The World Bank Serving People, Improving Health Project (P144893) REPORT NO.: RES56930 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF SERVING PEOPLE, IMPROVING HEALTH PROJECT APPROVED ON MARCH 4, 2015 TO UKRAINE HEALTH, NUTRITION & POPULATION EUROPE AND CENTRAL ASIA Regional Vice President: Antonella Bassani Country Director: Arup Banerji Regional Director: Fadia M. Saadah Practice Manager/Manager: Tania Dmytraczenko Task Team Leader(s): Elvira Anadolu, Olena Doroshenko The World Bank Serving People, Improving Health Project (P144893) ABBREVIATIONS AND ACRONYMS AF Additional Financing COVID-19 an infectious disease caused by the SARS-CoV-2 virus DLI Disbursement-linked indicator DLR Disbursement-linked result EEP Eligible Expenditures Program FM Financial management MoH Ministry of Health NHSU National Health Service of Ukraine PDO Project Development Objective PIU Project Implementation Unit The World Bank Serving People, Improving Health Project (P144893) BASIC DATA Product Information Project ID Financing Instrument P144893 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 04-Mar-2015 31-Mar-2024 Organizations Borrower Responsible Agency Ukraine Project Development Objective (PDO) Original PDO 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. Current PDO 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. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IBRD-91100 27-Apr-2020 15-May-2020 28-May-2020 31-Mar-2024 135.00 112.89 22.11 IBRD-84750 04-Mar-2015 19-Mar-2015 15-Jun-2015 31-Mar-2024 214.73 205.19 9.54 The World Bank Serving People, Improving Health Project (P144893) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING Project Status 1. The Serving People, Improving Health Project was approved in March 2015 for an initial amount of US$214.7 million. The Project has been restructured four times and has received additional financing (AF) once, in the amount of US$135 million, increasing the total financing amount to US$349.7 million. The current Project Development Objective (PDO) is to: (i) improve the 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. 2. The first restructuring (March 2019) added a results-based financing component and disbursement-linked indicators (DLIs). The second restructuring (April 2020) extended the closing date by 18 months to allow additional time to complete the Vinnytsia subproject, reallocated funds to COVID-19-related procurements, and added DLIs to finance expenditures of designated facilities engaged in the COVID-19 response. A US$135 million AF was approved to address the country’s health reform priorities and investment needs, as well as to respond to the COVID-19 pandemic (April 2020). The third restructuring (September 2021) extended the closing date by six months to allow sufficient time for the completion of activities that were delayed due to the COVID-19 pandemic, namely: (i) completion of the construction of the 144-bed Vinnytsia Cardiac Hospital; (ii) procurement of equipment for the Vinnytsia Cardiac Hospital; and (iii) initiation and completion of new procurement of COVID-19 antigen tests. The fourth restructuring (June 2022) extended the closing date by 18 months to allow additional time to complete activities that were delayed due to the ongoing war, namely: (i) completion of the construction of the Vinnytsia Cardiac Hospital; and (ii) procurement of equipment for the Vinnytsia Cardiac Hospital. 3. The PDO remains relevant and is on track to be achieved by the Project closing date. Progress toward achievement of the PDO has been rated Satisfactory since March 2019. Three of the four PDO-level indicators have been achieved: PDO indicator 1 (number of hospitals reprofiled or merged); PDO indicator 3 (improved quality management (prevention, early diagnosis, and treatment) of cardiovascular diseases (CVDs) at primary and secondary care); and PDO indicator 4 (number of hospital COVID-19 cases treated). PDO indicator 2 (average length of stay in hospitals) is progressing well, but its achievement may be impacted by the ongoing war and the increase in complex treatment cases requiring a longer duration of hospitalization. Overall Implementation Progress has consistently been rated Moderately Satisfactory since Project approval and was upgraded to Satisfactory in the Implementation Status and Results Report in May 2022. However, it was downgraded to Moderately Satisfactory in the December 2022 Implementation Status and Results Report given the persistent delays in completing the reconstruction works and equipment installation under the Vinnytsia sub- project due to the ongoing war. Of the ten intermediate results indicators, seven have been achieved, while the remaining three are on track to be achieved by the current closing date. In addition, of the eight DLIs, five have been fully achieved and three have been partially achieved. Detailed implementation progress by component is outlined below. 4. Component 1: Improving Service Delivery at the Local Level. Seven of the eight subprojects have been successfully completed, including new construction and rehabilitation of primary care facilities, equipment of outpatient health The World Bank Serving People, Improving Health Project (P144893) facilities and select hospitals, and improvement of indicators for the management of non-communicable diseases. However, implementation of the remaining activities under the subproject in the Vinnytsia region, including the construction of the 144-bed Vinnytsia Cardiac Hospital, has suffered delays. Construction began in June 2018, but was delayed due to COVID-19 lockdowns and remote work in early 2020. Changes in subproject management (mid-2020) further delayed the completion of the procurement of critical equipment. All major construction works (remaining works are internal finish, communications, and landscaping) had been completed by the end of February 2022 and the disbursements reached 62.7 percent (total contract amount of US$18.8 million). However, the completion of this subproject has been further disrupted by Russia’s invasion of Ukraine on February 24, 2022. In the latest report (May 2023), 90 percent of construction works were completed and 80 percent of the contract value had been disbursed. The construction deadline was extended until the end of September 2023. Procurement of medical equipment has been completed, and contracts for the supply were concluded with three suppliers for a total amount of US$7.9 million. Delivery of the equipment is ongoing and is expected to be fully completed by September 2023. Bids evaluation for the package for laboratory equipment has been completed; the contract was signed in June 2023; and delivery and installation of equipment and training and commissioning are expected to be completed by November 2023. 5. Component 2: Supporting Selected Priority Areas of Health Reform. The US$50 million finances Eligible Expenditures Program (EEP) supports six DLIs, including one global, no-cost DLI. The Global DLI (DLI 6) is a prerequisite to be met prior to disbursement against achievements under the other DLIs, with its achievement having been confirmed in all previous verifications. The intermediate results under four of the five reform-oriented DLIs have been fully achieved (DLIs 1 and 2) or partially achieved (DLIs 3, 4 and 5), and a combined total of US$39 million has been disbursed. While achievement of the DLIs progressed well before the war began, feasibility of fully achieving the end targets of DLIs 3 and 4 (specifically, disbursement-linked result (DLR) 3.3, DLR 3.4, DLR 4.2, and DLR 4.3) in the context of the ongoing war is unlikely. 6. Component 3. COVID-19 Emergency Response Activities. All activities under this component have been completed. Of the total US$35 million financing for this component, US$15 million allocated for the achievement of DLIs were disbursed in 2020 for the achievement of DLI 7 (number of hospital COVID-19 cases treated following agreed protocols and reimbursed by National Health Service of Ukraine (NHSU), also PDO indicator 4) and DLI 8 (number of COVID-19 patients with complications attended by emergency medical services following agreed protocols and reimbursed by NHSU). The supply of laboratory equipment to strengthen performance of polymerase chain reaction tests done under the agreement with the World Health Organization (US$ 8.94 million), cold chain equipment under the agreement with the United Nations Development Programme (US$ 1.2 million), and COVID-19 tests under three agreements with UNICEF (US$ 13.5 million, US$ 2 million, US$ 6.9 million) have been completed. The status of contracts for the provision of technical assistance for strengthening the COVID-19 response is as follows: the $1.4 million contract with UNICEF was completed on August 31, 2022 and has fully disbursed, the $870,000 contract with the United Nations Development Programme was extended until September 30, 2023, and the $1.025 million contract with the World Health Organization was partially completed and closed and the refund of unused funds being processed. 7. Component 4. Project Implementation Support and Monitoring and Evaluation. The composition of the Project Implementation Unit (PIU) has been updated with several additional positions advertised. The contracts of core PIU staff with satisfactory performance were extended under this project, and under other ongoing World Bank projects (the Emergency COVID-19 Response and Vaccination project, and will be continued in the Health Enhancement and Lifesaving Ukraine project). The achievement of most monitoring and evaluation indicators is on track according to the monitoring and evaluation reports provided to the World Bank on April 14, 2023; the next update on the achievement of indicators from the Results Matrix is scheduled for September 2023. The Ministry of Health (MoH) is working with Ternopil National Medical University on capacity building activities, specifically training for staff of the emergency care departments at selected hospitals (training of instructors is completed, online course for emergency brigades and internships for instructors are planned to be held by October 2023). As the implementation of the contract is progressing well, the World The World Bank Serving People, Improving Health Project (P144893) Bank has agreed to the MoH request to train more staff in the emergency care centers of hospitals. The World Bank has recently approved the Terms of Reference for training for medical personnel of emergency departments and stroke departments. 8. Detailed progress on remaining DLIs is outlined below. a. DLR 3.3 and 3.4: Achievement of the targets for DLR 3.3 (at least 90 percent of all contracted facilities with detected anomalies have mitigation plans approved, if fraud was confirmed by NHSU by December 31, 2022) and DLR 3.4 (the implementation of the mitigation plans has been monitored, and corrective measures have been implemented by the NHSU and the contracted facilities) are at risk of not being achieved by the closing date. The monitoring by the NHSU was suspended after the start of the war and only partially resumed in August 2022. In December 2022, the NHSU sent to MoH the first draft of Resolution of the Cabinet of Ministers of Ukraine "On amendments to the Resolution of the Cabinet of Ministers of Ukraine No. 410 dated 25.04.2018", which provides for drawing up mitigation plans to eliminate identified violations and action plans to improve medical care. The draft Resolution is undergoing public discussions and approval by relevant authorities. The legal procedure of approval and adoption of this Resolution, its implementation, and organization of the monitoring process are expected to be finalized in 2023. Therefore, there is a significant risk that these DLRs may not be met prior to the closing date. b. DLR 4.2 and 4.3: The percentage of all eligible patients with confirmed ischemic stroke during twelve consecutive months that have undergone intravenous thrombolysis and/or mechanical thrombus removal (DLR 4.2 and DLR 4.3) has increased from 1.9 percent in 2020 to 5.4 percent in 2021 to 6.8 percent in 2022 according to NHSU data. However, with the current values and the pace of improvement, achievement of the original targets (15 percent for DLR 4.2 and 20 percent for DLR 4.3) is unlikely. Eligible patients for this DLI include those who were hospitalized within the first 24 hours after the onset of stroke symptoms in accordance with the current clinical guidelines of the European Stroke Organization.1 However, there is an issue with identifying such patients who meet these requirements in Ukraine, since the existing technical capabilities of the electronic health system do not allow obtaining this information. To resolve this issue, the MoH plans to introduce an updated eHealth module within the Project during 2023-2024, which will allow the recording of this information. However, measurement of this indicators will only be possible after the closing date. c. DLI 6 (global, no-cost DLI):2 This DLI was well performing until Russia’s invasion. However, due to the significant burden of budget expenses to respond to urgent needs (10% decrease in general health expenses reflected in UAH (40% in USD equivalent) corresponds to the decrease in other sectors except for defense3), shortage of available funds in the budget (at least US$3 billion equivalent per month to close the fiscal deficit and meet debt repayment obligations will be needed as of March 20234), and reduction in non-urgent activities, achievement of this DLI in the last implementation year is unlikely due to circumstances associated with the ongoing war, despite the continuation and good progress of health care reforms in Ukraine. 1 Registered in the State Expert Center of the Ministry of Health of Ukraine under the number KN 2021-TR 2 DLI 6: Health reforms advanced and sustained as evidenced by the following: (a) the Borrower has financed the PMG in an amount equal to at least the allocation for the PMG set forth in the annual state budget from the previous fiscal year, excluding COVID-19 related expenditures; (b) starting on January 1, 2021, the number of NHSU staff has not decreased more than the average reduction of public service staff, as reflected in the Borrower’s annual state budget; (c) the NHSU has signed contracts for the provision of stroke and cardiac care with hospitals included in the Capable Network Plan that met the requirements for the provision of such care set forth in specifications for these types of care defined by the NHSU; and (d) the Borrower has financed the reconstruction of emergency departments only in the hospitals included in the Capable Network Plan. 3 State Budget 2023 Review, UHC. https://drive.google.com/file/d/1fA2PHb_ZnEgELT9x_1LeIklhkOSymifn/view 4 Ukraine Rapid Damage and Need Assessment, February 2022 – February 2023. https://documents1.worldbank.org/curated/en/099184503212328877/pdf/P1801740d1177f03c0ab180057556615497.pdf The World Bank Serving People, Improving Health Project (P144893)  DLI 6.a. The Borrower has financed the Program of Medical Guarantees (PMG) in an amount equal to at least the allocation for the PMGs set forth in the annual state budget from the previous fiscal year, excluding COVID-19 related expenditures: At risk of not being achievable. While PMG funding increased in 2021 and 2022 (from UAH 123 billion to UAH 146 billion), it decreased slightly in 2023 (to UAH 142 billion). However, due to a decrease in the population, expenses per person have not decreased and the scope of health packages and tariffs remains unchanged.  DLI 6.b. Starting on January 1, 2021, the number of NHSU staff has not decreased more than the average reduction of public service staff, as reflected in the Borrower’s annual state budget: At risk of not being achievable. While the 1,060 NHSU staff positions5 have not decreased since January 2021, the Government may consider future cuts to optimize expenditures.  DLI 6.c. The NHSU has signed contracts for the provision of stroke and cardiac care with hospitals included in the Capable Network Plan that met the requirements for the provision of such care set forth in specifications for these types of care defined by the NHSU: At risk of not being achievable. In 2021, contracts were signed with 183 facilities for stroke and 43 facilities for infarction; in 2022, contracts were signed with an additional 158 facilities for stroke, and 32 for infarction. However, in February 2023, a new cluster approach for the hospital network was approved as part of the ongoing hospital network optimization reform led by the MoH, and the approval for the new hospital network is expected soon. The new approach will impact the contracting process for these services. Due to the difference in Capable Network and Cluster Approach, there may be challenges in achieving this indicator in 2023, even if the general requirements for contracting health facilities align with health reform objectives.  DLI 6.d. The Borrower has financed the reconstruction of emergency departments only in the hospitals included in the Capable Network Plan: At the risk of not being achievable. In 2020, funds were allocated for the reconstruction and repair of 215 emergency departments, and their allocation and disbursement were aligned with the specified facilities. However, the Russian invasion and the related damage to hospital infrastructure have forced the current government to focus on the reconstruction of destroyed and damaged facilities. Additionally, the new hospital network approach that will be approved by MOH soon will define cluster, above-cluster, and general hospitals that will be prioritized for reconstruction works. 9. The Project’s financial management (FM) arrangements remain adequate in terms of staffing and performance. The FM rating remains Moderately Satisfactory due to delays in the completion of project audits for the loan IBRD-9110 (ongoing) and the NHSU audit report, as well as the delayed submission of the audit report for the loan IBRD-8475, as described in detail below. Other than the audit delays, FM and disbursement arrangements are in place and satisfactory. Qualified FM staff are available in both the MoH and NHSU, and both PIUs at central and regional levels can operate normally as it is possible ithe n current context, including relevant internal controls and systems access, despite the overall situation in Ukraine. Statement of Expenditures disbursement reporting is done without notable delays, including timely countersigning of disbursement documents by MoH and Ministry of Finance officials. Moreover, a notable improvement in the timeliness and quality of documents was noted compared to prior periods. Project budget allocation in the FY2023 state budget is sufficient for the projected disbursements. The Project’s quarterly interim financial reports for 2022 were submitted on time and found to be acceptable. The audit of the IBRD-8475 loan for 2021 carried out by BDO audit firm was submitted with notable delay in February 2023 and was confirmed acceptable. The contract for the audit of 2022 financial statements for the IBRD-8475 loan is already under negotiations with the same audit firm. However, the audit of financial statements of the IBRD-9110 loan has been delayed, as the Accounting Chamber, the designated agency to carry out the financial audits according to the legal agreement for the IBRD-9110 loan, was facing capacity constraints and was unable to provide audit services. The Accounting Chamber is now carrying out this audit, with the expected submission of 5Approved by CMU Resolution No. 85 dated April 5, 2014, titled 'Certain issues of approval of the maximum number of employees of the apparatus and territorial bodies of central executive authorities and other state bodies'. The World Bank Serving People, Improving Health Project (P144893) the audit report in August 2023. However, the ongoing Accounting Chamber audit will not cover the NHSU budget line 2308060, which was financed with funds from the achieved DLIs under both the IBRD-8475 and IBRD-9110 loans. Therefore, the MoH is in the process of hiring a private audit firm to conduct the audit for the NHSU budget line 2308060 by September 2023. It is expected that simplified auditor contracting procedures will be used, and the MoH will hire BDO (already familiar with this project), to complete this audit. 10. As of July 12, 2023, US$318.08 million (90.95 percent) of total project funds has been disbursed, including US$205.19 million from the loan IBRD-8475 (95.6 percent of original loan) and US$112.89 million from the loan IBRD-9110 (82 percent of the AF loan). Rationale for Restructuring 11. The Ministry of Finance requested a Project restructuring on June 9, 2023 to: (a) reallocate US$1,757,046 in savings from Component 3 and US$2,970,000 in uncommitted funds from Component 4 to Component 1 to finance angiographic systems with neuro-interventional functions for the regions of Ukraine with the greatest need in such medical interventions for patients with stroke; and (b) make adjustments to DLIs and DLRs, which will enable completion of the Project activities that were delayed due to the ongoing war. To ensure timely procurement and installation of medical equipment under Component 1, this procurement is planned to be implemented through Bank-facilitated procurement. 12. The proposed restructuring is in line with the PDO, will not affect its achievement, and does not require any PDO changes; at the same time, the restructuring will allow the MoH to fully disburse the allocated funds before the Project closing date. The Results Framework will need to be updated in view of activities proposed in the restructuring. However, after the detailed review of the Government request, the World Bank has determined that reallocation from Category 4 for Component 3.1 to Category 1 for Component 1.2 is not feasible. This is because the US$35 million COVID-19 facility funds allocated to Categories 3 and 4 have certain restrictions: (a) they originate from the COVID-19 MPA, which only allows specific COVID-related eligible activities, and (b) according to Article 2.04 of the Legal Agreement, these funds are earmarked solely for Component 3 of the Project. Component 3 is subject to a different commitment charges scheme that applies to the Fast Track COVID-19 Facility. In this context, the proposed restructuring includes only the requested reallocation from Component 4 to Component 1. 13. The main risk to completing the remaining activities is the ongoing war and the related disruptions already incurred, as well as the likelihood of further war-associated delays in the future. The Task Team has worked to mitigate this risk through close communication and collaboration with the MoH, NHSU, PIU, and other stakeholders involved and will continuously re-assess the situation as it unfolds. II. DESCRIPTION OF PROPOSED CHANGES 14. The proposed Level II restructuring entails a reallocation of funds across DLIs and from uncommitted funds to support activities that improve service delivery at the local level under the IBRD-9110. The changes are described in detail below. 15. Changes to Components and Costs. US$2,970,000 will be reallocated from Component 4 to Component 1 to support the procurement of additional angiographic systems for health care facilities. 16. Reallocation across disbursement categories. US$2,970,000 will be reallocated from Category 5 for Part 4 (Goods, works, non-consulting services, consults' services and Operating Costs for Part 4 of the Project) to Category 1 for Part 1.2. (Goods, works, non-consulting services, consults' services and Operating Costs for Part 1.2 of the Project) of the Project. The World Bank Serving People, Improving Health Project (P144893) 17. Changes to the Results Framework. The DLIs will remain unchanged, but changes will be made to DLRs, as detailed below.  DLR 3.3 “At least 90 percent of all contracted facilities with detected anomalies have mitigation plans approved if fraud was confirmed by NHSU by December 31, 2022” and DLR 3.4 “The implementation of the mitigation plans has been monitored, and corrective measures have been implemented by the NHSU and the contracted facilities” will be dropped and US$4,000,000 will be reallocated to DLR 4.2, which is proposed to be revised (see below).  DLR 4.2 “At least 15 percent of all Eligible Patients with confirmed ischemic stroke during a period of twelve consecutive months have undergone intravenous thrombolysis and/or mechanical thrombus removal” and DLR 4.3 “At least 20 percent of all Eligible Patients with confirmed ischemic stroke during a period of twelve consecutive months have undergone intravenous thrombolysis and/or mechanical thrombus removal” will be merged as DLR 4.2, which will read “At least 8 percent of all Eligible Patients with confirmed ischemic stroke during a period of twelve consecutive months have undergone intravenous thrombolysis and/or mechanical thrombus removal.” The revised end target will be eight percent and the allocation will increase from US$4,000,000 (for the original formulation of DLR 4.2 and 4.3) to of US$8,000,000. The funds for DLR 4.2 will help to stimulate the health system and ensure proper health services for stroke patients (second place in mortality6 and first in the structure of permanent disability among the adult population),7 particularly during times of war emergencies. Furthermore, merging of the two DLRs will allow sufficient time to collect, review and verify target achievement by the Project end date in the country which is crucial during the war when the health system needs to respond to the consequences of war emergencies.  The no-cost, global DLI 6 will be dropped to prevent its potentially preclusive effect on disbursement of funds against other well-performing indicators in EEP under Categories 2 and 3. 18. Procurement Plan. In view of the existing time limitations, procurement of the angiographic systems will be organized using the Bank-facilitated procurement mechanism. 19. Project Operations Manual. The Project Operations Manual will be updated to detail the changes in financial management arrangements, including reporting, annual auditing, and flow of funds for the EEP component, in a manner acceptable to the Bank, no later than one month after the Effective Date of the Amendment to the Loan Agreement. 6 https://ukrstat.gov.ua/druk/publicat/kat_u/2022/zb/10/zb_nasel%20_2021.pdf 7 https://core.ac.uk/download/pdf/346618452.pdf The World Bank Serving People, Improving Health Project (P144893) III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Components and Cost ✔ Reallocation between Disbursement Categories ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ PBCs ✔ Loan Closing Date(s) ✔ Cancellations Proposed ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) The World Bank Serving People, Improving Health Project (P144893) OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Improving Service Delivery at the Improving Service Delivery at 193.75 Revised 196.72 Local Level the Local Level Supporting Selected Priority Supporting Selected Priority 112.21 No Change 112.21 Areas of Health Reform Areas of Health Reform Project Implementation Project Implementation support 7.90 Revised support and monitoring and 4.93 and monitoring and evaluation evaluation Commission 0.25% 0.87 No Change Commission 0.25% 0.87 COVID-19 Emergency Response COVID-19 Emergency Response 35.00 No Change 35.00 Activities Activities TOTAL 349.73 349.73 OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IBRD-91100-001 | Currency: USD iLap Category Sequence No: 1 Current Expenditure Category: GD,CW,Non-CS,CS,OC for Part 1.2 44,912,500.00 39,009,314.56 47,882,500.00 100.00 100 iLap Category Sequence No: 2 Current Expenditure Category: EEP Part 2.2 50,000,000.00 39,000,000.00 50,000,000.00 100.00 100.00 iLap Category Sequence No: 4 Current Expenditure Category: GD,CW,Non-CS,CS,OC for Part 3.1 87,500.00 0.00 87,500.00 100.00 100.00 iLap Category Sequence No: 5 Current Expenditure Category: GD,CW,Non-CS,CS,OC for Part 4 The World Bank Serving People, Improving Health Project (P144893) 4,750,000.00 284,648.73 1,780,000.00 100.00 100 iLap Category Sequence No: 7 Current Expenditure Category: Int. rate cap, or collar premium 0.00 0.00 0.00 iLap Category Sequence No: FEF Current Expenditure Category: FRONT END FEE 250,000.00 250,000.00 250,000.00 Total 100,000,000.00 78,543,963.29 100,000,000.00 IBRD-91100-002 | Currency: USD iLap Category Sequence No: 3 Current Expenditure Category: EEP uncder Part 3.2 15,000,000.00 15,000,000.00 15,000,000.00 100.00 100.00 iLap Category Sequence No: 4 Current Expenditure Category: G,W,non-CS,CS,OC Part 3.1 19,912,500.00 15,540,246.78 19,912,500.00 100.00 100 iLap Category Sequence No: FEF Current Expenditure Category: FRONT END FEE 87,500.00 87,500.00 87,500.00 Total 35,000,000.00 30,627,746.78 35,000,000.00 . The World Bank Serving People, Improving Health Project (P144893) . Results framework COUNTRY: Ukraine Serving People, Improving Health Project Project Development Objectives(s) 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. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 Improved efficiency of health services PDO Indicator 1: Number of hospitals reprofiled or 0.00 20.00 40.00 60.00 100.00 merged (Number) PDO Indicator 2: Average in- patient length of stay in 11.70 11.60 11.50 11.00 10.50 9.50 8.00 hospitals (Days) Enhanced efficiency of the health care system PDO Indicator 3: Improved quality management (prevention, early diagnosis and treatment) of CVDs at 5.80 5.70 5.40 5.20 5.00 4.80 4.00 primary and secondary care measured as: a) reduction of hypertension-related hospitalization (Number) b) number of patients 93.60 117.20 146.20 163.90 184.60 193.70 400.00 who received stenting The World Bank Serving People, Improving Health Project (P144893) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 for acute myocardial infarction with ST segment elevation (Number) c) Percentage of health care providers implementing improved patient care pathways 0.00 50.00 for emergency, stroke care and day surgeries (Number) Prevent, detect and respond to threat posted by COVID-19 PDO 4: Number of hospital COVID-19 cases treated following agreed protocols 0.00 10,000.00 and reimbursed by NHSU (Number) Number of males 0.00 5,000.00 (Number) Number of females 0.00 5,000.00 (Number) PDO Table SPACE The World Bank Serving People, Improving Health Project (P144893) Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 Improving Service delivery at the local level Health facilities constructed, renovated, 0.00 10.00 139.00 145.00 145.00 119.00 and/or equipped (number) (Number) Improved patient care pathways for emergency stroke care and day No Yes surgeries developed and endorsed (Yes/No) DLI 5: Share of outpatient- based procedures and day 35.80 10.00 20.00 30.00 surgeries (Percentage) Supporting Selected Priority Areas of Health Reform Hospital beds per 880.00 860.00 820.00 780.00 700.00 650.00 600.00 population (Number) DLI 3: NHSU monitors contracted providers and reviews records from No Yes contracted facilities (Yes/No) Action: This indicator has been Revised Percentage of patients with acute stroke admitted to 0.00 70.00 75.00 80.00 hospitals contracted by The World Bank Serving People, Improving Health Project (P144893) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 NHSU for provision of stroke care (Percentage) percentage for male 0.00 80.00 patients (Percentage) percentage for female 0.00 80.00 patients (Percentage) Percentage of all patients with acute stroke received thrombolytic 1.10 8.00 therapy/mechanical thrombus removal (Percentage) Action: This indicator has been Revised percentage of male 0.00 8.00 patients (Percentage) Action: This indicator has been Revised percentage of female 0.00 8.00 patients (Percentage) Action: This indicator has been Revised COVID-19 Emergency Response Activities DLI 8: Number of COVID-19 patients with complications 0.00 12,500.00 attended by emergency medicine service following The World Bank Serving People, Improving Health Project (P144893) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 agreed protocols and reimbursed by NHSU (Number) Project Implementation support and monitoring and evaluation Health personnel receiving 0.00 1,929.00 9,820.00 14,749.00 20,480.00 24,937.00 25,000.00 training (number) (Number) Share of health care providers benefiting from Project activities that that 0.00 0.00 10.00 15.00 20.00 used the citizen feedback to enhance the quality of health services (Percentage) Results-based financing DLI 1: Hospitals from the capable network contracted 0.00 210.00 210.00 210.00 210.00 by NHSU using case-based payments (Number) DLI 2: PDO Indicator 1: Number of hospitals 0.00 20.00 60.00 100.00 100.00 reprofiled or merged (Number) DLI 3: NHSU monitors contracted providers and reviews records from No Yes Yes Yes Yes contracted facilities (Yes/No) Action: This indicator has been Revised The World Bank Serving People, Improving Health Project (P144893) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 5 DLI 4: Percentage of all patients with acute stroke received thrombolytic No Yes Yes Yes Yes therapy/ mechanical thrombus removal (Yes/No) Action: This indicator has been Revised DLI 5: Share of outpatient- based procedures and day 35.80 10.00 20.00 30.00 30.00 surgeries (Percentage) DLI 6: Global DLI for DLIs 1- 5: Health reforms advanced On track On track On track On track On track and sustained (Text) Action: This indicator has been Marked for Deletion DLI 7: PDO4: Number of hospital COVID-19 cases treated following agreed 0.00 10,000.00 0.00 0.00 10,000.00 protocols and reimbursed by NHSU (Number) DLI 8: Number of COVID-19 patients with complications attended by emergency medicine services following 0.00 12,500.00 0.00 0.00 0.00 agreed protocols and reimbursed by NHSU (Number) IO Table SPACE The World Bank Serving People, Improving Health Project (P144893) The World Bank Serving People, Improving Health Project (P144893)