Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) EUROPE AND CENTRAL ASIA | Kazakhstan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 5 | ARCHIVED on 06-Jul-2018 | ISR32756 | Implementing Agencies: Ministry of Health, Ministry of Health, Ministry of Finance Key Dates Key Project Dates Bank Approval Date:27-Apr-2016 Effectiveness Date:27-Jun-2017 Planned Mid Term Review Date:11-Nov-2019 Actual Mid-Term Review Date:-- Original Closing Date:30-Jun-2021 Revised Closing Date:30-Jun-2021 Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed Project Development Objective is to improve accessibility, quality, and efficiency of health service delivery, and reduce financial risks to the population that are caused by serious health problems. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1. Supporting implementation of the national mandatory Social Health Insurance system:(Cost $16.63 M) Component 2. Strengthening of health service delivery to support implementation of the national mandatory Social Health Insurance system:(Cost $62.94 M) Component 3. Project management, monitoring and evaluation, and communications strategy:(Cost $10.43 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Unsatisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory Overall Risk Rating  Substantial  Substantial 7/6/2018 Page 1 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Implementation Status and Key Decisions The Ministry of Health and the World Bank (WB) held a project launch workshop on February 26, 2018 attended by 130 participants from the MoH and other stakeholders. During the workshop, the Ministry of Health has familiarized the stakeholder with the Project objectives, design, and implementation arrangements, and the Bank team presented key elements of the legal documents, project implementation, monitoring and reporting, and the Bank’s policies and procedures in relation to procurement and financial management. The MoH and WB have also jointly organized the Flagship Course on Health System Strengthening as part of capacity building activities under the Project that was held in Astana between February 26 - March 2, 2018. The course was specifically tailored to the context and development priorities of the Kazakhstan health system and attended by 88 stakeholders from various government agencies, medical universities, and NGOs. This massive capacity building course was well received by the participants who appreciated the interaction and content discussed. As such, it has the potential to contribute to a more strategic and well-thought implementation of the envisaged reforms, including the mandatory social health insurance (MSHI) system. Following initial delays, the processes of contracting the envisaged international and local consulting services have accelerated recently, including with the introduction of online procurement processing system. Given the decision to postpone implementation of the mandatory social health insurance (MSHI) system until 2020, the Ministry of Health and the Bank team are currently in the process of adjusting the Project monitoring indicators to the new timeline of the MSHI implementation. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  Moderate  Moderate  Moderate Macroeconomic  Substantial  Substantial  Substantial Sector Strategies and Policies  Substantial  Substantial  Substantial Technical Design of Project or Program  Substantial  Substantial  Substantial Institutional Capacity for Implementation and Sustainability  Substantial  Substantial  Substantial Fiduciary  Substantial  Substantial  Substantial Environment and Social  Moderate  Moderate  Moderate Stakeholders  Substantial  Substantial  Substantial Other  Substantial  Substantial  Substantial Overall  Substantial  Substantial  Substantial Results Project Development Objective Indicators PHINDPDOTBL  Increase public expenditure share for PHC + consultation and diagnostic care + outpatient drugs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/6/2018 Page 2 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Value 35.00 35.00 37.00 40.00 Date 18-Sep-2015 -- 28-Jun-2018 30-Jun-2021 Comments "37.00" represents the refined value for 2016 based on National Health Accounts (NHA). The value for 2017 will become available in calendar quarter 4 when the respective NHA report is produced. PHINDPDOTBL  Percent of all surgeries included in the “outpatient elective surgeries” list performed as outpatient surgeries in project- supported hospitals and outpatient facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 5.00 5.00 50.00 Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments No progress yet since the Mandatory Social Health Insurance system, with financial / payment incentives to be introduced by the Social Health Insurance Fund, will be implemented as of January 2020. PHINDPDOTBL  Percent of all contracted inpatient services subject to technical audit (annually) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 20.00 20.00 40.00 Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments No progress yet since the Mandatory Social Health Insurance system will be implemented as of January 2020. PHINDPDOTBL  SHIF is fully functional based on predefined criteria (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/6/2018 Page 3 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Value N N N Y Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments Not all criteria of SHIF full functionality have been met as the Mandatory Social Health Insurance system will be implemented as of January 2020. PHINDPDOTBL  Decline in the proportion of the bottom 40% of households incurring out-of-pocket expenditures on health that exceed 10% of total non-food related household spending over a 12-month period (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9.30 9.30 10.50 6.50 Date 31-Dec-2013 -- 28-Jun-2018 30-Jun-2021 Comments "10.50" represents the value for 2016 based on data from the Statistics Committee of the Ministry of National Economy. Overall Comments While some progress is observed in PDO indicator 1, there is no progress in the other four PDO indicators, with PDO indicator 5 on financial risk protection even showing some regress compared to the baseline (to be confirmed based on comparison of the methodologies used by WB to estimate the baseline and by Statistics Committee to report the current value). The overall reason for this situation was the postponement of the MSHI implementation to 2020 whereby the SHIF has not yet started using functions, tools and incentives aimed at stimulating improvements in access, quality, efficiency and financial risk protection. Intermediate Results Indicators PHINDIRITBL  Percent of population for whom SHIF received SHI contributions/subsidies and people with access to an insurance package of health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 31.80 60.00 Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments 7/6/2018 Page 4 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Percent of population for whom SHIF received SHI contributions/subsidies: collection of SHI contributions from employers and the self- employed has formally started as of July 1, 2017, and contributions for 31.8% of the total population were collected in 2017. People with access to an insurance package of health services: the value for this part of the indicator is 0 because the MSHI implementation has been postponed to January 2020. PHINDIRITBL  People with access to an insurance package of health services (Number (Thousand), Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10,500.00 PHINDIRITBL  Achievement of key benchmarks for functioning social health insurance system (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments The value for Year 1 has been achieved: an implementation plan (roadmap) for the SHI was defined and approved (Ministry of Health Order No.764 dated October 16, 2017), including benchmarks. However, achievement of the benchmarks will be delayed to a certain degree due to the postponement of full MSHI implementation. PHINDIRITBL  Key adjustments in the contracting methods are adopted to include incentives for providers to improve quality (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N -- N Y Date 18-Sep-2015 -- 28-Jun-2018 30-Jun-2021 Comments 7/6/2018 Page 5 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) No progress yet due to the postponement of MSHI implementation to January 2020. PHINDIRITBL  Number of fully functional regional PHC excellence centers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 16.00 Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments On track, not yet due - first value is expected in Year 3; preparatory activities are underway. PHINDIRITBL  Number of regions implementing disease management programs with evidence-based effectiveness, including incentives for health providers and patients (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 7.00 7.00 16.00 Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments On track. 7/6/2018 Page 6 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) PHINDIRITBL  Percent of health facilities meeting International Patient Safety Goals (minimum 5 points) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 10.00 10.00 50.00 Date 31-Dec-2014 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments No progress. It is proposed to drop this indicator as part of the Project restructuring because of a selection bias: because national accreditation is voluntary in Kazakhstan, only around 200 health facilities (out of over 5,000) participate in the national accreditation program every year (and many others, especially the private ones, prefer to pass international accreditation (JCI) or specialized accreditation for services of various international organizations (ISO)). All organizations that have received national accreditation meet the Patient Safety Goals, which creates a selection bias. PHINDIRITBL  Number of educational programs developed and implemented in medical education institutions based on competence-based approach and professional standards through strategic partnerships (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 2.00 5.00 Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments On fast track: a bachelor-level educational program "Public Health" and State Educational Standards in "General Medicine", "Pediatrics", and "Dentistry" approved (MoH Order No.530 dated July 17, 2017) and implemented as of academic year 2017. Development / revision of educational programs in nursing at the vocational, academic bachelor's, master's and doctorate levels was started in 2018. PHINDIRITBL  Unified register of human resources for health implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value N N N Y Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments On track: Professional Register module (HR management system) has been developed in draft version as part of the e-Health Integration and Interoperability Platform, which will become functional after the Platform is fully tested and operational. 7/6/2018 Page 7 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) PHINDIRITBL  Direct project beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10,000.00 Date 18-Sep-2015 15-Dec-2017 28-Jun-2018 30-Jun-2021 Comments Given that technical activities under the Project (implementation of activities under signed contracts) have started relatively recently, data on this indicator is not yet available. PHINDIRITBL  Female beneficiaries (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 52.00 PHINDIRITBL  Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 350.00 3,400.00 Date 18-Sep-2015 -- 28-Jun-2018 30-Jun-2021 Comments Based on cumulative data for quarter 1 of calendar year 2018. 7/6/2018 Page 8 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1.00 50.00 Date 18-Sep-2015 -- 28-Jun-2018 30-Jun-2021 Comments Based on data for quarter 1 of calendar year 2018. PHINDIRITBL  Percentage of patients reporting improved health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 50.00 70.00 Date 18-Sep-2015 -- 28-Jun-2018 30-Jun-2021 Comments Not yet due. The data collection / measurement methodology will be adjusted based on the technical activities planned. 7/6/2018 Page 9 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) PHINDIRITBL  Increase in transparency, credibility, and effectiveness of the complaints handling system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 60.00 Date 18-Sep-2015 -- 28-Jun-2018 30-Jun-2021 Comments The data collection / measurement methodology will be adjusted based on the technical activities planned. Overall Comments Similar to the situation with the PDO indicators, while some of the intermediate indicators show progress (e.g., number of regions implementing disease management programs, number of competence-based educational programs developed and implemented), those affected by the postponement in the implementation of the MSHI are off-track (e.g., achievement of key benchmarks for functioning social health insurance system, incentive-based adjustments in the contracting methods, and others) and need adjustments as part of the planned Project restructuring. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P152625 IBRD-86170 Effective USD 80.00 80.00 0.00 1.09 78.91 1.4% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P152625 IBRD-86170 Effective 27-Apr-2016 01-Nov-2016 27-Jun-2017 30-Jun-2021 30-Jun-2021 Cumulative Disbursements 7/6/2018 Page 10 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 7/6/2018 Page 11 of 11 Public Disclosure Copy