The World Bank Report No: ISR12457 Implementation Status & Results Vietnam Central North Region Health Support Project (P095275) Public Disclosure Copy Operation Name: Central North Region Health Support Project (P095275) Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Archive Date: 06-Feb-2014 Country: Vietnam Approval FY: 2010 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 06-Apr-2010 Original Closing Date 31-Aug-2016 Planned Mid Term Review Date 23-Sep-2013 Last Archived ISR Date 22-Jun-2013 Effectiveness Date 23-Aug-2010 Revised Closing Date 31-Aug-2016 Actual Mid Term Review Date 23-Sep-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project development objective is to strengthen district-level curative and preventive health services and improving their accessibility for the economically vulnerable population in the Central North Provinces. Intermediate objectives are: Increasing health insurance coverage among the near-poor population; Upgrading capacities of district hospitals and District Preventive Health Centers; Improving supply and quality of health care personnel. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Supporting health insurance for the near poor population 9.11 Public Disclosure Copy Strengthening district health services 32.20 Improving supply and quality of human resources for health 15.99 Project management, monitoring and evaluation 7.71 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 Moderate Moderate Page 1 of 9 The World Bank Report No: ISR12457 Implementation Status Overview The progress of the project towards meeting its development objective is determined to be moderately satisfactory. The utilization of the poor and near poor of district health services would appear to have increased with the poor and near poor as a percent of all patients using district health services increasing from 16.4 to 20.3 and 3.2 to 5.3, respectively. At the same time, we see that district hospitals claims as a percent of all claims processed by the VSS have increased from 47.9% to 68.4% indicating that district Public Disclosure Copy hospital use have generally increased. The utilization rates of the poor and near poor will be additionally assessed using the 2012 VHLSS data which have recently been made available as well as other supplementary information. In part the increase in utilization for the near poor may be attributed to the increase in the coverage rates from 10 to 37 %. The implementation progress generally shows a positive trend towards strengthening of the district health services with the construction of 30 district preventive health centers. While procurement and delivery of medical equipment has been slower than planned, the majority of the equipment will likely be delivered by end of 2014. The Project has been implemented for little more than three years since October 2010. At the time of the mid-term review, about 50% of the project implementation period has elapsed and the project has disbursed US$25.2 million or 38.8% of the credit which is slightly below the originally planned disbursement schedule. Locations Country First Administrative Division Location Planned Actual Vietnam Tinh Nghe An Tinh Nghe An Vietnam Tinh Thua Thien-Hue Tinh Thua Thien-Hue Vietnam Tinh Thanh Hoa Tinh Thanh Hoa Vietnam Tinh Quang Tri Tinh Quang Tri Vietnam Tinh Quang Binh Tinh Quang Binh Vietnam Tinh Ha Tinh Tinh Ha Tinh Vietnam Tinh Nghe An Huyen Nam Dan Vietnam Tinh Nghe An Huyen Nghi Loc Vietnam Tinh Nghe An Huyen Dien Chau Vietnam Tinh Nghe An Huyen Yen Thanh Vietnam Tinh Nghe An Huyen Thanh Chuong Public Disclosure Copy Vietnam Tinh Nghe An Huyen Quynh Luu Vietnam Tinh Nghe An Huyen Nghia Dan Vietnam Tinh Nghe An Huyen Que Phong Vietnam Tinh Nghe An Huyen Tuong Duong Vietnam Tinh Nghe An Huyen Ky Son Vietnam Tinh Thanh Hoa Huyen Tinh Gia Page 2 of 9 The World Bank Report No: ISR12457 Country First Administrative Division Location Planned Actual Vietnam Tinh Thanh Hoa Huyen Nhu Xuan Public Disclosure Copy Vietnam Tinh Thanh Hoa Huyen Hoang Hoa Vietnam Tinh Thanh Hoa Huyen Thuong Xuan Vietnam Tinh Thanh Hoa Huyen Ngoc Lac Vietnam Tinh Thanh Hoa Huyen Lang Chanh Vietnam Tinh Thanh Hoa Huyen Cam Thuy Vietnam Tinh Thanh Hoa Huyen Hau Loc Vietnam Tinh Thanh Hoa Huyen Ba Thuoc Vietnam Tinh Thanh Hoa Huyen Quan Son Vietnam Tinh Thanh Hoa Huyen Quan Hoa Vietnam Tinh Thanh Hoa Huyen Muong Lat Vietnam Tinh Quang Tri Huyen Hai Lang Vietnam Tinh Quang Tri Huyen Gio Linh Vietnam Tinh Quang Tri Huyen Vinh Linh Vietnam Tinh Quang Binh Huyen Le Thuy Vietnam Tinh Quang Binh Huyen Bo Trach Vietnam Tinh Quang Binh Huyen Quang Trach Vietnam Tinh Quang Binh Huyen Tuyen Hoa Public Disclosure Copy Vietnam Tinh Quang Binh Huyen Minh Hoa Vietnam Tinh Ha Tinh Huyen Cam Xuyen Vietnam Tinh Ha Tinh Huyen Ky Anh Vietnam Tinh Ha Tinh Huyen Huong Khe Vietnam Tinh Ha Tinh Huyen Nghi Xuan Vietnam Tinh Ha Tinh Huyen Duc Tho Vietnam Tinh Ha Tinh Huyen Huong Son Page 3 of 9 The World Bank Report No: ISR12457 Vietnam Tinh Thua Thien-Hue Thanh Pho Hue Vietnam Tinh Thua Thien-Hue Huyen Phu Vang Public Disclosure Copy Vietnam Tinh Thua Thien-Hue Huyen Phong Dien Vietnam Tinh Thua Thien-Hue Huyen Huong Tra Vietnam Tinh Thua Thien-Hue Huyen Phu Loc Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target 10% increase in the utilization of inpatient and Text Value inpatient - 16.38/100 inpatient - 20.13/100 inpatient 2.58/100 (10% outpatient services by the poor outpatient - 17.04 /100 outpatient - 15.64 /100 increase) outpatient - 5.79/100 (10% increase) Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 Comments The baseline information was Indicators were calculated updated by the baseline based on numbers of poor IP survey in 2012. and OP per total patients in project district hospitals. Further analysis ofVHLS 2012 is needed to clarify and compare utilization across income groups when data is available by Dec 2013 10% increase in the utilization of inpatient and Text Value inpatient – 3.24/100 inpatient – 5.33/100 inpatient - 2.63/100 (10% outpatient services by the near-poor Sub Type outpatient - 2.7/100 outpatient - 5.46/100 increase) outpatient - 6.75/100 (10% Breakdown increase) Public Disclosure Copy Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 Comments The baseline information was Indicators were calculated updated by the baseline based on numbers of near survey in 2012. poor IP and OP per total patients in project district hospitals. Further analysis of VHLS 2012 is needed to clarify and compare utilization across income groups when data is available by Dec 2013 Page 4 of 9 The World Bank Report No: ISR12457 30% reduction in the referrals for deliveries, Percentage Value 10.40 5.30 4.00 pneumonia and appendicitis from district Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 hospitals to provincial hospitals Comments The baseline information was The base line data was Public Disclosure Copy updated by the baseline collected from only 8 hospitals survey in 2012. during the project preparation. It was then updated at base line survey as of 10.4%. Project assumption is that with more capacity to deliver quality of care, that there would be less need to refer for relatively simple cases. We haven’t done much to improve the quality of care, but supposedly there is this huge reduction to 5.3% by the mid-term. There is a concern on the quality of data collection or something is happened in the hospitals. The “capitation” paymentstrongly reinforces the incentive not to refer (since district hospitals will have to finance referrals from their pot of funds).So,any reduction not completely attributed to project impact. The final target for these normal cases was 4%. Referral rates lower than this could be a concern because hospitals could be referring too few cases (i.e. a Public Disclosure Copy complication with delivery). We will need to monitor the indicator closely and request hospitals to collect the data at regular basis. 90% of children under age 1 fully vaccinated Percentage Value 80.00 98.00 90.00 according with national EPI program Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 Comments The baseline information was This is the sector core indicator. This indicator is Page 5 of 9 The World Bank Report No: ISR12457 updated by the baseline good to monitor for risk survey in 2012. mitigation, but not directly for purposes of determining project impact. Public Disclosure Copy Health facilities constructed, renovated, and/or Number Value 0.00 30.00 67.00 equipped (number) Date 31-Dec-2010 31-Aug-2013 26-Feb-2016 Comments This indicator is strictly In progress. 30 district health The indicator includes 30 referencing the 30 district centers were built. district health centers, 30 health centers being Procurement of equipment is district hospitals and 1 constructed and equipped in progress provincial hospital, and 5 under the Project . An medical colleges and NgheAn additional 32 health facilities Medical University. are being equipped 20 new District Preventive Health Centers Number Value 0.00 30.00 20.00 constructed with adequate facilities and Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 equipment to provide the full range of Comments The indicator also monitor the preventive health services accordingto the government norms capacity of health centers to provide full range of services according to the government norm. By the mid-term, only construction of 30 centers is completed. Significant support on equipment is not yet implemented. The indicator will be monitored in the next year. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target 40% of the near poor are covered by the health Percentage Value 10.00 37.00 40.00 insurance program Date 31-Dec-2010 30-Jun-2013 28-Feb-2016 Public Disclosure Copy Comments There is a new Gov policy to support 100% of the premium for some sub-groups of near poor (not all). Provinces have to re-identify the eligible near poor to receive project support. It really slow the progress and affect the coverage. Page 6 of 9 The World Bank Report No: ISR12457 People with access to a basic package of Number Value 420000.00 913011.00 600000.00 health, nutrition, or reproductive health services Date 31-Dec-2010 30-Jun-2012 28-Feb-2016 (number) Comments The actual indicator is 40% of 60.7%. 347,086 cards have 40%. End target Public Disclosure Copy the near poor are covered by been issued with project conservatively set assuming the health insurance program. support since this year, plus (i) baseline was 10% of the The baseline was estimated 565,925 near poor people target population; and (ii) low to be 10% or 150,000. already covered by the take-up considering Government support. The experience in the Mekong It was estimated that 10% of data will be updated when Region. the near poor were covered provinces finalize the new by health insurance. Once project beneficiaries the Project identified the 1.5 according to new Government million near poor, 28% or Policy 420,000 were identified as beingcovered by health insurance through another progress group. The share of near-poor households spending Percentage Value 18.40 12.00 25% of more of their non-food consumption on Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 health is reduced to 12% or less Comments The baseline information was Data will be updated by updated by the baseline December 2013 when VLSS survey in 2012. 2012 data is released. The share of district hosptials in claims Percentage Value 47.90 68.39 50.00 reimbursed by health insurance (VSS) is 50% Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 or more Comments The baseline information was Data updated by September updated by the baseline 2013. survey in 2012. 50% of patients satisfied with (a) overall quality Text Value (a) 35% (a) 98.5% (a) 50% of care at district hospitals, (b) reduction of (b) 35% (b) 98% (b) 50% waiting time, and (c) availability of services and (c) 32% (c) 95.3% (c) 50% diagnostic facilities Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 Public Disclosure Copy Comments The indicators are very questionable. It is related to the method of data collection. The survey was self-reported by patients right after they discharged from the hospitals. However, the survey was not closely and independently supervised by consultants. The team recommend to have Page 7 of 9 The World Bank Report No: ISR12457 the survey with sound method by end of project evaluation. Nghe An medical college fully meets the Text Value Nil Fully meets standards national standards for medical university Public Disclosure Copy Date 31-Dec-2010 31-May-2013 28-Feb-2016 Comments Nghe An Medical college is recognized as a Medical University in July 2010. The project provides support to improve capacity for the new college, in both facility and staff quality. Health personnel receiving training (number) Number Value 0.00 953.00 854.00 Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 Comments This includes training of 175 In progress and will exceed MD: 680 Doctors in Level 1 Specialty. the original targets. 806 Specialist level 1: 174 and Training of 680 Assistant Assistant Doctors are under Doctors as full fledged training to be full fledge doctors. doctors. 147 staff are taking Specialist level 1 training. 175 Doctors from District Hospitals trained for Number Value 0.00 953.00 854.00 Level 1 specialization and at least 680 health Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 professionals trained for MD degree Comments In progress and will exceed MD: 680 the original targets. 806 Specialist level 1: 174 Assistant Doctors are under training to be full fledge doctors. 147 staff are taking Specialist level 1 training. 80% of medical professional return to their Percentage Value 100.00 80.00 original place of work/residence after long-term Date 31-Dec-2010 31-Aug-2013 28-Feb-2016 training supported by the project Comments Since the training is still on- going, the indicator will be Public Disclosure Copy monitored closely through out the project implementation. Data on Financial Performance (as of 18-Dec-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P095275 IDA-46880 Effective 06-Apr-2010 25-May-2010 23-Aug-2010 31-Aug-2016 31-Aug-2016 Disbursements (in Millions) Page 8 of 9 The World Bank Report No: ISR12457 Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095275 IDA-46880 Effective XDR 41.50 41.50 0.00 18.30 23.20 44.00 Public Disclosure Copy Disbursement Graph Key Decisions Regarding Implementation The Project mid-term review was carried out as scheduled. No major changes to the Project design or Financing Agreement are planned. A reallocation of the Credit proceeds will be requested mainly due to increased funding to continue the health insurance premium subsidy to cover the near poor. Restructuring History There has been no restructuring to date. Public Disclosure Copy Related Projects There are no related projects. Page 9 of 9