The World Bank Implementation Status & Results Report China Health Reform Program (P154984) China Health Reform Program (P154984) EAST ASIA AND PACIFIC | China | Health, Nutrition & Population Global Practice | Requesting Unit: EACCF | Responsible Unit: HEAHN IBRD/IDA | Program-for-Results Financing | FY 2017 | Team Leader(s): Dinesh M. Nair, Wei Han Seq No: 8 | ARCHIVED on 24-Feb-2021 | ISR45223 | Created by: Wei Han on 07-Jan-2021 | Modified by: Wei Han on 19-Feb-2021 Program Development Objectives Program Development Objective (from Program Appraisal Document) To improve the quality of healthcare services and the efficiency of the healthcare delivery systems in Anhui and Fujian provinces. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Implementation Status and Key Decisions The Program-for-Results became effective on September 11, 2017, and its overall performance has been satisfactory thus far. Over the past three years, both program provinces have piloted and scaled up key reforms as planned in the three result areas: (i) public hospital reforms including public hospital governance, efficiency and quality; (ii) people centered integrated care including primary health care capacity building, non- communicable disease management, prospective provider payment; and (iii) enabling environment, including consolidation of the health insurance system, human resources for health, as well as the health information system. Two domestic workshops were held to promote knowledge sharing and learning across the provinces in identified key reform areas.. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P154984 IBRD-87440 Effective USD 600.00 600.00 0.00 282.65 317.35 47% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P154984 IBRD-87440 Effective 09-May-2017 30-Jun-2017 11-Sep-2017 31-Dec-2021 31-Dec-2021 2/24/2021 Page 1 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) DLI Disbursement Achievement Disbursed amount in Disbursement % for DLI ID DLI Type Description Coc DLI Amount Status Coc DLI Loan: IBRD87440-001 County-level IDS in 50 1.1 Regular USD 15,000,000.00 Fully Achieved 15,000,000.00 100 % counties-AH Integra 3 health insurance 1.2 Regular USD 40,000,000.00 Fully Achieved 40,000,000.00 100 % scheme-FJ Discharged patients % are Partially 2.1 Regular USD 68,000,000.00 34,000,000.00 50 % paid-AH Achieved Discharged patients % are Partially 2.2 Regular USD 68,150,000.00 24,650,000.00 36 % paid-FJ Achieved Inpatients % treat thru Partially 3.1 Regular USD 66,240,000.00 51,840,000.00 78 % clinical path-AH Achieved Inpatients % treat thru Partially 3.2 Regular USD 66,090,000.00 31,090,000.00 47 % clinical path-FJ Achieved Outpatient care services % 4.1 Regular USD 40,000,000.00 Not Achieved 0.00 delivere-AH Outpatient care services % Partially 4.2 Regular USD 40,000,000.00 0.00 delivered-FJ Achieved Partially 5.1 Regular # prefectures use NCD-AH USD 45,047,500.00 15,047,500.00 33 % Achieved Partially 5.2 Regular # prefectures use NCD-FJ USD 44,972,500.00 14,972,500.00 33 % Achieved # County-township-village Partially 6 Regular USD 50,000,000.00 20,000,000.00 40 % health IS-AH Achieved # THCs/CHCs estab. Care Partially 7 Regular USD 50,000,000.00 30,300,000.00 61 % health IS-FJ Achieved Experience sharing& Partially 8 Regular USD 5,000,000.00 3,000,000.00 60 % dissemin-National Achieved Program Action Plan Technical: Make steady progress on the integration of the three health insurance schemes (such as starting with the Action Description integration of urban and rural resident schemes), so as to ensure unified provider payment policies across the different schemes. Source DLI# Responsibility Timing Timing Value Status Technical Client Due Date 31-Dec-2018 Completed Anhui and Fujian have established the healthcare security administrations (HSAs). The HSAs are responsible for the Completion Measurement management of all the medical insurance schemes, medical pricing, as well as procurement of medicine and equipment. Comments 2/24/2021 Page 2 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Technical: Strengthen the National Health and Family Planning Statistics online reporting system with a new data Action Description cleaning and data verification function, so as to improve the quality of M&E system of health reform. Source DLI# Responsibility Timing Timing Value Status Technical Client Due Date 31-Dec-2018 Completed Completion Measurement The new data cleaning and verification module is up running in the online reporting system. Comments Fiduciary: CPSM and two provinces issue clear instructions to the implementing agencies in charge of procurement at Action Description all levels with regard to the compliance with the PforR anticorruption guidelines. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Due Date 28-Sep-2017 Completed Guidelines were issued. According to the Progress Report, the guidelines were strictly implemented, and no event Completion Measurement has occurred against the suspended list as of now. Comments Fiduciary: Report in the progress report on any allegation of fraud or corruption, which has confirmed to be a major Action Description issue after a due investigation. Source DLI# Responsibility Timing Timing Value Status Fiduciary Systems Client Recurrent Semi-Annually Completed Completion Measurement According to the Progress Report, no cases or allegations of fraud or corruption were reported so far. Comments Environment & Social Development: Design and provide periodic training for hospital management, health workers Action Description and the hospital Infectious Disease Control Unit to ensure adequate awareness and skills across all levels healthcare facilities. Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Recurrent Semi-Annually Completed Systems Completion Measurement Both Anhui and Fujian organized trainings Comments Environment & Social Development: Strengthen the supervision & enforcement capacity of responsible agencies to Action Description ensure adequate supervision of the chain of custody that covers whole medical wastes classification, storage, collection, transport. 2/24/2021 Page 3 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Due Date 29-Dec-2017 Completed Systems Completion Measurement Anhui and Fujian have issued the relevant protocols and has conducted multiple inspections or trainings. Comments Environment & Social Development: Report in the progress report any land acquisition under this PforR including Action Description relevant evidence (land use certificates, compensation agreements, land price payments, and land lease agreements with affected parties). Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Recurrent Semi-Annually Completed Systems Completion Measurement No land acquisition so far Comments Environment & Social Development: Develop a public participation plan to increase the awareness of and the support Action Description on the health reform based on successful experience of pilot cities, which include more proactive public participation. Source DLI# Responsibility Timing Timing Value Status Environmental and Social Client Recurrent Semi-Annually Completed Systems Completion Measurement Both Anhui and Fujian disseminated health reform information via multiple channels e.g. wechat platform. Comments Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Low Low Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Low Low Technical Design of Project or Program High Moderate Moderate Institutional Capacity for Implementation and High Moderate Moderate Sustainability Fiduciary Substantial Moderate Moderate 2/24/2021 Page 4 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Environment and Social Moderate Moderate Moderate Stakeholders Low Low Low Other -- Low Low Overall High Moderate Moderate RiskComments Comments no change Results PDO Indicators by Objectives / Outcomes PDO Indicators IN00945358 ►Proportion of hospital discharges paid through case-based payment for all county-level public general hospitals and TCM hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH:46.53; FJ:37.48 AH:46.53; FJ:37.48 Value AH: 12 FJ: 3 AH: 32 FJ: 50 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945359 ►Proportion of inpatients to be treated through standardized clinical pathways at county level public general hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH:72.49; FJ:52.89 AH:72.49; FJ:52.89 Value AH: 4 FJ:0 AH:50 FJ: 50 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945360 ►Proportion of outpatient care delivered by primary care facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 61 FJ: 51 AH:58.57; FJ: 53.8 AH:58.57; FJ: 53.8 AH: 61.8 FJ: 55 Value Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Neither Anhui nor Fujian achieved 2019 target. Anhui has not met the targets for 3 years in a row and Fujian Comments is 0.2 percentage points behind the target for 2019. IN00945381 ►Number of prefectures that manage Type II diabetes patients using the integrated NCD service package (Threshold value for a prefecture to qualify as using the integrated service package is 25% of tota (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 AH:4; FJ:2 AH:4; FJ:2 AH: 6 FJ: 4 2/24/2021 Page 5 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments Intermediate Results Indicators by Results Areas Intermediate Results IN00945382 ►Growth rate of medical service revenue of public hospitals in the entire province (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 8% AH:15.3%; FJ:12.1% AH:15.3%; FJ:12.1% Value FJ: 8.88% <10% Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 This indicator is at the risk of not being achieved. The annual growth rate should be contained within 10%; Comments however, neither of the Provinces have achieved this target except for Fujian in 2017. IN00945383 ►Average length-of-stay for county level public hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 8.82 AH: 8 AH: 7.55; FJ:7.48 AH: 7.55; FJ:7.48 Value FJ: 7.41 FJ: 7.37 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 This indicator performed well in the previous years but not in 2019 for Fujian. It was reduced from 7.41 days Comments in 2015 to 7.28 days in 2018 but increased to 7.48 days in 2019 (the end target is 7.37 days). IN00945384 ►Number of counties that have public disclosure of quality report (e.g. ALOS, drug revenue as a proportion of hospital revenue, expenditure per visit for outpatient, expenditure per admission for inpat (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 55 AH: 61 AH:61; FJ:68 AH:61; FJ:68 Value FJ:10 FJ: 68 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945385 ►Proportion of labor based service revenue in total service revenue for all public hospitals in the province (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 25 AH: 30 AH:28.8; FJ:30.33 AH:28.8; FJ:30.33 Value FJ: 24.58 FJ: 30.00 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 2/24/2021 Page 6 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) This indicator performed well in previous years but not in 2019 in Anhui. It increased from 25% in 2015 to 29.7% in 2018 but reduced to 28.8% in 2019 (the end target is 30.0%). However, the risk of not achieving Comments the end target is not high. IN00945386 ►Out-of-pocket payment as portion of the total inpatient services expenditure (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 42 AH: 37 AH:31.87; FJ:44.83 AH:31.87; FJ:44.83 Value FJ: 50.83 FJ: 48.83 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945387 ►Proportion of patients hospitalized within county (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 69 AH: 73 AH:74.81; FJ:64.05 AH:74.81; FJ:64.05 Value FJ: 63 FJ: 80 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 This indicator is at the risk of not being achieved. Despite of the promotion of county-level medical alliances and the upgrade of county level hospitals, the progress on the within-county hospitalization is limited, more Comments so for Fujian. The share of within-county hospitalization of Fujian increased from 63.0% in 2015 to 67.1% to 2017 but then decreased to 64.1% in 2019. The chance of achieving the end target, which is 80%, is scant. IN00945388 ►Proportion of total Registered Physicians (assistant physician) and Registered Nurses practicing at the primary care facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 26.80 AH:28.39; FJ: 31.2 AH:28.39; FJ: 31.2 Value FJ:29.09 increase Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945389 ►Number of hypertension patients that are under standardized management (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 4500 000 AH:5116900; AH:5116900; AH: 4700 000 Value FJ: 1250 000 FJ:1776800 FJ:1776800 FJ: 1300 000 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945390 ►Number of counties that have established a county-township-village population health information system [Anhui] (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18.00 18.00 20.00 2/24/2021 Page 7 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945391 ►Number of THCs / CHCs that have established primary care health information systems [Fujian] (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 500.00 500.00 500.00 Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945392 ►Number of prefectures achieving integration (at least of the management) of the health insurance schemes, thereby allowing unified payment arrangement for all providers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 0 All Prefectures thanks to All Prefectures thanks AH: 12 Value FJ: 2 the integration at the to the integration at the FJ: 9 national level national level Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945393 ►Program experience sharing and dissemination (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 2019 results has been 2019 results has been Value NA NA achieved achieved Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945394 ►The county IDS system has been scaled up to at least 50 counties/districts in Anhui (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Achieved, verified, Achieved, verified, Value NA NA confirmed confirmed Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments IN00945395 ►The integration of the management of the three health insurance schemes at the provincial level in Fujian is undertaken (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Achieved and verified, Achieved and verified, Value NA NA confirmed confirmed Date 09-May-2017 30-Jun-2020 09-Feb-2021 31-Dec-2021 Comments 2/24/2021 Page 8 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 The County IDS system has been scaled up to at least 50 counties/districts in Anhui (Output, 15.00, 0%) Baseline Actual (Previous) Actual (Current) end Dec 2017 Achieved, verified, Achieved, verified, Acieved and verfied, Value NA confirmed confirmed confirmed Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 2 The integration of the management of the three health insurance schemes at the provincial level in Fujian is undertaken (Process, 40.00, 100%) Baseline Actual (Previous) Actual (Current) end Dec 2017 Achieved, verified, Achieved, verified, Achieved and Value NA confirmed confirmed verified, confirmed Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 3 Proportion of hospital discharges paid through case-based payment for all county-level public general hospitals and TCM hospitals (Intermediate Outcome, 27.15, 0%) Baseline Actual (Previous) Actual (Current) end Dec 2017 AH: 12 Value FJ: 3 AH:46.53; FJ:37.48 AH:46.53; FJ:37.48 -- Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 4 Proportion of inpatients to be treated through standardized clinical pathways at county level public general hospitals (Intermediate Outcome, 60.73, 0%) Baseline Actual (Previous) Actual (Current) end Dec 2017 AH:4 Value FJ:0 AH:72.49; FJ: 52.89 AH:72.49; FJ: 52.89 -- Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 5 Proportion of outpatient care delivered by primary care facilities (Intermediate Outcome, 20.00, 0%) Baseline Actual (Previous) Actual (Current) end Dec 2017 Value AH: 61 AH:58.57; FJ:53.8 AH:58.57; FJ:53.8 -- 2/24/2021 Page 9 of 10 The World Bank Implementation Status & Results Report China Health Reform Program (P154984) FJ: 51 Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 6 Number of prefectures that manage Type II diabetes patients using the integrated NCD service package (Threshold value for a prefecture to qualify as using the integrated service package is 25% of tota (Intermediate Outcome, 30.02, 0%) Baseline Actual (Previous) Actual (Current) end Dec 2017 Value No minimum AH:4; FJ:2 AH:4; FJ:2 -- Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 7 Number of counties that have established a county-township-village population health information system [Anhui] (Output, 7.50, 0%) Baseline Actual (Previous) Actual (Current) end Dec 2017 Value No minimum 18.00 18.00 -- Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 8 Number of THCs / CHCs that have established primary care health information systems [Fujian] (Output, 20.00, 0%) Baseline Actual (Previous) Actual (Current) end Dec 2017 Value No minimum 500.00 500.00 -- Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments ►DLI 9 Program experience sharing and dissemination (Process, 1.50, 100%) Baseline Actual (Previous) Actual (Current) end Dec 2017 held one international held one international and and two national two national workshops; Value NA workshops; completed -- completed three three operational operational research research Date 09-May-2017 30-Jun-2020 09-Feb-2021 -- Comments 2/24/2021 Page 10 of 10