Public Disclosure Copy
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: 7 | ARCHIVED on 26-Mar-2018 | ISR30011 |
Implementing Agencies: Government of Ukraine, Ministry of Health
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:--
Original Closing Date:30-Sep-2020 Revised Closing Date:30-Sep-2020
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 health caresystem.
Has the Project Development Objective been changed since Board Approval of the Project Objective?
No
PHRPDODEL
Components
Name
Improving Service delivery at the local level:(Cost $189.53 M)
Strengthen Ministry of Health Governance:(Cost $20.20 M)
Project Implementation support and monitoring and evaluation:(Cost $4.46 M)
Commission 0.25%:(Cost $0.54 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
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The World Bank Implementation Status & Results Report
Serving People, Improving Health Project (P144893)
Implementation Status and Key Decisions
The project remains as a priority for the health sector and overall health reform agenda. The Ministry of Health and Project Oblasts are committed to
accelerating project implementation. Overall progress has been made over the last 6 months, and the available data show that the Project Development
Objective (PDO) indicators are moving in the right direction. A Mid-term review has started on March 12, 2018 and aims at: (1) reviewing and agreeing
on the necessary changes to improve performance of the Project and ensure achievement of the PDO at closing (September 30, 2020); and (2) better
aligning the project with ongoing health sector reforms in Ukraine.
Risks
Systematic Operations Risk-rating Tool
Risk Category Rating at Approval Previous Rating Current Rating
Political and Governance -- Substantial Substantial
Macroeconomic -- High High
Sector Strategies and Policies -- Substantial Substantial
Technical Design of Project or Program -- Moderate Moderate
Institutional Capacity for Implementation and
Sustainability
-- Substantial Substantial
Fiduciary -- Substantial Substantial
Environment and Social -- Moderate Moderate
Stakeholders -- Moderate Moderate
Other -- -- --
Overall -- Substantial Substantial
Results
Project Development Objective Indicators
PHINDPDOTBL
PDO Indicator 1: Early detection of cervical and breast cancer as measured: a) Ratio of new in situ to new invasive cervical
cancer (Number, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 0.79 0.81 0.58 0.88
Date 01-Jan-2014 04-Mar-2016 07-Mar-2018 31-Dec-2017
Comments
In 2017, the PDO indicator 1a was achieved by 66%. The following reasons explain the slow progress: 1) During 2015-2017, the total
number of women with cervical cancer increased mainly from detection of patients with cancer in later stages, as many women have never
been examined before; 2) Gynecological kits and cytological brushes for cervical cancer screening were delivered only in August 2017,
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The World Bank Implementation Status & Results Report
Serving People, Improving Health Project (P144893)
and screening centers were opened in July-September 2017.
the PDO indicator 1b was achieved by 72%. The purchased mammography machines became operational in June-September 2017 with
67740 mammograms performed in 2017, which is more than double of the 2016 figure, and 82% of the total number of screenings
performed in the second half of the year. Of all screened, 19 women were diagnosed with D05 (Carcinoma in situ of breast).
However, the reason for non-achievement of the PDO 1b indicator is that the detected breast pathologies with a suspicion of stage 1 cancer
in 2017 were histologically confirmed, but treatment has not been initiated and therefore not reported in 2017. According to the statistical
guidelines, these cases will be reported in 2018.
PHINDPDOTBL
b) Share of new breast cancer detected at stage I (Percentage, Custom Supplement)
Baseline Actual (Previous) Actual (Current) End Target
Value 21.80 25.40 21.50 30.00
PHINDPDOTBL
PDO Indicator 2: High blood pressure under control as measured by the share of patients aged 40-60 achieving target level of
blood pressure (measure is 140/90mmHg) (Percentage, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 15.40 16.50 16.50 19.00
Date 01-Jan-2014 04-Mar-2016 04-Mar-2016 31-May-2020
Comments
The indicator is not updated due to absence of survey data to validate official statistics. Currently, the MoH has selected a company to
supplement and verify the data by analyzing medical forms. The survey is scheduled to begin in April 2018
PHINDPDOTBL
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 -- 5.32 4.80
Date 01-Jan-2014 -- 07-Mar-2018 31-May-2020
Comments
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Serving People, Improving Health Project (P144893)
PDO 3a: The indicator is on track, although slightly behind the target (5.20 cases of hospitalizations per 1,000 population). There is a
positive dynamic towards achievement of the end target (the indicator value decreased by 11% from 5.95 in 2015 to 5.32 in 2017) due to
improved quality of primary hypertension management. Additionally, the equipment for diagnostics and treatment of CVDs for the primary
health care facilities and emergency care institutions were supplied only in 2017, and training activity is behind the schedule. It is expected
that the indicator will continue improving after all components for its achievement (trainings, campaigns and materials) will be in place.
PDO 3b: in 2017, the number of patients per 100,000 population, who received stenting for acute myocardial infarction with ST-segment
elevation was 174 against the target value of 164. With completion of procurement and commissioning of additional angiographic
equipment in the Rivne Oblast Clinical Hospital and Dnipropetrovsk Clinical Center for Cardiology and Cardiac Surgery, the indicator will
continue improving.
PHINDPDOTBL
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 93.60 207.00 174.40 193.70
PHINDPDOTBL
PDO Indicator 4: Average in-patient length of stay in hospitals (Days, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 11.70 11.30 11.00 9.50
Date 01-Jan-2014 04-Mar-2016 07-Mar-2018 31-May-2020
Comments
The indicator is on track
Overall Comments
Intermediate Results Indicators
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Serving People, Improving Health Project (P144893)
PHINDIRITBL
Health personnel receiving training (number) (Number, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 0.00 4,592.00 5,805.00 24,937.00
Date 01-Jan-2015 24-Jul-2017 07-Mar-2018 31-May-2020
Comments
The indicator was achieved by 40%. The low level of achievement was mainly due to delays in training of medical personnel in the central
components (in particular, pilot implementation of DRGs require a lot of additional trainings, which is expected to start in April-May 2018)
PHINDIRITBL
Health facilities constructed, renovated, and/or equipped (number) (Number, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 0.00 -- 23.00 260.00
Date 01-Jan-2015 -- 07-Mar-2018 31-May-2020
Comments
Implementation of construction and reconstruction works has been one of the major bottlenecks of the projects. During 2017, the planned
works were carried out only at 11 general and family medicine outpatient clinics in Dnipropetrovsk Oblast, and in Zakarpattia Oblast
reconstruction of the Interventional Cardiology Department in Khust was performed. The main reason for non-achievement of the target
value of the indicator was the fact that in August 2017 in Volyn, Dnipropetrovsk and Rivne Oblasts there were problems with documentation
for registration of budget commitments under contracts for construction, reconstruction and rehabilitations of health care facilities with the
State Treasury authorities, which delayed concluding contracts based on tender results and commencement of works.
PHINDIRITBL
7. % of primary health care facilities meeting the equipment norms for improved management of CVD (according to an explicit
list) (Percentage, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 31.00 35.00 10.40 55.00
Date 01-Jan-2014 30-Apr-2016 07-Mar-2018 31-May-2020
Comments
The interim target for the indicator was achieved by 26%. Currently, only 206 outpatient clinics (10.4%) are matching the normative for
necessary equipment for improved CVD management in the Project oblasts. The indicator is fully implemented only in Zaporizhzhia Oblast,
where 166 outpatient clinics (58.9%) are equipped. In the other project Oblasts, the procurement of medical equipment for improved CVD
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Serving People, Improving Health Project (P144893)
management is ongoing.
PHINDIRITBL
8. Number of cancer screening procedures performed: a) cervical cancer tests (Number, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 709,184.00 804,165.00 784,341.00 830,000.00
Date 01-Jan-2014 07-Feb-2017 07-Mar-2018 31-May-2018
Comments
Indicator 8a: In 2017, the indicator was achieved by 94%. The gap is mainly explained by the delays in supplies of test kits and setting up
screening centers: gynecological kits and cytological brushes were delivered in August 2017, and screening centers were opened in July-
September 2017.
Indicator 8b: The indicator was only achieved by 45%, as new mammography machines became operational in Lviv oblast only in
September 2017. In the second half of 2017, 55664 mammograms were performed, which is 4 times more the number of mammograms
performed in the first half of 2017. The number of cancer screening mammograms during the Project operation increased 2.7 times from
25,299 in 2015 to 67,740 in 2017.
PHINDIRITBL
b) mammograms (Number, Custom Supplement)
Baseline Actual (Previous) Actual (Current) End Target
Value 20,893.00 31,832.00 67,740.00 150,000.00
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Serving People, Improving Health Project (P144893)
PHINDIRITBL
9. Share of acute myocardial infarction with ST segment elevation diagnoses confirmed according to appropriate protocols in
the previous 12 months (Percentage, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 65.00 -- -- 78.00
Date 01-Jan-2014 11-Mar-2016 11-Mar-2016 31-May-2020
Comments
The data to measure this indicator is not yet available. The survey to measure the baseline and progress to date will be launched in April
2018
PHINDIRITBL
10. Share of primary care centers which have structured schools of health or similar initiatives working on educational group
activities related to main NCDs’ risk factors (Percentage, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 0.00 -- 25.50 50.00
Date 01-Jan-2014 -- 07-Mar-2018 31-May-2020
Comments
In 2017, 558 Schools of Health (25.5% of the total number of outpatient clinics) operated in five Project oblasts. The indicator was achieved
by 85%. In Vinnytsia, Poltava and Rivne oblasts, Draft Orders on Schools of Health at general and family outpatient clinics with
corresponding methodological guidance are being prepared by Departments of Health.
On December 15, 2017, an agreement was signed with WHO to support MoH in the development of appropriate policies and strategies
aimed at improving the public health system, which includes the methodological support for the establishment of Schools of Health;
accordingly, work in this direction will be intensified in 2018.
PHINDIRITBL
11. Critical e-Health standards approved by MoH (Yes/No, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value N N N Y
Date 01-Jan-2014 17-Jul-2017 17-Jul-2017 31-May-2017
Comments
The MoH has developed and submitted for approval several eHealth standards: ‘Health Care Facilities’, ‘Health Personnel’, ‘Medicines’,
‘Diagnoses’. The MoH has signed a contract in December 2017 with the firm which will develop standards and legislation for eHealth. The
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Serving People, Improving Health Project (P144893)
work in this direction will be intensified in 2018.
PHINDIRITBL
12. Communication campaign designed and implemented at central level (Yes/No, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value N -- N Y
Date 01-Jan-2014 -- 07-Sep-2017 31-May-2020
Comments
The consultant for the communication support of reforms has been hired in March 2018. The activities under this cluster will be accelerated
with the designated coordinator on board.
PHINDIRITBL
13. Availability of hospital beds (Number, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 880.00 -- 746.00 650.00
Date 01-Jan-2014 -- 24-Jul-2017 31-May-2020
Comments
The indicator is on track
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PHINDIRITBL
14. Number of Oblasts that in any given year have implemented at least one productivity enhancing reform (Number, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 0.00 -- 4.00 8.00
Date 01-Jan-2014 -- 07-Mar-2018 31-May-2020
Comments
Four Project oblasts (Zaporizhzhia, Vinnytsia, Rivne and Lviv regions) submitted reform implementation reports. Upon review and
verification of the report, achievement of the mid-term target will be confirmed.
PHINDIRITBL
15. Share of beneficiaries in participating oblasts reporting improvement in the access and quality of the targeted healthcare
services (Percentage, Custom)
Baseline Actual (Previous) Actual (Current) End Target
Value 0.00 -- -- 20.00
Date 01-Jan-2014 30-Aug-2017 30-Aug-2017 31-May-2020
Comments
Improvements in accessibility and quality of care were measured for the project oblasts and compared with non-project oblasts in the Health
Index Survey 2017. The ToR for the project-specific beneficiary survey is being developed and agreed. It will define the representative
sample-based survey of households on access to and quality of targeted services in the health care sector. According to the MoH report,
the survey will be launched and completed in 2018 calendar year.
Overall Comments
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 41.47 173.26 19%
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Serving People, Improving Health Project (P144893)
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 30-Sep-2020
Cumulative Disbursements
Restructuring History
There has been no restructuring to date.
Related Project(s)
There are no related projects.
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