The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Kyrgyz Health Results Based Financing (P120435) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Investment Project Financing | FY 2013 | Seq No: 13 | ARCHIVED on 29-May-2019 | ISR37110 | Implementing Agencies: Mandatory Health Insurance Fund, Ministry of Health, KYRGYZ REPUBLIC Key Dates Key Project Dates Bank Approval Date: 18-Apr-2013 Effectiveness Date: 29-Jul-2014 Planned Mid Term Review Date: 26-Sep-2016 Actual Mid-Term Review Date: 26-Sep-2016 Original Closing Date: 30-Jun-2017 Revised Closing Date: 31-May-2019 pdoTable 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 Objective? No Components Table Name Component 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Care:(Cost $9.59 M) Component 2: Strengthen the Government's and Providers' Capacity in Performance-Based Payment Reform and Monitoring and Evaluation f or Results:(Cost $1.41 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions The Project, in the amount of USD$ 11 million, funded by the Health Results Innovation Trust Fund's grant, was declared effective on July 29, 2014. The extended closing date is May 31, 2019. The project is on track and will achieve its Project Development Objectives (PDO) by the closing date. Over the period of 5 years, the project has contributed to substantial achievements in rayon hospitals performance, changing providers' behavior, and introducing a team work. It succeeded in achieving its development objectives of piloting performance-based payments and/or enhanced supervision for quality of care and strengthening the Government and providers' capacity in performance based contracting and monitoring and evaluation. The project's results are confirmed by achievements of the set targets for the PDO and intermediate results 5/29/2019 Page 1 of 6 The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) indicators. Results of the Impact Evaluation confirmed improvements along three dimensions of quality of care (structural quality, process quality and outcomes) and showed significant and positive effects of intervention on the newborn's Apgar score and mother's blood loss, as well as blood supply, drug availability and quality, and provider's motivation. The “positive incentives” scheme based on a results-based financing quality score has been institutionalized across all hospital and PHC level facilities (except national facilities) using public funds since July 2018 with the Mandatory Health Insurance Fund taking a leadership in conducting regular verifications with support of the project. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Substantial Substantial Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- High High Fiduciary -- Substantial Substantial Environment and Social -- Low Low Stakeholders -- Substantial Substantial Other -- Low Low Overall -- High High Results PDO Indicators by Objectives / Outcomes pilot performance-based payments and/or enhanced supervision for quality of maternal/neonatal care IN00703467 ►Proportion of eligible rayon hospitals that received the authorized performance-based payments within two weeks after the MHIF’s receipt of RBF payment to their bank account (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Achieved. Comments: IN00703469 ►Proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals submitted to MHIF within 30 working days after the end of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/29/2019 Page 2 of 6 The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Value 0.00 90.00 100.00 100.00 Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Achieved Comments: IN00703571 ►Number of counter-verification carried out for a subset of Group 1 rayon hospitals and Group 2 rayon hospitals every six months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 8.00 8.00 Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Achieved . The 7th round of counter verifications was completed on Sept 16-21, 2018 in 8 hospitals Comments: strengthen the Government’s and providers’ capacity in performance-based contracting and M&E results IN00703468 ►Impact Evaluation Surveys completed on schedule to generate evidence for policy (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Two rounds of Impact Two rounds of Impact Evaluation Surveys Evaluation Surveys At least 2 round of (baseline and end line) (baseline and end line) surveys implemented Value No surveys were completed by the were completed by the by the end of the end of the project end of the project project Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-Dec-2018 Target is met as two rounds of Impact Evluation surveys (quantitative and qualitative studies) were Comments: completed. IN00703470 ►Average quarterly quality score of Group 1 hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9.30 79.80 77.10 75.00 Date 29-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Overachieved. Comments: Intermediate Results Indicators by Components Component 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Care IN00703572 ►Performance Contracts signed with the Group 1 rayon hospitals (20) and updated annually based on any modifications introduced to the Balanced Scorecard (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 5/29/2019 Page 3 of 6 The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Value 0.00 22.00 22.00 20.00 Date 30-Nov-2014 25-Oct-2018 20-May-2019 31-May-2019 Overachieved. Contracts with participating providers are signed on annual basis. Performance contracts Comments: with all 22 hospitals (Group 1) were signed in December 2018 for the year 2019 IN00703574 ►Proportion of Group 1 rayon hospitals (20) that received quarterly performance-based payments in accordance to their level of performance as per agreed Performance Contracts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Achieved. All 22 hospitals (Group I) received performance based payments in accordance with their BSC Comments: scores IN00703576 ►Average % score Balance Score Card (BSC) indicator 1.7 Red Blood Cell Availability (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 73.00 73.00 75.00 Date 20-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Mostly achieved. There has been a significant increase from the baseline of 19% in August 2014 to 73% in 2018. There is no room for further improvement because small size hospitals refer high risk Comments: pregnancies to higher level hospitals and thus don't need have blood cell at the hospital IN00703578 ►Average % score for Category 6 Maternity Department (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 80.00 79.90 85.00 Date 20-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Mostly achieved as there has been a significant increase from the baseline 5% till 79.9% as of today. The target of 85 Comments: IN00703579 ►Average % score for Category 7 Pediatric/Neonatal Department (Group 1 hospitals) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.30 79.00 81.20 80.00 Date 20-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Overachieved Comments: 5/29/2019 Page 4 of 6 The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Component 2: Strengthen the Government's and Providers' Capacity in Performance-Based Payment Reform and Monitoring and Evaluation f or Results IN00703573 ►National RBF Steering Committee meets at least twice a year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 2.00 Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Achieved. Comments: IN00703575 ►Extended RBF team meets at least every 4 months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 3.00 Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Achieved. Comments: IN00703577 ►MOH/MHIF produce quarterly monitoring reports within 3 weeks after the end of each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 4.00 Date 25-Aug-2014 25-Oct-2018 20-May-2019 31-May-2019 Achieved Comments: Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P120435 TF-13310 Effective USD 11.00 11.00 0.00 10.64 0.36 97% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P120435 TF-13310 Effective 30-Dec-2013 30-Dec-2013 29-Jul-2014 30-Jun-2017 31-May-2019 Cumulative Disbursements 5/29/2019 Page 5 of 6 The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Restructuring History Level 2 Approved on 21-Jun-2017 ,Level 2 Approved on 17-Dec-2018 Related Project(s) There are no related projects. 5/29/2019 Page 6 of 6