The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Primary Health Care Quality Improvement Program (P167598) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | Requesting Unit: ECCCA | Responsible Unit: HECHN IBRD/IDA | Program-for-Results Financing | FY 2019 | Team Leader(s): Ha Thi Hong Nguyen Seq No: 1 | ARCHIVED on 04-Sep-2019 | ISR38343 | Created by: Ha Thi Hong Nguyen on 22-Aug-2019 | Modified by: Ha Thi Hong Nguyen on 03-Sep-2019 Program Development Objectives Program Development Objective (from Program Appraisal Document) The Program Development Objective is to contribute to improving the quality of primary health care services in the Kyrgyz Republic. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Implementation Status and Key Decisions The negotiated draft Financing Agreement has been reviewed by relevant line ministries and is being signed. The project has not became effective yet and it is still in too early a stage to report on progress. Three conditions of effectiveness include: (1) signing of a contract with an independent verification agency; (2) a Program Operation Manual developed to the satisfaction of the Bank and approved by appropriate government body; and (3) a Memorandum of Understanding between the MoH, MHIF, and MoF signed and approved by an appropriate government body. In addition, parliament ratification is required from the client's side. Based on the experience of other projects, it is estimated that the project will be ratified between December 2019-March 2020. By that time, the three conditions for effectiveness should be fulfilled. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Not P167598 IDA-64140 USD 10.00 10.00 0.00 0.00 10.10 0% Effective Not P167598 IDA-D4680 USD 10.00 10.00 0.00 0.00 10.10 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P167598 IDA-64140 07-Jun-2019 -- -- 31-Dec-2024 31-Dec-2024 Effective Not P167598 IDA-D4680 07-Jun-2019 -- -- 31-Dec-2024 31-Dec-2024 Effective 9/4/2019 Page 1 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Program Action Plan The Program’s IDA and MDTF funds will be reflected in the republican budget under separate functional classification Action Description for the MoH and MHIF. Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoF Other Not Yet Due implementation Completion The approved and published republican budget will separately indicate the Program funds. Measurement Comments During the formation of the subsequent year’s republican budget, reflect the expected amount cash flow under the Action Description Program in the income and expenditure parts of the republican budget. Source DLI# Responsibility Timing Timing Value Status During the formation of the republican budget Fiduciary Systems MoF Other Not Yet Due (as per the budget calendar) Completion As per the MoH and MHIF requests the Program funds will be reflected in the income and expenditure parts of the Measurement approved budget. Comments Action Description Ensure timely transfer of the IDA and MDTF funds to the MoH and the MHIF in corresponding amounts. Source DLI# Responsibility Timing Timing Value Status Within reasonable time after the IDA and Fiduciary Systems MoF Other MDTF funds are Not Yet Due received to the MoF treasury account Completion The MoH and MHIF will confirm the receipt of relevant funds after each transfer. Measurement Comments The MoH and MHIF will present the quarterly financial reports to the MoF on utilization of the Program funds Action Description considering also the effectiveness of achieved indicators. Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoH, MHIF Other Not Yet Due implementation 9/4/2019 Page 2 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Completion The MoH and MHIF will present quarterly financial reports to the MoF. Measurement Comments Ensure adequate fiduciary capacity at the central and regional levels with at least Head of Procurement Unit and Action Description three specialists (full-time staff) and two Procurement Specialists and one Contract Manager (consultants) in Procurement Unit/MoH. Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoH Other Not Yet Due implementation Roster of existing staff and consultants to be reported semi-annually as part of Program implementation progress reports and prior to World Bank implementation support visits. Completion Measurement Comments Ensure adequate fiduciary capacity with at least 2 consultants at the MoH for FM/Disbursement function, 2 Action Description consultants (accounting and IT support) at the central level who will support MHIF regional depts in providing services to PHC accounting system Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoH Other Not Yet Due implementation Completion Roster of existing staff and consultants to be reported semi-annually as part of Program implementation progress Measurement reports and prior to World Bank implementation support visits. Comments Develop and implement a health sector fiduciary capacity building plan, including measures to reduce the fiduciary Action Description staff turnover and to increase the fiduciary staff professional capacity both at the MoH and the PHC level. Source DLI# Responsibility Timing Timing Value Status No later than 6 months Fiduciary Systems MoH Other after the Program Not Yet Due effectiveness The health sector fiduciary capacity building plan specifying concrete activities, resources and deadlines is Completion developed, agreed with the Bank and approved by the MoH. The Bank will monitor the implementation of the action Measurement plan activities. Comments 9/4/2019 Page 3 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Ensure that each PHC facility is audited at least once in a three-year period, with more frequent audits of PHC Action Description facilities with higher fiduciary risks as assessed by MoH and MHIF Internal Audit units. Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoH, MHIF Other Not Yet Due implementation Completion Annual internal audit plans, with terms of reference and audit scope, will be agreed with the Bank. Annual audit Measurement reports of MoH and MHIF Internal Audit units will be shared with the Bank. Comments Approve internal instructions for acceptance of medical goods by PHC facilities and disseminate to all PHC facilities Action Description for execution. Source DLI# Responsibility Timing Timing Value Status No later than 6 months Fiduciary Systems MoH, PHCs Other after Program Not Yet Due effectiveness Completion Approved instructions to be shared with the Bank upon dissemination to PHC facilities Measurement Comments Ensure that PHC facilities pay Contractors/Suppliers/Consultants according to exact dates indicated in their contracts Action Description but no later than four months after fulfilment by Contractors/Suppliers/Consultants of their contractual obligations. Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoH, PHCs Other Not Yet Due implementation Completion Contract execution report that is included in the annual procurement audit, with the target of at least 80% of the PHC Measurement facilities having paid Contractors/Suppliers/Consultants within four months during the audited year. Comments Adopt measures to eliminate the practice of dual fiduciary function (procurement and accounting/financial Action Description management functions assumed by the same individuals) at PHC facilities by segregating these duties. Source DLI# Responsibility Timing Timing Value Status No later than 6 months Fiduciary Systems MoH, PHCs Other after Program Not Yet Due effectiveness A MoH order prohibiting the practice of dual fiduciary function. MoH to report semi-annually as part of Program Completion implementation progress reports and prior to World Bank implementation support visits. 100% of segregation shall be Measurement achieved within 2 yrs 9/4/2019 Page 4 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Comments Ensure that the ICRC functions sustainably and includes sufficient number of experts with capacity and qualifications to perform their duties in appropriate manner. Action Description Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoF (PPD) Other Not Yet Due implementation Completion MoF (PPD) to report annually that ICRC experts are motivated using relevant incentives to perform quality reviews of Measurement procurement complaints in the health sector in a timely manner within the period outlined in the PPL. Comments Revise Standard Bidding Document (SBD) for pharmaceuticals to allow companies from countries with Stringent Action Description Regulatory Authorities to participate in tender processes and submit required registration requests to the License Department. Source DLI# Responsibility Timing Timing Value Status No later than 12 Fiduciary Systems MoF (PPD)/MoH Other months after Program Not Yet Due effectiveness Completion Revised SBD that includes the provision that submission of the License and certification shall be a condition for Measurement contract signature on pharmaceuticals are adopted. Comments Ensure that all PHC procurement specialists are trained in the MoF Training Center and certified.All individuals Action Description carrying out procurement functions for PHCs shall be trained and certified as per requirements of PPL as soon as as possible. Source DLI# Responsibility Timing Timing Value Status Throughout Program Fiduciary Systems MoH Other Not Yet Due implementation Completion MoH to ensure 100% compliance within one year after Program effectiveness and to report semi-annually as part of Measurement Program implementation progress reports and prior to World Bank implementation support visits Comments Action Description Complete the e-Government Procurement Module for selection of consultants. Source DLI# Responsibility Timing Timing Value Status 9/4/2019 Page 5 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) No later than 6 months Fiduciary Systems MoF (PPD) Other after Program Not Yet Due effectiveness Completion MoF with input from PPD to report that E-GP Module for consultancy is completed and functional Measurement Comments Complete adjustment of e-Government Procurement portal to include standard bidding documents for Action Description pharmaceuticals. Source DLI# Responsibility Timing Timing Value Status No later than 6 months Fiduciary Systems MoF (PPD) Other after Program Not Yet Due effectiveness Completion MoH with input from MoF PPD to report that e-GP module for pharmaceuticals is completed and functional. Measurement Comments Update legislation, sector policies and standards to enable integrated infection and pollution control at the PHC level Action Description as well as processing, utilization, and final disposal of HCW generated by PHC organizations. Source DLI# Responsibility Timing Timing Value Status No later than 12 Environmental and Social MoH in coordination Other months after the Not Yet Due Systems with MHIF & SAEPF, Program effectiveness Completion Related legislation, sector policies, and standard operations procedures formally adopted. Measurement Comments Strengthen the information management framework for preventing infectious diseases and environmental pollution at Action Description PHC level, including indicators of infection prevention and control, health care waste management, and water quality. Source DLI# Responsibility Timing Timing Value Status No later than 12 Environmental and Social MoH in coordination Other months after the Not Yet Due Systems with MHIF Program effectiveness Completion Indicators of infectious safety and HCWM included and regularly collected in the system of state and/or sectoral Measurement statistics. Comments 9/4/2019 Page 6 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Develop systems for capacity building on infection prevention and control and health care waste management for Action Description PHC-level personnel. Source DLI# Responsibility Timing Timing Value Status MoH, MoE, SAP No later than 6 months Environmental and Social “Preventive Other after Program Not Yet Due Systems Medicine” effectiveness Completion Number of trained personnel from PHC-level facilities and relevant organizations (in line with capacity building plans Measurement for online CPD learning under DLI 2) Comments Pilot and implement health care waste management models in selected districts and PHC facilities, with adequate Action Description budget allocated, and a committee designated to provide adequate oversight of the full HCWM cycle. Source DLI# Responsibility Timing Timing Value Status Pilot to start 6 months Environmental and Social MoH in coordination Other after Program Not Yet Due Systems with other relevant effectiveness Completion MoH to report semi-annually as part of Program implementation progress reports and prior to World Bank Measurement implementation support visits indicating number of pilots that have started and their implementation status. Comments 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 Moderate -- Moderate Technical Design of Project or Program Substantial -- Substantial Institutional Capacity for Implementation and Sustainability Substantial -- Substantial Fiduciary High -- High Environment and Social Moderate -- Moderate Stakeholders Substantial -- Substantial Other Low -- Low Overall Substantial -- Substantial 9/4/2019 Page 7 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Results PDO Indicators by Objectives / Outcomes Program objective is to contribute to improving the quality of primary health care services. IN00737559 ►PDO 1: Increase in the percentage of pregnant women who received hemoglobin test and urine analysis for bacteriuria during the first trimester in a public PHC facility (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 16.00 -- 16.00 50.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator serves as a proxy for the quality of antenatal care. Numerator: Number of pregnant women during the year who received hemoglobin test and urine analysis for bacteriuria (microscopic and/or culture) Comments during the first trimester in a PHC facility. Denominator: Number of pregnant women during the year (estimated backwards from the deliveries in the following year). Targets are annual. IN00737560 ►PDO 2: Increase in the percentage of diabetic patients (type I and II) who received recommended care (an HbA1C test at least once a year) in a public PHC facility (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 35.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator serves as proxy for the quality of diabetic care. Numerator: Number of diabetic patients (type I and II) who received HbA1C test at least once a year in a PHC facility. Denominator: Number of registered diabetic patients (type I and II) as recorded in the Diabetic Registry. As noted, diabetes in Kyrgyz Republic Comments is likely under-detected. It is expected that the number of patients in the Registry will increase as detection improves, especially when the Program starts providing the HbA1C test for free. The denominator will be reviewed every year and possibility is open for revising indicator target at midterm depending on the magnitude of the change in the Registry patient volume. The targets are annual. IN00737611 ►PDO 3: Increase in drug coverage for priority conditions under the ADP, as measured by number of prescriptions reimbursed for (i) Test strips, (ii) Iron supplements and (iii) Hypertension drugs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target (i) 3,149 (i) 22,200 (i) 3,149 (ii) 169,480 (ii) 1,224,000 Value -- (ii) 169,480 (iii) 333,545 (iii) 2,429,000 (iii) 333,545 Date 31-Dec-2017 -- 16-Aug-2019 31-Dec-2024 This indicator measures the accessibility of drugs/tests for the three priority conditions (diabetes, anemia, hypertension) for individuals covered under the Additional Drug Package (ADP). Specifically, the indicator Comments monitors the annual number of reimbursed prescriptions for (i) test strips for monitoring blood sugar; (ii) iron supplements; and (iii) hypertension drugs. Targets are cumulative. IN00737612 ►PDO 4: A unit fully designated to quality improvement is established within the Ministry of Health and functioning (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 The Quality Improvement Unit within the Ministry of Health will be deemed as functioning when its TOR has Comments been developed and endorsed by an MoH Order and the QI unit has been established within the MoH with 9/4/2019 Page 8 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) at least 4 staff. The responsibilities of the QI Unit will include producing reports from online system, revising evidence-based medicine guidelines, coordinating among quality players, and implementing selected activities from the quality strategy and roadmap. Intermediate Results Indicators by Results Areas Integrating sustainable quality improvement mechanisms into service delivery IN00737614 ►Number of online learning curriculum on priority conditions (including MCH, CVD, diabetes) developed and approved for use in Continuous Professional Development (CPD) online platform (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 25.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator tracks the number of online learning materials on priority conditions (including MCH, CVD, and diabetes) developed and approved for use in the online CPD platform. Learning materials within the Comments Program are defined as: (i) a set of self-learning materials that include a pre-test assessment, learning materials (i.e. lecture, reading materials, audio-visual materials) and a post-test assessment; or (ii) a set of disease specific clinical vignettes with detailed explanation of answer choices. The targets are cumulative. IN00737617 ►Number of PHC physicians who meet requirement of credit hours for CPD to be obtained in online mode (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 900.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator will monitor the annual number of PHC physicians (including specialists) who meet the credit hour requirement for Continuous Professional Development by taking the online course through the Comments Continuous Medical Education (CME) platform. The physician will have to meet all the requirements specified in the online course (including passing an assessment if applicable) to count towards this indicator. The targets are cumulative. IN00737620 ►Number of pregnant women who received hemoglobin test and urine analysis for bacteriuria during the first trimester in a public PHC facility (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 24,000.00 -- 24,000.00 270,000.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator monitors the number of pregnant women who received hemoglobin test and urine analysis for Comments bacteriuria during the first trimester in a public PHC facility. Targets are cumulative. IN00737622 ►Number of diabetic patients (type I and II) who received HbA1C test at least once a year in a public PHC facility (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 95,000.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator monitors the number of diabetic patients (type I and II) who received HbA1C test at least once Comments a year in a public PHC facility. To comply with World Bank’s corporate gender requirements, this indicator is disaggregated by gender to enable gender-disaggregated monitoring. Targets are cumulative. IN00737625 9/4/2019 Page 9 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Number of men (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 36,100.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 IN00737626 Number of women (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 58,900.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 IN00737627 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1,350,000.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 Comments IN00737628 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 1,350,000.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 Strengthening strategic purchasing for quality of care IN00737613 ►The SGBP is revised to improve coverage for selected priority conditions at PHC (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 A methodology will be developed for SGBP revisions. This indicator will track whether the SGBP has been revised based on the new methodology to incorporate new benefits for the population. The revised SGBP Comments will include, among others, HbA1C test for all diabetic patients and antihypertensive drugs for uninsured patients at the same level of benefits as the insured. IN00737616 ►Revised payment mechanism is implemented that includes pay for quality and fee-for-service for selected priority services (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 9/4/2019 Page 10 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) For achievement of new payment mechanism design, a Resolution of the government is required, which Comments formally adopts revisions to the current capitation payment, namely: (a) introduction of fee-for-service (FFS) for selected priority and/or preventive services; and (b) revision of pay for performance indicators (P4P). IN00737619 ►The drugs list under the ADP program is revised to prioritize spending on evidence-based generic medications (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No -- No Yes Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 A methodology will be developed for Additional Drug Package (ADP) revisions. This indicator will track Comments whether the ADP has been revised based on the new methodology and budget for the ADP is increased by 15% annually. Strengthening health sector stewardship and governance for quality improvement IN00737615 ►Number of meetings by the Coordination Committee of the QI unit to discuss quality issues and actions (at least quarterly) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 16.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator monitors the number of meetings by the Coordination Committee of the QI Unit. The meetings should be conducted at least once per quarter. The Coordination Committee will meet to discuss quality of Comments care issues and reports and provide recommendations to the MoH collegium and MHIF. Targets are cumulative. IN00737618 ►Number of clinical guidelines revised or developed by the QI unit (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 30.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 From Year 3 to Year 5, at least 10 clinical guidelines on priority conditions (MCH, CVD, and diabetes) will be Comments revised or developed and endorsed annually. Targets are cumulative. IN00737621 ►Number of PHC facilities* receiving reports from the QI Unit on their own performance with benchmarking (at least quarterly) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 160.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator monitors the number of PHC facilities that receive reports from the QI Unit on a quarterly basis. The reports will be based on the quality of care e-platform and will include information on the facility’s performance as well as benchmarking with other comparable facilities (e.g. by type of PHC facility or Comments location). The reports will be delivered in an electronic form via email and/or quality of care e-platform. Targets are cumulative. *Includes Centers for General Practice (CGPs), Family Medicine Centers (FMCs), and Family Group Practices (FGPs) but not Feldsher-midwifery Posts (FAPs). IN00737623 ►Number of PHC facilities* whose Quality Committee receives training on quality improvement (at least once a year) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/4/2019 Page 11 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Value 0.00 -- 0.00 160.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 This indicator monitors the quality of care training delivered to PHC facility Quality Committee members under the coordination of the QI Unit. Topics for training may vary from year to year but should include a Comments session on review and discussion of quality reports. Targets are cumulative. *Includes Centers for General Practice (CGPs), Family Medicine Centers (FMCs), and Family Group Practices (FGPs) but not Feldsher- midwifery Posts (FAPs) IN00737624 ►Number of PHC facilities* that pilot a new mechanism to collect patient experience information regularly (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 21.00 Date 31-Dec-2018 -- 16-Aug-2019 31-Dec-2024 A patient experience questionnaire will be developed/adapted and piloted in a selected sample of PHC facilities (CGPs, FMCs, and legally independent FGPs). Targets are cumulative. *Includes Centers for Comments General Practice (CGPs), Family Medicine Centers (FMCs), and Family Group Practices (FGPs) but not Feldsher-midwifery Posts (FAPs). Disbursement Linked Indicators DLI_IND_TABLE ►DLI 1 A national e-platform for collecting and reporting quality of care indicators from PHC facilities is established and functioning (Output, 3,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 Data from at least 20% of FAPs are Value None -- None incorporated in the quality of care platform. Date -- -- 16-Aug-2019 -- Comments ►DLI 2 A national in-service training e-platform is established and functioning (Process, 3,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 25% PHC physicians meet CPD credit Value None -- None hour/point requirements for online learning. Date -- -- 16-Aug-2019 -- Comments ►DLI 3 Number of pregnant women who received hemoglobin test and urine analysis for bacteriuria during the first trimester in a public PHC facility (Output, 5,000,000.00, 0%) 9/4/2019 Page 12 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Baseline Actual (Previous) Actual (Current) Year 2024 Value 24,000.00 -- 24,000.00 74,000.00 Date -- -- 16-Aug-2019 -- Comments ►DLI 4 Number of diabetic patients (type I and II) who received HbA1C test at least once a year in a PHC facility (Output, 4,750,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 Value 0.00 -- 0.00 30,000.00 Date -- -- 16-Aug-2019 -- Comments ►DLI 5 The benefit package (SGBP) is revised to improve effective coverage for priority conditions at the primary care level (Output, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 Value None -- None -- Date -- -- 16-Aug-2019 -- Comments ►DLI 6 The provider payment mechanism for PHC is revised to improve quality and effective coverage for priority services (Output, 3,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 Value None -- None -- Date -- -- 16-Aug-2019 -- Comments ►DLI 7 The Additional Drug Package (ADP) for insured population is revised and its budget is increased to improve effective coverage for priority conditions at the primary care level (Output, 5,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 ADP approved budget for CY 2024 Value None -- None is increased by 15% compared to CY2023 Date -- -- 16-Aug-2019 -- 9/4/2019 Page 13 of 14 The World Bank Implementation Status & Results Report Primary Health Care Quality Improvement Program (P167598) Comments ►DLI 8 Price regulation mechanisms for the Additional Drug Package for insured population are developed and implemented (Output, 4,000,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 5% of contracted drug dispensing points randomly Value None -- None checked by MHIF for compliance by end of year 5. Date -- -- 16-Aug-2019 -- Comments ►DLI 9 A unit fully designated to quality improvement (QI unit) is established within the MoH and functioning (Output, 3,500,000.00, 0%) Baseline Actual (Previous) Actual (Current) Year 2024 Report on quality of care developed and distributed to key Value None -- None decision makers and PHCs on a quarterly basis by end of Year 5. Date -- -- 16-Aug-2019 -- Comments 9/4/2019 Page 14 of 14