 2018 on Supplementary Report on DLIs for Year 1 from Aug 2017 through Jan 2018. PHINDIRITBL  Percentage of health centers, hospitals and OD/PHD receiving HEF and SDG payments within specified timelines (DLI 7). (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 30-Oct-2015 05-Oct-2017 24-Apr-2018 30-Jun-2021 Comments Source: DBF administrative data 7/30/2018 Page 10 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) PHINDIRITBL  Percentage of HMIS reports submitted on time. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 95.00 95.00 100.00 95.00 Date 30-Oct-2015 05-Oct-2017 24-Apr-2018 30-Jun-2021 Comments Note: This data is from the 2018 National Health Congress (NHC) Overall Comments Note: This data is from the 2018 National Health Congress (NHC) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P157291 IDA-58130 Effective USD 30.00 30.00 0.00 9.02 21.43 30% P157291 TF-A2562 Effective USD 1.00 1.00 0.00 0.24 0.76 24% P157291 TF-A3114 Effective USD 20.00 20.00 0.00 15.03 4.97 75% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P157291 IDA-58130 Effective 19-May-2016 26-Aug-2016 09-Nov-2016 30-Jun-2021 30-Jun-2021 P157291 TF-A2562 Effective 19-May-2016 15-Sep-2016 15-Sep-2016 30-Jun-2020 30-Jun-2020 P157291 TF-A3114 Effective 19-May-2016 26-Aug-2016 09-Nov-2016 30-Jun-2021 30-Jun-2021 Cumulative Disbursements 7/30/2018 Page 11 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Restructuring History There has been no restructuring to date. Related Project(s) P167351-Additional Financing for Health Equity and Quality Improvement Project (H-EQIP) 7/30/2018 Page 12 of 12 Public Disclosure Copy