The World Bank Report No: ISR9878 Implementation Status & Results Croatia Development of Emergency Medical Services and Investment Planning Project (P086669) Public Disclosure Copy Operation Name: Development of Emergency Medical Services and Project Stage: Implementation Seq.No: 10 Status: ARCHIVED Archive Date: 31-Mar-2013 Investment Planning Project (P086669) Country: Croatia Approval FY: 2009 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 30-Sep-2008 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 29-Feb-2012 Last Archived ISR Date 26-Dec-2012 Effectiveness Date 15-Jan-2009 Revised Closing Date 31-Dec-2013 Actual Mid Term Review Date 08-Mar-2012 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project objective is to improve the efficiency and outcomes of the Emergency Medical Services system and to strengthen the capacity of the Ministry of Health and Social Welfare to develop and implement strategic projects. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Development of EMS 124.60 Institutional Support to MoHSW for Strategic Planning 2.60 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview This ISR reflects the findings of the implementation support visit conducted from March 11 to 15, 2013. There is noticeable progress in the implementation of key project activities contributing to the achievement of the Project Development Objectives. Twenty-one Emergency Medical Services (EMS) Centers are now fully functional since November 2012 and two additional hospital EMS Departments and Emergency Services have been established, reaching 9 (target achieved). An additional 12 EMS Departments and Emergency Services will receive equipment by July 2013. The procurement of telemedicine equipment has also been Page 1 of 7 The World Bank Report No: ISR9878 launched. The project is also supporting several technical assistances including the development of the Hospital Masterplan, the outsourcing plan for hospitals services and the development of the pipeline of projects for European Union (EU) funding. A second phase of developing proposals to access EU funds is ongoing. Public Disclosure Copy Locations Country First Administrative Division Location Planned Actual Croatia Not Entered Bjelovarsko-Bilogorska Zupanija Croatia Not Entered Brodsko-Posavska Zupanija Croatia Not Entered Dubrovacko-Neretvanska Zupanija Croatia Not Entered Istarska Zupanija Croatia Not Entered Karlovacka Zupanija Croatia Not Entered Koprivnicko-Krizevacka Zupanija Croatia Not Entered Krapinsko-Zagorska Zupanija Croatia Not Entered Licko-Senjska Zupanija Croatia Not Entered Medimurska Zupanija Croatia Not Entered Osjecko-Baranjska Zupanija Croatia Not Entered Pozesko-Slavonska Zupanija Croatia Not Entered Primorsko-Goranska Zupanija Croatia Not Entered Sibensko-Kninska Zupanija Croatia Not Entered Sisacko-Moslavacka Zupanija Croatia Not Entered Splitsko-Dalmatinska Zupanija Public Disclosure Copy Croatia Not Entered Varazdinska Zupanija Croatia Not Entered Vukovarsko-Srijemska Zupanija Croatia Not Entered Zadarska Zupanija Croatia Not Entered Zagrebacka Zupanija Croatia Not Entered Grad Zagreb Croatia Not Entered Viroviticko-Podravska Zupanija Page 2 of 7 The World Bank Report No: ISR9878 Results Project Development Objective Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Field calls as percent of total calls (increase). Text Value 9.7% 100% 75% Date 30-Sep-2008 07-Sep-2012 30-Jun-2013 Comments Exceeded. All field calls are now related to the emergency system and no ambulances or emergency teams are being deployed for medical transportation or discharges EMS teams per capita (decrease cross-county Text Value Coefficient of variation = 0.450 Coefficient of variation=0.20 variation) 0.503 (2005) (2013) Date 30-Sep-2008 31-Dec-2012 30-Jun-2013 Comments Cross-county variation would be reduced to 0.3, but it will not achieve the target (0.2) because different population densities andgeographical distances cannot have similar number of teams per inhabitants in all regions Improved emergency care outcomes in pre- Text Value a.i. 100% Polytrauma 90% Trauma: 90% Cardiac: 35% hospital emergency care (a) percentage of (a.i) a.ii. 96.5% Cardiac arrest 40% poly-trauma and (a.ii) cardiac arrest Date 30-Jun-2010 31-Dec-2012 30-Jun-2013 caseswhich survive to hospital ER admission Comments Exceeded Project targets Improved emergency care outcomes as Text Value bi. 100% Polytrauma 92%d Trauma: 90% Cardiac: 35% evidenced by (b) better outcomes in in-hospital bii. 86% Cardiac arrest 79% emergency care as indicated (b.i) poly-trauma Date 30-Jun-2010 31-Dec-2012 30-Jun-2013 and (b.ii) cardiac arrest cases which survive 48 Public Disclosure Copy Comments Exceeded. Data reflects all 9 hours existing hospitals with integrated emergency reception area Active involvement of MoH in EU funds Text Value None 35 staff trained and 5 draft 4 applications utilization (measured through dedicated staff, applications Number of applications prepared by MoH, Date 30-Sep-2008 15-Mar-2013 30-Jun-2013 funds leveraged) Comments Achieved. Accession of Croatia to the EU is expected to take place on July 1st, Page 3 of 7 The World Bank Report No: ISR9878 2013. A new set of proposals are being developed. Intermediate Results Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Number of health professionals who have (i) Text Value None 1) 250; 2) 206 (i) 200 (ii) 220 begun training in EMS specialty according to Date 30-Sep-2008 31-Mar-2012 30-Jun-2013 national guidelines and (ii) received certification Comments Target achieved Establishment of the enabling legislative Text Value 0 of 5 5 Not Applicable environment for (i) EMS financing, (ii) Date 30-Sep-2008 24-Jun-2010 30-Jun-2013 separating of pre-hospital emergency services Comments Target achieved. In addition from PHC, (iii) establishing national management arrangements to the 3 listed under the indicator name, the following 2 legislations were adopted to: (iv) integrateemergency areas; and (v) recognize the EMS specialty. Croatian Institute of EMS has been established Text Value Institute not established Institute established and The CIEMS established and and is functioning. functioning andfunctioning Date 30-Sep-2008 30-Jun-2009 30-Jun-2013 Comments Target met. County variation in field calls per capita Text Value Coefficient of variation = 0.306 Coefficient of variation = 0.35 (decrease). 0.604 (2005) (2013) Date 30-Sep-2008 31-Dec-2012 30-Jun-2013 Comments Greater number of EMS units are reporting field calls Percent of counties with EMS dispatch centers Text Value 4.8% (1 center, 112 only) 21 EMS linked to #112. Not Applicable linked to 112 and TETRA 1 to TETRA Date 30-Sep-2008 07-Sep-2012 30-Jun-2013 Public Disclosure Copy Comments Response times from receipt of call to time at Text Value Average response time to 12.1 80% meet 10 minutes urban, the scene scene is 16.8 minutes, with 20 minutes rural 28% of calls in less than or equal to 8 minutes, 20% less than or equal to 6 minutes Average time from scene to hospital is 41.5 minutes Date 30-Sep-2008 31-Dec-2012 30-Jun-2013 Page 4 of 7 The World Bank Report No: ISR9878 Comments This indicator was built using average times for “red� and “orange� priorities. It was agreed that the indicator Public Disclosure Copy should only include red priority cases. Given the lack of an operational definition of urban and rural areas, the system still reports the average time of all emergency calls. Nevertheless, the average is very close to the target for urban calls. Percentage of ER visits coming by ambulance Text Value (i) 38% cardiac 45% MVA MVA 47%c (i) 46% cardiac 56% MVA (i) for selected diagnoses (MVA, cardiac, 45% multiple symptoms (ii) Cardiac 35% 52% multiple symptoms (ii) multiple symptoms); and (ii) where symptoms 62% of patientscoming to 80% starting<= 12 hours began in the last 12 hours hospital by ambulance had symptoms starting 12 hours orless Date 30-Sep-2008 07-Sep-2012 30-Jun-2013 Comments Multiple symptoms related- indicator and b) where symptoms began in the last 12 hours are dropped given that these indicators are not well defined and not used. Elapsed time between arrival in emergency Text Value Average stay in emergency 148 min Avg: 75 <60 mins: 80% receiving area and hospital admission or admittance to hospital for 33% discharge heart failure, polytrauma, traffic accident and polytrauma in traffic accident (i.e. clear emergency) is 3 hrs. 44 minutes. Public Disclosure Copy Date 30-Jun-2011 07-Sep-2012 30-Jun-2013 Comments Based all 9 existing hospitals with an integrated emergency reception area Number of hospitals with integrated emergency Text Value 3 9 9 reception area. Date 30-Sep-2008 28-Feb-2013 30-Jun-2013 Comments Target achieved. Strategic plans completed Text Value No Baseline 1 4 Date 30-Sep-2008 07-Sep-2012 30-Jun-2013 Page 5 of 7 The World Bank Report No: ISR9878 Comments National Health Sector Strategic Plan 2012-2020 completed; Under development: Hospital Master Public Disclosure Copy plan, Outsourcing of non- medical hospital services; Public relations strategy; Applications for EU funds Proposals presented by MoH to make use of Text Value 0 5 4 EU related funds Date 30-Sep-2008 07-Sep-2012 30-Jun-2013 Comments Target achieved. Croatia expected to access to EU in July 2013 Health personnel receiving training (number) Number Value 0.00 301.00 Date 01-Oct-2008 07-Sep-2012 30-Jun-2013 Comments Component 2 - 26 people went to Romania (12), Austria (8), Estonia (6) Study Tours. 35 staff trained for developing proposals for EU funds. Component 1: 149 dispatchers trained Data on Financial Performance (as of 07-Mar-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P086669 IBRD-75980 Effective 30-Sep-2008 21-Oct-2008 15-Jan-2009 30-Jun-2013 31-Dec-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Public Disclosure Copy P086669 IBRD-75980 Effective USD 28.30 28.30 0.00 15.74 10.10 56.00 Disbursement Graph Page 6 of 7 The World Bank Report No: ISR9878 Public Disclosure Copy Key Decisions Regarding Implementation Not applicable Restructuring History Level two Approved on 26-Nov-2012 Related Projects There are no related projects. Public Disclosure Copy Page 7 of 7