The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Serving People, Improving Health Project (P144893) EUROPE AND CENTRAL ASIA | Ukraine | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 17 | ARCHIVED on 10-Jun-2023 | ISR56422 | Implementing Agencies: Ministry of Finance of Ukraine, Ministry of Health, Ukraine Key Dates Key Project Dates Bank Approval Date: 04-Mar-2015 Effectiveness Date: 15-Jun-2015 Planned Mid Term Review Date: 30-Mar-2018 Actual Mid-Term Review Date: 12-Mar-2018 Original Closing Date: 30-Sep-2020 Revised Closing Date: 31-Mar-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed "Serving People, Improving Health" Project seeks to improve the quality of health services in selected Oblasts, with special focus on primary and secondary prevention of cardiovascular diseases and cancer, and to enhance efficiency of the healthcare system. 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 objectives of the Project are to: (i) improve efficiency and quality of health services, particularly for non-communicable diseases, in line with the health sector reforms; and (ii) prevent, detect and respond to the threat posed by COVID-19. Components Table Name Improving Service Delivery at the Local Level:(Cost $193.75 M) Supporting Selected Priority Areas of Health Reform:(Cost $112.21 M) Project Implementation support and monitoring and evaluation:(Cost $7.90 M) Commission 0.25%:(Cost $0.87 M) COVID-19 Emergency Response Activities:(Cost $35.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Overall, the implementation pace of the project is on track. However, some project activities have been impacted by Russia's full-scale invasion of Ukraine started on February 24, 2022. Nevertheless, key project activities will be completed by the current closing date, including Component 1 activities under the Vinnytsia subproject, as well as Component 2 activities related to the health financing reform. Of the 4 PDO indicators, 3 have 6/10/2023 Page 1 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) already been achieved (PDOs 1, 3, and 4), while the achievement of the remaining indicator (PDO 2) may be impacted by ongoing Russia’s invasion of Ukraine and the increase in complex cases requiring extended hospitalization. In addition, of the 8 DLIs, 5 have been fully achieved and 3 have been partially implemented. Finally, of the 10 IRIs, 7 have been achieved, while the remaining 3 are on track to be achieved by the current closing date. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- High High Sector Strategies and Policies -- Substantial Substantial Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Substantial Substantial Sustainability Fiduciary -- High High Environment and Social -- Substantial Substantial Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improved efficiency of health services IN01298695 ►PDO Indicator 1: Number of hospitals reprofiled or merged (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Mar-2024 The WB health team has confirmed the achievement of the target in 100 hospitals. In total, there were 13 hospitals that were reprofiled, meaning that some hospital departments were closed down or restructured. Comments: Additionally, 87 hospitals were merged together. IN01298763 6/10/2023 Page 2 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) ►PDO Indicator 2: Average in-patient length of stay in hospitals (Days, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11.70 9.60 8.90 8.00 Date 01-Jan-2014 02-Nov-2022 23-May-2023 31-Mar-2023 The achievement of the indicator is on track. MoH confirmed 8.9 days for 2022 compared to 9.6 in 2021. The average in-patient length of stay continues to decrease, however, due to the military aggression of Comments: Russia against Ukraine, the number of complex cases of treatment requiring a longer stay in a hospital bed has increased which may negatively affect the overall results. Enhanced efficiency of the health care system IN01298761 ►PDO Indicator 3: Improved quality management (prevention, early diagnosis and treatment) of CVDs at primary and secondary care measured as: a) reduction of hypertension-related hospitalization (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.80 1.50 3.20 4.00 Date 01-Jan-2014 02-Nov-2022 23-May-2023 31-Mar-2022 The target has been met. Comments: IN01298764 b) number of patients who received stenting for acute myocardial infarction with ST segment elevation (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 93.60 207.00 402.60 400.00 IN01298766 c) Percentage of health care providers implementing improved patient care pathways for emergency, stroke care and day surgeries (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Prevent, detect and respond to threat posted by COVID-19 IN01298762 ►PDO 4: Number of hospital COVID-19 cases treated following agreed protocols and reimbursed by NHSU (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 52,630.00 52,630.00 10,000.00 Date 15-Apr-2020 25-Apr-2022 23-May-2023 31-Dec-2020 52,630 patients (21,908 males and 30,722 females) were treated in intensive care units in 2021, target Comments: 10,000 patients (achieved) IN01298765 Number of males (Number, Custom Supplement) 6/10/2023 Page 3 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 21,908.00 21,908.00 5,000.00 IN01298767 Number of females (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 30,772.00 30,772.00 5,000.00 Intermediate Results Indicators by Components Improving Service delivery at the local level IN01298768 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 136.00 136.00 119.00 Date 01-Jan-2015 02-Nov-2022 23-May-2023 29-Mar-2024 A total of 136 healthcare facilities were built, reconstructed, and renovated, including 32 in Volyn Oblast, 65 in Dnipropetrovsk Oblast, 1 in Zakarpattia Oblast, and 38 in Rivne Oblast, of which 104 from the Loan Comments: 84750 and 32 from co-financing. Within AF SPIH (Loan 9110) 753 health facilities were equipped with medical equipment (X-ray, diagnostic and ECG machines, anaesthesia devices, ultrasound devices, etc.). IN01298773 ►Improved patient care pathways for emergency stroke care and day surgeries developed and endorsed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 15-Apr-2020 02-Nov-2022 02-Nov-2022 31-May-2022 The Emergency standard for emergency departments was developed and approved (regulation as of 23/02/22 No. 210) and 6 regulatory documents on stroke care were developed and are currently reviewed by the MoH. The MoH has developed and approved a Health care standard for spontaneous intracerebral haemorrhage (regulation as of 05/01/22 No. 9). The healthcare standard for secondary stroke prevention Comments: has passed public discussion and is waiting for MoH approval. The healthcare standard for Ischemic stroke is under development. According to Cabinet of Ministry of Ukraine Order No. 1440 dated 29.12.2021, NHSU has started to contract facilities for the package for one-day surgery. IN01298776 ►DLI 5: Share of outpatient-based procedures and day surgeries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.80 43.21 27.00 30.00 Date 31-Dec-2021 02-Nov-2022 23-May-2023 29-Dec-2023 The baseline for DLI was identified for 2021 at 39.8%. MOH reported that during 2022 the share of Comments: outpatient-based procedures and day surgeries increased by 27%. 6/10/2023 Page 4 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Supporting Selected Priority Areas of Health Reform IN01298771 ►Hospital beds per population (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 880.00 594.30 565.40 600.00 Date 01-Jan-2014 02-Nov-2022 23-May-2023 31-Mar-2022 The target value of the indicator has been achieved. Comments: IN01298775 ►DLI 3: NHSU monitors contracted providers and reviews records from contracted facilities (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes No Yes Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Dec-2023 The current monitoring procedure in 2022 doesn't oblige concluding the mitigation plans. The new draft order is going through the approval procedure; however, it seems that there won;t be enough time to Comments: evaluate the monitoring of the concluded mitigation plans by the end of the Project. IN01298777 ►Percentage of patients with acute stroke admitted to hospitals contracted by NHSU for provision of stroke care (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 87.90 91.00 80.00 Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Dec-2023 Target achieved. In 2022, there were a total of 122,087 stroke patients admitted to hospitals. Among them, 111,382 were admitted to hospitals contracted by NHSU specifically for stroke patient care (54,351 Comments: women and 57,031 men). The percentage of stroke patients admitted to NHSU-contracted hospitals consistently surpasses 75% and is currently at 91%. IN01298780 percentage for male patients (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 76.60 76.60 80.00 IN01298781 percentage for female patients (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 74.20 74.20 80.00 IN01298782 ►Percentage of eligible patients with acute stroke received thrombolytic therapy/ mechanical thrombus removal (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/10/2023 Page 5 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Value 1.10 3.40 6.80 20.00 Date 31-Dec-2019 02-Nov-2022 23-May-2023 29-Dec-2023 A positive dynamic is reported for this indicator: it improved three times from the baseline of 1.1% to 3.4% in 2021. During 2022, the share of patients that have undergone intravenous thrombolysis and/or Comments: mechanical thrombus removal reached 6.8%. IN01298785 percentage of male patients (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 7.22 20.00 IN01298786 percentage of female patients (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 6.37 20.00 COVID-19 Emergency Response Activities IN01298770 ►DLI 8: Number of COVID-19 patients with complications attended by emergency medicine service following agreed protocols and reimbursed by NHSU (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 94,091.00 94,091.00 12,500.00 Date 15-Apr-2020 01-Dec-2020 01-Dec-2020 29-Dec-2023 The NHSU has contracted emergency services centers in all regions of Ukraine for additional workload related to attending COVID patients. The number of patients will be collected and reported by the MoH. As Comments: of November 2020, 94,091 patients hospitalized after being transported by emergency brigades. This indicator is achieved. Project Implementation support and monitoring and evaluation IN01298769 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 25,966.00 26,930.00 25,000.00 Date 01-Jan-2015 02-Nov-2022 23-May-2023 31-Mar-2023 Target achieved. In 2022, 2,344 people received training: (1) 160 completed the 'Integrated hypertension and diabetes case management distance CPH course; (2) 1,907 were trained on 'Organization of handling COVID-19-contaminated medical waste' under MOH and UNDP Agreement; (3) 104 physicians and 133 care workers from 11 pilot hospitals received online and offline training on emergency medical care and Comments: traumatic injuries under the AURCEM contract; (4) 40 individuals completed 192-hour in-person simulation training for trainers of regional and Kyiv emergency medical assistance and disaster training centers at the Medical Simulation Training Center IN01298774 6/10/2023 Page 6 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) ►Share of health care providers benefiting from Project activities that that used the citizen feedback to enhance the quality of health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 35.80 20.00 Date 01-Jan-2014 02-Nov-2022 23-May-2023 01-Mar-2024 The target has been achieved. The MOH contact centre, operated by Adelina Outsourcing LLC, remains active in collecting and processing citizens' inquiries. The MOH consistently monitors these processes. Efforts to enhance the feedback mechanism are currently underway in collaboration with NHSU and the Comments: national contact centre of the MOH. The project activities have benefited a total of 308 facilities where applications/complaints have been completed, out of a total of 861 facilities benefiting from the project activities. Results-based financing IN01298772 ►DLI 1: Hospitals from the capable network contracted by NHSU using case-based payments (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 215.00 215.00 210.00 Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Dec-2023 Achieved. According to the data provided, 215 hospitals from the capable network were contracted for at least two packages: ‘In-patient surgery for adults and children' and ‘In-patient care for adults and children Comments: without surgery. However, due to the war, all case-based payments were changed and all providers receive 1/12 of the yearly amount. IN01298778 ►DLI 2: PDO Indicator 1: Number of hospitals reprofiled or merged (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Dec-2023 Achieved. A total of 100 facilities were reformed, of which: - 87 facilities were reorganized by merging with more powerful multidisciplinary facilities; in 13 facilities the structure was optimized in accordance with the Comments: need for medical assistance to the population of the region. IN01298779 ►DLI 3: NHSU monitors contracted providers and reviews records from contracted facilities (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes No Yes Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Dec-2023 The current monitoring procedure in 2022 doesn't oblige concluding the mitigation plans. The new draft order is going through the approval procedure; however, it seems that there won't be enough time to Comments: evaluate the monitoring of the concluded mitigation plans by the end of the Project. IN01298783 6/10/2023 Page 7 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) ►DLI 4: Percentage of eligible patients with acute stroke received thrombolytic therapy/ mechanical thrombus removal (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Dec-2023 The target of 70 percent of eligible patients with acute stroke that are hospitalized in specialized hospitals Comments: is achieved. IN01298784 ►DLI 5: Share of outpatient-based procedures and day surgeries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.80 36.60 27.00 30.00 Date 01-Apr-2021 02-Nov-2022 23-May-2023 29-Dec-2023 The baseline for DLI was identified for 2021 at 39.8%. MOH reported that during 2022 the share of Comments: outpatient-based procedures and day surgeries increased by 27%. IN01298787 ►DLI 6: Global DLI for DLIs 1-5: Health reforms advanced and sustained (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value On track On track On track On track Date 15-Apr-2020 02-Nov-2022 23-May-2023 29-Dec-2023 This DLI is a necessary condition for all disbursements under DLIs 1-5, and, as such, constitutes a “global DLI”. No funding is linked to this DLI. The disbursements of DLIs 1-5 will only take place if this DLI is met. Comments: DLI 6 was currently on track for 2022, however, its achievement in 2023 is at risk. IN01298788 ►DLI 7: PDO4: Number of hospital COVID-19 cases treated following agreed protocols and reimbursed by NHSU (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 23,441.00 23,441.00 10,000.00 Date 15-Apr-2020 01-Dec-2020 01-Dec-2020 31-Dec-2020 Indicator achieved. Comments: IN01298789 ►DLI 8: Number of COVID-19 patients with complications attended by emergency medicine services following agreed protocols and reimbursed by NHSU (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 94,091.00 94,091.00 0.00 Date 15-Apr-2020 01-Dec-2020 01-Dec-2020 29-Dec-2023 Indicator achieved. Comments: 6/10/2023 Page 8 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P144893 IBRD-84750 Effective USD 214.73 214.73 0.00 203.64 11.09 95% P144893 IBRD-91100 Effective USD 135.00 135.00 0.00 110.08 24.92 82% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P144893 IBRD-84750 Effective 04-Mar-2015 19-Mar-2015 15-Jun-2015 30-Sep-2020 31-Mar-2024 P144893 IBRD-91100 Effective 27-Apr-2020 15-May-2020 28-May-2020 31-Mar-2024 31-Mar-2024 Cumulative Disbursements 6/10/2023 Page 9 of 10 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Restructuring History Level 2 Approved on 26-Mar-2019 ,Level 2 Approved on 14-Apr-2020 ,Level 2 Approved on 06-Oct-2021 ,Level 2 Approved on 30-Jun-2022 Related Project(s) P170740-Additional Financing to Serving People, Improving Health Project 6/10/2023 Page 10 of 10