Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) Health System Quality and Efficiency Improvement (P144871) EUROPE AND CENTRAL ASIA | Croatia | Health, Nutrition and Population Global Practice | IBRD/IDA | Program-for-Results | FY 2014 | Seq No: 4 | ARCHIVED on 08-Jun-2015 | ISR19035 | Implementing Agencies: Ministry of Health and Social Welfare Program Development Objectives Program Development Objective (from Program-for-Results Appraisal Document) The Program will contribute to (a) improving the health care delivery system in order to provide more equitable quality and sustainable health services to the population; (b) rationalizing the hospital network in order to streamline health care services to the population; (c) strengthening Government's capacity to develop and monitor effective health sector policies in the area of health financing, resource allocation, and provider payments; and (d) promoting effective public health interventions. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  Moderate  Moderate Implementation Status and Key Decisions The Program was approved by the World Bank (WB) Board of Directors on May 8, 2014 and declared effective on Sep 8, 2014. The hospital Master Plan was approved by Parliament on February 27, 2015. Operational plans for 2015 and 2016 are currently being finalized with input from hospitals. The Program is making progress on several DLIs. Based on the HIF's review of supporting verification evidence, it is evident that the final target of 90% for DLI 7 (% of identified doctors with whom corrective course of action has been discussed on a person-to-person basis in the preceding six months) and 50% for DLI 9 (% of PHC doctors in the country working in group practices) have been achieved ahead of schedule. 6/8/2015 Public Disclosure Copy Page 1 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P144871 IBRD-83650 Effective USD 103.50 103.50 0.00 9.39 93.15 9% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date 6/8/2015 Public Disclosure Copy Page 2 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) P144871 IBRD-83650 Effective 08-May-2014 10-Jun-2014 08-Sep-2014 30-Jun-2018 -- Disbursement Linked Indicators (DLI) PHDLIPDOTBL  1. Total number of hospital beds in Rationalized Hospitals classified as Acute Care Beds. (Number) Baseline Actual (Previous) Actual (Current) Value 15930.00 15930.00 15930.00 Date 31-Dec-2012 -- 20-Nov-2014 Comments The HIF anticipates that the target of 12,800 will be met by the end of 2015. PHDLIPDOTBL  2. Number of “hospital reshaping scheme” projects implemented (Number) Baseline Actual (Previous) Actual (Current) Value 0.00 0.00 0.00 Date 31-Dec-2012 -- 20-Nov-2014 Comments The Master Plan was approved by Parliament in February 2015, and operational plans were being finalized as of the mission in April. PHDLIPDOTBL  3. Percentage of rationalized hospitals without arrears incurred during the preceding calendar year. (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 0.00 0.00 Date 31-Dec-2012 -- 20-Nov-2014 Comments The MoH anticipates that the final target of 80 percent will be met by end-2017. PHDLIPDOTBL 4. Percentage of all surgeries included in the elective surgeries list performed as outpatient surgeries in the preceding six months. . (Percentage) Baseline Actual (Previous) Actual (Current) Value 5.00 15.00 15.00 6/8/2015 Public Disclosure Copy Page 3 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) Date 31-Dec-2012 -- 20-Nov-2014 Comments Progress on this indicator has been slower than initially anticipated despite higher payments for elective surgeries when performed on an outpatient basis. The HIF plans to sensitize hospital providers and managers to the quality and financial benefits of outpatient surgeries to increase the proportion of day surgeries. PHDLIPDOTBL 5. Percentage of best-performing rationalized hospitals which are publicly disclosed (including results) based on the technical audit in the preceding 12 months. (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 46.00 46.00 Date 31-Dec-2012 -- 20-Nov-2014 Comments This list has been publicly disclosed. Since the November mission, the HIF has revised the methodology and indicators for the technical audit and is planning a pilot with revised indicators in 3-5 hospitals with good information systems starting in September. PHDLIPDOTBL  6. Percentage of Rationalized Hospitals accredited by AQAHS through the Acceptable Accreditation Process (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 0.00 0.00 Date 31-Dec-2012 -- 20-Nov-2014 Comments AQAHS has prepared and submitted an accreditation rule book which lays out procedures and standards for accreditation and submitted it to the MoH at the end of 2014. A government decision is needed before implementation can proceed. PHDLIPDOTBL  7. Percentage of identified doctors with whom corrective course of action has been discussed on a person-to-person basis in the preceding six months. (Percentage) Baseline Actual (Previous) Actual (Current) Value 20.00 84.00 93.10 Date 31-Dec-2012 -- 17-Apr-2015 Comments Based on the HIF's review of evidence, the final target for this indicator has been met. 6/8/2015 Public Disclosure Copy Page 4 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) PHDLIPDOTBL  8. Percentage of total public spending per fiscal year on medical consumables, drugs, and devices for hospital (in and outpatient) services made through centralized procurement and disclosed (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 30.00 30.00 Date 31-Dec-2012 -- 20-Nov-2014 Comments There has been good progress on this DLI. As of April, the MoH was compiling the verification evidence on this indicator. PHDLIPDOTBL  9. Percentage of primary health care doctors in the Republic of Croatia working in group practices (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 62.25 65.11 Date 31-Dec-2012 -- 14-May-2015 Comments Based on the HIF's review of the evidence, the final target of 50 percent of this indicator has been surpassed. PHDLIPDOTBL  10. Percentage of hospitals with surgery wards that have established quality- and safety-related sentinel surveillance schemes thatare reporting the rates of specific events (Percentage) Baseline Actual (Previous) Actual (Current) Value 0.00 31.50 53.30 Date 31-Dec-2012 -- 17-Apr-2015 Comments Hospitals are self-reporting on sentinel events including a list of 13 that the MoH has developed and two of the three events specified in the DLI as tracers (i.e., on wrong site/ wrong patient surgery and postoperative pulmonary embolism & deep vein thrombosis). Non-traumatic diabetes- related lower-limb amputations are not yet part of the reporting, but will be extracted from the diabetes registry and included in monitoring starting in June 2015. These data are submitted by hospitals via a web platform since December 2014 and published online on the AQAHS website. Hospital participation in the sentinel surveillance reporting has increased to 16 of 30 hospitals. Results Results Area Intermediate Results Area Project Development Objective Indicators 6/8/2015 Public Disclosure Copy Page 5 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) PHINDPDOTBL  First phase of the hospital master plan achieved: Total number of hospital beds in Rationalized Hospitals a classified as acute care beds (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15930.00 15930.00 15930.00 12800.00 Date 31-Dec-2012 20-Nov-2014 20-Nov-2014 31-Dec-2017 PHINDPDOTBL  First phase of the hospital master plan achieved: Percentage of rationalized hospitals without arrears incurred during the preceding calendar year (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 31-Dec-2012 20-Nov-2014 20-Nov-2014 31-Dec-2017 PHINDPDOTBL  Quality control procedures in place: Percentage of best-performing rationalized hospitals which are publicly disclosed (including results) based on the technical audit in the preceding 12 months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 46.00 53.30 40.00 Date 31-Dec-2012 -- 10-Apr-2015 31-Dec-2017 PHINDPDOTBL  Quality control procedures in place: Percentage of Rationalized Hospitals accredited by AQAHS through the Acceptable Accreditation Process (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 31-Dec-2012 20-Nov-2014 20-Nov-2014 31-Dec-2017 Overall Comments Intermediate Results Indicators 6/8/2015 Public Disclosure Copy Page 6 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) PHINDIRITBL  1. Ratio between primary health care/secondary outpatient care/ and hospital inpatient care services (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Ratio 58 / 18 / 1 58/18/1 58/18/1 90 / 19 / 1 Date 31-Dec-2012 20-Nov-2014 20-Nov-2014 30-Dec-2017 PHINDIRITBL  2. Number of “hospital reshaping scheme” projects implemented (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 31-Dec-2012 20-Nov-2014 20-Nov-2014 31-Dec-2017 PHINDIRITBL 3. Percentage of all surgeries included in the elective surgeries list performed as outpatient surgeries in the preceding six months. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 15.00 15.00 60.00 Date 31-Dec-2012 20-Nov-2014 20-Nov-2014 31-Dec-2017 PHINDIRITBL  4.Number of clinical guidelines with specific protocols for most prevalent NCDs (including care pathways). (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20.00 Date 31-Dec-2012 20-Nov-2014 20-Nov-2014 24-Dec-2017 PHINDIRITBL  5. Number of Primary Health Care doctors re-trained in updated clinical protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4000.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL  6. Percentage of primary health care doctors working in group practices (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/8/2015 Public Disclosure Copy Page 7 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) Value 0.00 62.25 62.25 50.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL  7. Percentage of Primary Health Care group practices achieving performance indicators and accessing to payment incentives. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL  8. Percentage of identified doctors a with whom corrective course of action has been discussed on a person-to-person basis in the preceding six months. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 84.00 84.00 90.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL 9. Percentage of total public spending per fiscal year on medical consumables, drugs, and devices for hospital (inpatient and outpatient) services made through centralized procurement/ framework contr (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 30.00 30.00 60.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL  10. Number of counties implementing specialized services on palliative care. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.00 1.00 15.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL 11. Number of proposals for EU structural funds accepted by the relevant authority after being correctly submitted. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 8.00 6/8/2015 Public Disclosure Copy Page 8 of 9 Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Quality and Efficiency Improvement (P144871) Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL  12. Percentage of Nosocomial Infections Surveillance system in place in tertiary hospitals and secondary hospitals. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL  13. Percentage of hospitals with surgery wards that have established quality-and safety-related sentinel surveillance schemes that are reporting the rates of specific events. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 31.50 31.50 60.00 Date -- 20-Nov-2014 20-Nov-2014 -- PHINDIRITBL  14. Percentage of patients’ satisfaction by a perception of increased responsiveness. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.00 0.00 0.00 75.00 Date -- 20-Nov-2014 20-Nov-2014 -- Overall Comments 6/8/2015 Public Disclosure Copy Page 9 of 9