The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Health System Strengthening and Support Project (P152799) EUROPE AND CENTRAL ASIA | Turkey | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2016 | Seq No: 7 | ARCHIVED on 14-Nov-2018 | ISR34698 | Implementing Agencies: Ministry of Health, Ministry of Treasury and Finance Key Dates Key Project Dates Bank Approval Date: 21-Sep-2015 Effectiveness Date: 26-Nov-2015 Planned Mid Term Review Date: 23-Feb-2018 Actual Mid-Term Review Date: 13-Apr-2018 Original Closing Date: 31-May-2020 Revised Closing Date: 31-May-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective (PDO) of the HSSSP is to improve primary and secondary prevention of selected NCDs, increase the efficiency of hospital management, and enhance the capacity of the MoH for evidence-based policy making. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Primary and Secondary Prevention:(Cost $44.03 M) Increasing Efficiency of Hospital Management and Operations:(Cost $47.65 M) Improving the Effectiveness of Overall Health Sector Administration:(Cost $44.30 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions This implementation status and results report (ISR) reflects the outcomes of the implementation support visit that took place from September 24 to October 19, 2018 in Ankara, Turkey. During the mid-term review (MTR) in April 2018, the World Bank team conducted a thorough assessment of progress towards achievement of the project development objectives (PDO) and agreed with the Ministry of Health (MoH) on a Project restructuring. During this visit, the Bank team and key stakeholders reviewed the scope and content of the proposed Project restructuring previously agreed at the MTR. Development objective and implementation progress ratings of the Project remain Moderately Unsatisfactory. The ratings will be revisited after the proposed restructuring is completed. 11/19/2018 Page 1 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial High Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Low Moderate Moderate Technical Design of Project or Program Moderate Substantial Substantial Institutional Capacity for Implementation and Sustainability Substantial Substantial Substantial Fiduciary Substantial Substantial Substantial Environment and Social Low Low Low Stakeholders Low Low Low Other -- -- -- Overall Moderate Substantial Substantial Results PDO Indicators by Objectives / Outcomes Objective 1: to improve primary and secondary prevention of selected non-communicable diseases IN00591079 ►Percent of households that receive from health workers counselling or education related to healthy living (by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 10.00 40.50 40.50 11.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. Comments: The proposed restructuring will revise the target values for 2018, 2019, 2020, and 2021. IN00591080 ►Percent change of target population using services of Healthy Living Centers (by province, age, gender, education, health status, and by type of services provided) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 Comments: No changes from the previous reporting. 11/19/2018 Page 2 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) The proposed restructuring will drop this indicator as the counselling and education activities related to healthy living are within the scope of the HLC services and PDO indicator #1 measures the coverage of these services on a broader scale. IN00591126 ►Early detection of (a) cervical (by province and age) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 26.00 26.00 50.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will drop this indicator as the current scope and coverage of the remaining Comments: activities will have only a marginal effect on the achievement of the PDO. IN00591145 Early detection of (b) breast cancer (by province and age) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 44.00 44.00 65.00 Objective 2: to increase the efficiency of hospital management IN00591127 ►Increase in average composite productivity index for all public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. Comments: The proposed restructuring will drop this indicator. Objective 3: to enhance the capacity of the MoH for evidence-based policy making IN00591128 ►Percent of policy and decision makers that regularly use HMIS (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 3.00 80.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 Intermediate Results Indicators by Components Component 1: Primary and Secondary Prevention IN00591129 ►Percent of general population who can state two or more negative health impacts of selected risk factors of non- communicable diseases and substance use (by province, age, and gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/19/2018 Page 3 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Value 0.00 0.00 0.00 4.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will reword this indicator to clarify that this indicator tracks the change in the Comments: ratio of population that can state two or more negative health impacts of selected risk factors of NCDs. IN00591130 ►Percent of target population in 8 provinces covered by newly established Healthy Living Centers (by province) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 90.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will revise this indicator as MoH will start identifying the target population that Comments: HLCs will serve in 2019. IN00591131 ►Number of individuals in 5 project provinces who visit Substance Use Treatment Centers to receive patient-specific counselling (new and returning visitors) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 90.00 7,292.00 7,292.00 8,400.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will drop this indicator as the Bank has not received any information on (i) the Comments: development of a long-term care model for substance abuse, and (ii) the draft regulations on integrated treatment and long-term care models. IN00591132 ►Percent of target population screened for 3 types of cancer: (a) by province (for colorectal and cancer type) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 81.30 81.30 70.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will revise this indicator to focus on early detection of cervical and breast Comments: cancer. IN00591146 Percent of target population screened for 3 types of cancer : (b) by age (for colorectal and cancer type) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 30.00 35.60 35.60 70.00 IN00591147 Percent of target population screened for 3 types of cancer: (c) by gender (for colorectal and cancer type) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 25.70 25.70 50.00 11/19/2018 Page 4 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) IN00591133 ►Percent of PHC-level staff who have satisfactorily completed standardized training modules required by the staff’s job profile: (a)distance learning (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 60.00 60.00 80.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. Comments: IN00591148 Percent of PHC-level staff who have satisfactorily completed standardized training modules required by the staff's job profile: (b)face-to-face (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 30.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 IN00591141 ►Direct project beneficiaries (number), of which female (percentage) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11,411,083.00 11,411,083.00 2,678,769.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. This is a core sector and citizen engagement indicator. Comments: The proposed restructuring will revise cumulative target values in line with the changes in the scope of related activities. IN00591142 ►Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,450.00 3,450.00 40,953.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. This is a core sector and citizen engagement indicator. Comments: The proposed restructuring will revise cumulative target values in line with the changes in the scope of related activities. IN00591143 ►Health facilities constructed, renovated, and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 3.00 50.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. This is a core sector and citizen engagement indicator. Comments: The proposed restructuring will revise cumulative target values in line with the changes in the scope of related activities. IN00591144 11/19/2018 Page 5 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) ►Percent of users of Healthy Living Centers satisfied with ease of access to Healthy Living Centers and/or responsiveness of services to users’ individual needs (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. As the implementation of the HLC pilot was delayed, MoH could not conduct a satisfaction survey. The Comments: survey will be conducted in 2019. Component 2: Increasing Efficiency of Hospital Management and Operations IN00591134 ►Number of Public Hospital Unions where newly developed hospital management models implemented (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 89.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will revise this indicator to better reflect the changing priorities of the MoH to Comments: give more emphasis to high value-added capacity building efforts in public hospitals. IN00591135 ►Standard guidelines and templates for PPP transactions developed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Standard guidelines No standard No standard No standard Value and templates for PPP documentation documentation documentation transactions in place Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will revise this indicator to facilitate the monitoring/tracking and standardization Comments: of Public Private Partnership (PPP) processes. Component 3: Improving the Effectiveness of Overall Health Sector Administration IN00591136 ►National-level Health System Assessment conducted annually and published (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Yes No No Yes Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will drop this indicator as MoH’s priorities to conduct annual assessments of Comments: the system were changed. IN00591137 ►Key information technology standards developed and integrated into updated draft regulations (Number, Custom) 11/19/2018 Page 6 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 12.00 12.00 20.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. Comments: IN00591138 ►Percent of health facilities that share data to HMS (a) public hospitals (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.50 55.00 55.00 100.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. Comments: IN00591149 Percent of health facilities that share data to HMS (b) family/community health centers (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.00 66.00 100.00 IN00591150 Percent of health facilities that share data to HMS (c) private hospitals (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 14.00 14.00 60.00 IN00591139 ►Percent of health indicators on Health.Net that meet international standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 70.00 70.00 97.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will revise this indicator as the scope of the MoH electronic databases has Comments: expanded since the project design. IN00591140 ►At least 12 Health Technology Assessments on prioritized topics prepared in line with new HTA strategy and published (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 4.00 3.00 3.00 12.00 Date 20-Apr-2015 13-Apr-2018 19-Oct-2018 31-May-2020 No changes from the previous reporting. The proposed restructuring will drop this indicator as relevant project activities will be discontinued Comments: to eliminate duplication of efforts conducted by other MoH units with the national budget. 11/19/2018 Page 7 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P152799 IBRD-85310 Effective USD 134.30 134.30 0.00 27.95 106.61 21% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P152799 IBRD-85310 Effective 21-Sep-2015 30-Sep-2015 26-Nov-2015 31-May-2020 31-May-2020 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 11/19/2018 Page 8 of 9 The World Bank Implementation Status & Results Report Health System Strengthening and Support Project (P152799) 11/19/2018 Page 9 of 9