The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Health System Strengthening and Support Project (P152799) EUROPE AND CENTRAL ASIA | Turkey | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 11 | ARCHIVED on 23-Dec-2020 | ISR44457 | Implementing Agencies: Ministry of Health, Ministry of Treasury and Finance Key Dates Key Project Dates Bank Approval Date: 21-Sep-2015 Effectiveness Date: 26-Nov-2015 Planned Mid Term Review Date: 23-Feb-2018 Actual Mid-Term Review Date: 13-Apr-2018 Original Closing Date: 31-May-2020 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) of the HSSSP is to improve primary and secondary prevention of selected NCDs, increase the efficiency of hospital management, and enhance the capacity of the MoH for evidence-based policy making. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The Project Development Objective (PDO) of the HSSSP is to improve primary and secondary prevention of selected NCDs, increase the efficiency of hospital management, enhance the capacity of the MoH for evidence-based policy making, and strengthen the Government’s capacity to respond to COVID-19. Components Table Name Primary and Secondary Prevention:(Cost $29.77 M) Increasing Efficiency of Public Hospital Management:(Cost $30.49 M) Improving the Effectiveness of Overall Health Sector Administration:(Cost $43.87 M) Strengthening capacity to respond to COVID-19:(Cost $30.27 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Project was restructured, for the second time, on May 6, 2020. This restructuring has added an additional (4th) Component, namely Strengthening Capacity to Respond to COVID-19. 12/23/2020 Page 1 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) The project implementation slowed down due to the postponement of most of project activities as a result of negative effects of COVID-19 pandemic between March and November 2020. As of November 23, 2020, US$54 million (38%) of the Loan has been disbursed. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Substantial Substantial Sector Strategies and Policies Low Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial High Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Low Substantial Substantial Stakeholders Low Low Low Other -- -- -- Overall Moderate Substantial Substantial Results PDO Indicators by Objectives / Outcomes Objective 1: to improve primary and secondary prevention of selected non-communicable diseases IN00922515 ►Percent of households that receive from health workers counselling or education related to healthy living (by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 40.50 40.50 50.00 Date 31-Dec-2012 31-Mar-2020 23-Nov-2020 31-Dec-2021 The actual value reflects the results of 2018 survey. The reporting period for this survey is 2021. Comments: IN00922519 Percent of households that receive from health workers counselling or education related to healthy living (males) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target 12/23/2020 Page 2 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Value 7.00 38.10 38.10 40.00 Date 31-Dec-2012 31-Mar-2020 23-Nov-2020 31-Dec-2021 IN00922520 Percent of households that receive from health workers counselling or education related to healthy living (females) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 13.00 42.90 42.90 60.00 Date 31-Dec-2012 31-Mar-2020 23-Nov-2020 31-Dec-2021 IN00922521 ►Early detection of (a) cervical cancer (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 39.20 54.00 58.50 59.00 Date 31-Dec-2014 31-Dec-2019 23-Nov-2020 31-Dec-2021 This indicator has been restructured as the 2019, 2020 and 2021 targets and early detection formula for breast cancer and cervical cancer has been revised to align with 2019-2023 MoH Strategic Plan. The Comments: revision in the early detection formula also allows MoH to adequately track high quality data in 12 provinces of Turkey. IN00922522 Early detection of (b) breast cancer (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 48.70 49.00 50.50 51.00 Objective 2: to increase the efficiency of hospital management IN00922518 ►Simulation assisted trainings and implementations' coverage ratio of the targeted healthcare professionals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.48 10.00 Date 31-Dec-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 As of November 2020, he cumulative target value is below the annual target value for 2020 due to the delays in training activities due to the COVID-19 pandemic. MoH will provide the actual value for 2020 by Comments: the end of January 2021. Objective 3: to enhance the capacity of the MoH for evidence-based policy making IN00922516 ►Percent of policy and decision makers that regularly use HMIS regularly (monthly) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/23/2020 Page 3 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Value 0.00 22.00 53.00 80.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 The cumulative target value is on track. Comments: Objective 4: to strengthen MoH’s capacity to control and fight the threat posed by COVID-19 IN00922517 ►Vaccine production center against COVID-19 is operational (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Mar-2020 31-Mar-2020 23-Nov-2020 31-Dec-2021 The cumulative target value is on track. Comments: Intermediate Results Indicators by Components Component 1: Primary and Secondary Prevention IN00922526 ►Percent change in share of the general population who can state two or more negative health impacts of selected risk factors of non- communicable diseases and substance use (disaggregated by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 19-Oct-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 The actual value reflects the results of 2018 survey. The progress on this indicator will be reported in Comments: 2021. IN00922528 Percent change in share of the general population who can state two or more negative health impacts of selected risk factors of non- communicable diseases and substance use (Males) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 IN00922531 Percent change in share of the general population who can state two or more negative health impacts of selected risk factors of non- communicable diseases and substance use (Females) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 IN00922533 ►Number of Healthy Living Centers established (Number, Custom) 12/23/2020 Page 4 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 202.00 207.00 230.00 Date 31-Dec-2017 31-Mar-2020 23-Nov-2020 31-Dec-2021 As of November 2020, the number of HLCs is below the annual target for 2020 due to the negative effects Comments: of COVID-19 pandemic. MoH will provide the actual number for 2020 by the end of January 2021. IN00922535 ►Number of individuals in 12 project provinces who visit Substance Use Treatment Centers to receive patient-specific counselling (new and returning visitors) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 90.00 32,167.00 16,687.00 13,887.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 The indicator is on track. Comments: IN00922536 ►Direct project beneficiaries (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 23,000,000.00 0.00 27,600,000.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 The actual MoH will provide the number of project beneficiaries by the end of January 2021. Comments: IN00922539 Direct project beneficiaries of which female (percentage) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 81.70 0.00 66.00 IN00922540 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3,450.00 18,775.00 196,777.00 16,478.00 Date 31-Dec-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 The significant increase in the number of training activities is related with the distant learning activities. Comments: IN00922542 ►Percent of users of Healthy Living Centers satisfied with ease of access to Healthy Living Centers and/or responsiveness of services to users’ individual needs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 84.11 0.00 80.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 12/23/2020 Page 5 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Given the COVID-19 outbreak HLCs could not be utilized as intended, and an HLC patient satisfaction survey held during the COVID-19 disruptions would be difficult to implement and ultimately not representative. A decision was made to delay the survey until January 2021. The development of ToR, Comments: survey design, contract and fieldwork will be finalized following the approval from the Minister to proceed. Moving forward, depending on COVID-19 restrictions, MoH intends to use the results from future HLC patient satisfaction surveys to improve the HLC model. IN00922543 ►Percent of target population screened for 3 types of cancer: (a) cervical (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 80.00 39.50 80.30 Date 31-Dec-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 MoH will provide the percent of target population screened for 3 types of cancer by the end of January Comments: 2021. Due to the COVID-19 pandemic, the number screenings fell down. IN00922544 Percent of target population screened for 3 types of cancer: (b) breast (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 37.00 38.20 18.30 37.30 IN00922545 Percent of target population screened for 3 types of cancer: (c) colorectal (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 24.00 24.20 10.20 24.30 IN00922546 ►Number of PHC-level staff who have satisfactorily completed standardized face-to-face training modules required by the staff’s job profile (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,000.00 4,800.00 0.00 5,000.00 Date 19-Oct-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 MoH will provide the number of PHC-level staff who have satisfactorily completed standardized face-to- face training modules for 2020 by the end of January 2021. Due to the COVID-19 pandemic, the annual Comments: target is less likely to be met for 2020. IN00922547 ►Health facilities constructed, renovated, and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 106.00 128.00 241.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 Component 2: Increasing Efficiency of Public Hospital Management IN00922525 12/23/2020 Page 6 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) ►Number of simulation-based medical education centers established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 2.00 3.00 Date 19-Oct-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is on track. Comments: IN00922529 ►Establishment of a PPP M&E system (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 28-Feb-2019 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is on track. Comments: Component 3: Improving the Effectiveness of Overall Health Sector Administration IN00922523 ►National-level Health System Assessment conducted annually and published (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes No No Date 31-Dec-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 IN00922527 ►Key information technology standards developed and integrated into updated draft regulations (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 20.00 20.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is on track. Comments: IN00922530 ►Percent of health facilities that share data to HMS (a) public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 91.00 100.00 100.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is on track. Comments: IN00922532 Percent of health facilities that share data to HMS (b) family medicine centers (Percentage, Custom Supplement) 12/23/2020 Page 7 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 91.00 100.00 100.00 IN00922534 Percent of health facilities that share data to HMS (c) private hospitals (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 54.00 65.00 60.00 IN00922537 ►Percent of health indicators within MoH databases meeting international standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 59.50 82.50 75.00 Date 19-Oct-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is on track. Comments: IN00922538 ►At least 12 Health Technology Assessments on prioritized topics prepared in line with new HTA strategy and published (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 12.00 Date 20-Apr-2015 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is lagging. MoH will provide the number of HTA assessments by the end of January 2021. Comments: IN00922541 ►Process mapping of all MoH units (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Process flow charts Process flow charts Process mapping Value No process mapping updated updated completed Date 19-Oct-2018 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is on track. Comments: Component 4: Strengthening MoH's capacity to respond to COVID-19 IN00922524 ►Percentage of new recruits trained in BSL-4 operations/standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 31-Mar-2020 31-Mar-2020 23-Nov-2020 31-Dec-2021 This indicator is on track. Comments: 12/23/2020 Page 8 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P152799 IBRD-85310 Effective USD 134.30 134.30 0.00 54.74 79.91 41% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P152799 IBRD-85310 Effective 21-Sep-2015 30-Sep-2015 26-Nov-2015 31-May-2020 31-Dec-2021 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC 12/23/2020 Page 9 of 10 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Restructuring History Level 2 Approved on 23-Apr-2019 ,Level 2 Approved on 21-May-2020 Related Project(s) There are no related projects. 12/23/2020 Page 10 of 10