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: 3 | ARCHIVED on 15-Jan-2018 | ISR30931 | 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)  Satisfactory  Moderately Satisfactory Overall Risk Rating  Substantial  Substantial 1/15/2018 Page 1 of 11 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 with delays, project implementation is progressing well since its effectiveness on November 9, 2016. Lumpsum grants financed by the Royal Government of Cambodia is flowing to the health facilities on time and innovative ways of its use are introduced for the facilities to improve their performance. The first phase of quality ex-ante assessment has been rolled out and coaching process has begun. Utilization of of Health Equity Fund (HEF) has increased in the last 6 months and HEF payment has been on schedule. Status of achievement of Disbursement-linked indicators Year 1 targets has been validated and subject to receiving supplementary documents, payment is expected early next year. 1/15/2018 Page 2 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) 1/15/2018 Page 3 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) 1/15/2018 Page 4 of 11 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  High  High Environment and Social  Moderate  Substantial  Moderate Stakeholders  Moderate  Substantial  Substantial Other  --  --  -- Overall  Substantial  Substantial  Substantial 1/15/2018 Page 5 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) 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 -- 46.00 300.00 Date 30-Apr-2016 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments Out of 1,191 targeted HCs, 452 HCs were assessed in Q2 2017. Among those assessed, only 46 HCs (or 10.18%) exceeded 60% in score, starting from 60.01%. Source: MoH assessment results. 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 0.90 0.70 Date 30-Oct-2015 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments Baseline from Cambodia Socioeconomic Survey (CSES) 2014. Status will be updated once the CSES 2016 is released, expected in either December 2017 or January 2018 as informed by the National Institute of Statistics (NIS), Ministry of Planning. Source: NIS focal person. PHINDPDOTBL  Reduction in out of pocket health expenditure as percentage of the total health expenditure. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.30 -- 62.30 55.00 Date 30-Oct-2015 -- 05-Oct-2017 30-Jun-2021 1/15/2018 Page 6 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) Comments Baseline from National Health Account (NHA) 2013, actual from NHA 2014. Status will be updated once the NHA 2015 & 2016 is released, expected in December 2017. PHINDPDOTBL  Increase in the utilization of health services by HEF beneficiaries. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 -- 84.90 81.00 Date 30-Oct-2015 -- 05-Oct-2017 30-Jun-2021 Comments Data will be updated after the National Health Congress (NHC) in March 2018. The NHC only recorded number of cases and not individual HEF users who utilized OPD services at HC and hospitals. 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 4.01 -- 5.00 Date 30-Oct-2015 30-Jul-2016 05-Oct-2017 30-Jun-2021 Comments The 2017 NHC report did not include this indicator. We are exploring alternative modalities of obtaining this data. 1/15/2018 Page 7 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) PHINDIRITBL  Proportion of health centers with functioning health center management committees. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 64% -- 64% Baseline + 25% Date 24-Mar-2017 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments This data is from the 2017 National Health Congress (NHC), p139 and will be updated after the NHC in March 2018. 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 0.00 100.00 70.00 Date 30-Oct-2015 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments Data excluded 13 PRHs that just completed the quality assessment in September 2017. All 452 HCs and 29 district RHs received payments by 12 September 2017. Source: DBF focal person and a health center chief at the province. 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 -- 68.13% points Date 30-Oct-2015 -- 05-Oct-2017 30-Jun-2021 Comments The difference between the highest and the lowest score in the first round (latest round) of NQEM program was 68.13% Source: MoH assessment results. 1/15/2018 Page 8 of 11 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 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 -- 0% Baseline +50% Date 30-Oct-2015 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments All 42 CPA1, CPA2 and CPA3 Hospitals (including 29 district RH and 13 Provincial RHs) were assessed in Q2, 2017. The maximum score for these is below 60 percent in the first round. Source: MoH assessment results PHINDIRITBL  Outpatient Department (OPD) consultations (new cases only) per person per year. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.59 -- 0.63 0.95 Date 30-Oct-2015 -- 05-Oct-2017 30-Jun-2021 Comments Data will be updated after the NHC in March 2018. 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 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments No further updated curriculum. UHS is currently developing a detailed workplan to revise the 7 curriculums, which has been submitted to Project Director. These activities will be implemented after the workplan is reviewed and approved by the MEF. Source: MoH Submission letter to WB dated July 31, 2017 on DLIs Report for Year 1 1/15/2018 Page 9 of 11 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 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 0.00 100.00 80.00 Date 30-Oct-2015 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments Source: DBF focal person and MoH Submission letter to WB on DLIs Report for Year 1, dated July 31, 2017. PHINDIRITBL  Percentage of HMIS reports submitted on time. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 95.00 95.00 95.00 95.00 Date 30-Oct-2015 24-Mar-2017 05-Oct-2017 30-Jun-2021 Comments Data will be updated after the NHC in March 2018. Overall Comments 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 4.47 25.55 15% P157291 TF-A2562 Effective USD 1.00 1.00 0.00 0.00 1.00 0% P157291 TF-A3114 Effective USD 20.00 20.00 0.00 4.61 15.39 23% 1/15/2018 Page 10 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Cambodia Health Equity and Quality Improvement Project (H-EQIP) (P157291) 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 Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 1/15/2018 Page 11 of 11 Public Disclosure Copy