The World Bank Report No: ISR7983 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: 6 Status: ARCHIVED Archive Date: 02-Nov-2012 (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 26-Nov-2012 Last Archived ISR Date 22-Mar-2012 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 significant progress in overcoming many of the bottlenecks identified last year. Implementation of the results-based financing mechanism in the two pilot Page 1 of 6 The World Bank Report No: ISR7983 regions is well underway. Moreover, there is clear ownership of the process in both Regional Health Services (RHS), which has contributed to increased use of the clinical management system (CMS). Enrollment rates for the population to be covered by the Project through capitation payments to the RHS for an essential package of health services at the first level of care have continued to increase and have now surpassed their targets for the year 2012 (132% in Region VI and 218% in Region VIII). The Project has advanced on most key indicators and two process indicators’ targets have been surpassed; nonetheless some indicators' performance remain much lower relative to targets and will be assessed Public Disclosure Copy in detail during the Project’s Mid-Term Review which will take place in November 2012. 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 is under review. In the meantime, the MOH is working on 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 2.66 50.00 population with risk evaluation completed Date 27-Jun-2011 31-Aug-2012 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 partly because doctors to follow health care although use of the CMS has protocols and enter the improved it is still fairly limited. information electronically. The Government is trying to Source: Clinical Management address this issue. system Source: Clinical Management system (CMS) Percentage of children from target population Percentage Value 0.00 21.00 60.00 under 15 months with vaccination scheme Date 27-Jun-2011 31-Aug-2012 30-Oct-2015 completed according to national protocols Comments Source: CMS Number has significantly To be measured annually improved but remains low Public Disclosure Copy 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: ISR7983 Percentage of individuals from target Percentage Value 37.20 17.70 50.00 population diagnosed with hypertension under Date 27-Jun-2011 31-Aug-2012 30-Oct-2015 treatment according to national protocols Comments Source: Registry information Number has significantly Public Disclosure Copy from the regional health improved relative to previous services (RHS) ISR but is still low relative to target. This can be partly due to still limited use of the CMS. Studies on risk factors and burden of disease Text Value 0 Major survey completed. Data Study results used by MOH to has been conducted, disseminated and used analysis ongoing develop annual plans by corresponding MOH units (salud colectiva) Date 20-Aug-2009 31-Aug-2012 30-Oct-2015 to develop operational plans for health Comments No studies Study report expected to be promotion and prevention available in November 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 01-Aug-2012 30-Oct-2015 received medication in 48 hrs Comments No monthly reports In progress. No reports yet but the consultancy on the information system for medicines and hospital inputs which will facilitate the development of the reports and the reporting system has been drafted and is expected to be finalized by early October 2012. Information systems are being developed and linked to enable at least 1 region to produce reports. Intermediate Results Indicators Public Disclosure Copy Page 3 of 6 The World Bank Report No: ISR7983 Indicator Name Core Unit of Measure Baseline Current End Target Percentage of clinical files with complete Percentage Value 0.00 96.00 85.00 information for external audit to verify RHS Date 20-Aug-2009 15-May-2012 30-Oct-2015 Public Disclosure Copy reported MRI results Comments Target surpassed. Number To be based on quarterly presented is the average for reports the Project pilot regions (i.e., the External Audit found that 97% of clinical files of Region VI and 95% of clinical files of Region VIIII are complete and of good quality). Studies on risk factors and burden of disease Text Value No Studies 0. Survey completed and data Studies' results completed surveys designed, implemented, results analysis underway. and disseminated and used disseminated and used for planning public for planning public health health interventions with an emphasis on interventions with an health promotion and prevention. emphasis on health promotion and prevention. Date 20-Aug-2009 31-Aug-2012 30-Oct-2015 Comments Component 2 indicator. Study results expected by November 2012. The Health Management System of the MOH Text Value No module The General Health Results-adjusted Capitation includes an automated/electronic module for information System (the Module used in regions VI M&I with all the information needed for official information portal for and VIII monitoring results on a quarterly basis at the the health sector managed by first level of care the MOH) was officially launched in April 2012. Some modules are already functioning while some are still being developed or fine- tuned. Date 20-Aug-2009 31-May-2012 30-Oct-2015 Public Disclosure Copy Comments Component 2 indicator. Both the family electronic files (FFM) and data base for a set of basic data for attended illnesses ( CMBD) systems have been pre-tested in the pilot regions and are pending the implementation plan for them to be officially used. The information module to Page 4 of 6 The World Bank Report No: ISR7983 calculate the indicators for Component 1 is already functioning. It was agreed that efforts will be made by the Public Disclosure Copy MOH to ensure that all these information system modules are well integrated. Percentage of accredited health centers from Text Value 0 100 80 participating RHS that do not have a Date 20-Aug-2009 30-Apr-2012 30-Oct-2015 PROMESE/CAL pharmacy and receive on a Comments Component 3 indicator. All regular basis medicines procured and distributed by PROMESE/CAL accredited health centers receive medicines regularly from PROMESE/CAL but it is not clear if they received all of the medicines that they requested. This indicator will be reviewed in the MTR. Data on Financial Performance (as of 05-Oct-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P106619 IBRD-77770 Effective 17-Sep-2009 30-Oct-2009 19-Jan-2010 30-Oct-2015 30-Oct-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106619 IBRD-77770 Effective USD 30.50 30.50 0.00 8.27 22.23 27.00 Disbursement Graph Public Disclosure Copy Page 5 of 6 The World Bank Report No: ISR7983 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