Public Disclosure Copy 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: 4 | ARCHIVED on 27-Jun-2017 | ISR28774 | Implementing Agencies: Ministry of Health, Undersecretariat of Treasury Key Dates Key Project Dates Bank Approval Date:21-Sep-2015 Effectiveness Date:26-Nov-2015 Planned Mid Term Review Date:01-Jan-2018 Actual Mid-Term Review Date:-- Original Closing Date:31-May-2020 Revised Closing Date:31-May-2020 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 PHRPDODEL Components Name Primary and Secondary Prevention:(Cost $44.03 M) Increasing Efficiency of Hospital Management and Operations:(Cost $47.65 M) Improving the Effectiveness of Overall Health Sector Administration:(Cost $44.30 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 6/27/2017 Page 1 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Implementation Status and Key Decisions The Ministry of Health (MoH) has been preparing the new Health Strategic Plan covering the period of 2017 - 2021. The new Plan has been the result of discussions held within a series of policy labs that started on November 25, 2016. Dedicated teams composed of upper management officials, international experts, staff of the MoH implementation units, and field observers participated in these labs. The Strategic Plan aims to achieve the following goals: (i) To promote healthy lifestyles behaviors for individuals; (ii) to strengthen primary care to assume a central role in the health system; (iii) to raise quality of secondary and tertiary care and increase access to specialized care; (iv) to implement end-to-end service models in common healthcare services which will meet citizen’s health needs; (v) to ensure sustainability of the health system by focusing on the satisfaction of citizens and health workers; (vi) to improve the health system as a contributor to socioeconomic development of Turkey and global health; and (vii) to carry out regulatory and audit duties concerning products, which may impact citizen’s health. As a result of the work in the labs and subsequent discussions around the new Strategic Plan, Project activities have been aligned with the new strategic objectives. Nevertheless, it will take some time before the implementation of Project activities catch up with the new objectives To expedite the implementation process, it was agreed that the MoH coordination and implementation units will carry out meetings to revise the Project’s Operation and Procurement Plans by July 31, 2017. 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  Substantial  Substantial 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 Project Development Objective Indicators PHINDPDOTBL  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 10.00 10.00 11.00 6/27/2017 Page 2 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The General Directorate of Health Research (GDHR) has informed the Bank team that the initial survey results under the Chronic Diseases Study (Household Health Survey) will be submitted to the Bank in September 2017. PHINDPDOTBL  Percent change of target population using services of Healthy Living Centers (by province, age, gender, education, health status, and by type of services provided) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments No progress - as implementation of piloting Healthy Living Centers has been delayed. PHINDPDOTBL  Early detection of (a) cervical (by province and age) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 25.00 25.00 50.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The actuals reflect the achievement as of December 2017. The progress the will be evaluated in the November 2017 mission. PHINDPDOTBL  Early detection of (b) breast cancer (by province and age) (Percentage, Custom Supplement) 6/27/2017 Page 3 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 43.00 43.00 65.00 PHINDPDOTBL  Increase in average composite productivity index for all public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 PHINDPDOTBL  Percent of policy and decision makers that regularly use HMIS (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments In the original results framework no target values were set for 2017. Overall Comments Intermediate Results Indicators 6/27/2017 Page 4 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Percent of general population who can state two or more negative health impacts of selected risk factors of non-communicable diseases and substance use (by province, age, and gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The General Directorate of Health Research (GDHR) has informed the Bank team that the initial survey results under the Chronic Diseases Study (Household Health Survey) will be submitted to the Bank in September 2017. PHINDIRITBL  Percent of target population in 8 provinces covered by newly established Healthy Living Centers (by province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments No progress - as implementation of piloting Healthy Living Centers has been delayed. PHINDIRITBL  Number of individuals in 5 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 90.00 90.00 8,400.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The progress will be evaluated in the November 2017 mission. 6/27/2017 Page 5 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Percent of target population screened for 3 types of cancer: (a) by province (for colorectal and cancer type) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 83.70 83.70 70.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments As of December 2016, MoH surpassed the screening targets for cervical cancer by innovative implementation modalities that increased the role of family practitioners in screening. The progress will be evaluated in the November 2017 mission. PHINDIRITBL  Percent of target population screened for 3 types of cancer : (b) by age (for colorectal and cancer type) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 30.00 30.90 30.90 70.00 PHINDIRITBL  Percent of target population screened for 3 types of cancer: (c) by gender (for colorectal and cancer type) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 22.60 22.60 50.00 PHINDIRITBL  Percent of PHC-level staff who have satisfactorily completed standardized training modules required by the staff’s job profile: (a)distance learning (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 80.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The Public Health Institution (PHeI)’s planned training activities to strengthen the Family Physician Training Program were also negatively 6/27/2017 Page 6 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) affected due to the delays in the design and implementation of the Health Living Program. The PHeI could only provide training to 300 health personnel from the beginning of project implementation. Under the revised Activity Plan, all training activities (on the leading causes of disease burden in Turkey, such as diabetes and obesity, as well as for other factors, including tobacco use, passive smoking, unhealthy diet and physical inactivity, cardiovascular diseases. and substance abuse) will be coordinated by the PHeI Family Medicine Training and Development Department. PHINDIRITBL  Percent of PHC-level staff who have satisfactorily completed standardized training modules required by the staff's job profile: (b)face-to-face (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 30.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2015 PHINDIRITBL  Number of Public Hospital Unions where newly developed hospital management models implemented (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 89.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments In the original results framework no target value was set for 2017. PHINDIRITBL  Standard guidelines and templates for PPP transactions developed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Standard guidelines and No standard No standard No standard templates for Value documentation documentation documentation PPP transactions in place Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 6/27/2017 Page 7 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Comments The “Public Private Partnership Roadmap and Action Plans” deliverable will be submitted by July 31, 2017. The Bank team will evaluate the progress in the November 2017 mission. PHINDIRITBL  National-level Health System Assessment conducted annually and published (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Y N N Y Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The first Health Sector Performance Report (HSPA) covering the period between 2011 and 2016 will be completed by November 2017. PHINDIRITBL  Key information technology standards developed and integrated into updated draft regulations (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 5.00 20.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The General Directorate of Health Information Systems (GDHIS) has successfully developed and integrated the following standards: Minimum Logging Standards in Health Informatics (SAMILOG), Minimum Data Model in Health Informatics (VEM), Minimum Data Model in Family Medicine Information System (FMIS-VEM), Logical Observation Identifiers Names and Codes (LOINC), and International Classification of Diseases for Oncology (ICD-O). 6/27/2017 Page 8 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  Percent of health facilities that share data to HMS (a) public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 17.10 39.30 100.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 PHINDIRITBL  Percent of health facilities that share data to HMS (b) family/community health centers (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18.30 57.00 100.00 PHINDIRITBL  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 6.20 9.20 60.00 PHINDIRITBL  Percent of health indicators on Health.Net that meet international standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 70.00 70.00 97.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 6/27/2017 Page 9 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  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 4.00 3.00 3.00 12.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 PHINDIRITBL  Direct project beneficiaries (number), of which female (percentage) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2,678,769.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The progress will be evaluated in the November 2017 mission. PHINDIRITBL  Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 293.00 3,450.00 40,953.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 3.00 50.00 Date 20-Apr-2015 15-Dec-2016 19-Jun-2017 30-Jun-2020 Comments The progress is minimal as implementation of piloting Healthy Living Centers has been delayed. 6/27/2017 Page 10 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) PHINDIRITBL  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 15-Dec-2016 19-Jun-2017 30-Jun-2020 Overall Comments No satisfaction survey was conducted as implementation of piloting Healthy Living Centers has been delayed. 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 11.96 121.88 9% 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 6/27/2017 Page 11 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 6/27/2017 Page 12 of 12 Public Disclosure Copy