The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Second Serbia Health Project (P129539) EUROPE AND CENTRAL ASIA | Serbia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 15 | ARCHIVED on 26-Apr-2021 | ISR46143 | Implementing Agencies: Ministry of Health, Republic of Serbia Key Dates Key Project Dates Bank Approval Date: 25-Feb-2014 Effectiveness Date: 08-May-2015 Planned Mid Term Review Date: 14-Feb-2018 Actual Mid-Term Review Date: 29-Jan-2018 Original Closing Date: 30-Sep-2019 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to contribute to improving the efficiency and quality of the public health system of the Republic of Serbia through the strengthening of: (i) health financing, purchasing, and maintenance systems; and (ii) quality improvement systems and management of selected priority non- communicable diseases. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improvement of Health Financing:(Cost $11.20 M) Improve Access to Quality Health Care:(Cost $8.90 M) Strengthening Quality of Service Delivery:(Cost $46.00 M) Monitoring and Evaluation and Project Management:(Cost $4.90 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions According to the latest data from the March 2021 visit, two out of five project development objective indicators met their end targets. In addition, 9 out of 16 intermediate results indicators achieved or exceeded their end targets. In addition, two out of three disbursement conditions related to the procurement of diagnostic equipment under Component 3 have been fulfilled, with the third one expected to be fulfilled soon.. Under Component 1 - Improvement of Health Financing, the development of a health care network optimization plan is completed and its adoption is expected in forthcoming period. A new costing methodology for health services, including DRGs, is under development. Strengthening of hospitals IT systems to support better reporting has been initiated. The implementation of grants scheme for the improvement of quality of care in primary health care (PHC) facilities has been completed. 4/26/2021 Page 1 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Under Component 2 - Improve Access to Quality Health Care, the Ministry of Health has continued to implement multiple activities for the rational use of antibiotics. The results of the analysis of the consumption of antibiotics in Serbia for the period 2015-2018 show that the consumption of antibiotics have decreased by 37.6% from 2015. Delivery of a total of 1,900 dispensers and 9,500 liters of alcohol-based hand sanitizer for intensive care units has been completed, with delivery of new quantities planned. On health technology assessment, a capacity building program has started for staff of institutions that perform HTA has started. On medical equipment maintenance, activities have been agreed to support implementation of multi-vendor medical equipment maintenance contracts. Finally, under Component 3 - Strengthen Quality of Service Delivery, 16 clinical pathways for PHC are in the process of computerization and integration in PHC centers’ information system, which is expected to ensure their effective utilization by PHC staff. The quality of care information system is being updated and computerized. Activities on development and deployment of the Cancer Registry Information System of Serbia have started. Eight linear accelerators are in operation. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Moderate Moderate Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Moderate Moderate Sustainability Fiduciary -- Moderate Substantial Environment and Social -- Low Low Stakeholders -- Moderate Moderate Other -- Moderate Moderate Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes To contribute to improving the efficiency and quality of the public health system of Serbia IN00975370 ►Percentage of total acute care hospitalization cases in public hospitals reported accurately based on DRGs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 95.00 95.00 95.00 4/26/2021 Page 2 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975441 ►Percent reduction in average unit price relative to baseline for the 50 most frequently dispensed multi-source pharmaceuticals that are procured through centralized framework contracts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 27.00 27.00 27.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975442 ►Percentage of patients starting radiotherapy treatment at public hospitals within 28 days between the date of issuance of treatment protocol and the first radiotherapy session for a) breast, b) cervic (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Monitoring system in Monitoring system in Monitoring system in No monitoring system in place to measure the place to measure the place to measure the Value place to report on the indicator, baseline indicator, baseline indicator, baseline and indicator defined, target defined target values defined tentatively defined Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975443 ►Percentage of registered adult patients in Dom Zdravljas with recorded blood pressure value, BMI, smoking status and recommended tips for healthy behavior in the preceding 12 months in their med recor (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 34.70 34.70 45.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 The current value is for 2019; the 2020 value will be available mid-2021. Comments: IN00975444 ►Percentage of registered insured persons covered by the targeted examination for early detection of a) breast (age 50-69 in the past two years), b) cervical (age 25-64 in the past three years) and c) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target a) 6%; a) 13%; a) 13%; a) 25%; Value b) 27%; b) 29.1%; b) 29.1%; b) 35%; c) 10% c) 28.5% c) 28.5% c) 35% Date 30-Nov-2017 24-Sep-2020 28-Feb-2021 31-Dec-2021 The current values are for 2019; the 2020 values will be available mid-2021. Comments: Overall Comments PDO The value date for indicators is based on the latest Second Serbia Health Project progress report submitted by the MOH/PCU before the virtual implementation support mission (March 29 - April 1, 2021). Intermediate Results Indicators by Components 4/26/2021 Page 3 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) 1. Improvement of Health Financing IN00975445 ►Percentage of pilot Dom Zdravljas who meet grant agreement performance criteria in the preceding one year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 Quality Improvement Grants were launched in December 2019. Data will be available after one year of implementation. The achievement is expected to be surpassed and will be documented upon closing of Comments: the grants, which was on March 31, 2021. IN00975448 ►DRGs payment system developed and financing for a portion of acute hospital care based on DRGs initiated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975451 ►Number of health workers receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 500.00 24,803.00 30,152.00 13,000.00 Date 16-Jan-2014 24-Sep-2020 28-Feb-2021 31-Dec-2021 This indicator is mapped to all three components. Comments: 2. Improve Access to Quality Health Care IN00975446 ►Number of pharmaceuticals and health products that are procured through centralized framework contracts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 700.00 700.00 700.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 1,421 brand names / 700 INNs equivalent Comments: IN00975449 ►Percentage of a) Dom Zdravljas and b) pharmacies implementing e-prescription system (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DZs - 0 DZs - 98%; DZs - 98%; DZs - 90% Value Pharm - 0 Pharm - 98% Pharm - 98% Pharm - 90% Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 4/26/2021 Page 4 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) IN00975452 ►Reduction in the total consumption of antibiotics for systemic use (J01) DDD/1000 person/per day (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 37.60 37.60 22.00 Date 30-Nov-2017 24-Sep-2020 28-Feb-2021 31-Dec-2021 Data for 2018. data for 2019 will be available in November 2020. Comments: IN00975454 ►Strengthen systems for Health Technology Assessment (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The linkage between Stakeholder groups national clinical defined in the practice guidelines and Roadmap. Training basic benefit package Stakeholder groups Limited institutional according to their roles well established and defined in the Roadmap. efficiency related to the under way. functional. The new, Training according to Value decision making process Implementation of robust and their roles prepared, but in the area of drug activities in transparent, system of delayed due to COVID- reimbursement accordance with evidence based 19 pandemic implementation supported decision schedule defined in making process fully the Roadmap. established and functional Date 30-Nov-2017 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975456 ►Strengthen systems for medical equipment maintenance (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Medical equipment registry set up within No national systems or Medical equipment IHIS and Entity Budget allocated to policies in place, Medical registry set up within established for expand maintenance Value equipment database in IHIS. oversight of medical system. National the IPH equipment system(s) in use maintenance. Date 16-Jan-2014 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975458 ►Annual training organized for health Roma mediators (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 5.00 4.00 Date 30-Nov-2017 24-Sep-2020 28-Feb-2021 31-Dec-2021 3. Strengthen Quality of Service Delivery IN00975447 4/26/2021 Page 5 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) ►Number of clinical pathways developed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 14.00 48.00 48.00 48.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975450 ►Number of health care institutions that have completed staff training on priority clinical pathways (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 131.00 131.00 160.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975453 ►Ranking of health institutions according to quality criteria in place based on quality indicators in health care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Ranking of health Improved quality institutions according indicators determined, Improved quality Value Existing quality indicators to quality criteria based new information under indicators on data from previous preparation/no ranking year/Yes Date 16-Jan-2014 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975455 ►Number of new linear accelerators installed at national level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 8.00 8.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 IN00975457 ►Percentage of adult diabetic patients in Dom Zdravljas with at least one determined value of glycosylated hemoglobin (HbA1c) in the last year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 44.10 44.10 50.00 Date 16-Oct-2013 24-Sep-2020 28-Feb-2021 31-Dec-2021 This indicator is mapped to components 2 and 3. Comments: The current value is for 2019; the 2020 value will be available mid-2021. IN00975459 ►Percentage of registered adult patients in DZs with hypertension under treatment whom in the last recorded blood pressure (measured in the preceding one year) is ≤ 140/90 mm Hg (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 46.50 46.50 70.00 4/26/2021 Page 6 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Date 16-Jan-2014 24-Sep-2020 28-Feb-2021 31-Dec-2021 This indicator is mapped to components 2 and 3. Comments: The current value is for 2019; the 2020 value will be available by mid-2021. IN00975460 ►Percentage of patients satisfied with the quality of care in PHC facilities (CE) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 80.07 80.07 80.00 Date 30-Nov-2017 24-Sep-2020 28-Feb-2021 31-Dec-2021 The current value is for 2019; the 2020 value will be available by mid-2021. Comments: Overall Comments IR The value date for indicators is based on the latest Second Serbia Health Project progress report submitted by the MOH/PCU before the virtual implementation support mission (March 29 - April 1, 2021). Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P129539 IBRD-83380 Effective USD 40.00 40.00 0.00 32.00 2.87 92% P129539 IBRD-88300 Effective USD 31.10 31.10 0.00 9.87 20.27 33% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P129539 IBRD-83380 Effective 25-Feb-2014 10-Jul-2014 08-May-2015 30-Sep-2019 31-Dec-2021 P129539 IBRD-88300 Effective 20-Mar-2018 21-Mar-2018 24-Jul-2018 31-Dec-2021 31-Dec-2021 Cumulative Disbursements 4/26/2021 Page 7 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 14-Sep-2015 Related Project(s) P166025-Additional Financing for Second Serbia Health Project 4/26/2021 Page 8 of 8