The World Bank Report No: ISR255 Implementation Status & Results Dominican Republic Public Disclosure Copy Health Sector Reform Second Phase APL (PARSS 2) (P106619) Operation Name: Health Sector Reform Second Phase APL (PARSS 2) Project Stage: Implementation Seq.No: 3 Status: ARCHIVED Last Modified Date: 11-Feb-2011 (P106619) Country: Dominican Republic Approval FY: 2010 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): CERSS, Secretaria de Estado de Salud Publica y Asistencia Social (SESPAS) Key Dates Board Approval Date 17-Sep-2009 Original Closing Date 30-Oct-2015 Planned Mid Term Review Date 14-May-2012 Last Archived ISR Date 29-Jun-2010 Effectiveness Date 19-Jan-2010 Revised Closing Date 30-Oct-2015 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project's Development Objectives are to: (i) Improve the capacity of Regional Health Services (RHS) to deliver, in a timely fashion, quality services known to improve the health of mothers, children and people with chronic conditions by public providers at the first level of care; (ii) improve health system responsiveness, defined here as the institutional capacity of public sector health organizations to conduct strategic purchasing of health care services and goods, and to respond to public health emergencies. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Results-based financing mechanism for the first level of care 21.49 Strengthening the capacity of the MOH 10.00 Public Disclosure Copy quality of public spending 12.57 Response to Public Health Emergencies 0.10 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview Since it became effective on January 19, 2010 and since the July 2010 Supervision Mission, the Project has made notable progress in laying the groundwork and implementing a Page 1 of 6 The World Bank Report No: ISR255 number of key steps for its four components. For example, Component 1's Operational Guide for Management has been prepared and it has also moved forward with the establishment of an internal team in the Executive Commission on Health Reform (CERSS) that will support the Regional Health Services (RHS) in implementing results-based Public Disclosure Copy financing oriented toward the primary level of care. The Project has also advanced in terms of setting up the required information system (e.g. the ongoing development of a system application for the registration of the required minimum basic data for the analysis of attended illnesses, as well as the ongoing development of the module for population based information based on the Family Health Files). Moreover it has started implementing activities to improve the supply chain of medicines and to strengthen the institutional capacity of the National Health Insurance Authority (SeNaSa) to expand and improve social health insurance for the poorest segments of the population. Results Project Development Objective Indicators Indicator Baseline Current End Target Indicator Name Value Value Value Percentage of pregnant women from target population with risk 0.00 50.00 evaluation completed before the 15th week of pregnancy. Date Date Date 20-Aug-2009 11-Nov-2010 30-Oct-2015 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage To be established during Y1 Key activities for baseline data To be measured annually collection are being carried out. Data expected by early second half 2011 Indicator Baseline Current End Target Indicator Name Value Value Value Percentage of children from target population under 15 months with 0.00 60.00 vaccination scheme completed according to national protocols Date Date Date 20-Aug-2009 11-Nov-2010 30-Oct-2015 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage To be established during Y1 Key activities for baseline data To be measured annually Public Disclosure Copy collection are being being implemented. Data expected by second half of 2011 Page 2 of 6 The World Bank Report No: ISR255 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Percentage of individuals from target population diagnosed with 0.00 50.00 hypertension under treatment according to national protocols Date Date Date 20-Aug-2009 11-Nov-2010 30-Oct-2015 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage To be established during FY1 Key activities to construct baseline and implement results adjusted capitation payments are underway. Data expected by second half of 2011 Indicator Baseline Current End Target Indicator Name Value Value Value Studies on risk factors and burden of disease has been conducted, 0 0 Studies results used by MOH to disseminated and used by corresponding MOH units (salud colectiva) develop annual plans Date Date to develop annual operational plans for health promotion and preven 20-Aug-2009 11-Nov-2010 Date Type Unit of Measure Comment Comment 30-Oct-2015 Custom Indicator Text No studies Some TORs for required Comment consultancies have been prepared while some are being developed. Indicator Baseline Current End Target Indicator Name Value Value Value At least one region is producing monthly reports on the number of poor 0 0 At least one region is producing individuals who were prescribed a medicine at the first level of care and monthly reports Date Date actually received medication within 48 hours at the poi 20-Aug-2009 11-Nov-2010 Date Type Unit of Measure Comment Comment 30-Oct-2015 Public Disclosure Copy Custom Indicator Text No monthly reports Activities are underway to ensure Comment that this will take place during the 1st half of 2011 Intermediate Results Indicators Page 3 of 6 The World Bank Report No: ISR255 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Percentage of clinical files with complete information for external audit 0.00 0.00 85.00 to verify RHS reported MRI results Date Date Date 20-Aug-2009 18-Nov-2010 30-Oct-2015 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage RHS VI and VIII have provided To be based on quarterly reports support to primary health units (UNAPS) that do not have sufficient capacity to prepare these files or lack these files. Training of doctors on the importance and use of information registration has been initiated in primary health units. The MOH has provided the instruments for data collection which will need to be filled by each health unit. The Social Cabinet is implementing a System for Electronic Validation of Condicionalities of Solidaridad wich which will be interfased with the applications used in capturing therequired minimum set of basic data at the primary level of attention and the module of population based information based on the Family Health Files. Public Disclosure Copy Page 4 of 6 The World Bank Report No: ISR255 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value The Health Management System of the MOH includes an automated/ Algorithms for the information electronic module for M&I with all the information needed for monitoring system application needed for the Date Date results on a quarterly basis at the first level of c monitoring of basic indicators have 20-Aug-2009 been developed. Some TORS for 30-Oct-2015 Type Unit of Measure Comment consultancies and activities for the Comment Custom Indicator Text Results-adjusted Capitation integrated M&E system have been RACM used in with info from Module (RACM) not yet prepared and some are being regions VI & VIII established developed. Date 11-Nov-2010 Comment Indicator Baseline Current End Target Indicator Name Value Value Value Studies on risk factors and burden of disease surveys designed, Some TORs for needed Studies' results completed and implemented, results disseminated and used for planning public health consultancies have been prepared disseminated and used for Date interventions with an emphasis on health promotion and prevention. and some are being developed. planning public health interventions 20-Aug-2009 Project will organize discussions with an emphasis on health Type Unit of Measure Comment with key stakeholders to move the promotion and prevention. Custom Indicator Text Studies not yet conducted process forward. Date Date 30-Oct-2015 11-Nov-2010 Comment Comment Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Percentage of accredited health centers from participating RHSs that 0.00 0.00 80.00 dont have a PROMESE/CAL pharmacy and receive on a regular basis Date Date Date medicines procured and distributed by PROMESE/CAL 20-Aug-2009 11-Nov-2010 30-Oct-2015 Type Unit of Measure Comment Comment Comment Custom Indicator Percentage PCU coordinating with PROMESE/ CAL and Regional Health Services in developing action plan. Data on Financial Performance (as of 10-Feb-2011) Financial Agreement(s) Key Dates Page 5 of 6 The World Bank Report No: ISR255 Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P106619 IBRD-77770 Effective 17-Sep-2009 30-Oct-2009 19-Jan-2010 30-Oct-2015 Public Disclosure Copy Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106619 IBRD-77770 Effective USD 30.50 30.50 0.00 2.57 27.93 8.00 Disbursement Graph Key Decisions Regarding Implementation The Project introduced the new task team leader or TTL (Christine Lao Pena) to the Government during the virtual mission which took place during November 8 to 11, 2010. The Public Disclosure Copy Government welcomed the new TTL (whose assignment became effective on November 12, 2010) and thanked the outgoing TTL (Fernando Montenegro Torres) for his invaluable contributions and wished him well in his new assignments. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Page 6 of 6