The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Kosovo Health Project (P147402) EUROPE AND CENTRAL ASIA | Kosovo | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 13 | ARCHIVED on 06-Sep-2019 | ISR38379 | Implementing Agencies: Republic of Kosovo, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 13-May-2014 Effectiveness Date: 20-May-2015 Planned Mid Term Review Date: 30-Oct-2017 Actual Mid-Term Review Date: 30-Oct-2017 Original Closing Date: 30-Oct-2019 Revised Closing Date: 30-Jun-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To contribute to improving financial protection from health spending for the poor and quality of care for priority maternal and child health and non communicable disease services. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The Project Development Objective is to contribute to (i) developing the building blocks to introduce Social Health Insurance; and (ii) strengthening Primary Health Care in selected municipalities. Components Table Name Support capacitiy building and establishment of building blocks for introduction of SHI:(Cost $5.82 M) Support primary health care strengthening:(Cost $9.10 M) Project management and communications:(Cost $0.77 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 Substantial Substantial Implementation Status and Key Decisions This is an interim ISR. The latest full-fledged implementation support visit of the Kosovo Health Project was held from February 4 to 8, 2019, which informed the previous ISR archived on March 15, 2019. The Kosovo Health Project was then discussed during a visit to Pristina that was held from 9/6/2019 Page 1 of 5 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) March 18 to 22, 2019, and during the Spring Meetings on April 12, 2019. The next full-fledged implementation support visit will take place once the new government is in place, i.e. end of October-beginning of November 2019. Since the previous ISR, progress has been made in the implementation of activities directly influencing the achievement of PDO and intermediate results indicators related to the first expected outcome of the project, i.e. the development of the building blocks to introduce social health insurance. Specifically, the Government has continued to receive technical support to the establishment of the outpatient drug benefit scheme; there was progress in the functionalization of the Health Insurance Fund Information System; and the preparation of the survey on patients' satisfaction and expectations was initiated. Progress has also been made in the implementation of activities influencing the achievement of intermediate results indicators relating to the second expected outcome of the project, i.e. primary health care strengthening. Specifically, medical training of primary health care staff is ongoing; and the new basic health information system, including a registration module that will allow for the continuation of capitation-based payments, has been rolled out to 9 municipalities. On the other hand, actual capitation-based payments to municipalities have been stalled in 2019. The next full-fledged implementation support visit planned for end October-early November 2019 will assess progress in detail. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- High High Technical Design of Project or Program -- Substantial Substantial Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- High High Environment and Social -- Low Low Stakeholders -- Substantial Substantial Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To contribute to developing the building blocks to introduce Social Health Insurance IN00738699 ►Outpatient (OP) drug benefit scheme established (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The costed list of The costed list of drugs The list of drugs for drugs for the for the outpatient drug outpatient drug benefit outpatient drug benefit Value No benefit scheme is scheme adopted by scheme is submitted to submitted to the Steering the HIF is submitted to the Steering Board of Board of the HIF the Government the HIF 9/6/2019 Page 2 of 5 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Date 13-May-2014 28-Feb-2019 29-Aug-2019 30-Jun-2020 IN00738751 ►HIFIS is functional (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 13-May-2013 28-Feb-2019 29-Aug-2019 30-Jun-2020 To contribute to strengthening Primary Health Care IN00738700 ►Number of municipalities participating in CBPP scheme (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6.00 6.00 6.00 20.00 Date 13-May-2013 28-Feb-2019 28-Feb-2019 30-Jun-2020 It is expected that the web-based HIS application will be rolled out in 14 municipalities by April 2019, Comments: allowing for the signature of performance agreements with 20 municipalities. Intermediate Results Indicators by Components Establishing Building Blocks for the Introduction of Social Health Insurance IN00738752 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,358.00 4,358.00 2,449.00 Date 13-May-2014 28-Feb-2019 28-Feb-2019 30-Jun-2020 An updated value will be provided after the next full-fledged implementation support mission. Comments: IN00738753 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.00 11.00 11.00 Date 13-May-2014 28-Feb-2019 29-Aug-2019 30-Jun-2020 IN00738756 ►Percentage of patients using primary health care facilities who are satisfied with services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.80 65.80 65.80 70.00 9/6/2019 Page 3 of 5 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Date 31-Dec-2017 28-Feb-2019 29-Aug-2019 30-Jun-2020 The current value is the baseline value (end of December 2017). The follow-up survey is under Comments: preparation, the results should be available in 2020. Strengthening Primary Health Care IN00738754 ►Number of patients registered in the HIS (Number (Thousand), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 349,711.00 378,975.00 511,074.00 Date 13-May-2013 28-Feb-2019 29-Aug-2019 30-Jun-2020 IN00738755 Of which female (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 56.00 78.00 IN00738757 ►Percentage of capitation-based performance payment budget spent at municipality level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72.14 72.14 95.00 Date 13-May-2014 28-Feb-2019 29-Aug-2019 30-Jun-2020 The current value is the end of 2018 value. Since then, effective capitation-based payments to Comments: municipalities have been stalled. IN00738758 ►Percentage of participating municipalities with a performance improvement action plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 75.00 Date 13-May-2014 28-Feb-2019 29-Aug-2019 30-Jun-2020 The current value is the end of 2018 value. Since then, actual capitation-based payments have been stalled. Therefore, municipalities have not been in a position to prepare performance improvement action Comments: plans. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P147402 IDA-54420 Effective USD 25.50 17.31 8.19 4.88 9.99 33% 9/6/2019 Page 4 of 5 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P147402 IDA-54420 Effective 13-May-2014 15-Jan-2015 20-May-2015 30-Oct-2019 30-Jun-2020 Cumulative Disbursements Restructuring History Level 2 Approved on 12-Jun-2018 ,Level 2 Approved on 24-Jul-2019 Related Project(s) There are no related projects. 9/6/2019 Page 5 of 5