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: 12 | ARCHIVED on 26-Sep-2019 | ISR38518 | 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) ≤Satisfactory ≤Satisfactory Overall Risk Rating ≤Moderate ≤Moderate Implementation Status and Key Decisions 9/26/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) According to the latest data obtained during the June 2019 visit, four out of five project development objective (PDO) indicators have met their 2018 annual target values and one has partially met its sub-targets (two out of three sub-targets). Out of those five PDO indicators, two met their end-of-project target values. In addition, ten out of 16 intermediate results indicators have achieved their 2018 annual target values. Out of those, five have met their end-of-project target values. Furthermore, there is significant progress toward the fulfillment of the three disbursement conditions related to the procurement of diagnostic equipment under Component 3. Under Component 1 - Improvement of Health Financing, payments to hospitals based on diagnosis-related groups (DRGs) and the use of the improved formula for the variable part of salary at primary health care level, which started on January 1, 2019 have continued. A new costing methodology for health services, including DRGs, is under development. Contract with an international firm that will assist the Government with the development of a health care network optimization plan has been signed, with contract implementation expected to last 12 months. Under Component 2 - Improve Access to Quality Health Care, the Ministry of Health has continued to implement multiple activities for the rational use of antibiotics, e.g. publication of the guidelines for the rational use of antibiotics, publication of the program for the control of bacterial resistance to antibiotics for 2019-2021 (including an action plan), and publication of the report on the fourth survey on healthcare-associated infections and antibiotic consumption. These key documents were disseminated through multiple training sessions and events. The strengthening of the e-prescription system also successfully continued. On health technology assessment, the situation analysis and the roadmap (including a detailed action plan), which were developed with the support of an international consultant, have yet to be adopted. There is a need to accelerate the activities to improve the medical equipment maintenance system. Finally, under Component 3 - Strengthen Quality of Service Delivery, seventeen clinical pathways for primary health care are in the process of computerization and integration in PHC centers’ information system, which is expected to ensure their effective utilization by PHC staff. Six linear accelerators are in operation, and civil works in another site that should host two additional linear accelerators have been initiated. 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 -- ≤Moderate ≤Moderate Environment and Social -- ≤Moderate ≤Moderate Stakeholders -- ≤Moderate ≤Moderate Other -- ≤Moderate ≤Moderate Overall -- ≤Moderate ≤Moderate Results PDO Indicators by Objectives / Outcomes 9/26/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) To contribute to improving the efficiency and quality of the public health system of Serbia IN00742780 ≤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 95.00 95.00 95.00 Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742896 ≤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 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742897 ≤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 Monitoring system in place to place to measure the Value place to report on the place to measure the measure the indicator indicator, baseline and indicator indicator target values defined Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742898 ≤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 33.25 34.50 45.00 Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742899 ≤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) 9%; a) 25%; Value b) 27%; b) 27%; b) 28.5%; b) 35%; c) 10% c) 10% c) 28% c) 35% Date 30-Nov-2017 19-Mar-2019 14-Jun-2019 31-Dec-2021 Screening is done once every two or three years. The data for this indicator is reported on an annual basis by the Institute of Comments: Public Health. The 2018 value should be available by June 2019. Intermediate Results Indicators by Components 9/26/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) 1. Improvement of Health Financing IN00742900 ≤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 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742903 ≤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 Value No Yes Yes Yes Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742906 ≤Number of health workers receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 500.00 13,152.00 19,021.00 13,000.00 Date 16-Jan-2014 19-Mar-2019 14-Jun-2019 31-Dec-2021 This indicator is mapped to all three components Comments: 2. Improve Access to Quality Health Care IN00742901 ≤Number of pharmaceuticals and health products that are procured through centralized framework contracts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 700.00 700.00 700.00 Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742904 ≤Percentage of a) Dom Zdravljas and b) pharmacies implementing e-prescription system (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target DZs - 0 DZs - 100%; DZs - 98%; DZs - 90% Value Pharm - 0 Pharm - 100% Pharm - 98% Pharm - 90% Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742907 ≤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 32.80 32.80 22.00 9/26/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Date 30-Nov-2017 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742909 ≤Strengthen systems for Health Technology Assessment (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The linkage between national clinical practice Situation analysis guidelines and basic Limited institutional Situation analysis completed. completed. Roadmap benefit package well efficiency related to the Roadmap document with document with detailed established and functional. Value decision making process in detailed plan of activities for plan of activities for HTA The new, robust and the area of drug HTA system establishment system establishment transparent, system of reimbursement drafted drafted and to be adopted evidence based supported by the MOH decision making process fully established and functional Date 30-Nov-2017 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742911 ≤Strengthen systems for medical equipment maintenance (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Medical equipment registry set up within No national systems or Budget allocated to IHIS. policies in place, Medical Medical equipment registry expand maintenance Value Rulebook for the equipment database in the set up within IHIS system. National system(s) establishment of a unit IPH in use within MoH under preparation. Date 16-Jan-2014 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742913 ≤Annual training organized for health Roma mediators (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 2.00 4.00 Date 30-Nov-2017 19-Mar-2019 14-Jun-2019 31-Dec-2021 3. Strengthen Quality of Service Delivery IN00742902 ≤Number of clinical pathways developed (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 14.00 35.00 35.00 48.00 Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742905 ≤Number of health care institutions that have completed staff training on priority clinical pathways (Number, Custom) 9/26/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 77.00 64.00 160.00 Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742908 ≤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 Improved quality Ranking of health indicators prepared and institutions according to Improved quality indicators Value Existing quality indicators approval by MoH quality criteria based on under discussion/no ranking expected by end 2019/no data from previous ranking year/Yes Date 16-Jan-2014 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742910 ≤Number of new linear accelerators installed at national level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6.00 6.00 8.00 Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 IN00742912 ≤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 40.90 40.80 50.00 Date 16-Oct-2013 19-Mar-2019 14-Jun-2019 31-Dec-2021 This indicator is mapped to components 2 and 3 Comments: IN00742914 ≤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 50.00 54.20 70.00 Date 16-Jan-2014 19-Mar-2019 14-Jun-2019 31-Dec-2021 This indicator is mapped to components 2 and 3 Comments: IN00742915 ≤Percentage of patients satisfied with the quality of care in PHC facilities (CE) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 78.00 78.00 78.34 80.00 Date 30-Nov-2017 19-Mar-2019 14-Jun-2019 31-Dec-2021 9/26/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) The survey on patients' satisfaction is conducted every year in all primary, secondary and tertiary health care facilities by the Institute of Public Health (IPH) of Serbia. The latest survey at the primary health care (PHC) level was conducted from Nov 27 to Dec 1, 2018 in 176 PHC facilities and 46,482 questionnaires were administered. In 2018, the average rating provided by patients using PHC facilities was 3.968 on a scale of 1 (very dissatisfied) to 5 (very satisfied). Further results are available in the results report that is available online Comments: (http://www.batut.org.rs/download/izvestaji/Analiza%20zadovoljstva%20korisnika%202018.pdf). Every year, such a results report is publicly disclosed on the IPH's website. In addition, every facility publicly discloses the survey results on its own website. Finally, each facility comprises a Quality Commission that is responsible for addressing, inter alia, the challenges highlighted through the patients' satisfaction survey. 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 28.22 7.41 79% P129539 IBRD-88300 Effective USD 31.10 31.10 0.00 5.99 24.48 20% 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 Cumulative Disbursements 9/26/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Second Serbia Health Project (P129539) Restructuring History Level 2 Approved on 14-Sep-2015 Related Project(s) P166025-Additional Financing for Second Serbia Health Project 9/26/2019 Page 8 of 8