The World Bank Report No: ISR9730 Implementation Status & Results Turkey Project in Support of Restructuring of Health Sector (P102172) Public Disclosure Copy Operation Name: Project in Support of Restructuring of Health Sector Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: 31-Mar-2013 (P102172) Country: Turkey Approval FY: 2009 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Key Dates Board Approval Date 11-Jun-2009 Original Closing Date 31-Jul-2013 Planned Mid Term Review Date Last Archived ISR Date 15-Oct-2012 Effectiveness Date 29-Sep-2009 Revised Closing Date 31-Jul-2013 Actual Mid Term Review Date 24-Oct-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) The specific objectives of the Project are: (i) increasing the effectiveness of the Social Security Institute (SSI) and the Ministryof Health (MOH) in formulating and implementing reforms in provider payments and health systems performance; and (ii) piloting output-based financing for non-communicable diseases (NCD) prevention and control. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Support for MOH's Strategic Plan 46.17 Output Based Financing for Preventive Health Services 6.84 Capacity Building for Social Security Institution 3.09 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Moderate Substantial Implementation Status Overview The Project has disbursed 47% of loan proceeds. Significant progress is noted with key legislations (MOH Restructuring Law and Hospital Union Law) having been passed as a decree law in November 2011. The MOH Restructuring Law redefines the role of the MOH away from that of a provider to that of a steward for the sector focusing on policy formulation, regulation and monitoring and evaluation. The family medicine program has achieved nationwide coverage as of December 2010. Utilization of primary care services has Page 1 of 6 The World Bank Report No: ISR9730 increased from 2 to 3.3 outpatient visits per capita between 2008 and 2011. Patient satisfaction with primary care services in provinces where family medicine was introduced increased from 69 % in 2004 to 90% percent in 2012, and overall patient satisfaction with health services in public hospitals increased from 41% to 76$ between 2003 and 2011. The Project Development Objective as currently formulated under the project is not being fully met as because 2 of the 3 components are now being carried out by the Government Public Disclosure Copy and therefore not financed by the Project. A Project Restructuring is under preparation which includes a change in the PDO to reflect this change. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target 1. Increase in the utilization of primary health Number Value 2.00 3.30 4.00 care. Date 30-Jul-2009 28-Feb-2013 30-Jul-2013 Comments Target on track. 3.3 visits per 4 visits per capita capita in 2011 2. Increase in the percentage of first-time visits Number Value 1.20 1.50 1.50 to specialists that are referrals by family Date 30-Jun-2009 28-Feb-2013 31-Jul-2013 medicine practices Comments Target met. 2010 data 3. Increased client satisfaction with health Text Value 63.4 89.8 70 services as compared with baseline. Date 14-Jul-2008 28-Feb-2013 30-Jul-2013 Comments percent Target met. 89.8% in 2011. percent 4. Smoking prevalence among 18-29 age Percentage Value group in pilot provinces relative to non-pilot Date 08-Jul-2009 17-Sep-2012 31-Jul-2013 provinces. Comments NCD survey to be The OBF component will be implemented in 2011. deleted as a part of the project restructuring. 5. High blood pressure in population in pilot Percentage Value Public Disclosure Copy provinces decreases more as compared to Date 08-Jul-2009 17-Sep-2012 31-Jul-2013 non-pilot provinces Comments Baseline NCD assessment to The OBF component will be be carried out in 2011 deleted as a part of the project restructuring. 6. Decrease in SSI expenditures on Percentage Value 40.00 41.80 33.00 pharmaceuticals and outpatient health care Date 08-Jul-2009 17-Sep-2012 31-Jul-2012 Comments 40% of expenditures on 38.7% in the end of 2011 - 33% ,42% SSI expenditures on Page 2 of 6 The World Bank Report No: ISR9730 pharmaceuticals 50% of pharmaceuticals as a % of treatment costs on inpatient SSI spending Intermediate Results Indicators Public Disclosure Copy Indicator Name Core Unit of Measure Baseline Current End Target Component A: 1. Percentage of family Percentage Value 0.00 21.00 80.00 medicine practices that have completed Date 08-Jul-2009 28-Feb-2013 31-Jul-2013 second level training as compared with Comments 0 21% in 2011 80% baseline 2. Annual performance reports on Text Value 2011 Performance Program Third Report published implementation of MOH Strategic Plan using publsihed. information from MOH Monitoring and Date 08-Jul-2009 28-Feb-2013 30-Jul-2013 Evaluation system disseminated by MOH to Comments Done. Parliament and published on MOH website 3. Percentage of acute care public Text Value 0 0 hospitals using revised clinical guidelines for Date 31-Jul-2009 28-Feb-2013 31-Jul-2013 secondary care as requirement of performance Comments Indicator to be revised as part payment system of level 1 restructuring. 4. Dissemination of bi-annual HTP Text Value Not available HSPA report published 1 bi-annual report Tracking reports by M&E Directorate of MOH Date 08-Jul-2009 28-Feb-2013 31-Jul-2013 Comments 5. Percentage of family physicians using Percentage Value 0.00 30.00 rational drug prescription guidelines Date 28-Feb-2013 31-Jul-2013 Comments No data available - indicator 30% increase to be revised by MOH and as part of a level 1 restructuring 6. Percentage of MOH Implementing Percentage Value 0.00 100.00 Units for HTSSRP have formed Project Offices Date 28-Feb-2013 and connected to PMSU-Net for project Comments This is being implemented. Public Disclosure Copy monitoring Indicator to be revised by MOH. Component B: 1. Percentage of population of Percentage Value 0.00 0.00 70.00 pilot provinces screened for NCD risk factors Date 08-Jul-2009 28-Feb-2013 31-Jul-2013 Comments 0 percent OBF component will be 70 percent deleted as a part of project restructuring. Page 3 of 6 The World Bank Report No: ISR9730 2. Higher increase in appropriate knowledge Percentage Value 0.00 0.00 72.00 and attitudes regarding global risk factors for Date 08-Jul-2009 28-Feb-2013 31-Jul-2013 NCDs in pilot provinces as compared with non- Comments To be determined on the OBF component will be pilot provinces Public Disclosure Copy basis of baseline KAP survey deleted as a part of project in pilot provinces and selected restructuring non-pilot provinces 3. Percentage of cases in pilot provinces Percentage Value 0.00 100.00 diagnosed and under follow-up by family group Date 28-Feb-2013 31-Jul-2013 practices for the following NCDs: hypertension, Comments OBF component will be diabetes, obesity/overweight deleted as a part of project restructuring 4. 100 percent compliance with reporting on Percentage Value 0.00 0.00 100.00 implementation of screening activities as well Date 08-Jul-2009 28-Feb-2013 31-Jul-2013 as patient records (through family medicine Comments System will be set up by the OBF component will be 100 percent compliance information system) end of 2009 deleted as a part of project restructuring Component C: 1. Actuarial analysis of UHI Text Value 1st actuarial analysis Not being conducted under 2 actuarial analysis of UHI updated for 2010 and 2012 based on updated completed Project. conducted in 2010 and 2012 macro and micro data respectively. Date 08-Jul-2009 28-Feb-2013 31-Jul-2013 Comments SSI procured services for Distance Learning programs for capacity building. No remaining activities will be implemented by SSI as remaining funds will be canceled. 2. Costly interventions under Benefits Package Text Value Review of Benefits Package Not being conducted under Decrease in spending on the for UHI revised using cost-effectiveness criteria and identification of Project. interventions as compared to and guidelines developed by SSI; interventions and baseline baseline expe nditures Public Disclosure Copy Date 08-Jul-2009 28-Feb-2013 31-Jul-2013 Comments SSI procured services for Distance Learning programs for capacity building.No remaining activities will be implemented by SSI as remaining funds will be canceled. Page 4 of 6 The World Bank Report No: ISR9730 3. Prospective payment systems based on Text Value Stock-taking and Not being conducted under Relevant prospective international evidence (capitation, global development of action plan for Project. payment systems budgets, DRGs) or outpatient and acute care implementation of prospective implemented adopted for University, private and MOH payment systems Public Disclosure Copy hospitals Date 08-Jul-2009 17-Sep-2012 31-Jul-2013 Comments SSI procured services for Distance Learning programs for capacity building. No remaining activities will be implemented by SSI as remaining funds will be canceled. Data on Financial Performance (as of 12-Mar-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P102172 IBRD-77170 Effective 11-Jun-2009 30-Jun-2009 29-Sep-2009 31-Jul-2013 31-Jul-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P102172 IBRD-77170 Effective USD 75.13 75.13 0.00 36.94 38.46 49.00 Disbursement Graph Public Disclosure Copy Page 5 of 6 The World Bank Report No: ISR9730 Public Disclosure Copy Key Decisions Regarding Implementation There are no pending key decisions. Restructuring History There has been no restructuring to date. Related Projects P120948-Health Systems Performance Assessment Public Disclosure Copy Page 6 of 6