The World Bank North East and Red River Delta Regions Health System Support Project (P122629) REPORT NO.: RES37021 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF NORTH EAST AND RED RIVER DELTA REGIONS HEALTH SYSTEM SUPPORT PROJECT APPROVED ON MAY 31, 2013 TO SOCIALIST REPUBLIC OF VIETNAM HEALTH, NUTRITION & POPULATION EAST ASIA AND PACIFIC Regional Vice President: Victoria Kwakwa Country Director: Ousmane Dione Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Enis Baris Task Team Leader: Huong Lan Dao The World Bank North East and Red River Delta Regions Health System Support Project (P122629) I. BASIC DATA Product Information Project ID Financing Instrument P122629 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 31-May-2013 31-Dec-2019 Organizations Borrower Responsible Agency Socialist Republic of Vietnam Ministry of Health Project Development Objective (PDO) Original PDO The Project Development Objective is to increase the efficiency and equity in the use of hospital services in selected provinces ofthe North East and Red River Delta Regions. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-52590 31-May-2013 01-Aug-2013 17-Oct-2013 31-Dec-2019 150.00 91.24 48.09 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES The World Bank North East and Red River Delta Regions Health System Support Project (P122629) 1. Project status (i) By the time of project restructuring, the Progress towards achievement of Project Development Objective (PDO) was rated Moderately Satisfactory; the justification for this rating is the fair progress toward achieving PDO indicators. (ii) The Implementation Progress of the Project is rated as Moderately Satisfactory. At the time of restructuring, the project has disbursed USD 85.3 million, accounted for 61.3% of the project fund. 1,632 new techniques (683 at provincial level and 949 at district level) were transferred from central to local level hospitals, achieved 92% the target values. In total, 710,187 patients have received new techniques, in which 35,753 patients used new clinical techniques, achieved 58% and 80% of the target values, respectively; health insurance coverage for the near poor reached 100% with co-subsidy by provincial budget and the card valid for 11.8 months, surpassed the end target of 70%. 100% project hospitals implement quality improvement plans/activities and have improved their quality scores over time, overachieved the original target of 75%; The number of health staff trained overachieved the planned target as of 116%. (iii) Among the above indicators, there is a risk that the project will not be able to achieve the final target of two indicators, numbers of technical transferred and numbers of patient received new techniques. The main reason are some new techniques in the areas of radiation therapy for oncology treatment and cardiological interventions have not yet been transferred due to slow disbursement of major equipment and the complexity of the techniques. These can affect the overall achievement of the project as they are key techniques to be transferred to the local level hospitals 2. Rationale for restructuring (extension of closing date) (iv) While the project has achieved the above good results, the Project has to face with difficulties in transferring clinical techniques on two major areas, radiation therapy for oncology treatment and cardiological intervention for the local level hospitals. The operation of these techniques requires high-tech equipment, intensive staff training, and well - prepared infrastructure (for instance, concrete bunker for the Linear Accelerator System (LINAC) that the project is going to purchase for the beneficiaries hospitals). Addition to that, the LINAC system is the highest technology, the most sophisticated specifications equipment and the highest value package (almost USD 15 million) that a WB Health project has supported Vietnam so far. The preparation for the LINAC system also requires not only domestic but also international standards for environment safeguards (radiation safeguards) that the Project has to follow. (v) In March 2019, the CPMU and the WB task team requested the IAEAs’ (International Atomic Energy Agency) Technical Support to conduct Technical Review about the readiness of the Hospitals and provide pertinent recommendations related to the establishment of Radiotherapy services in the project hospitals. Findings from the IAEA mission have been well received by the project team to improve the project preparation and bidding document to purchase the LINAC system. This diligent review process helps to ensure that Project beneficiaries hospitals met the required safeguard and technical standards to operate the radiation therapy services. However, this process has been time consuming and requires enormous efforts by the Project team. (vi) The bid of the LINAC system was opened in early May. However, with the original closing date of December 31, 2019, it is very difficult for the project to complete the purchasing and installing of the equipment, fully transfer clinical techniques, and monitor the operation of the equipment and its benefits to the patients. Within this context, the Ministry of Health requested the World Bank to extend the project closing date to December 31, 2020. A detailed The World Bank North East and Red River Delta Regions Health System Support Project (P122629) action plan has been developed and agreed between the WB Task Team and the MOH to ensure that the Project can be completed successfully within the extended timeline. II. DETAILED CHANGES LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-52590 Effective 31-Dec-2019 31-Dec-2020 30-Apr-2021