The World Bank Report No: ISR16466 Implementation Status & Results Kyrgyz Republic Kyrgyz Health Results Based Financing (P120435) Public Disclosure Copy Operation Name: Kyrgyz Health Results Based Financing (P120435) Project Stage: Implementation Seq.No: 4 Status: ARCHIVED Archive Date: 22-Nov-2014 Country: Kyrgyz Republic Approval FY: 2013 Product Line: Recipient Executed Activities Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Mandatory Health Insurance Fund, Ministry of Health Key Dates Board Approval Date 18-Apr-2013 Original Closing Date 30-Jun-2017 Planned Mid Term Review Date 20-Jan-2016 Last Archived ISR Date 16-Apr-2014 Effectiveness Date 29-Jul-2014 Revised Closing Date 30-Jun-2017 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to (1) pilot performance-based payments and/or enhanced supervision for quality of maternal and neonatal care in randomly selected rayon hospitals; and (2) strengthen the Government’s and providers’ capacity in performance-based contracting and monitoring and evaluating for results. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Care 9.59 Component 2: Strengthen the Government's and Providers' Capacity in Performance-Based Payment 1.41 Reform and Monitoring and Evaluation f or Results Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Satisfactory Overall Risk Rating Moderate Implementation Status Overview The Grant Agreement for a pilot project was signed on December 30, 2013. The pilot project became effective on July 29, 2014 after fulfilling all conditions of effectiveness: issuance of the Legal Opinion; approval of the Project Operations Manual (POM); establishment of RBF Secretariat, RBF Technical Team and RBF National Steering Committee; and development and adoption of the POM. The Government remains committed to the project implementation. Implementation of the pre-pilot project in Chui rayon/district hospital since the fall 2013 allowed to develop and Page 1 of 5 The World Bank Report No: ISR16466 test the RBF project processes, procedures and instruments (setting up accounts, flow of funds, verification and counter-verification processes). This provided opportunity to the MOH, MHIF and key stakeholders, including the pre-pilot hospital to learn from the implementation before the roll out of the RBF. The pre-pilot project demonstrated promising results by bringing changes to management of the hospital - the baseline score has increased from 37% to 53% and 67% between December 2013 when the pre-pilot started and April and July 2014 when second and third rounds of peer verification took place. The RBF pre-pilot project was closed on Sept 30, 2014. Public Disclosure Copy Comprehensive Baseline Impact Evaluation (IE) survey was conducted in the end of 2012 with a coverage of 66 rayon hospitals and 130 primary care facilities (PHC facilities were surveyed on the limited spectrum of aspects); its preliminary results were presented to the Mandatory Health Insurance Fund (MHIF), purchaser of health services which performs also a function of quality expertise in the existing health system. Selected key results of the baseline IE were also presented at the National Perinatal Forum in July 2014. Randomization of hospitals into 3 arms was completed during the randomization ceremony which took place on June 18, 2014. It was attended by various stakeholders, including representatives of the MOH, MHIF, selected hospitals, National Pediatrics Center/tertiary MCH facility, professional associations, civil society and press representatives. The random assignment was determined though an iterative Stata computer program in front of the entire audience. All of the attendees who made public comments were satisfied with the transparency of the process. The randomization outcomes were placed on the MOH's website. Baseline survey using the the Balanced Scorecard (BSC) of all 63 hospitals was completed in July-August 2014 , and after each baseline assessment the training on the BSC for core staff of the 42 hospitals assigned to arms 1 and 2 of the study was done. The baseline quality score ranged from as low as 0-0.4 percent to as high as 42.4 percent with the average quality score varying between 8.5 percent to 11,5 percent by different arms. Training on the BSC for core staff of the 42 hospitals in arms 1 and 2 was done after each baseline assessment. Pilot RBF project is being scaled up to 42 hospitals assigned to Arms 1 and 2 since the project effectiveness in July 2014. Next critical actions include: (i) to make the first payment to 21 hospitals assigned to Arm 1 based on results of the baseline survey by October 30, 2014; (ii) to accelerate re-tender for design of an open-source information and communication technology (ICT) system for the RBF program based on tablet-based data-entry and automatic upload to a server; (iii) to roll out further the performance based payments and/or enhanced supervision for quality in randomly selected 42 pilot hospitals assigned to Arms 1 and 2 as planned in October 2014. (iv) to ensure payment to 21 hospitals to be done within two weeks after the MHIF's receipt of payment invoices based on results of the first quarterly verification scheduled for completion by the end of October 2014; Locations Country First Administrative Division Location Planned Actual Kyrgyz Republic Osh Osh Oblasty ✔ Kyrgyz Republic Batken Batken Oblasty ✔ Kyrgyz Republic Talas Talas Oblasty ✔ Public Disclosure Copy Kyrgyz Republic Naryn Naryn Oblasty ✔ Kyrgyz Republic Ysyk-Koel Issyk-Kul'skaya Oblast' ✔ Kyrgyz Republic Bishkek Gorod Bishkek ✔ Kyrgyz Republic Jalal-Abad Jalal-Abad Oblasty ✔ Kyrgyz Republic Chuy Chuy Oblasty ✔ Results Page 2 of 5 The World Bank Report No: ISR16466 Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Proportion of quarterly peer verification records Percentage Value 0.00 100.00 Public Disclosure Copy for Groups 1 and 2 rayon hospitals submitted Date 31-Dec-2015 to MHIF within one week after the end of each Comments No peer verification Yr1: 80% quarter Yr2: 100% Yr3: 100% Proportion of eligible rayon hospitals that Percentage Value 0.00 100.00 received the authorized performance-based Date 31-Dec-2015 payments within two weeks after the MHIF’s Comments No performance based Yr1: 80% receipt of payment invoices payments Yr2: 100% Yr3: 100% Number of counter-verification carried out for a Number Value 0.00 8.00 subset of Group 1 rayon hospitals and Group 2 Date 31-Dec-2015 rayon hospitals every six months Comments No counterverification Yr1: 8 Yr2: 8 Yr3: 8 Impact Evaluation Surveys completed on Text Value No surveys Atleast 2 round of serveys schedule to generate evidence for policy implmented by the end of the project Date 31-Dec-2015 Comments Yr1: Baseline survey completed before pilot start YR3: Follow-up survey completed at the end of the project Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy Performance Contracts signed with the Group Number Value 0.00 20.00 1 rayon hospitals (20) and updated annually Date 31-Dec-2015 based on any modifications introduced to the Comments No contract signed Yr1: Contracts signed with 20 Balanced Scorecard rayon hospitals. Yr2: Contracts renewed and adjusted if needed with 20 rayon hospitals. Yr3: Contracts renewed and adjusted if needed with 20 rayon hospitals Page 3 of 5 The World Bank Report No: ISR16466 Proportion of Group 1 rayon hospitals (20) that Percentage Value 0.00 100.00 received quarterly performance-based Date 31-Dec-2015 payments in accordance to their level of Comments No performance based Yr1: 100% performance as per agreed Performance Public Disclosure Copy Contracts payments disbursed Yr2: 100% Yr3: 100% MOH/MHIF produce quarterly monitoring Number Value 0.00 4.00 reports within 2 weeks after the end of each Date 31-Dec-2015 quarter Comments No quarterly reports Yr1: 4 Yr2: 4 Yr3: 4 National RBF Steering Committee meets at Number Value 0.00 2.00 least twice a year Date 31-Dec-2015 Comments Yr1: 2 Yr2: 2 Yr3: 2 Extended RBF team meets at least every 2 Number Value 0.00 6.00 months Date 31-Dec-2015 Comments Yr1: 6 Yr2: 6 Yr3: 6 Data on Financial Performance (as of 30-Jul-2014) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P120435 TF-13310 Effective 30-Dec-2013 30-Dec-2013 29-Jul-2014 30-Jun-2017 30-Jun-2017 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Public Disclosure Copy P120435 TF-13310 Effective USD 11.00 11.00 0.00 0.00 11.00 0.00 Disbursement Graph Page 4 of 5 The World Bank Report No: ISR16466 Public Disclosure Copy Key Decisions Regarding Implementation Not applicable Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 5 of 5