The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Strengthening Universal Health Insurance in Costa Rica (P148435) LATIN AMERICA AND CARIBBEAN | Costa Rica | Health, Nutrition & Population Global Practice | Requesting Unit: LCC2C | Responsible Unit: HLCHN IBRD/IDA | Program-for-Results Financing | FY 2016 | Team Leader(s): Eleonora Del Valle Cavagnero Seq No: 11 | ARCHIVED on 29-Jul-2021 | ISR47629 | Created by: Vanessa Marin Arbelaez on 08-Jul-2021 | Modified by: Vanessa Marin Arbelaez on 28-Jul-2021 Program Development Objectives PDO Table Program Development Objective (from Program Appraisal Document) The objectives of the Program are to contribute to: (i) improving the timeliness and quality of health services; and (ii) enhancing the institutional efficiency of the CCSS. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Implementation Status and Key Decisions The Strengthening Universal Health Insurance in Costa Rica Program-for-Results was approved by the Board of Directors on March 15, 2016. A loan in the amount of US$420 million was signed by the Government of Costa Rica and World Bank on April 21, 2016 and the loan was declared effective on November 17, 2016. Project implementation is underway. As of July 2021, the loan has disbursed $390 million (93%), from which $324.3 million (77.2%) correspond to confirmed results. The program has a remainder of $95.7 million of results to be achieved. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P148435 IBRD-85930 Effective USD 420.00 420.00 0.00 390.00 30.00 93% Key Dates (by loan) 7/29/2021 Page 1 of 7 The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148435 IBRD-85930 Effective 15-Mar-2016 21-Apr-2016 17-Nov-2016 30-Apr-2022 30-Apr-2022 DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IBRD85930-001 43% major surgeries from 1.1 Regular USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % Priority List 46% of major surgeries 1.2 Regular USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % from priorities l Cumulative of 10% of 2.1 Regular USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % Target Population p Cumulative of 40% of Partially 2.2 Regular USD 30,000,000.00 14,300,000.00 48 % Target Population p Achieved 41% of individuals 3.1 Regular USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % diagnosed with Diabet 43% of individuals Partially 3.2 Regular USD 30,000,000.00 22,500,000.00 75 % diagnosed with Diabet Achieved 4.1 Regular Pilot project approved USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % Evaluation of pilot publicly 4.2 Regular USD 30,000,000.00 Not Achieved 0.00 disseminate 60% of total number of 5.1 Regular USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % primary health ca 80% of total number of 5.2 Regular USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % primary health ca CCSS Board approval of 6.1 Regular USD 30,000,000.00 Fully Achieved 30,000,000.00 100 % redesign of patie Report on impact of 6.2 Regular USD 30,000,000.00 Not Achieved 0.00 interventions to imp Ten-year investment plan 7.1 Regular USD 20,000,000.00 Fully Achieved 20,000,000.00 100 % approved by CCS Actuarial valuation of 7.2 Regular USD 20,000,000.00 Fully Achieved 20,000,000.00 100 % health insurance Annual budget of CCSS 7.3 Regular USD 20,000,000.00 Not Achieved 0.00 approved by CCSS B Program Action Plan Action Description Contracting an Independent Verification Entity (IVE). Source DLI# Responsibility Timing Timing Value Status Technical CCSS Due Date 29-Jun-2018 Completed 7/29/2021 Page 2 of 7 The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Completion Measurement Contract signed Comments 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 Moderate Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- Moderate Overall Moderate Moderate Moderate RiskComments Comments Other risks include the uncertain evolution of COVID-19 pandemic and its impact on the Program and achievement of Program indicators. Results PDO Indicators by Objectives / Outcomes Improving Timeliness and Quality of Health IN01020128 ►Percentage of major surgeries from priority list conducted in outpatient settings according to CCSS institutional guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18.00 49.80 49.80 46.00 Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 29-Apr-2022 Indicator achieved its end of Project target. Comments IN01020130 ►Cumulative percentage of target population personally invited to undergo colon cancer screening in five priority counties. (Percentage, Custom) 7/29/2021 Page 3 of 7 The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 24.30 29.90 40.00 Date 29-Feb-2016 31-Dec-2020 30-Jun-2021 29-Apr-2022 Comments Improving the institutional efficiency of CCSS IN01020129 ►Percentage of total number of primary health care units (Areas de Salud) with the Unique Digital Health Record e-health package (EDUS) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 90.10 90.10 80.00 Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 29-Apr-2022 Indicator achieved its end of Project target. Comments IN01020131 ►Development and execution of a comprehensive medium-and long-term plan to ensure the financial sustainability of the CCSS (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Annual target expected Annual target expected Annual budget Budget does not use Value to be achieved by end of to be achieved by end execution using prospective tools. 2021. of 2021. prospective tools. Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 29-Apr-2022 Comments Intermediate Results Indicators by Results Areas Health Care Model IN01020132 ►Cumulative percentage reduction in average waiting days for selected procedures (tracers): hip and knee replacement. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1032 days 573 days 573 days 35% lower Date 29-Feb-2016 15-Jun-2020 15-Jun-2020 29-Apr-2022 Comments IN01020135 ►Percentage of individuals diagnosed with hypertension that are under optimal clinical control. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 65.70 65.70 64.00 Date 31-Dec-2013 15-Jun-2020 15-Jun-2020 29-Apr-2022 Comments Indicator achieved its end of Project target. 7/29/2021 Page 4 of 7 The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Institutional Management IN01020133 ►Percentage of households covered by the Family Socio-Economic & Health Risks Information File. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 100.00 100.00 100.00 Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 29-Apr-2022 Indicator achieved its end of Project target. Comments IN01020136 ►Percentage of households with Family Socio-Economic & Health Risks Information File digital geo-referencing data available online. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.70 15.70 16.00 Date 29-Feb-2016 15-Jun-2020 15-Jun-2020 29-Apr-2022 Comments IN01020138 ►Use of institutional strategic intelligence system data to publish and disseminate two annual reports measuring progress of SASHI (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target System designed, approved and System designed, System designed, launched Value - approved by Board of approved by Board of Two annual reports Directors Directors published and disseminated Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 28-Apr-2022 Comments IN01020139 ►Institutional Review of core institutional management functions, and operational plan for progressive implementation of streamlining central level management. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Approved by Board of Approved by the Board of Approved by the Board Value - Directors Directors of Directors Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 29-Apr-2022 Comments Financial Management IN01020134 ►Financial statements produced using new international public accounting standards, streamlined and digital automated processes. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 7/29/2021 Page 5 of 7 The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Approved Evaluation report of first two years Value - In progress In progress Annual Financial Statement using outputs from new automated streamlined system Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 29-Apr-2022 Comments IN01020137 ►Shadow budget constructed based on gender and age risk adjusted capitations. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value - In progress In progress Completed Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 29-Apr-2022 Comments Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 Percentage of major surgeries from priority list conducted in outpatient settings according to CCSS institutional guidelines. (Outcome, 60,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2 Value 41.60 49.80 49.80 46.00 Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 -- Verified. Indicator achieved its end of Project target. Comments ►DLI 2 Cumulative percentage of target population personally invited to undergo colon cancer screening in five priority counties. (Outcome, 60,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2 Value 0.00 24.30 24.30 40.00 Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 -- Verified (only first milestone). Comments ►DLI 3 Percentage of individuals diagnosed with Diabetes Type II that are under optimal clinical control. (Output, 60,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2 Value 39.00 42.50 42.50 41.00 7/29/2021 Page 6 of 7 The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Date 31-Dec-2014 31-Dec-2020 31-Dec-2020 -- Verified. Indicator achieved its end of Project target. Comments ►DLI 4 Pilot project on integrated health networks approved by the CCSS Board and implemented for a selected population and territory and evaluated with the results publicly disseminated. (Output, 60,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2 Pilot Project on Pilot Project on integrated integrated health health networks approved Value - networks approved by -- by the CCSS Board of the CCSS Board of Directors. Directors. Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 -- Verified (only first milestone). Comments ►DLI 5 Percentage of total number of primary health care units (Areas de Salud) with the Unique Digital Health Record e-health package (EDUS). (Outcome, 60,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2 Value 50.00 90.10 90.10 80.00 Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 -- Verified. Indicator achieved its end of Project target. Comments ►DLI 6 Redesign, implementation and use of data collected by the new annual survey to measure impact of new interventions to improve patient satisfaction. (Output, 60,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2 Redesign survey was Redesign survey was Value - approved by the Board of approved by the Board of -- Directors Directors Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 -- Verified (only first milestone). Comments ►DLI 7 Development and execution of a comprehensive medium- and long-term plan to ensure the financial sustainability of the CCSS. (Outcome, 60,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2 Milestone 7.1 being Milestone 7.1 and 7.2 Value - -- verified being verified Date 29-Feb-2016 31-Dec-2020 31-Dec-2020 -- Verified (two of three milestones). Comments 7/29/2021 Page 7 of 7