The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Kosovo Health Project (P147402) EUROPE AND CENTRAL ASIA | Kosovo | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 15 | ARCHIVED on 30-Jun-2020 | ISR42359 | Implementing Agencies: Republic of Kosovo, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 13-May-2014 Effectiveness Date: 20-May-2015 Planned Mid Term Review Date: 30-Oct-2017 Actual Mid-Term Review Date: 30-Oct-2017 Original Closing Date: 30-Oct-2019 Revised Closing Date: 30-Jun-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To contribute to improving financial protection from health spending for the poor and quality of care for priority maternal and child health and non communicable disease services. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) To contribute to (i) developing the building blocks to introduce Social Health Insurance, (ii) strengthening Primary Health Care in selected regions and (iii) prevent, detect and respond to the threat posed by COVID-19. Components Table Name Support capacitiy building and establishment of building blocks for introduction of SHI:(Cost $5.20 M) Support primary health care strengthening:(Cost $4.90 M) Project management and communications:(Cost $0.70 M) COVID-19 emergency response:(Cost $4.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Moderate Implementation Status and Key Decisions This ISR presents the findings of the implementation support visit during March 9 - 13, 2020 and progress to-date. Overall, good progress has been achieved in the implementation of most project activities, contributing positively towards the achievement of project development objectives. Specifically, key activities have progressed as planned, including: (I) development and utilization of the Health Information System for the Health Insurance Fund; (ii) finalizing the drug benefits list and preparing the piloting of the e-prescription and outpatient drug 6/30/2020 Page 1 of 7 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) benefits package; (iii) successful completion of the technical assistance support on hospital management and re-organization of the University Clinical Center; and (iv) rolling out the web-application with a simple HIS module to support the capitation-based payments to 29 municipalities. However, there have been some delays in passing the amendment to the current Health Insurance Law, and approving the Administrative Guidelines for exempted categories. Due to the COVID-19 pandemic, the Government requested a project restructuring (May 2020) to: (i) slightly change the PDO scope to include supporting the Government’s response to the threat posed by COVID-19; (ii) include a new Component, “Emergency response to COVID-19,” with a cost of US$ 4 Million, to finance the COVID-19 response activities; (iii) revise the Results Framework to reflect the change in the PDO and the scope of the project; (iv) modify procurement arrangements to enable direct contracting; (v) upgrade the Environmental and Social Safeguards Framework category to reflect the scope of the project; and (vi) extend the project closing date by 12 months to June 30, 2021 to allow for extra time to respond to COVID-19. The restructuring was approved in early June 2020. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High Substantial Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- High Moderate Technical Design of Project or Program -- Substantial Moderate Institutional Capacity for Implementation and -- Substantial Substantial Sustainability Fiduciary -- High Moderate Environment and Social -- Low Low Stakeholders -- Substantial Low Other -- -- Moderate Overall -- Substantial Moderate Results PDO Indicators by Objectives / Outcomes To contribute to developing the building blocks to introduce Social Health Insurance IN00859343 ►Outpatient (OP) drug benefit scheme established (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The costed list of drugs The list of drugs for List of drugs under the for the outpatient drug outpatient drug benefit ODBS presented to Value No benefit scheme is scheme adopted by the HIF Board of the submitted to the Steering the HIF is submitted to HIF Board of the HIF the Government 6/30/2020 Page 2 of 7 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Date 13-May-2014 06-Dec-2019 12-Jun-2020 30-Jun-2021 The approval of the list is expected to be done when the new Government will be in place. Comments: IN00859345 ►HIFIS is functional (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 13-May-2013 06-Dec-2019 12-Jun-2020 30-Jun-2021 The system is expected to be functional by end of December, 2020. Comments: To contribute to strengthening Primary Health Care IN00859344 ►Number of municipalities participating in CBPP scheme (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6.00 18.00 18.00 20.00 Date 13-May-2013 06-Dec-2019 12-Jun-2020 30-Jun-2021 Out of the 20 municipalities which were expected to participate in CBPP in 2019, the following 18 Municipalities did so: On May 24, 2019, the following municipalities signed performance agreements with MoH: 1. Dragash, 2. Malisheva, 3. Prishtina, 4. Prizren, 5. Rahovec, 6. Suharekë, 7. Gllogoc, 8. Fushë Comments: Kosovë, 9. Lipjan , 10.Obiliq, 11.Podujevo, 12.Mamusha, 13.Gjilan, 14.Kamenica, 15.Novobërdë, 16.Viti, 17.Partesh, and 18.Ranillug. To prevent, detect, and respond to the threat posed by COVID-19 IN00859342 ►Prishtina Student Campus quarantine area has been upgraded, as per approved MoH guidelines (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 15-May-2020 01-May-2020 12-Jun-2020 30-Jun-2021 Intermediate Results Indicators by Components Establishing Building Blocks for the Introduction of Social Health Insurance IN00859346 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/30/2020 Page 3 of 7 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Value 0.00 12,278.00 16,527.00 2,449.00 Date 13-May-2014 06-Dec-2019 12-Jun-2020 30-Jun-2021 Medical training on access to PHC on the five modules is continuing in 32 municipalities, in accordance with the schedule foreseen by the company holding the trainings. During the period of February 11, 2019 to December 13, 2019. Total number of trainees: 6,159. Training on “Capacity Building for Outpatient Drug Benefit Scheme,” completed with nine modules from June 10 to June 21, 2019. Total number of trainees: 167. Training on “Capacity Building for Outpatient Drug Benefit Scheme - Workshop on External Reference Price Calculation”, completed from September 30 to October 1, 2019. Total number of trainees: 27. Comments: Training for “System platform for HIFIS (hardware system software) Ref.1.2.4 held November –December 2019. Total number of trainees: 936. Training workshop MLSW “Concept document of the social assistance scheme and new poverty test” held November 29, 2019. Total number of trainees: 74. Management training for KHUCS – UCCK held from January 21, 2010 - February 5, 2020. Total number of trainees: 450. IN00859348 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.00 11.00 11.00 Date 13-May-2014 06-Dec-2019 12-Jun-2020 30-Jun-2021 IN00859352 ►Percentage of patients using primary health care facilities who are satisfied with services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.80 65.80 65.80 70.00 Date 31-Dec-2017 06-Dec-2019 12-Jun-2020 30-Jun-2021 Based on the results “Expectation and Perception of Population Towards Quality of Services in Primary Health Care and their Expectation Regarding the Outpatient Drug Benefit Scheme in the Republic of Kosovo” Comments: (February 2018), 65.8% of patients using primary health care services are satisfied with the services received. Strengthening Primary Health Care IN00859349 ►Number of patients registered in the HIS (Number (Thousand), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 378,965.00 528,625.00 511,074.00 Date 13-May-2013 06-Dec-2019 12-Jun-2020 30-Jun-2021 In total 528,625, out of which 56% are female. Patients registered in AVICENNA are not transferred to Comments: PRA-HIS by the MOH-HIS Department. IN00859351 6/30/2020 Page 4 of 7 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Of which female (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 56.00 78.00 IN00859353 ►Percentage of capitation-based performance payment budget spent at municipality level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72.14 72.14 95.00 Date 13-May-2014 06-Dec-2019 12-Jun-2020 30-Jun-2021 The current value is the end of 2018 value. Since then, effective capitation-based payments to Comments: municipalities have been stalled in 2019. IN00859354 ►Percentage of participating municipalities with a performance improvement action plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 90.00 100.00 75.00 Date 13-May-2014 06-Dec-2019 12-Jun-2020 30-Jun-2021 The current value is the end of 2018 value. Since then, actual capitation-based payments have been stalled. All eighteen participating municipalities have developed performance improvement action plans Comments: although nt receiving the payments yet. Emergency response to COVID-19 IN00859347 ►Number of health staff trained in infection prevention and control per MOH approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 400.00 Date 15-May-2020 01-May-2020 12-Jun-2020 30-Jun-2021 IN00859350 ►Number of volunteer healthcare staff covered with salaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 400.00 Date 15-May-2020 01-May-2020 12-Jun-2020 30-Jun-2021 Performance-Based Conditions Data on Financial Performance 6/30/2020 Page 5 of 7 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P147402 IDA-54420 Effective USD 25.50 17.31 8.19 6.82 8.05 46% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P147402 IDA-54420 Effective 13-May-2014 15-Jan-2015 20-May-2015 30-Oct-2019 30-Jun-2021 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC 6/30/2020 Page 6 of 7 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Restructuring History Level 2 Approved on 12-Jun-2018 ,Level 2 Approved on 24-Jul-2019 ,Level 2 Approved on 02-Jun-2020 Related Project(s) There are no related projects. 6/30/2020 Page 7 of 7