PILOT HEALTH RESULTS-BASED FINANCING PROJECT IDA GRANT NUMBER TF01 3310 IMPLEMENTED BY RESULT-BASED FINANCING SECRETARIAT UNIT UNDER THE MINISTRY OF HEALTH OF THE KYRGYZ REPUBLIC SPECIAL PURPOSE PROJECT FINANCIAL STATEMENTS AND INDEPENDENT AUDITOR'S REPORT For the period from 1 January 2019 to 15 August 2019 BISHKEK August 2019 The special purpose financial statements and the conclusion are in English and translated into Russian. If there is a discrepancy, the English version prevails. 2 PILOT HEALTH RESULTS-BASED FINANCING PROJECT IDA GRANT NUMBER TF013310 TABLE OF CONTENTS Page STATEMENT OF MANAGEMENT'S RESPONSIBILITIES FOR THE PREPARATION AND PRESENTATION OF THE SPECIAL PURPOSE FINANCIAL STATEMENTS 4 INDEPENDENT AUDITOR'S REPORT 5-6 SPECIAL PURPOSE FINANCIAL STATEMENTS For the period from 1 January 2019 to 15 August 2019: Statement of cash receipts and payments 7 Statement of expenditures per components 8 Notes to the special purpose financial statements 9-14 ANNEX 1. RECONCILIATION BETWEEN THE AMOUNTS SUBMITTED BY RBF SECRETARIAT AND DISBURSED BY THE WORLD BANK 15 3 STATEMENT OF MANAGEMENT'S RESPONSIBILITIES FOR THE PREPARATION AND PRESENTATION OF THE SPECIAL PURPOSE FINANCIAL STATEMENTS The management of the RBF Secretariat under the Ministry of Health of Kyrgyz Republic (hereafter: RBF Secretariat) is responsible for the preparation of the special purpose financial statements of Health Results-Based Financing Project (hereafter: the Project) financed by IDA Grant Number TF013310 that present fairly the Project's cash receipts and payments, expenditures per components for the period from 1 January 2019 to 15 August 2019, in compliance with the International Public Sector Accounting Standard "Financial Reporting under the Cash Basis of Accounting" (IPSAS-Cash Basis) issued by the International Public Sector Accounting Standards Board (IPSASB) within the International Federation of Accountants (IFAC) and the Financial Management Manual for World Bank Financed Investment Operations (WB Guidelines). In preparing the special purpose project financial statements, PIU's management is responsible for: * Properly selecting and applying accounting policies; * Presenting information, including accounting policies, in a manner that provides relevant, reliable, comparable and understandable information; * Providing additional required disclosures for the period from 1 January 2019 to 15 August 2019. PIU's Management is also responsible for: * Designing, implementing and maintaining an effective and sound system of internal controls, throughout the Project; * Maintaining adequate accounting records that are sufficient to show and explain the Project's transactions, and which enable them to ensure that the special purpose financial statements of the Project comply with IPSAS - Cash Basis and the WB Guidelines; * Taking such steps that are reasonably available to them to safeguard the assets of the Project and to affirm that funds received have been used in accordance with the IDA Grant Number TF013310 dated 30 December 2013, and World Bank related guidelines, with due attention to economy and efficiency, and only for the purposes for which the financing was provided; and * Preventing and detecting fraud and other errors. The special purpose financial statements for the period from 1 January 2019 to 15 August 2019 were authorized for issue on 16 August 2019 by RBF Secretariat under the Ministry of Health of Kyrgyz Republic. Madaminjan Kirataev Deputy Minister of Health of the Kyrgyz Republic Oskom6aeva Klara Esengulov anatbek Director Finance Manager RBF Secretariat RBF Secretariat 4 B D O V/Ji'11,~ ia:,'m! "M 1 INDEPENDENT AUDITOR'S REPORT To the Ministry of Health of the Kyrgyz Republic Opinion We have audited the special purpose financial statements of Pilot "Health Results-Based Financing Project" ("Project") financed by Financing Agreement IDA Grant Number TF013310 dated 30 December 2013 ("Grant Agreement"), and implemented by RBF Secretariat under the Ministry of Health of Kyrgyz Republic ("RBF Secretariat"), which comprise the statement of cash receipts and payments and the statement of expenditures per components for the period from 1 January 2019 to 15 August 2019, and notes to the special purpose financial statements, including a summary of significant accounting policies. In our opinion, the accompanying financial statements present fairly, in all material respects, the cash flows for the period from 1 January 2019 to 15 August 2019 in accordance with International Public Sector Accounting Standard: Financial Reporting Under the Cash Basis of Accounting, (IPSAS- Cash Basis). Basis for Opinion We conducted our audit in accordance with International Standards on Auditing (ISAs) as issued by International Auditing and Assurance Standards Board (IAASB) of the International Federation of Accountants (IFAC). Our responsibilities under those standards are further described in the Auditor's Responsibilities for the Audit of the Financial Statements section of our report. We are independent of the Project and of the RBF Secretariat in accordance with the International Ethics Standards Board for Accountants' Code of Ethics for Professional Accountants (IESBA Code), and we have fulfilled our other ethical requirements in accordance with IESBA Code. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Emphasis of Matter- Cash Basis of Accounting We draw attention to Note 2 to the financial statements, which describes that financial statements are prepared in accordance with cash basis framework, as a result, they may not be suitable for another purposes. Our opinion is not modified in respect of this matter. Emphasis of Matter - Completion of the Project We draw your attention to Note 9 of these special purpose financial statements which disclose that the Project was completed as at the reporting date. Our opinion is not modified in this respect. Responsibilities of the Management for the Financial Statements Management of the RBF Secretariat is responsible for the preparation and fair presentation of the special purpose financial statements in accordance with IPSAS-Cash Basis issued by the International Public Sector Accounting Standards Board (IPSASB) of the IFAC and Financial Management Manual for World Bank Financed Investment Operations ("WB Guidelines"), and for such internal control as management determines is necessary to enable the preparation of special purpose financial statements that are free from material misstatement, whether due to fraud or error. Auditor's Responsibility for the Audit of the Special Purpose Financial Statements Our objectives are to obtain reasonable assurance about whether the special purpose financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes our opinion. Reasonable assurance is high level of assurance, but is not a guaranty that an audit conducted in accordance with ISAs will always detect a material misstatement when it exists. Misstatements arise from fraud and error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these special purpose financial statements. As part of an audit in accordance with ISAs. we exercise professional judgement and maintain professional skepticism throughout the audit. We also: * Identify and assess the risks of material misstatement of the special purpose financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. * Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the internal control. * Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by management. * Evaluate the overall presentation, structure and content of the special purpose financial statements, including the disclosures, and whether the special purpose financial statements represent the underlying transactions and events in a manner that achieves fair presentation. We communicate with management regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit. Report on Other Legal Requirements To comply with the terms of the Financing Agreement, the RBF Secretariat management shall insure that: 1. funds have been used in accordance with the conditions of the Grant Agreement concluded between the International Development Association (IDA) and the Kyrgyz Republic, and WB Guidelines, with due attention to economy and efficiency, and only for the purposes for which the financing was provided; 2. supporting documents, records and accounts have been maintained to support claims for reimbursement of expenditures incurred. Expenditures included in the withdrawal applications and reimbursed against are eligible for financing under the Grant Agreement: Interim Unaudited Financial Statements (lFSs) issued by RBF Secretariat during the reporting period are in agreement with the underlying books of account; 3. The Designated account used has been maintained in accordance with the provision of the Grant Agreement, and World Bank related guidelines; 4. Goods and Services financed have been procured in accordance with the Grant Agreement and World Bank related guidelines; 5. Financial covenants in the Part B of the Section II of the Schedule 2 of the Grant Agreement were complied. In our opinion, the RBF Secretariat management has complied with the above requirements for the period from 1 January 2019 to 15 August 2019. "BDO Armenia" CJSC 16 August 2019 co o Gnel Khachatryan, FCCA o. 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General information 1. 1. The Project The Grant Agreement IDA Grant TF01 3310 was concluded on 30 December 2013 between the Kyrgyz Republic and the International Development Association (IDA), according to which IDA, acting as administrator of grant funds provided by the Multi-Donor Trust Fund for Health Results Innovation, provided financing in the amount of 11,000,000 United States dollars (USD) for the implementation of "Health Results-Based Financing Project" (the Project). The Project became effective on 29 July 2014. The Closing date of the IDA Grant Number TF01 3310 is set 31 May 2019 (as updated). The Grace Period for submitting withdrawal application for expenditures incurred before the Closing date is four months following the Closing dates: 30 September 2019 (as updated). 1.2. The Project objectives The objectives of the Project are: 1. to pilot performance- based payments and enhanced supervision for quality of maternal and neonatal care in randomly selected rayon hospitals; and 2. to strengthen the Recipient's and healthcare providers' capacity in performa nce- based contracting and monitoring and evaluating for results. The Project consists of the following parts: Part 1: Pilot Performance- Based Payments and Enhanced Supervision for Quality of Health Care (a) Conducting a randomized controlled trial at the rayon hospitat level (b) Supporting Incremental Operating Costs of MHIF to manage performance- based contracts with health facilities. Part 2: Strengthen the Government's and Health Care Providers' Capacity in Performance- Based Payment Reform and Monitoring and Evaluation for Results (a) Improving the capacity of MOH and MHIF through provision of technical assistance, (b) Improving the capacity of Participating Providers through provision of technical assistance and training, (c) Supporting Project coordination, implementation, management and monitoring through the provision of training, goods, and financing of MOH Incremental Operating Costs. 1.3. The Project Budget and Financing The Project is 100% financed (inclusive of taxes) by IDA Grant Number TF013310. Category IDA Grant Number Total TF013310 USD USD (1 ) Incentive Payments to Participating Providers under Part 1 of the Project 8,832,230 8,832,230 (2) Goods, Consultant Services, Incremental Operating Costs, and Training 2,167,770 2,167,770 Total 11,000,000 11,000,000 9 Health Results-Based Financing Project IDA Grant Number TFO1 3310 Notes to the special purpose financial statements For the period from 1 January 2019 to 15 August 2019 1.4. Project Implementation The Ministry of Health of the Republic of Kyrgyzstan (MOH) established the RBF Secretariat to ensure the project implementation with the following functions: (i) providing day-to-day implementation and management of the Project, including financial management, procurement, and fiduciary audits for service providers; (ii) participating as observers during peer verification; (iii) assessing the validity of reported data to ensure accuracy and reduce the likelihood of misreporting; and (iv) conducting counter-verification on a semi-annual basis. For the project purposes MOH has allocated 64 health facilities for 3 groups since commencement of the Project: * Group 1 (21 facilities + pilot Chui hospital): use of an enhanced supervision scheme that utilizes a Balanced Scorecard (BSC) to assess quality of care together with a performance-based payment made against the level of facility performance achieved on a quarterly basis; * Group 2 (21 facilities): use of only the enhanced supervision scheme that utilizes the BSC without performance-based payments. * Group 3 (21 facilities): a control group of hospitals, without any involvement under the Project. I' 2018, the Ministry of Health and WB came to an agreement to commence result based financing to medical centers under Group 2 and 3 since quarter 2, 2018. These 42 hospitals periodically receive intensive monitoring / enhanced review using a balanced system of indicators with a payout of no more than 5%. The total number of rayon hospitals participated and financed under the RBF project became 64 instead of initial 22. In addition, the project included Primary Health Care (PHC) organizations and from 2018 the Centers for Family Medicine. The RBF PHC approach was scaled up for the whole country in 2018. Two rounds of semi-annual verification were completed in 2018. Based on the verification results RBF funds were allocated to the regional PHC Facilities. City PHC Facilities were financed from public funds. Currently the RBF Secretariat, together with the MHI Fund, is conducting the implementation of the RBF PHC across the country with a share of government funding. RBF Secretariat address is: room 6, Togolok Moldo Street 1, Bishkek, Kyrgyz Republic. 10 Health Results-Based Financing Project IDA Grant Number TF013310 Notes to the special purpose financial statements For the period from 1 January 2019 to 15 August 2019 2. Summary of significant accounting policies 2.1. Preparation and presentation of financial statements The special purpose financial statements are prepared in accordance with the International Public Sector Accounting Standard: Financial Reporting Under the Cash Basis of Accounting (IPSAS-Cash Basis), issued by the International Public Sector Accounting Standards Board (IPSASB) within the International Federation of Accountants (IFAC), and presented in accordance with Financial Management Manual for World Bank Financed Investment Operations (March 2010): RM 3 - Financial Reporting and Auditing. The principal accounting policies applied in the preparation of these special purpose financial statements are set out below. These policies have been consistently applied to all the periods presented. 2.2 Cash basis of accounting Project financing is recognised as a source of project funds when the cash is received. Project expenditures are recognised as a use of project funds when the payments are made. 2.3 Reporting currency The reporting currency of these special purpose financial statements is United States dollars (USD). The expenditures made in local currency, Kyrgyz Som (KGS), are translated into USD based at the exchange rate prevailing at the date of the transaction. The effect of exchange rate changes on cash held on foreign currency is reported as separate line item in the statement of cash receipts and payments. The exchange rate defined by the National Bank of the Kyrgyz Republic is as follows: 31 December 2018: USD 1 = 69.8500 KGS, 15 August 2019: USD 1 = 69.7405 KGS. 2.4. Taxes Taxes are paid in accordance with the tax regulations of the Kyrgyz Republic. 2.5. Budget Expenditure budget is created based on actual accumulated expenditures for the last period plus the updated procurement plans for the Reporting period. 11 Health Results-Based Financing Project IDA Grant Number TF01 3310 Notes to the special purpose financial statements For the period from 1 January 2019 to 15 August 2019 3. Summary of Summary Reports and SOEs Payment categories Total Withdrawal Withdrawal application application (1) Incentive Payments to (2) Goods, Consultant No value date Participating Providers Services, Incremental under Part 1 of the Operating Costs, and Project Training 28 11.Feb.2019 856,258.00 96,181.20 952,439.20 34 O1.Aug.2019 - 363,392.52 363,392.52 36 12.Aug.2019 - 1,196.00 1,196.00 Total 856,258.00 460,769.72 1,317,027.72 4. Statement of Designated Account Bank account number 1013350200002170 Bank National Bank of The Kyrgyz Republic Bank location 101 T. Umutalive Street, Bishkek, Kyrgyz Republic Currency USD IDA Grant No. TF013310 Year ended 15.Aug.2019 1. Opening balance as at 1.Jan.2019 147,561 2. Add: opening discrepancy - 3. WB advance/replenishment 217,028 4. Less: Refund to WB from DA - 5. Present outstanding amount advanced to DA 364,589 6. DA closing balance as at 15.Aug.2019 - 7. Add: Amount of eligible expenditures paid 364,589 8. Less: interest earned (if credited to DA) - 9. Total advance accounted for 364,589 10. Closing discrepancy (5)-(9) - 12 Health Results-Based Financing Project IDA Grant Number TFO1 3310 Notes to the special purpose financial statements For the period from 1 January 2019 to 15 August 2019 5. Statement of Financial Position The Statement of Financial Position discloses assets, liabilities and net assets of the Projects as at reporting date. It is prepared in accrual basis that is transactions are recognized when they occur (and not only when cash is received or paid). Note 15 Aug 2019 31 Dec 2018 USD USD ASSETS Cash 6 - 147,561 Prepayments Total assets - 147,561 LIABILITIES Payables Total liabilities _ _ NET ASSETS Cumulative income IDA Grant No. TF013310 8 10,976,104 10,550,536 10,976,104 10,550,536 Cumulative expenses Project expenses 7 10,976,104 10,402,975 10,976,104 10,402,975 Total net assets - 147,561 6. Cash Underlying 15 Aug 2019 31 Dec 2018 Currency USD USD Designated Account (IDA Grant TF01 3310) USD - 147,561 - 147,561 13 Health Results-Based Financing Project IDA Grant Number TF013310 Notes to the special purpose financial statements For the period from 1 January 2019 to 15 August 2019 7. Project Expenditures budget execution Cumulative Expenditures Total Project as at 15 Aug 2019 Budget Progress Category USD USD % (1) Incentive Payments to Participating Providers under Part 1 of the Project 8,832,219 8,832,230 100% (2) Goods, Consultant Services, Incremental Operating Costs, and Training 2,143,885 2,167,770 99% Total 10,976,104 11,000,000 100% 8. Financing IDA Grant No TF013310 Reporting Cumulative as period at 15 Aug 2019 USD USD Advances/ (advance recovery) (1,100,000) - Direct Payments 208,541 336,701 SOE and Summary Report 1,317,028 10,639,403 Total 425,569 10,976,104 Total financing budget 11,000,000 Percentage of finance provided as at 15 Aug 2019 100% 9. Project completion The Project was completed as at 31 May 2019 (the Closing Date), and the Grace period for submitting withdrawal application for expenditures incurred before the Closing date set 30 September 2019. The transactions were completed as at 15 August 2019 (Reporting date). As at the date of signing these special purpose financial statements: a. No expenditures related to the Project were incurred after the Closing Date; the payments made during the Grace period related to expenditures incurred before the Closing Date; b. Expenditures related to the Project to be submitted to the WB after the Reporting date relates only to payment for final audit service: USD 10,760. c. There were no uncovered prepayments or payables outstanding to contractors related to the Project as at the Reporting Date; except for the final audit service. d. The undisbursed fund as at Reporting Date, in total of USD 23,896 will be used to pay for audit service, the remaining amount will be cancelled; e. We are not aware about any pending or existing litigations against the Project. 14 Health Results-Based Financing Project IDA Grant Number TF013310 ANNEX 1. RECONCILIATION BETWEEN THE AMOUNTS SUBMITTED BY THE RBF SECRETARIAT AND DISBURSED BY THE WORLD BANK For the period from 1 January 2019 to 15 August 2019 (Amounts are shown in US dollars) IDA Grant TF013310 Expenditure Category Appl. RBF Secretariat WB Difference 28 (952,439.20) (952,439.20) - 31 217,027.72 217,027.72 Advance/(advance recovery) 34 (363,392.52) (363,392.52) 36 (1,196.00) (1,196.00) (1,100,000.00) (1,100,000.00) (1) Incentive Payments to Participating Providers under Part 28 856,258.00 856,258.00 - 1 of the Project 856,258.00 856,258.00 (2) Goods, Consultant Services, 28 96,181.20 96,181.20 Incremental Operating Costs, and Training 29 DP 13,125.00 13,125.00 - 30 DP 72,239.00 72,239.00 - 32 DP 72,238.00 72,238.00 33 DP 36,119.00 36,119.00 34 363,392.52 363,392.52 35-1 DP 14,820.00 14,820.00 36 1,196.00 1,196.00 669,310.72 669,310.72 Total 425,568.72 425,568.72 15