The World Bank Report No: ISR8602 Implementation Status & Results Azerbaijan Health Sector Reform Project (P094220) Public Disclosure Copy Operation Name: Health Sector Reform Project (P094220) Project Stage: Implementation Seq.No: 13 Status: ARCHIVED Archive Date: 03-Dec-2012 Country: Azerbaijan Approval FY: 2006 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 29-Jun-2006 Original Closing Date 31-Dec-2012 Planned Mid Term Review Date Last Archived ISR Date 06-Nov-2012 Effectiveness Date 20-Dec-2006 Revised Closing Date 01-Jul-2013 Actual Mid Term Review Date 12-Apr-2010 Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective of the proposed project is to improve overall health system stewardship and financing, and enhance equitable access to, and technical and perceived quality of essential healthcare services, in the selected districts in a fiscally responsible and sustainable manner with a view to improving health outcomes. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Building MOH Capacity for Stewardship 5.17 Improving Delivery of Healthcare Services 40.69 Ensuring Sustainable Financing 1.43 Human Resources Development 0.78 Project Management 1.93 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview This ISR is to record a six-month extension from Dec. 31, 2012 to July 1, 2013, approved on October 24, 2012. Page 1 of 7 The World Bank Report No: ISR8602 The Project continues to make important progress with implementation and is likely to achieve its development objectives, but more evaluation is needed to link the activities to actual impact on health outcomes: (i) The National Master Plan (NMP) for Health Workforce and Health Infrastructure, developed and approved by the Ministry of Health (MoH) in January 2009, is now implemented in Public Disclosure Copy the entire country; (ii) A health sector strategic plan for 2011-2015 has been developed and approved by the MoH. The technical basis for piloting new financing mechanisms has been launched with (a) data collection on patients; and (b) development of Diagnosis-Related Groups (or new payment mechanism for hospitals) model for the country; (iii) Construction. Two new hospitals have been constructed and equipped and construction of 8 Primary Health Care (PHC) facilities and 4 village hospitals are underway; (iv) Health Human Resources Strengthening. The national standards for the allocation of human resources based on the population size have been adopted by Ministerial Order. Certification of medical staff has been introduced. Training in public health, clinical and managerial capacity, drug procurement, pharmaco-vigilance, rational drug use, health statistics, information systems, health financing, human resources and laboratory practice have been conducted for medical staff in the pilot areas and surrounding districts, as well as for MOH staff. Two key policy documents/strategies (i) Development of under-graduate medical education; and (ii) Development of Post-Graduate medical education, have been prepared and endorsed by MoH and all stakeholders. Concrete steps have already been taken in terms of changing teaching methods, examinations, and restructuring the faculties of the under-graduate medical education program, including the launching of the residency program in post-graduate medical education. However, due to the complexities in measuring the indicators, which have been recognized as being very ambitious, it is difficult to demonstrate the impact of the above successful implementation on actual health outcomes and the project overall development objective achievement. In the case of a follow-up operation, the DO and indicators will be restructured and the activities realigned. Locations Country First Administrative Division Location Planned Actual Azerbaijan Shekinskiy Rayon Shekinskiy Rayon Azerbaijan Qax Rayonu Qax Rayonu Azerbaijan Ismayilli Rayonu Ismayilli Rayonu Azerbaijan Baku Baku Azerbaijan Not Entered Republic of Azerbaijan Azerbaijan Abseron Rayonu Abseron Rayonu Azerbaijan Agdas Rayonu Agdas Rayonu Public Disclosure Copy Results Project Development Objective Indicators Page 2 of 7 The World Bank Report No: ISR8602 Indicator Name Core Unit of Measure Baseline Current End Target A long-term health sector investment plan Text Value Nationwide mapping of prepared as a result of a nationwide mapping facilities adopted Public Disclosure Copy of facilities and the subsequent rationalization Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 plan. Comments No master plan for guiding the Target achieved. restructuring of the health Rationalization of health system network available. facilities network in the entire country done in accordance with recommendations of Master Plan adopted by Ministry of Health. Impact evaluation of implementation of recommendations of Master Plan has been finalized andsubmitted for Bank review. Public expenditures on health gradually Percentage Value 1.90 4.00 increased to a sustainable level that would Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 ensure full coverage of the population with Comments Public expenditures on health At present with collaboration basic package of services. amounted to 115.3 million of the PREM team a Health manats or 1.9% of non-oil public expenditure review is GDP. ongoing and will provide data. There is indication of increased expenditures but very small when measured as % of overall public budget. A White Paper on health is adopted Yes/No Value No No Yes Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 Comments Draft White paper was prepared with support form WHO in 2008 and was submitted for MOH approval, Public Disclosure Copy It is proposed to drop this indicator as part of the restructuring/AF. Household out-of-pocket expenditures for Percentage Value 38.00 10.00 health as a proportion of total health Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 expenditures decreased as a result of free Comments The Health PER will provide access to essential package of healthcare services. (applicable to pilot dist trend data which will be reported when available. At present this target is Page 3 of 7 The World Bank Report No: ISR8602 ambitious and likely unreachable due to the delayed decision in the health insurance reform, an Public Disclosure Copy important reform to reduce OOP.It is proposed to drop this indicator as part of the restructuring/AF. Proportion of sick people seeking healthcare Percentage Value increased. Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 Comments No baseline. It is proposed to have a survey carried out under the HSRP to provide baseline data as part of proposed restructuring/AF Satisfaction of the community with overall Percentage Value access to care increased Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 Comments No baseline. It is proposed to have a survey carried out under the HSRP to provide baseline data as part of proposed restructuring/AF Perceived quality of care of the services Percentage Value covered by the BBP by the community Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 increased. (applicable to pilot districts only) Comments To be measured twice, ex- ante and ex-post Budget allocations to districts is made on the Yes/No Value No No basis of demographic and morbidity criteria. Date 31-Dec-2006 31-Dec-2012 (applicable to pilot districts only) Comments The technical basis for piloting new financing mechanisms is ready with the Public Disclosure Copy collection of data about patients and development of DRG model for the country. Infant mortality rate.Under-five mortality rate. Percentage Value Maternal mortality ratio.Underweight Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 prevalence rate in children (<5y).Adult age and Comments PDO indicator are to be cause-specific mortality rates.Self-reported health status dropped as part of restructuring Intermediate Results Indicators Page 4 of 7 The World Bank Report No: ISR8602 Indicator Name Core Unit of Measure Baseline Current End Target Health facilities constructed, renovated, and/or Number Value 0.00 2.00 18.00 equipped (number) Date 31-Dec-2006 05-Oct-2011 31-Dec-2012 Public Disclosure Copy Comments The rehabilitation, On track. construction, and equipping of health facilities to be done on the basis of Master Plan recommendations for restructuring health facilities network in pilot regions of the project. Health personnel receiving training (number) Number Value 5418.00 1500.00 Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 Comments Retraining of health personnel Exceeded. Target to be Training provided in different at central and regional level to adjusted to new closing date fields. be conducted under each of upon approval of AF project components to strengthen public health, clinical, and managerial capacity within the health system. Output based budgeting for health facilities in Text Value project districts designed and piloted Date 31-Dec-2006 05-Oct-2011 31-Dec-2012 Comments Budgetary allocations done New payment mechanisms Out-based budgets developed on the basis of historical are under preparation for pilot and piloted in selected budgets estimated largely on testing. hospitals for allocating budget the basis of existing facilities to health facilities. and personnel. Development of quality assurance mechanisms Text Value 0 59 as measured by the number of clinical Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 standards and protocols developed and Comments Development of new medical On track. Public Disclosure Copy adopted by the MOH standards and protocols to improve quality of care. Improved collection and use of patient clinical Text Value information for coordinating the process of care Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 across the health care network as measured by Comments Paper-based data collection On track Electronic medical records the development and piloting of electronic medical record largely done for reporting prototype developed and pilot purposes to central level tested for scaled up use at rather than for clinical and regional health facilities. managerial purposes. Page 5 of 7 The World Bank Report No: ISR8602 Improved supply and rational use of Text Value pharmaceuticals as measured by the adoption Date 31-Dec-2006 05-Oct-2012 31-Dec-2012 of national drug strategy, national drug Comments Outdated drug policies, On track. National drug strategy, formulary,essential drug list, and improved Public Disclosure Copy procurement and distribution syste processes and procedures national drug formulary and within the health system in revised essential drug list need of reform. adopted by MOH and used by health service providers. Drug supply procurement and distribution systems are reformed and strengthened. Data on Financial Performance (as of 21-Nov-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P094220 IDA-42100 Effective 29-Jun-2006 09-Oct-2006 20-Dec-2006 31-Dec-2012 01-Jul-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P094220 IDA-42100 Effective XDR 34.30 34.30 0.00 27.12 7.18 79.00 Disbursement Graph Public Disclosure Copy Page 6 of 7 The World Bank Report No: ISR8602 Key Decisions Regarding Implementation N/A Public Disclosure Copy Restructuring History Level two Approved on 24-Oct-2012 Related Projects P129093-Additional Financing - Health Sector Reform Project Public Disclosure Copy Page 7 of 7