FOR OFFICIAL USE ONLY Report No: RES45906 INTERNATIONAL DEVELOPMENT ASSOCIATION RESTRUCTURING PAPER ON A PROPOSED PROGRAM RESTRUCTURING OF MOLDOVA HEALTH TRANSFORMATION PROJECT APPROVED ON MAY 22, 2014 IN THE AMOUNT OF SDR 20 MILLION (US $30.8 MILLION EQUIVALENT) TO THE REPUBLIC OF MOLDOVA December 22, 2021 Health, Nutrition & Population Global Practice Europe And Central Asia Region Regional Vice President: Anna M. Bjerde Country Director: Arup Banerji Regional Director: Fadia M. Saadah Practice Manager: Tania Dmytraczenko Task Team Leader(s): Volkan Cetinkaya, Adrien Arnoux Dozol The World Bank Moldova Health Transformation Project (P144892) ABBREVIATIONS AND ACRONYMS CNAM National Health Insurance Company (Compania Națională de Asigurări în Medicină) COVID-19 Coronavirus disease CPF Country Partnership Framework CVD Cardiovascular disease DLI Disbursement-linked indicator DLR Disbursement-linked result DRG Diagnosis-related group ECA Europe and Central Asia ES Environmental and Social ESMP Environmental and Social Management Plan ESSA Environment and Social System Assessment GDP Gross Domestic Product HTP Health Transformation Project IDA International Development Association IPF Investment Project Financing IT Information technology MoH Ministry of Health NCDs Non-communicable diseases PAP Program Action Plan PDO Project Development Objective PForR Program-for-Results PIU Project Implementation Unit SDR Special Drawing Rights STEP Systematic Tracking of Exchanges in Procurement WBG World Bank Group The World Bank Moldova Health Transformation Project (P144892) DATA SHEET (Moldova Health Transformation Project - P144892) BASIC DATA Project ID Financing Instrument IPF Component P144892 Program-for-Results Financing Yes Original Environmental Assessment Category (IPF Current Environmental Assessment Category (IPF Component) Component) Not Required (C) Not Required (C) Approval Date Current Closing Date 22-May-2014 31-Dec-2021 Organizations Borrower Responsible Agency Ministry of Health National Health Insurance Company (CNAM) Program Development Objective(s) The Program Development Objective is to contribute to reducing key risks for non-communicable and infectious diseases, including COVID-19, and improving efficiency of health services in Moldova. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Approval Effectiveness Closing Ln/Cr/TF Signing Date Commitment Disbursed Undisbursed Date Date Date 22-May- IDA-54690 11-Jul-2014 08-Apr-2015 31-Dec-2021 28.70 14.71 11.55 2014 22-May- IDA-54700 11-Jul-2014 08-Apr-2015 31-Dec-2021 2.10 1.81 .14 2014 Policy Waiver(s) Does the Program require any waivers of Bank policies applicable to Program-for-Results operations? No Page 1 of 18 The World Bank Moldova Health Transformation Project (P144892) The World Bank Moldova Health Transformation Project (P144892) I. PROGRAM STATUS AND RATIONALE FOR RESTRUCTURING Program Status 1. The Health Transformation Project (HTP), a Program-for-Results (PForR), was approved on May 22, 2014, in the amount of SDR 20 million (US$30.8 million equivalent) and became effective on April 8, 2015. The Program Development Objective (PDO) is to contribute to reducing key risks for non-communicable and infectious diseases, including COVID-19, and improving efficiency of health services in Moldova. To achieve the PDO, the Program employs a mix of result-oriented and investment-oriented activities financed by two credits: (i) SDR 18.6 million (US$28.7 million equivalent) to address part of health system challenges through the use of disbursement- linked indicators (DLIs) (Program Credit No. 5469-MD); and (ii) SDR 1.4 million (US$2.1 million equivalent) in investment project financing (IPF) to provide technical assistance and institutional capacity building activities to support attainment of Program objectives and ensure sustainability (Project Credit No. 5470-MD). 2. The Program has been restructured twice. The first restructuring was approved on October 23, 2018 to: (i) adjust the Program scope to evolving circumstances in the country and health sector; (ii) revise the results framework commensurate with the change in Program scope; (iii) reallocate funds between DLIs and the IPF component; and (iv) extend the closing date of the Program by 21 months to December 31, 2020. In light of the COVID-19 pandemic, a second restructuring was approved on December 22, 2020 to expand the original scope to include critical government priorities required for an effective response to the COVID-19 pandemic, namely: (i) behavior change communication related to COVID-19 response; and (ii) preparedness for COVID-19 vaccine deployment. The second restructuring also extended the closing date, by an additional 12 months, to December 31 2021, the current closing date. 3. Shortly after the second restructuring, the Government of Moldova resigned on December 23, 2020. An interim government was put in place until the July 2021 elections but was not authorized to sign the restructuring or submit it to the Parliament for ratification despite positive implementation progress. A new government was established on August 6, 2021 and the restructuring is expected to be ratified by the Parliament by December 31, 2021. 4. Although both implementation progress and progress toward achieving the PDO had been rated Moderately Satisfactory since June 2016, both were downgraded to Moderately Unsatisfactory in June 2020 due to the COVID- 19 pandemic and resulting measures. Despite the lack of authorizing environment following the December 2020 resignation of the Government, the technical work of the Ministry of Health (MoH) and the National Health Insurance Company (CNAM)1 continued. As a result of the technical advancements, overall implementation progress was upgraded to Moderately Satisfactory in February 2021. As of December 22, 2021, three of the six PDO indicators and four of the six intermediate indicators have been achieved. In addition, seven of the 11 DLIs have been achieved, while one DLI has been partially achieved. Following ratification of the second restructuring, this is expected to increase to eight DLIs fully achieved and two partially achieved. Given this progress, overall progress toward achievement of PDO is also expected to be upgraded to Moderately Satisfactory following ratification of the restructuring. 5. Approximately SDR 11.9 million (US$ 16.53 million equivalent) has been disbursed as of December 22, 2021. Following verification of the achievement of additional DLIs (mentioned above), an additional SDR 5.4 million in disbursements are expected by the December 31, 2021, or approximately 86.3% of the Program. 6. The Program is in compliance with financial management covenants and interim financial reports and audits are up to date. The audits are conducted annually by the country’s Supreme Audit Institution. For fiscal year 2020, 1 Compania Naţională de Asigurări în Medicină The World Bank Moldova Health Transformation Project (P144892) project financial statements, the auditors expressed unmodified opinion and did not note any issues. The same opinion was issued for the Program audit for CNAM. The audit of the Program related to the MoH resulted in modified opinion due to misstatements noted in the value of fixed assets and depreciation, but this does not have impact on the Program itself. The internal audit function at MoH has significantly improved with the technical assistance provided by the Delegation of the European Union to Moldova. The Program-related expenditures are captured in the individual budgets of the MoH and CNAM, which are part of the consolidated state budget. Annual budget allocations provided for Program implementation are sufficient. The Program financial management arrangements are rated as Moderately Satisfactory. 7. The Program is rated Moderately Satisfactory for Environmental and Social Systems. A practical guide for health care waste management was developed by an internal working group in collaboration with representatives from the World Health Organization (Program Action Plan (PAP), action 9). The guide was discussed and approved by the Scientific Council of the National Agency for Public Health on January 15, 2019. In addition, close cooperation among the key institutions dealing with health care waste management continues to be functional (PAP, action 10). The Environment and Social System Assessment (ESSA) prepared for the Program was slightly revised to adequately address the health care waste management risks within the Program boundary and includes appropriate recommendations to improve health care waste management in Moldova. The ESSA was re-disclosed at the time of the first restructuring (March 2018). Rationale for Restructuring 8. The Government requested a six-month extension on October 21, 2021 to address the delays in project implementation and to ensure achievement of the DLIs. Achievement of the DLIs were stalled due to the political uncertainty and weak authorizing environment since the resignation of the previous Government in December 2020. Following the receipt of the Government request for extension, an action plan and timeline for completion of remaining project activities was developed. Based on this, the World Bank management proposed an eight- month extension to ensure sufficient time to complete these important actions. As such, the proposed eight- month extension will allow sufficient time to verify results already achieved under the second restructuring as soon as it is ratified, as well as time to implement the COVID-19 related activities and to achieve the remaining DLIs and DLRs (Table 1). In addition, the additional time will also ensure delivery of breast cancer diagnostic equipment under the IPF component, preventing one of the major non-communicable disease for women. Successful procurement and implementation require an additional eight-months. While ratification of the previous restructuring took nearly a year, this restructuring will not require parliamentary approval, as it is limited to extension of the closing date. Table 1: Status of remaining DLIs and DLRs DLI 2: Increase in the number of people with CVDs benefitting from compensated medications for treatment of CVDs. DLR 2.1: Increase in the number of SDR 1,294,000 ACHIEVED. people with CVDs benefitting from The number of beneficiaries of compensated compensated medications for treatment drugs increased by 9.26% (compared to the 10% of CVDs by 5 percent from the baseline. target). This is a scalable DLI and, as such, SDR DLR 2.2: Increase in the number of SDR 1,617,500 2,696,049 in disbursements (92.6%) are expected. people with CVDs benefitting from The MoH will send the achievement notification of compensated medications for treatment as soon as the ratification of the December 2020 of CVDs by 10 percent from the baseline. restructuring is completed. DLI 7: Design and piloting of the Performance-Based Incentive Scheme for all hospitals. The World Bank Moldova Health Transformation Project (P144892) DLR 7.2: Revision of the pay-for- SDR 485,250 ACHIEVED. performance scheme The MoH will send the achievement notification of as soon as the ratification of the December 2020 restructuring is completed. DLR 7.3: Piloting of the revised SDR 485,250 Ongoing. The preparatory work commenced, and methodology in at least seven hospitals the pilot is expected to launch by February 2022. DLI 9: Consolidation of departmental hospitals under the MoH authority. DLR 9.1: Three public hospitals in SDR 517,500 Ongoing. The three public hospitals are in the Chisinau are under common process of transitioning to common management, management which is expected to be complete by June 2022. DLI 11: Incorporate lessons learned in population-based behavior change communication campaigns and vaccine readiness assessment. DLR 11.1: Implementation of a survey to SDR 1,099,000 Ongoing. assess people’s knowledge, behaviors The survey has been implemented, the Vaccine and attitudes related to slowing the Readiness Assessment has been completed, and transmission of COVID-19 the communication strategy is in the revision DLR 11.2: Implementation of a COVID-19 SDR 1,099,000 process. The MoH will send the achievement Vaccine Readiness Assessment notification of DLR 11.1 and 11.2 as soon as the DLR 11.3: Revision of the National SDR 1,099,000 ratification of the December 2020 restructuring is Communication Strategy for COVID-19 completed. The notification for the achievement of DLR 11.3 is expected by mid-February 2022. 9. Despite the negative impact of recent political changes before the last parliamentary election in July 2021, the new Government is fully supportive of this work and the Minister of Health explicitly requested the World Bank’s continued support to implement the Government’s reform agenda in the coming years. In this context, the extension will have the added benefit of allowing time for the new MoH team to work with the Bank and pave the way for continued engagement. II. DESCRIPTION OF PROPOSED CHANGES 10. Change in Credit Closing Date: The closing date of the Program and the two associated credits (Program Credit No. 5469-MD and the Project Credit No. 5470-MD) has been extended by 8 months, from December 31, 2021 to August 31, 2022. 11. Change in Disbursement Estimates: Disbursement estimates have been revised to reflect the extension of the Program closing date. 12. Change in Implementation Schedule: The implementation schedule has been revised to reflect the extension of the Program closing date. 13. There are no changes proposed on the implementation or fiduciary arrangements. The Program will continue to be implemented by the existing Project Implementation Unit in the MoH. Procurement of equipment and services will be made from the IPF component and will follow the agreed procedures. The MoH will update the procurement plan in the STEP system by reflecting the proposed changes and will submit it to the Bank for approval. The PP will provide a timeline for completing the delivery of the equipment or completion of services by the closing date of the project. The project funds cannot be used for services provided or goods delivered after the closing date of the project. Payment for such services or goods will need to be made from other resources identified by the Borrower. With respect to environmental and social safeguards, since there are no changes The World Bank Moldova Health Transformation Project (P144892) proposed on safeguards application, the ESSA guidelines and suggested action plan are applicable to this restructuring. III. SUMMARY OF CHANGES Changed Not Changed Change in Loan Closing Date(s) ✔ Change in Disbursement Estimates ✔ Change in Implementation Schedule ✔ Change in Implementing Agency ✔ Change in Program's Development Objectives ✔ Change in Program Scope ✔ Change in Results Framework ✔ Change in Cancellations Proposed ✔ Reallocation between and/or Change in DLI ✔ Change in IPF Component ✔ Change in Disbursements Arrangements ✔ Change in Systematic Operations Risk-Rating Tool ✔ (SORT) Change in Safeguard Policies Triggered ✔ Change in EA category (IPF Component) ✔ Change in Legal Covenants ✔ Change in Institutional Arrangements ✔ Change in Technical Method ✔ Change in Fiduciary ✔ Change in Environmental and Social Aspects ✔ Other Change(s) ✔ The World Bank Moldova Health Transformation Project (P144892) IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/TF Status Closing Date Closing(s) Date Closing Date for Withdrawal Applications 31-Dec-2020, 31- IDA-54690 Effective 30-Mar-2019 31-Aug-2022 31-Dec-2022 Dec-2021 31-Dec-2020, 31- IDA-54700 Effective 30-Mar-2019 31-Aug-2022 31-Dec-2022 Dec-2021 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Year Current Proposed 2014 0.00 0.00 2015 933,055.20 2,905,919.24 2016 1,615,213.60 8,507,102.05 2017 2,066,125.60 1,703,251.64 2018 3,160,326.40 843,902.85 2019 4,925,844.00 1,947,426.69 2020 6,702,788.40 50,000.00 2021 7,355,871.60 568,208.72 2022 3,040,775.20 14,274,188.81 . The World Bank Moldova Health Transformation Project (P144892) ANNEX 1: RESULTS FRAMEWORK . . Results framework Program Development Objectives(s) The Program Development Objective is to contribute to reducing key risks for non-communicable and infectious diseases, including COVID-19, and improving efficiency of health services in Moldova. Program Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Reducing key risks for non-communicable and infectious diseases PDO Indicator 1: Smoking prevalence among adults (Percentage) 16.10 14.10 Smoking prevalence among adults, Male (Percentage) 33.00 29.00 Smoking prevalence among adults, Female (Percentage) 3.40 2.90 PDO Indicator 2: Increase in the number of people with CVDs benefitting from compensated medications for treatment of 414,744.00 456,218.00 CVDs (Number) PDO Indicator 6: Revise the national communication strategy for COVID-19 (based on the results of the survey and the Vaccines 0.00 6.00 Readiness Assessment) and implement six activities of the revised strategy (Number) Improving efficiency of health services Page 8 of 18 The World Bank Moldova Health Transformation Project (P144892) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target PDO Indicator 3: Annual acute care hospital discharges per 100 17.60 15.60 persons (Number) PDO Indicator 4: Acute care hospital beds (Number) 17,586.00 15,000.00 PDO Indicator 5: Average length of stay in acute care hospitals 8.00 7.20 (Days) PDO Table SPACE Intermediate Results Indicators by Result Areas RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Intermediate Results Area 1: Reducing NCD risks Intermediate Results Indicator 1: Approval of the new tobacco No Yes control legislation (Yes/No) Intermediate Results Indicator 2: Revision of the outpatient drug No Yes benefit package with regard to antihypertensive drugs (Yes/No) Intermediate Results Area 2: Improved efficiency of health services Intermediate Results Indicator 4: Approval of the revised national health strategy which includes hospital rationalization measures No Yes (Yes/No) Intermediate Results Indicator 5: Annual hospitalizations through 36.00 44.00 referrals by family medicine providers (Percentage) Intermediate Results Indicator 6: Consolidation of departmental No Yes hospitals under the MoHLSP authority (Yes/No) Page 9 of 18 The World Bank Moldova Health Transformation Project (P144892) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Intermediate Results Indicator 7: Percentage of citizen satisfied 62.60 70.00 with quality of health services (Percentage) IO Table SPACE Disbursement Linked Indicators Matrix DLI IN01082744 ACTION DLI 1 All imported and locally produced cigarettes in the market are in line with the tobacco labelling regulation Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output No Text 455,634.00 0.00 Period Value Allocated Amount (USD) Formula Baseline N/A. 2016 0.00 2017 0.00 2018 0.00 Starting in 2018, all imported and locally produced 2019 cigarettes in the market are in line with the tobacco 455,634.00 labelling regulation Page 10 of 18 The World Bank Moldova Health Transformation Project (P144892) DLI IN01082743 ACTION DLI 2 Increase in the number of people with CVDs benefitting from compensated medications for treatment of CVDs Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output No Number 4,100,704.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 414,744.00 2016 0.00 2017 0.00 2018 0.00 2019 456,218.00 4,100,704.00 DLI IN01082742 ACTION DLI 3 Annual acute care hospital discharges per 100 persons Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome No Number 3,000,000.00 91.33 Period Value Allocated Amount (USD) Formula Baseline 17.60 2016 17.00 900,000.00 2017 16.50 750,000.00 2018 16.00 750,000.00 Page 11 of 18 The World Bank Moldova Health Transformation Project (P144892) 2019 15.60 600,000.00 DLI IN01082741 ACTION DLI 4 Acute care hospital beds Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output No Number 4,700,000.00 91.49 Period Value Allocated Amount (USD) Formula Baseline 17,586.00 2016 17,000.00 1,100,000.00 2017 16,500.00 900,000.00 2018 16,000.00 900,000.00 2019 15,000.00 1,800,000.00 DLI IN01082740 ACTION DLI 5 Adoption of a revised outpatient drug benefit package for anti-hypertensive drugs Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Yes/No 2,000,000.00 91.50 Period Value Allocated Amount (USD) Formula Baseline No 2016 Yes 2,000,000.00 2017 Yes 0.00 Page 12 of 18 The World Bank Moldova Health Transformation Project (P144892) 2018 Yes 0.00 2019 Yes 0.00 DLI IN01082739 ACTION DLI 6 Revision and implementation of performance-based incentive scheme in primary care Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 2,000,000.00 23.00 Period Value Allocated Amount (USD) Formula Revision of the performance-based incentive Baseline scheme Revision of incentive scheme for family medicine: 2016 500,000.00 Yes Performance based incentive agreements signed 2017 with all primary care centers contracted by CNAM in 500,000.00 Year 2: YES Performance based incentive agreements signed 2018 with all primary care centers contracted by CNAM in 500,000.00 Year 3: YES Performancebased incentive agreements signed 2019 with all primary care centers contracted by CNAM in 500,000.00 Year 4: Yes DLI IN01082738 ACTION DLI 7 Design and piloting of the Performance-Based Incentive Scheme for all hospitals Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 1,866,900.00 24.45 Period Value Allocated Amount (USD) Formula Page 13 of 18 The World Bank Moldova Health Transformation Project (P144892) Baseline No incentive scheme for hospitals 2016 Design of incentive scheme for hospitals 500,000.00 2017 Revision of the pay-for-performance scheme 683,450.00 Piloting of the revised methodology in at least 7 2018 683,450.00 hospitals 2019 0.00 DLI IN01082737 ACTION DLI 8 Implementation and update of DRG prices for public acute care hospitals Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 2,000,000.00 68.16 Period Value Allocated Amount (USD) Formula DRG accounting for less than 40 percent of total Baseline payment by CNAM to public hospitals DRG accounting for at least 40% of total payment by 2016 500,000.00 CNAM to public hospitals DRG accounting for at least 50% of total payment by 2017 500,000.00 CNAM to public hospitals DRG accounting for at least 60% of total payment by 2018 500,000.00 CNAM to public hospitals 2019 DRG updated using country data 500,000.00 Page 14 of 18 The World Bank Moldova Health Transformation Project (P144892) DLI IN01082736 ACTION DLI 9 Consolidation of departmental hospitals under the MoHLSP authority Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 728,873.00 0.00 Period Value Allocated Amount (USD) Formula Baseline N/A 2016 0.00 2017 0.00 2018 0.00 Three public hospitals in Chisinau are under 2019 728,873.00 common management DLI IN01082735 ACTION DLI 10 Adoption of the revised National Health System Development Strategy which includes hospital rationalization measures Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Process No Text 1,000,000.00 95.68 Period Value Allocated Amount (USD) Formula Baseline Strategy has not been revised and approved 2016 Revised strategy approved 1,000,000.00 2017 0.00 2018 0.00 Page 15 of 18 The World Bank Moldova Health Transformation Project (P144892) 2019 0.00 DLI IN01082734 ACTION Incorporate lessons learned in population-based behavior change communication campaigns and vaccine readiness DLI 11 assessment Type of DLI Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Output No Text 4,643,661.00 0.00 Period Value Allocated Amount (USD) Formula Baseline N/A. 2016 0.00 The Borrower has implemented a survey to assess 2017 people’s knowledge, behaviors and attitudes related 1,547,887.00 to slowing the transmission of COVID-19 The Borrower has implemented a COVID-19 Vaccine 2018 1,547,887.00 Readiness Assessment. The Borrower has revised the National Communication strategy for COVID-19, based upon 2019 the results of the survey and vaccine readiness 1,547,887.00 assessment, and has implemented 6 activities of the revised strategy. Page 16 of 18 The World Bank Moldova Health Transformation Project (P144892) ANNEX 2: PROGRAM ACTION PLAN . . PAP_NOT_CHANGE_TBL Action Description Source DLI# Responsibility Timing Completion Measurement At the time of monitoring, there 1. Provision of was no information on the lack of sufficient Program budget allocated to PforR-related annual budget Fiduciary Systems Client Recurrent Yearly activities. The GoM adopts 3-year (rolling) 2. Annual tobacco fiscal policy framework based on excise duty which tobacco excise taxes are increase as per the being defined. In 2018 the 3% ad roadmap in the valorem tax was added to the tobacco control non-filter cigarettes, however a legislation Technical Client Recurrent Yearly greater tax unification is needed. 3. Filling the vacancies in the MOH Policy Completed early during project Analysis and implementation (2016) and Monitoring Unit Technical Client Other 2016 maintained since then. 4. Completion of stakeholder analysis related to key health reforms supported by the Completed early during project Program Technical Client Other Yearly implementation (2016). For 2019, the Mass Media Information and Communication 5. Annual public Service has proposed to include awareness and several actions related to the communication communication campaigns. Above campaigns on mentioned Service is going to health reforms on develop the Communication the basis of the Strategy of the MoHLSP for 2021- completed 2023. stakeholder analysis under Action 4 Technical Client Due Date 31-Dec-2020 6. Adoption of There is a regulatory framework sanction in place that allows non-payment mechanisms by CNAM of inpatient case against hospitals treated by hospital if there is a with confirmed proof of out-of-pocket payments informal payment for drugs or medical services. The cases Technical Client Recurrent Continuous number of such cases decreasing. 7. CNAM is conducting verification Implementation of of DRG coding by means of IT annual audit of Technical Client Recurrent Yearly application which helps cross- Page 17 of 18 The World Bank Moldova Health Transformation Project (P144892) Diagnosis Related check and identify suspicious Group (DRG) cases, after which more detailed payment for verification takes place. The DRG hospitals audit report is submitted to the Bank by April each year. 8. Training conducted by hospital management consultants for all managers of hospitals under common management structures on reengineered Firm responsible for the business assignment is revising the content processes and of the report in light with workflows Technical Client Due Date 31-Dec-2020 MoHLSP’s comments. 9. The MoHLSP will revise the technical guidelines and sanitary regulation for health care waste management to address the This action was reformulated as potential impact Environmental and Social part of a restructuring in of COVID-19 Systems Client Due Date 30-Jun-2021 November 2020. 10. The MoHLSP will set up an efficient mechanism for close cooperation among the key institutions that have attributions in health care waste management. The cooperation will include plans for dealing with the medical waste generated by COVID-19. Environmental and Social This action was reformulated as Systems Client Due Date 31-May-2021 noted below. . Page 18 of 18