The World Bank Report No: ISR5392 Implementation Status & Results Dominican Republic Health Sector Reform Second Phase APL (PARSS 2) (P106619) Public Disclosure Copy Operation Name: Health Sector Reform Second Phase APL (PARSS 2) Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Archive Date: 13-Aug-2011 (P106619) Country: Dominican Republic Approval FY: 2010 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): CERSS, Secretaria de Estado de Salud Publica y Asistencia Social (SESPAS) Key Dates Board Approval Date 17-Sep-2009 Original Closing Date 30-Oct-2015 Planned Mid Term Review Date 05-Nov-2012 Last Archived ISR Date 13-Aug-2011 Effectiveness Date 19-Jan-2010 Revised Closing Date 30-Oct-2015 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project's Development Objectives are to: (i) Improve the capacity of Regional Health Services (RHS) to deliver, in a timely fashion, quality services known to improve the health of mothers, children and people with chronic conditions by public providers at the first level of care; (ii) improve health system responsiveness, defined here as the institutional capacity of public sector health organizations to conduct strategic purchasing of health care services and goods, and to respond to public health emergencies. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Results-based financing mechanism for the first level of care 21.49 Strengthening the capacity of the MOH 10.00 Quality of public spending 12.57 Public Disclosure Copy Response to Public Health Emergencies 0.10 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The Project has made some progress on certain key indicators such as percentage of children less than 15 months of age who received their complete immunization scheme and Page 1 of 6 The World Bank Report No: ISR5392 percentage of pregnant women evaluated for health risks before their 15th week of pregnancy. In terms of important milestones/processes, the Project has signed addendums with the National Social Security (SENASA), Ministry of Health (MOH) and the two Regional Health Services (RHS) to align the Project's results-based financing mechanism and SENASA’s. Enrollment rates for the population to be covered by the Project through capitation payments to the Regional Health Services (RHS) for an essential package of health services at the first level of care have increased as a result of (a) implementing the new eligibility criteria, and (b) the technical support provided by a team from SENASA and the Public Disclosure Copy Executive Commission for Health Sector Reform (CERSS). Enrollment rates are expected to further increase once registration data issues (e.g. data entry errors) are resolved. The Project team is proactively addressing these issues. While the Project has advanced in developing information systems and tools to monitor project performance, some challenges remain, particularly with regard to improving the use of the clinical management system (CMS). The Inter-institutional Committee (Social Cabinet, CERSS, MOH, SENASA, and the RHS) is addressing this issue by providing technical and logistical support, training, and incentives to regional, zonal, and health personnel. The proposed law to establish the creation of the autonomous Management Entity as part of the proposed separation of service delivery and stewardship/regulatory functions of the MOH has been submitted to Congress and is pending approval. In view of this reform, the MOH has initiated discussions to establish a road map to strengthen its capacity to perform its stewardship and essential public health functions. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of pregnant women from target Percentage Value 0.43 0.57 50.00 population with risk evaluation completed Date 27-Jun-2011 31-Oct-2011 30-Oct-2015 before the 15th week of pregnancy. Comments Number is low due to limited Number has improved but To be measured annually use of Clinical Management continues to be low relative to System (CMS) which requires target because use of the doctors to follow health care CMS continues to be limited. protocols and enter the The Government is trying to information electronically. address this issue. Source: Clinical Management Source: Clinical Management system system (CMS) Percentage of children from target population Percentage Value 0.00 2.27 60.00 under 15 months with vaccination scheme Public Disclosure Copy Date 27-Jun-2011 31-Oct-2011 30-Oct-2015 completed according to national protocols Comments Source: CMS Number has improved but To be measured annually continues to be low relative to target and actual practice because use of the CMS continues to be limited. The Government is trying to address this issue. Source: CMS Page 2 of 6 The World Bank Report No: ISR5392 Percentage of individuals from target Percentage Value 37.20 3.54 50.00 population diagnosed with hypertension under Date 27-Jun-2011 31-Oct-2011 30-Oct-2015 treatment according to national protocols Comments Source: Registry information Number is significantly lower Public Disclosure Copy from the regional health than in the previous ISR services (RHS) because a different data source was used. Based on agreements with the Government, the Project will start to use the CMS for this indicator. Source: CMS Studies on risk factors and burden of disease Text Value 0 0. Major study to be initiated Study results used by MOH to has been conducted, disseminated and used in late February 2012. develop annual plans by corresponding MOH units (salud colectiva) Date 20-Aug-2009 31-Jan-2012 30-Oct-2015 to develop operational plans for health Comments No studies Draft contract for the major promotion and prevention study under review by the Bank. Study results expected by second semester of 2012. At least 1 region is producing reports every 4 Text Value 0 0 at least one region is months on no. of poor individuals who were producing reports every 4 prescribed a medicine (from essential months medicines list) at the 1st level of care & Date 20-Aug-2009 27-Jun-2011 30-Oct-2015 received medication in 48 hrs Comments No monthly reports In progress. No reports yet but information systems are being developed and linked to enable at least 1 region to produce reports. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Public Disclosure Copy Percentage of clinical files with complete Percentage Value 0.00 0.00 85.00 information for external audit to verify RHS Date 20-Aug-2009 30-Nov-2011 30-Oct-2015 reported MRI results Comments Component 1 indicator. This To be based on quarterly information will be obtained reports from reports to be generated from the External Audit which has just started. The preliminary report is expected in March, 2012. Page 3 of 6 The World Bank Report No: ISR5392 Studies on risk factors and burden of disease Text Value No Studies Draft consultant contract for Studies' results completed surveys designed, implemented, results major study being reviewed and disseminated and used disseminated and used for planning public by the Bank. for planning public health health interventions with an emphasis on interventions with an Public Disclosure Copy health promotion and prevention. emphasis on health promotion and prevention. Date 20-Aug-2009 31-Jan-2012 30-Oct-2015 Comments Component 2 indicator. Technical and financial evaluation for major study cleared by the Bank in December 2011. Draft contract under review. Study results expected by 2nd semester of 2012. The Health Management System of the MOH Text Value No module Module (general health Results-adjusted Capitation includes an automated/electronic module for information system) or SIGS Module used in regions VI M&I with all the information needed for developed and pre-tested. and VIII monitoring results on a quarterly basis at the System to be launched first level of care formally in late February 2012. Date 20-Aug-2009 31-Jan-2012 30-Oct-2015 Comments Component 2 indicator. Both the family electronic files (FFM) and data base for a set of basic data for attended illnesses ( CMBD) systems are installed in the MOH servers and have been pre- tested. MOH is in the process of hiring a consultant to help improve complementarity between these two systems Public Disclosure Copy and the CMS. These two modules are expected to be officially launched in late February 2012. The information module to calculate the indicators for Component 1 has already been developed and is being used. Page 4 of 6 The World Bank Report No: ISR5392 Percentage of accredited health centers from Text Value 0 22 80 participating RHS that do not have a Date 20-Aug-2009 01-Nov-2011 30-Oct-2015 PROMESE/CAL pharmacy and receive on a Comments Component 3 indicator. This regular basis medicines procured and Public Disclosure Copy distributed by PROMESE/CAL percentage is lower than the figure reported in the previous ISR because the denominator has increased (there are more accredited health centers) since June 2011. Figure for the entire year of 2011 is expected to be available in late February 2012. Data on Financial Performance (as of 14-Feb-2012) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P106619 IBRD-77770 Effective 17-Sep-2009 30-Oct-2009 19-Jan-2010 30-Oct-2015 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106619 IBRD-77770 Effective USD 30.50 30.50 0.00 5.33 25.17 17.00 Disbursement Graph Public Disclosure Copy Page 5 of 6 The World Bank Report No: ISR5392 Public Disclosure Copy Key Decisions Regarding Implementation None for this implementation period. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 6 of 6