The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Belarus Health System Modernization Project (P156778) EUROPE AND CENTRAL ASIA | Belarus | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2017 | Seq No: 9 | ARCHIVED on 23-Dec-2020 | ISR41784 | Implementing Agencies: Ministry of Health, Republic of Belarus Key Dates Key Project Dates Bank Approval Date: 18-Nov-2016 Effectiveness Date: 19-May-2017 Planned Mid Term Review Date: 09-Dec-2019 Actual Mid-Term Review Date: 13-Dec-2019 Original Closing Date: 31-May-2022 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project development objective (PDO) is to contribute to improving selected aspects of the quality of health care delivery in the Republic of Belarus. This PDO is expected to be achieved through the: (a) establishment of e-Health system and adoptionof ICT-based clinical decision-support tools for quality improvement; (b) improvement of clinical competencies of health care providers in non-communicable disease (NCD) management; and (c) modernization of neonatal care provision at the Republic Center of Mother and Child (RCMC). Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Establishment of E-Health and clinical decision support systems:(Cost $65.20 M) Improvement of clinical competencies of health care providers in NCD management:(Cost $46.20 M) Modernization of neonatal care at the RCMC:(Cost $11.60 M) Project management, monitoring and evaluation:(Cost $2.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Overall the Project progress under each component is assessed as Moderately Satisfactory. Taking into account the global COVID-19 outbreak and its negative impact on all spheres, including project implementation (through disruption of bidding processes, equipment supplies and cancellation of training events), and, based upon a request from the Government of Belarus for a project extension and the World Bank technical assessment of project implementation to date the closing date has been extended until December 31, 2023 to ensure proper and timely implementation of the planned project activities. These include the complex design and implementation of the central platform under e-health, delivery of simulation equipment, construction of a new Intensive Care Unit building for RSPC “Mother and Child” and procurement of the medical equipment for it. 12/23/2020 Page 1 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improvement of health care delivery quality through establishment of e-health IN00843549 ►Number of oblasts using e-prescription (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 7.00 7.00 7.00 Date 26-Oct-2016 02-Dec-2019 09-Dec-2020 31-May-2022 IN00843577 ►Percentage of selected health facilities (PHC centers/ambulatories, polyclinics, hospitals, and diagnostic centers) that can electronically exchange patient summaries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 26-Oct-2016 02-Dec-2019 09-Dec-2020 31-May-2022 12/23/2020 Page 2 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) An integrated electronic medical record will be placed in the central medical information repository on the central software platform. This will be possible after the development and commissioning of the central Comments: software platform in 2022. Improvement of clinical competencies of health care providers in NCD management IN00843576 ►Percentage of trained PHC doctors in clinical skills at BelMapo Simulation Training Center and at Medical Universities skills labs according to standards (emergency services among others)-cumulative (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 97.27 96.90 50.00 Date 26-Oct-2016 02-Dec-2019 09-Dec-2020 31-May-2022 IN00843578 ►Percentage of diabetes patients who received A1C blood sugar test once a year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 30.00 99.37 81.38 80.00 Date 26-Oct-2016 02-Dec-2019 01-Oct-2020 31-May-2022 As of October 1, 2020, it is 81.38%. The percentage will increase by the end of the year. Comments: Modernization of neonatal care IN00843550 ►Percentage increase in survival rate of newborns at the Intensive Neonatal Department of the RCMC (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 78.00 81.00 86.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 Intermediate Results Indicators by Components Establishment of E-Health and clinical decision support systems IN00843579 ►Establishment of CHIS implementation unit at the RSPC MT and fully functional (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 1.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 Achieved one year earlier than the target year. CHIS implementation unit was established at the RSPC Comments: MT and staffed pursuant to the RSPC MT order No. 31 dated May 19, 2017 and is fully functional. 12/23/2020 Page 3 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) IN00843583 ►Central database operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 26-Oct-2016 10-Jun-2019 05-Nov-2020 31-May-2022 IN00843586 ►Percentage of PHC doctors in selected health facilities using clinical decision making tools (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 IN00843589 ►Increase in patients' satisfaction with e-prescription (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 66.00 24.20 70.00 Date 26-Oct-2016 15-Nov-2019 09-Dec-2020 31-May-2022 Two surveys are planned in the middle and at the end of the project. Current value 24.20% is based on a survey on the degree of satisfaction with the electronic prescription system conducted from November 12, 2019 to November 22, 2019 on the website of the Ministry of Health. The intermediate target for the indicator is 20%.The previous value was 66.0% based on the results of a sociological survey among the population on health issues, which was conducted by the National Academy of Sciences in 2019. The project has proceeded with three CE activities: (1) The beneficiary survey (questionnaire completed, procured and fieldwork currently underway) and a GRM (the GRM is staffed and functioning, although no complaints have been received). (2) During the first 12 months, the MoH conducted public consultations Comments: on the E-health concept from September 4-14, 2018. The contacts of the PIU were made available for any additional feedback. Based on the received responses changes were made to the E-concept note, and finalized through necessary Government channels by February 2019. This led to finalization of technical documents that were published on MOH website as well as on international platform for bidding for potential consulting firms that would design the central platform for E-health system. (3) Similar public consultations were held before the procurement of simulation equipment for medical universities and colleges on the website of Belmedtechnica from December 12-22, 2018. IN00843592 ►Percentage of PHC doctors in selected health facilities receiving patients' summaries from specialists after hospital discharge (report on all relevant health information sent from specialists to PHC) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 21.70 100.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 Improvement of clinical competencies of health care providers in NCD management IN00843580 ►BelMapo Simulation Center constructed and equipped (Number, Custom) 12/23/2020 Page 4 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 26-Oct-2016 10-Jun-2019 05-Nov-2020 31-May-2022 The indicator is on track: all preparatory activities (necessary permits, feasibility study, contracting of services for development of project and bidding documentation) are being implemented according to Comments: schedule. IN00843584 ►Percentage of participants in training institutions: BelMapo new Simulation Center, medical universities and medical colleges satisfied with the technical effectiveness and quality of training (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 IN00843587 ►Training modules for core specialties at BelMapo new Simulation Center developed and approved by MoH (GP, ER, surgery, obstetrics- gynecology, dentistry, anesthesiology, neonatal) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 11 modules developed 7 approved and Value 0.00 11 approved and approved implemented Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 On track. Three modules -Surgery, Dentistry, Neonatology-developed in 2017 are approved by MoH on April 6 2018. Eight modules -anesthesiology and resuscitation, ob/gyn, emergency medical care, general Comments: practice, laparoscopy and thoracoscopy; angiosurgery, traumatology and orthopedics, ophthalmology- approved by the MOH on August 22 2018 IN00843590 ►Number of departments in each of the training institutions (BelMapo, medical universities and medical colleges) offering trainings on reproductive health (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 31.00 34.00 22.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 On track. Comments: IN00843593 ►Clinical skill labs in (a) Medical Universities; and (b) Colleges rehabilitated and equipped (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value a) 0; b) 0 a) 0; b) 0 a) 0; b) 0 a) 4; b) 17 Date 26-Oct-2016 10-Jun-2019 05-Nov-2020 31-May-2022 Renovation works completed in 16 medical colleges, BSMU and Gomel SMU. Comments: Intensity and percentage of implementation of this indicator is: a) 45%; b) 85% IN00843594 12/23/2020 Page 5 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) ►Number of health care specialists trained in emergency medical care at BelMapo, including using simulation equipment (cumulative) (disaggregated by gender) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,084.00 7,332.00 7,500.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 4.084 health care specialists were trained in emergency medical care at BelMAPO and other 4 medical Comments: universities in using existing simulation equipment Modernization of neonatal care at the RCMC IN00843581 ►Construction of a nursing and breast milk pumping room in the new neonatal department (y/n) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 On track. Preparatory activities are implemented according to schedule. Delivery of medical equipment is Comments: scheduled for May 2021. IN00843585 ►Clinical decision making tool on quality of neonatal care developed and used (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 Clinical decision making tool has been developed. The tool can be used once the e-Health system is Comments: operating. IN00843588 ►Neonatal department constructed and equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 26-Oct-2016 10-Jun-2019 05-Nov-2020 31-May-2022 On track. Contract for construction works has been concluded. Comments: IN00843591 ►Reduction in average length of stay of infants at the Intensive Neonatal Department (days) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11.50 11.50 11.50 10.00 Date 26-Oct-2016 10-Jun-2019 09-Dec-2020 31-May-2022 12/23/2020 Page 6 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) Project management, monitoring and evaluation IN00843582 ►Grievances registered related to delivery of project benefits addressed (%) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 26-Oct-2016 31-Oct-2019 01-Oct-2020 31-May-2022 The project has proceeded with three CE activities: (1) the beneficiary survey (questionnaire completed, procured and fieldwork currently underway) and a GRM (the GRM is staffed and functioning, although no complaints have been received). (2) During the first 12 months, the MoH conducted public consultations on the E-health concept from September 4-14, 2018. The contacts of the PIU were made available for any additional feedback. Based on the received responses changes were made to the E-concept note, and finalized through necessary Government channels by February 2019. This led to finalization of technical Comments: documents that were published on MOH website as well as on international platform for bidding for potential consulting firms that would design the central platform for E-health system. (3) Similar public consultations were held before the procurement of simulation equipment for medical universities and colleges on the website of Belmedtechnica from December 12-22, 2018. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P156778 IBRD-86630 Effective USD 125.00 125.00 0.00 14.00 111.00 11% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P156778 IBRD-86630 Effective 18-Nov-2016 25-Nov-2016 19-May-2017 31-May-2022 31-Dec-2023 Cumulative Disbursements 12/23/2020 Page 7 of 8 The World Bank Implementation Status & Results Report Belarus Health System Modernization Project (P156778) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level Approved on 09-Jun-2020 ,Level 2 Approved on 10-Jun-2020 Related Project(s) There are no related projects. 12/23/2020 Page 8 of 8