The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) Supporting Egypt’s Universal Health Insurance System (P172426) MIDDLE EAST AND NORTH AFRICA | Egypt, Arab Republic of | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 2 | ARCHIVED on 27-Apr-2021 | ISR46246 | Implementing Agencies: Ministry of Finance, Arab Republic of Egypt Key Dates Key Project Dates Bank Approval Date: 16-Jun-2020 Effectiveness Date: -- Planned Mid Term Review Date: 01-Dec-2022 Actual Mid-Term Review Date: Original Closing Date: 31-Oct-2024 Revised Closing Date: 31-Oct-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To (i) increase the coverage of Egypt’s Universal Health Insurance System in Phase I Governorates, (ii) strengthen UHIS-related governance and institutions, and (iii) provide temporary financial protection against high out of pocket health expenditures for vulnerable populations outside Phase I Governorates. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1:Enrollment and empanelment of the population into UHIS:(Cost $208.00 M) Component 2: Strengthening UHIS governance, systems and facilitating environment:(Cost $132.00 M) Component 3: Providing temporary financial protection against high out of pocket health expenditures for vulnerable populations outside Phase I Governorates:(Cost $50.00 M) Component 4: Institutional Capacity Building, Technical assistance and Project Management:(Cost $10.00 M) Component 5: Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Supporting Egypt’s Universal Health Insurance System (UHIS) project was approved by the World Bank’s Board of Executive Directors on June 16, 2020, and the Loan agreement was signed on January 21, 2021. It is awaiting parliamentary approval to become effective. The implementing agency for the project is the Ministry of Finance (MOF), and a Project Management Unit (PMU) consisting of MOF staff and consultants will be responsible for the day-to-day project implementation. The PMU has been established and is currently operational. The Bank team is working 4/27/2021 Page 1 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) closely with the French Development Agency (AFD) and the Japanese International Cooperation Agency (JICA) towards achieving full coordination and complementarity in the support provided to the UHIS in Egypt. 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 Moderate Moderate 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 Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- Substantial Substantial Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Enrollment and Empanelment of the Population into UHIS IN00978706 ►Number of people enrolled with UHIA and empanelled with a GP in Phase I Governorates (excluding Targeted Vulnerable People) (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,700,000.00 0.00 3,107,065.00 Date 27-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 Implementation has begun. Comments: IN00978709 Percentage of people enrolled with UHIA and empanelled with a GP in Phase I Governorates (excluding Targeted Vulnerable People) who are female (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 4/27/2021 Page 2 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) Value 0.00 0.00 0.00 50.00 Date 02-Mar-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978711 ►Per capita annual PHC visits by UHIS enrollees in Phase I Governorates (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.10 1.10 1.10 2.50 Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978713 Per capita annual PHC visits by male UHIS enrollees in Phase I Governorates (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.98 0.98 0.98 2.40 Strengthening UHIS Governance, Systems and Facilitating Environment IN00978707 ►Percentage of contracted public provider entities that have been accredited by GAHAR (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978712 ►Annual percentage of payments by UHIA that are made to contracted providers in Phase I Governorates within 60 days from the date of claim submission (Percentage, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 26-Jan-2024 Under development and to be finalized on 2021. Comments: Temporary financial protection against high OOP healthcare expenditures for vulnerable populations IN00978708 ►Number of Other Vulnerable People benefiting from PTES in Other Governorates (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,000,000.00 Date 08-May-2020 22-Sep-2020 20-Apr-2021 28-Jun-2024 IN00978710 Female share of the number of Other Vulnerable People benefiting from PTES in other Governorates (Percentage, Custom Supplement) 4/27/2021 Page 3 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 45.00 Intermediate Results Indicators by Components Comp 1: Enrollment of the population in the UHIS and empanelment with General Practitioners (GP) IN00978714 ►Number of Targeted Vulnerable People enrolled with UHIA and empanelled with a GP (number) (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 30,000.00 30,000.00 2,620,584.00 Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 Number of vulnerable persons and their dependents for whom UHIA received state-paid subsidies (the poor) in the preceding calendar year in full. Under the universal health insurance system, the vulnerable Comments: and their dependents are identified using the proxy means tested administered by the “last resort” social assistance scheme. IN00978716 Number of Targeted Vulnerable People enrolled with UHIA and empanelled with a GP (number) and share of females among them (percentage) (Text, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2,620,584 / 60% IN00978718 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 6,727,649.00 Date 27-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978720 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 6,727,649.00 Comp 2: Strengthening capacity of UHIS-related agencies, governance & creating enabling environment IN00978715 ►Development and adoption by UHIA of a benefit package for the continuum of care (primary care, secondary and tertiary hospital care) (Yes/No, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 4/27/2021 Page 4 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) Development and adoption by UHIA of a benefit package has commenced. Comments: IN00978717 ►Supporting modular UHIS information system roll-out (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Supply chain No modular UHIS No modular UHIS No modular UHIS Value procurement module Information System Information System Information System within EASPMTM Date 29-Jan-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978719 ►Creation of official coordinating body for UHIS at national and Governorate levels (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 7.00 Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978721 ►Establishment of a one- stop shop for licensing of private primary healthcare services (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 29-Jan-2020 05-Oct-2020 20-Apr-2021 29-Dec-2023 IN00978722 ►Development and adoption of a process guide for hospital accreditation standards by GAHAR (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 31-Dec-2021 IN00978723 ►Operationalization of a Big Data Analytics unit within UHIA (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978724 ►Development of quality of care monitoring frameworks for PHC & hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Yes for PHC and Value No No No hospitals Date 26-Feb-2020 05-Oct-2020 20-Apr-2021 29-Dec-2023 4/27/2021 Page 5 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) From Year 1 to Year 4, at least 10 clinical guidelines on priority conditions (TBD) will be revised or Comments: developed and endorsed annually. IN00978725 ►Share of case-based payment in total UHIA’s annual payment to hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20.00 Date 26-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 This indicator measures the payment method used by the UHIA to pay hospitals. The measure is the Comments: proportion of hospital discharges paid using the case based payment system. IN00978726 ►Introduction of the risk adjusted capitation (at least for sex and age) in PHC payment (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 29-Jan-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978727 ►Development of National Strategy for Quality of Care and Patient Safety (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 29-Jan-2020 05-Oct-2020 20-Apr-2021 30-Dec-2022 For development of Quality Framework for Strategic Purchasing and its introduction into the payment mechanism, a decision of the UHIA Board of Directors is required, which formally adopts revisions to the Comments: current payment model, namely: (a) introduction of Key Performance Indicators (KPI) and (b) Quality Indicators (QI) to improve efficiency and quality of care in family medicine and hospitals. IN00978728 ►Annual UHIA performance and expenditure review report published (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978729 ►Annual report on patient satisfaction, grievances and utilization published (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1.00 Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978730 ►Annual UHIS Health Forum held at Governorate and national levels (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 4/27/2021 Page 6 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) No forums conducted at No forums conducted at No forums conducted All enrolled Value Governorate or national Governorate or national at Governorate or Governorates and levels levels national levels national level Date 24-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978731 ►Strengthening accreditation and provider contracting (Text, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target 15 public and 5 private ambulatory service Value 0.00 0.00 0.00 providers, 1 public and 1 private Telemedicine service providers Date 27-Feb-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 IN00978732 ►Client user satisfaction and utilization surveys conducted in project target areas (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 28-Apr-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 To track yearly the patient satisfaction and utilization levels in project target areas in the target Phase I Comments: Governorates. IN00978733 ►Development of guidelines and protocols on data privacy and management of health records, to mitigate risk of data breaches (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 28-Apr-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 Measures development of guidelines and protocols on data privacy and management of health records, to Comments: mitigate risk of data breaches. IN00978734 ►Development and formal adoption of the organizational structure and a multi-year Human Resource Plan for each of UHIA, GAHAR and HCO (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 08-May-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 In year 1, development and formal adoption of the organizational structure and a multi-year Human Comments: Resource Plan for each of UHIA, GAHAR and HCO IN00978735 ►Reduction of the staffing gap for each of UHIA, GAHAR and HCO (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 4/27/2021 Page 7 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) Date 08-May-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 From year 1 to 4, calculate the average percentage of filled (hired and onboarded) positions in the Comments: combined total number of positions in the UHIA, GAHAR and HCO officially adopted organizational structures IN00978736 ►Level of satisfaction of citizens and patients in their participation in coordination committees (disaggregated for national and regional levels (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 21-May-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 Level of satisfaction of citizens and patients in their participation in coordination committees Comments: (disaggregated for national and regional levels) IN00978737 ►Revision of the strategy to target vulnerable people for UHIS subsidies (Yes/No, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 25-May-2020 05-Oct-2020 20-Apr-2021 28-Jun-2024 Comments: Revision of the strategy to target vulnerable people for UHIS subsidies Performance-Based Conditions IN00978738 ►PBC 1 Number of people enrolled with UHIA and empanelled with a GP in Phase I Governorates (excluding Targeted Vulnerable People) (Number, Output, 28,000,000.00, 8%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Value 0.00 2,700,000.00 0.00 1,552,000.00 Date -- 05-Oct-2020 20-Apr-2021 -- IN00978739 ►PBC 2 Number of Targeted Vulnerable People enrolled with UHIA and empanelled with a GP (number) (Number, Output, 180,000,000.00, 41.2%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Value 0.00 30,000.00 30,000.00 1,320,000.00 Date -- 05-Oct-2020 20-Apr-2021 -- 4/27/2021 Page 8 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) IN00978740 ►PBC 3 Development and adoption by UHIA of a benefit package for the continuum of care (primary care, secondary and tertiary hospital care) (Yes/No, Process, 10,000,000.00, 4%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Value No No No -- Date -- 05-Oct-2020 20-Apr-2021 -- IN00978741 ►PBC 4 Supporting modular UHIS information system roll-out (Text, Process, 35,000,000.00, 14%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Provider No modular UHIS No modular UHIS No modular UHIS Value epanelment Information System Information System Information System enrollment module Date -- 05-Oct-2020 20-Apr-2021 -- IN00978742 ►PBC 5 Strengthening accreditation and provider contracting (Text, Output, 25,000,000.00, 7.2%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 10 public and 20 Value 0.00 0.00 0.00 private pharmacies Date -- 05-Oct-2020 20-Apr-2021 -- IN00978743 ►PBC 6 Annual percentage of payments by UHIA that are made to contracted providers in Phase I Governorates within 60 days from the date of claim submission (Percentage, Process, 20,000,000.00, 8%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Value 0.00 0.00 0.00 60.00 Date -- 05-Oct-2020 20-Apr-2021 -- IN00978744 ►PBC 7 Creation of official coordinating body for UHIS at national and Governorate levels (Number, Process, 27,000,000.00, 8.8%) 4/27/2021 Page 9 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Value 0.00 0.00 0.00 4.00 Date -- 05-Oct-2020 20-Apr-2021 -- IN00978745 ►PBC 8 Revision of the strategy to target vulnerable people for UHIS subsidies (Yes/No, Process, 15,000,000.00, 6%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Value No No No No Date -- 05-Oct-2020 20-Apr-2021 -- IN00978746 ►PBC 9 Number of Other Vulnerable People benefiting from PTES in Other Governorates (Number, Output, 50,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) FY21 to FY24 Value 0.00 0.00 0.00 1,000,000.00 Date -- 05-Oct-2020 20-Apr-2021 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Not P172426 IBRD-91320 USD 400.00 400.00 0.00 0.00 400.00 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P172426 IBRD-91320 16-Jun-2020 21-Jan-2021 -- 31-Oct-2024 31-Oct-2024 Effective Cumulative Disbursements 4/27/2021 Page 10 of 11 The World Bank Implementation Status & Results Report Supporting Egypt’s Universal Health Insurance System (P172426) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 4/27/2021 Page 11 of 11