The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Second Serbia Health Project (P129539) EUROPE AND CENTRAL ASIA | Serbia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 10 | ARCHIVED on 18-Sep-2018 | ISR34005 | Implementing Agencies: Ministry of Health, Ministry of Finance Key Dates Key Project Dates Bank Approval Date: 25-Feb-2014 Effectiveness Date: 08-May-2015 Planned Mid Term Review Date: 14-Feb-2018 Actual Mid-Term Review Date: 29-Jan-2018 Original Closing Date: 30-Sep-2019 Revised Closing Date: 31-Dec-2021 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO is to contribute to improving the efficiency and quality of the public health system of the Republic of Serbia through the strengthening of: (i) health financing, purchasing, and maintenance systems; and (ii) quality improvement systems and management of selected priority non- communicable diseases. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improvement of Health Financing:(Cost $11.20 M) Improve Access to Quality Health Care:(Cost $8.90 M) Strengthening Quality of Service Delivery:(Cost $46.00 M) Monitoring and Evaluation and Project Management:(Cost $4.90 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 Moderate Moderate Implementation Status and Key Decisions The 2018 annual target values for 2 out of 5 Project Development Objective (PDO) indicators have already been met at the end of July 2018. The 2018 annual target values for 6 out of 16 Intermediate Results indicators have also been met. It is noted that there has been significant progress in the implementation of the activities under all components since the Mid-Term Review (MTR) in January 2018. Specifically: Component 1 - Improvement of Health Financing. The Government of Serbia amended the legislation to allow for the payment of bonuses based on Diagnostic-Related Groups (DRGs) in 14 pilot hospitals in 2018. The legislation has also been revised to allow for the introduction of hospital payment based on DRGs in 71 hospitals in 2019. The legislation has been revised to allow for performance-based payments including indicators on 9/18/2018 Page 1 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) quality of care. The Terms of Reference (TORs) for a technical assistance to prepare an Optimization Plan are under preparation with the World Bank’s support. Component 2 - Improve Access to Quality Health Care. The Ministry of Health (MoH) has continued to implement communication campaigns for the rational use of antibiotic through 10 events, as well as exhibitions and public awareness campaigns for the population. The implementation of all activities related to e-prescription are completed. On Health Technology Assessment (HTA), activities have been initiated through the establishment of a working group in charge of the development of HTA and the selection of an international consultant for the development of a situation analysis and an action plan in this area. A working group has also been established for the development of medical equipment maintenance systems and consultations with key stakeholders have been conducted. Component 3 - Strengthen Quality of Service Delivery. After the development and implementation of 32 clinical pathways (CPs), three consultants have continued to work on the development of CPs for Primary Health Care institutions. A working group for the development of the National Cancer Program was established on May 18, 2018. The contract for equipment and works for four oncology centers (Belgrade, Kragujevac, Nis and Kladovo), including (i) 6 linear accelerators (LINACs) with extended warranty, (ii) 3 CT simulators, (iii) construction of 5 bunkers and adaptation of 1 existing bunker to house this new equipment, was signed in August 2017. The Government and the World Bank team agreed to intensify efforts to accelerate project implementation to meet all annual target values for 2018 on time, including the implementation of the requirements for the procurement of diagnostic equipment and, particularly, the health care facility optimization plan, given Government’s priority in reducing patient waiting times for diagnostic and treatment. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Moderate Moderate Fiduciary -- Substantial Moderate Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- Moderate Moderate Overall -- Moderate Moderate Results PDO Indicators by Objectives / Outcomes To contribute to improving the efficiency and quality of the public health system of Serbia IN00549456 ►Percentage of total acute care hospitalization cases in public hospitals reported accurately based on DRGs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 70.00 70.00 95.00 9/18/2018 Page 2 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549457 ►Percent reduction in average unit price relative to baseline for the 50 most frequently dispensed multi-source pharmaceuticals that are procured through centralized framework contracts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 27.00 27.00 27.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549458 ►Percentage of patients starting radiotherapy treatment at public hospitals within 28 days between the date of issuance of treatment protocol and the first radiotherapy session for a) breast, b) cervic (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Monitoring system in No monitoring system in Monitoring system in No monitoring system in place to measure the Value place to report on the place to measure the place indicator, baseline and indicator indicator target values defined Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549459 ►Percentage of registered adult patients in Dom Zdravljas with recorded blood pressure value, BMI, smoking status and recommended tips for healthy behavior in the preceding 12 months in their med recor (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 32.00 32.00 45.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00558459 ►Percentage of registered insured persons covered by the targeted examination for early detection of a) breast (age 50-69 in the past two years), b) cervical (age 25-64 in the past three years) and c) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target a) 6%; a) 6%; a) 6%; a) 25%; Value b) 27%; b) 27%; b) 27%; b) 35%; c) 10% c) 10% c) 10% c) 35% Date 30-Nov-2017 10-Jan-2018 27-Jul-2018 31-Dec-2021 Intermediate Results Indicators by Components 1. Improvement of Health Financing IN00549463 ►Percentage of pilot Dom Zdravljas who meet grant agreement performance criteria in the preceding one year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549460 ►DRGs payment system developed and financing for a portion of acute hospital care based on DRGs initiated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/18/2018 Page 3 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Value No No No Yes Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549471 ►Number of health workers receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 500.00 5,459.00 11,251.00 13,000.00 Date 16-Jan-2014 10-Jan-2018 27-Jul-2018 31-Dec-2021 This indicator is mapped to all three components Comments: 2. Improve Access to Quality Health Care IN00549462 ►Number of pharmaceuticals and health products that are procured through centralized framework contracts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,421.00 1,421.00 700.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549466 ►Percentage of a) Dom Zdravljas and b) pharmacies implementing e-prescription system (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DZs - 0 DZs - 10% DZs - 98% DZs - 90% Value Pharm - 0 Pharm - 27% Pharm - 98% Pharm - 90% Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00558581 ►Reduction in the total consumption of antibiotics for systemic use (J01) DDD/1000 person/per day (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18.00 18.00 22.00 Date 30-Nov-2017 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00558525 ►Strengthen systems for Health Technology Assessment (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The linkage between national clinical Situation analysis practice guidelines and Weak, ineffective completed. Roadmap Limited institutional basic benefit package institutional capacities document with detailed efficiency related to the well established and related to the decision plan of activities for Value decision making process functional. The new, making process in the HTA system in the area of drug robust and area of drug establishment drafted reimbursement transparent, system of reimbursement and adopted by the evidence based Ministry of Health supported decision making process fully 9/18/2018 Page 4 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) established and functional Date 30-Nov-2017 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549473 ►Strengthen systems for medical equipment maintenance (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No national systems or Budget allocated to A medical equipment policies in place, Medical A medical equipment expand maintenance Value registry set up within equipment database in registry set up within IHIS system. National IHIS the IPH system(s) in use Date 16-Jan-2014 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00558582 ►Annual training organized for health Roma mediators (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1.00 4.00 Date 30-Nov-2017 10-Jan-2018 27-Jul-2018 31-Dec-2021 3. Strengthen Quality of Service Delivery IN00549464 ►Number of clinical pathways developed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 14.00 32.00 32.00 48.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549467 ►Number of health care institutions that have completed staff training on priority clinical pathways (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 50.00 64.00 160.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549472 ►Ranking of health institutions according to quality criteria in place based on quality indicators in health care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Ranking of health institutions according Existing quality Value Existing quality indicators Existing quality indicators to quality criteria based indicators on data from previous year/Yes Date 16-Jan-2014 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549465 ►Number of new linear accelerators installed at national level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/18/2018 Page 5 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Value 0.00 1.00 6.00 8.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 IN00549469 ►Percentage of adult diabetic patients in Dom Zdravljas with at least one determined value of glycosylated hemoglobin (HbA1c) in the last year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 42.00 39.30 50.00 Date 16-Oct-2013 10-Jan-2018 27-Jul-2018 31-Dec-2021 This indicator is mapped to components 2 and 3 Comments: IN00549470 ►Percentage of registered adult patients in DZs with hypertension under treatment whom in the last recorded blood pressure (measured in the preceding one year) is ≤ 140/90 mm Hg (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.00 51.00 50.00 70.00 Date 16-Jan-2014 10-Jan-2018 27-Jul-2018 31-Dec-2021 This indicator is mapped to components 2 and 3 Comments: IN00558583 ►Percentage of patients satisfied with the quality of care in PHC facilities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 78.00 78.00 80.00 Date 30-Nov-2017 10-Jan-2018 27-Jul-2018 31-Dec-2021 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P129539 IBRD-83380 Effective USD 40.00 40.00 0.00 25.71 10.46 71% P129539 IBRD-88300 Effective USD 31.10 31.10 0.00 0.07 31.02 0.2% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P129539 IBRD-83380 Effective 25-Feb-2014 10-Jul-2014 08-May-2015 30-Sep-2019 31-Dec-2021 P129539 IBRD-88300 Effective 20-Mar-2018 21-Mar-2018 24-Jul-2018 31-Dec-2021 31-Dec-2021 9/18/2018 Page 6 of 7 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Cumulative Disbursements Restructuring History Level 2 Approved on 14-Sep-2015 Related Project(s) P166025-Additional Financing for Second Serbia Health Project 9/18/2018 Page 7 of 7