Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) Rural Health Project (P084437) EAST ASIA AND PACIFIC | China | Health, Nutrition and Population Global Practice | IBRD/IDA | Specific Investment Loan | FY 2008 | Seq No: 10 | ARCHIVED on 24-Dec-2014 | ISR17381 | Implementing Agencies: Key Dates Key Project Dates Board Approval date:24-Jun-2008 Effectiveness Date:31-Dec-2008 Planned Mid Term Review Date:30-Sep-2011 Actual Mid-Term Review Date:13-Sep-2011 Original Closing Date:31-Dec-2013 Revised Closing Date:31-Dec-2014 Project Development Objectives Project Development Objective (from Project Appraisal Document) The main project objective is increased and more equitable access to quality health services, improved financial protection, and better management of public health threats in pilot provinces and counties, with lessons to support reforms in non-project areas. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component One: Health Reform Innovations Supported via Block Grants:(Cost $46.00 M) Component Two: Project Coordination, Policy Development and Lesson Learning:(Cost $11.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  --  Low Implementation Status and Key Decisions 12/24/2014 Page 1 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) The underlying motivation for the project is to support innovations and generate knowledge useful to the government for its on-going health reform program. the project has generated a number of innovative pilots which have directly contributed to the policy development and reform implementation in project counties and for the nation as a whole.The project has met all the 22 project monitoring and performance indicators and in genenal has achieved the Project Development Objectives in the following three areas: (i) increased use of health services, decreased out of pocket expenses by patient, and improved equity of health services; (ii) increased health financing resources for the rural population and improved public health management; and (iii) improved technical quality of care, internal efficiency in service delivery, and increased rate of overall satisfaction with the rural health services. Final evaluations have been completed by the project counties, provinces and central level. Collection of best practice case studies have been published. Successful experiences have been summariezed and disseminated to the non-project areas and have contributed to national policy developments. A project completion and dissemination workshop has taken place in November, 2014. The central CPSM is in the process to prepare a borrower's ICR report based on its comprehensive project final evaluation report, and a province PMO director workshop has been held on Dec 17, 2014 for World Bank ICR report preparation. 12/24/2014 Page 2 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  --  Low Macroeconomic  --  --  Moderate Sector Strategies and Policies  --  --  Low Technical Design of Project or Program  --  --  Low Institutional Capacity for Implementation and Sustainability  --  --  Moderate Fiduciary  --  --  Moderate Environment and Social  --  --  Moderate Stakeholders  --  --  Low Other  --  --  Low Overall  --  --  Low Results Project Development Objective Indicators PHINDPDOTBL  Ratio of hospitalization rate of MA (Medical Assistance scheme) vs. non-MA beneficiaries (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Average 1.5; 12 counties<1; Value 2.1 2.1 Positive trend 29 counties 1-2; 9 counties>2 Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDPDOTBL  Ratio of outpatient visit rate of the bottom 20% vs. the top 40% in the income distribution in the previous year (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Average 1.1; # of counties Value 1.2 1.2 18 counties<1; with a ratio 12/24/2014 Page 3 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) 14 counties 1-1.5; lower than 1 8 counties >1.5 reduced to 6 Date 31-Dec-2008 31-Dec-2013 31-Oct-2013 31-Dec-2014 Comments # of counties with ration lower than 1 is 6 by the survey in 2013 PHINDPDOTBL  % households with annual health expenditures in excess of 20% of total income (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.20 13.20 13.20 14.20 Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDPDOTBL  Rate of overall satisfaction with rural health services among men (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 63.80 85.40 85.40 67.80 Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDPDOTBL  Rate of overall satisfaction with rural health services among women (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 66.60 85.50 85.50 70.60 Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDPDOTBL  Public health system scorecard rating (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 61.78 90.50 90.22 80.00 12/24/2014 Page 4 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDPDOTBL  Innovation accepted and rolled out at provincial or regional level (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0 199 199 Positive trend Date 31-May-2008 30-Jun-2014 31-Oct-2014 31-Dec-2014 Overall Comments Intermediate Results Indicators PHINDIRITBL  % of total annual (individual) inpatient expenses financed through out-of-pocket payments for NCMS members (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 74.7 48.4 48.4 67.7 Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDIRITBL % of total annual (individual) inpatient expenses financed through out-of-pocket payments for MA beneficiaries covered by the NCMS (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 72.30 35.60 35.60 65.30 Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 12/24/2014 Page 5 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) PHINDIRITBL  Total annual NCMS expenditures as % of total annual NCMS funds (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 72.7 98.6 98.6 >85 Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDIRITBL  % NCMS enrollment rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 93.90 97.30 97.30 -- Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 Comments the target is to maintain >90% PHINDIRITBL  Average number of outpatient visits per health professional per day over last year at THC (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.9 4 4 Positive trend Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 Comments The change is toward the positive direction, but not significant in value. This largely due to the following: The reform on payment to the THC staff as the results of essential drugs and zero markup policy has to some extent de-motivated the health professionals at THC. As the results, the productivity has dropped at the THC and the utilizaiton at higher level hospitals has increased all over the country. To be able to remain the same productivity, this is already an achivement for the project counties. 12/24/2014 Page 6 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) PHINDIRITBL  Rate of change in average cost per inpatient case in county hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Project counties should be lower than Value 7.70 9.3% 7.5% provincial average rate of change Date 31-Dec-2009 31-Dec-2013 31-Oct-2014 31-Dec-2014 Comments the provincial average is 8.5% PHINDIRITBL  % of deliveries by caesarean section (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target # of counties moving towards Value 28.90 29.4 28.5 WHO standard which is 15% Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 Comments The whole country has seen an increase of the c-section rate in the past years, based on the national health utilization survey: the national rate for 2008 is 27%, for 2013 is 41%. Under this context, the rate of project counties dropped rather than increased. PHINDIRITBL  % of outpatients at township health centers and village clinics that receive two or more antibiotics (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 18.9% township health 4.8% township health 4.8% township health 4% reduction Value centers and 19.8% village centers and 5% village centers and 6.5% village from baseline clinics clinics clinics Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 12/24/2014 Page 7 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) PHINDIRITBL  % of women who have access to a female qualified worker (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 28 Counties >90% 32 Counties Value 95.9 95.9 12 Counties <90% >90% Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 Comments 36 counties above 90% PHINDIRITBL  % of villages that meet 'healthy village' standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- -- Date 31-Dec-2008 31-Dec-2013 31-Dec-2013 31-Dec-2013 Comments this indicator has been changed to the following indicator during the mid-term evaluation PHINDIRITBL  Number of administrative villages that have initiated the implementation of 'healthy village' (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 50% of the project counties 35 out of total 40 project 87.5% of the project have initiated counties(87.5%) counties(totally 277 the launched " Healthy villages) have initiated implementation Villlage" construction the implementation of of healthy Value 0 and 277 villages met healthy village and at village and At with the standards, all least 1 village each least 1 village the provinces have province met 'healthy each province healthy villages that village' standards meet meet the standards 'healthyvillage' standards Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 12/24/2014 Page 8 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) PHINDIRITBL  % of women between age 15 and 49 who undergo gynecological check-up in last year (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 44.10(with big disparities Value 66.3 66.3 54.10 across provinces) Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDIRITBL  % of individuals over 35 with hypertension who have been followed-up in the last three months (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 66.20 89.4 89.4 >80% Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 PHINDIRITBL  Annual per capita government expenditures on county level public health institutions and programs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 14.6 yuan 56 Yuan 56 Yuan 20.9 yuan Date 31-Dec-2008 31-Dec-2013 31-Oct-2014 31-Dec-2014 Comments 3.8 times larger in 2013 than in 2008 PHINDIRITBL  Project lessons and experiences are documented and disseminated (Qualitative) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target All 40 project counties carried out 100% of project Will be available by Value 0 summarization and counties have end of August dissemination of the implemented project experiences Date 31-Dec-2008 30-Jun-2014 31-Oct-2014 31-Dec-2014 12/24/2014 Page 9 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) PHINDIRITBL  Project experiences are extended or adopted outside project areas (Qualitative) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 60% of the All 8 project provinces project had carried out provinces Will be available by promotion and disseminate Value 0 end of August application of project experiences experiences in non- in their project regions respective non- project counties Date 31-Dec-2008 30-Jun-2014 31-Oct-2014 31-Dec-2014 PHINDIRITBL  Health personnel receiving training (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value -- 180728.00 180728.00 -- Date 31-Dec-2008 30-Jun-2014 30-Jun-2014 -- Comments This is World Bank HNP core indicator, no target value is set, the team is required to report on the accumulated value. PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value -- 1755.00 1755.00 -- Date 31-Dec-2008 30-Jun-2014 30-Jun-2014 -- Comments This is World Bank HNP core indicator, no target value is set, the team is required to report on the accumulated value. Overall Comments Data on Financial Performance Disbursements (by loan) 12/24/2014 Page 10 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P084437 IBRD-75510 Effective USD 50.00 49.97 0.03 49.85 0.12 100% P084437 TF-92893 Closed USD 6.14 6.14 0.00 6.15 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P084437 IBRD-75510 Effective 24-Jun-2008 08-Oct-2008 31-Dec-2008 31-Dec-2013 31-Dec-2014 P084437 TF-92893 Closed 08-Oct-2008 08-Oct-2008 31-Dec-2008 31-Mar-2011 31-Mar-2011 Cumulative Disbursements Restructuring History Level Approved on 29-Mar-2011 ,Level Approved on 30-Jul-2012 ,Level Approved on 29-Apr-2013 Related Project(s) 12/24/2014 Page 11 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Rural Health Project (P084437) There are no related projects. 12/24/2014 Page 12 of 12 Public Disclosure Copy