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: 8 | ARCHIVED on 17-May-2019 | ISR36885 | 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-May-2020 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? No Components Table Name Primary and Secondary Prevention:(Cost $28.52 M) Increasing Efficiency of Hospital Management and Operations:(Cost $32.95 M) Improving the Effectiveness of Overall Health Sector Administration:(Cost $47.63 M) Unallocated:(Cost $25.30 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions This ISR reflects recent developments since project restructuring in May 2019. Progress towards achieving the PDO has been rated moderately unsatisfactory since November 2017 because only two out of four PDO indicators have achieved their respective target value expected for the end of 2018. However, the recent restructuring of the results framework is expected to show improvement towards the achievement of the revised target values. The Bank team will revisit the DO rating for the next ISR if improvement is demonstrated and sustained post restructuring with regards to both PDO indicators and intermediate results indicators. IP rating remains moderately unsatisfactory till the next review of the Bank team on the progress in major procurement activities. There have been progress in some key activities from the last ISR: 5/17/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799)  There has been some progress under Piloting Healthy Living Centers (HLCs) activity. The MoH started to use Project funds for the refurbishment of HLCs, including procurement of physical exercise equipment and digital X-rays, staff recruitment. Staff training activities continue as planned.  The MoH initiated the procurement activities for the establishment of simulation assisted training centers in Ankara and Izmir to increase the specialized health workforce supply, and to enhance the provision of specialized healthcare services in public hospitals.  In May 2019, the MoH has initiated the procurement of consultancy services for a new monitoring and evaluation system that would facilitate the tracking of PPP processes and contracts from planning to tendering, investment and management. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Low Low Low Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Sustainability Substantial Substantial Substantial Fiduciary Substantial Substantial Substantial Environment and Social Low Low Low Stakeholders Low Low Low Other -- -- -- Overall Moderate Moderate Moderate Results PDO Indicators by Objectives / Outcomes Objective 1: to improve primary and secondary prevention of selected non-communicable diseases IN00697283 ►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 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697386 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 5/17/2019 Page 2 of 8 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 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697387 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 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697388 ►Early detection of (a) cervical cancer (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 39.20 52.90 52.90 58.00 Date 31-Dec-2014 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697389 Early detection of (b) breast cancer (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 48.70 47.90 47.90 51.00 Objective 2: to increase the efficiency of hospital management IN00697285 ►Simulation assisted trainings and implementations' coverage ratio of the targeted healthcare professionals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 28-Feb-2019 28-Feb-2019 28-Feb-2019 30-Jun-2021 Objective 3: to enhance the capacity of the MoH for evidence-based policy making IN00697284 ►Percent of policy and decision makers that regularly use HMIS regularly (monthly) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 80.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 Intermediate Results Indicators by Components Component 1: Primary and Secondary Prevention IN00697391 5/17/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) ►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 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 19-Oct-2018 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697392 Percent change in share of general population who can state negative health impacts of substance use (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 IN00697397 ►Number of Healthy Living Centers established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 182.00 182.00 270.00 Date 31-Dec-2017 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697400 ►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 8,117.00 8,117.00 13,887.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697402 ►Percent of target population screened for 3 types of cancer: (a) cervical (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 82.70 80.00 80.00 83.50 Date 31-Dec-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697404 Percent of target population screened for 3 types of cancer: (b) breast (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 33.50 37.00 37.00 55.00 IN00697406 Percent of target population screened for 3 types of cancer: (c) colorectal (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 22.40 24.00 24.00 45.00 IN00697407 ►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 1,000.00 1,000.00 5,000.00 5/17/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Date 19-Oct-2018 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697408 ►Direct project beneficiaries (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11,411,083.00 11,411,083.00 28,000,000.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697409 Direct project beneficiaries of which female (percentage) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.00 66.00 66.00 IN00697410 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,450.00 3,450.00 42,500.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697411 ►Health facilities constructed, renovated, and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 83.00 83.00 285.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697412 ►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 0.00 0.00 80.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 Component 2: Increasing Efficiency of Hospital Management and Operations IN00697394 ►Number of simulation-based medical education centers established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 19-Oct-2018 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697398 ►Establishment of a PPP M&E system (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/17/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Value No No No Yes Date 28-Feb-2019 28-Feb-2019 28-Feb-2019 30-Jun-2021 Component 3: Improving the Effectiveness of Overall Health Sector Administration IN00697390 ►National-level Health System Assessment conducted annually and published (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Yes No No Yes Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697393 ►Key information technology standards developed and integrated into updated draft regulations (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 12.00 12.00 20.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697395 ►Percent of health facilities that share data to HMS (a) public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 80.00 80.00 100.00 Date 20-Apr-2015 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697396 Percent of health facilities that share data to HMS (b) family medicine centers (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 80.00 80.00 100.00 IN00697399 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 50.00 50.00 60.00 IN00697401 ►Percent of health indicators within MoH databases meeting international standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 51.00 51.00 75.00 Date 19-Oct-2018 28-Feb-2019 28-Feb-2019 30-Jun-2021 IN00697403 ►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 6.00 6.00 12.00 5/17/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Date 20-Apr-2015 19-Oct-2018 19-Oct-2018 30-Jun-2021 IN00697405 ►Process mapping of all MoH units (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Process mapping Value No process mapping No process mapping No process mapping completed Date 19-Oct-2018 28-Feb-2019 28-Feb-2019 30-Jun-2021 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 31.27 103.33 23% 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-May-2020 Cumulative Disbursements 5/17/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Restructuring History Level 2 Approved on 23-Apr-2019 Related Project(s) There are no related projects. 5/17/2019 Page 8 of 8