The World Bank Kyrgyz Health Results Based Financing (P120435) REPORT NO.: RES35309 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF KYRGYZ HEALTH RESULTS BASED FINANCING APPROVED ON APRIL 18, 2013 TO KYRGYZ REPUBLIC HEALTH, NUTRITION & POPULATION EUROPE AND CENTRAL ASIA Regional Vice President: Cyril E Muller Country Director: Lilia Burunciuc Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Tania Dmytraczenko Task Team Leader: Asel Sargaldakova The World Bank Kyrgyz Health Results Based Financing (P120435) I. BASIC DATA Product Information Project ID Financing Instrument P120435 Investment Project Financing Original EA Category Current EA Category Not Required (C) Not Required (C) Approval Date Current Closing Date 18-Apr-2013 31-Dec-2018 Organizations Borrower Responsible Agency KYRGYZ REPUBLIC Mandatory Health Insurance Fund,Ministry of Health Project Development Objective (PDO) Original PDO 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. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed TF-13310 30-Dec-2013 30-Dec-2013 29-Jul-2014 31-Dec-2018 11.00 10.55 .45 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No II. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES The World Bank Kyrgyz Health Results Based Financing (P120435) 1. The Kyrgyz Health Results-Based Financing Grant (the RBF) was approved on April 18, 2013 in the amount of US$11 million, signed on December 30, 2013, and became effective on July 29, 2014. The objective of this Level II restructuring is to process a second extension of the Closing Date from December 31, 2018, to May 31, 2019 with a cumulative extension of 23 months. 2. Progress toward achievement of the Project Development Objective (PDO) is rated Satisfactory. At this stage, all five PDO indicators have been achieved and seven out of eight intermediate results indicators have been achieved or on track to be achieved. The one intermediate results indicator that is lagging refers to the average percentage score for Maternity Department and is unlikely to be achieved as the end target of 85 percent was quite ambitious from a baseline of 5 percent. Nevertheless, this indicator has reached an actual value of 80 percent. 3. Implementation Progress is rated Satisfactory. All activities planned under this Grant have successfully been implemented to the exception of design of clinical vignettes, which will be completed by the revised Closing Date. 4. Disbursement rate has reached 96% of the total grant, with one pending withdrawal application for US$460,000. The major share of the remaining balance, in the amount of US$800 000, is committed for the payments to participating providers for the fourth quarter of 2018. 5. Procurement managed by the Ministry of Health's Results-based Financing (RBF) Secretariat is rated moderately satisfactory. This rating will be revisited upon completion of the ongoing procurement post-review at the level of participating providers. The financial management arrangements continue to be satisfactory. Audit reports have been delivered in a timely fashion during the life of the project, including the audit report for 2017, and have been found acceptable. Proposed changes and rationale: 6. A five-month extension of the Closing Date to May 31, 2019 would allow for: (i) additional technical support to the Mandatory Health Insurance Fund (MHIF) to ensure sustainability of the ongoing institutionalization of the RBF scheme across all levels of the health system using public funds starting July 1, 2018 which will cover 184 facilities, including 64 RBF pilot district level hospitals, 12 regional hospitals, 6 city hospitals and 102 district/city family medicine centers. This massive scale-up calls for a transformational behavior change of both the MHIF and providers, refinement of the RBF tools, and one additional joint verification scheduled in April-May 2019; (ii) the consolidation of development partners’ support in refining RBF procedures and tools while the World Bank will continue to play its leading role. Since RBF grant has demonstrated high quality achievements during its lifetime, various development partners (USAID/TB Defeat project and Swiss Development Cooperation/Provider Autonomy project) have shown a keen interest in using this results-oriented approach. However, refining RBF procedures and tools needs to be well managed to create synergy and avoid overlap among partners while avoiding confusion among national counterparts; (iii) the proper supervision in the implementation of clinical vignettes, the design of which has been procured under the RBF grant. This will ensure continuity and will maximize the benefits of vignettes generating synergy with other quality improvement activities planned under the upcoming Health Program-for-Results, which has an expected Board approval in May 2019; The World Bank Kyrgyz Health Results Based Financing (P120435) (iv) supporting the transition and handing over of the RBF activities to the upcoming Health Program-for-Results. The Program-for-Results will support the improvement of quality in primary health care, including consolidation of all performance-based incentive schemes at the primary health care level, and the development of a blended capitation to improve qualit y strategic purchasing; (v) the completion of the ongoing procurement of computers for primary health care facilities in 3 southern regions to improve facilities’ capacity in data collection. III. DETAILED CHANGES LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications TF-13310 Effective 30-Jun-2017 31-Dec-2018 31-May-2019 30-Sep-2019