The World Bank Report No: ISR14618 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: 9 Status: ARCHIVED Archive Date: 12-Jul-2014 (P106619) Country: Dominican Republic Approval FY: 2010 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): MINISTRY OF HEALTH, CERSS 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 27-Dec-2013 Effectiveness Date 19-Jan-2010 Revised Closing Date 30-Oct-2015 Actual Mid Term Review Date 26-Nov-2012 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 Dominican Republic Health Sector Reform APL Project was approved on September 17, 2009; signed on October 30, 2009; and became effective on January 19, 2010. Page 1 of 6 The World Bank Report No: ISR14618 As of early June 2014, the Project had disbursed US$17.57 million, representing 58 percent of the loan. The Project has demonstrated progress in its five development indicators, surpassing the annual target for one of them (percentage of children less than 15 months with complete Public Disclosure Copy vaccination scheme based on national protocols) and exceeding annual targets for 3 of its 11 intermediate indicators: (1) percentage of individuals from the target population screened for hypertension according to national protocols has exceeded its annual target; (2) percentage of clinical files that have complete information for the external audit to verify regional health services reported results and (3) the percentage of accredited health centers from participating regional health services that do not have a Program for Essential Medicines/Central Agency for Logistics (PROMESE/CAL) pharmacy that received on a regular basis medicines procured and distributed by (PROMESE/CAL). End of Project targets have already been achieved for the latter two indicators. 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 18.83 50.00 population with risk evaluation completed Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 before the 15th week of pregnancy. Comments Number is low due to limited Number has improved To be measured annually use of Clinical Management compared to last year but System (CMS) which requires continues to be low because doctors to follow health care of recent inclusion of Region protocols and enter the VII to RBF mechanism and information electronically. challenges with use of the Source: Clinical Management Clinical Management system. system Source: Clinical Management system (CMS) Percentage of children from target population Percentage Value 0.00 46.70 60.00 under 15 months with vaccination scheme Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 completed according to national protocols Comments Source: CMS Surpassed annual target of To be measured annually Public Disclosure Copy 40% Source: CMS Percentage of individuals from target Percentage Value 37.20 22.47 50.00 population diagnosed with hypertension under Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 treatment according to national protocols Comments Source: Registry information Number has improved but from the regional health lower than annual target services (RHS) because of recent inclusion of Region VII. Source: CMS Page 2 of 6 The World Bank Report No: ISR14618 Studies on risk factors and burden of disease Text Value 0 Baseline sudy completed and Study results used by MOH to has been conducted, disseminated and used results shared with more develop annual plans by corresponding MOH units (salud colectiva) MOH units. to develop operational plans for health Public Disclosure Copy Date 20-Aug-2009 31-Dec-2013 30-Oct-2015 promotion and prevention Comments No studies Plan is to expand dissemination of results so they can be incorporated systematically in MOH and regional planning. 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 30-Aug-2013 30-Oct-2015 received medication in 48 hrs Comments No monthly reports In progress. No reports yet but consultancy for the information system for medicines and medical inputs is well underway. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of clinical files with complete Percentage Value 0.00 92.00 85.00 information for external audit to verify RHS Date 20-Aug-2009 31-Dec-2013 30-Oct-2015 reported MRI results Comments Source: External technical Component 1 indicator. To be based on quarterly concurrent audit Surpassed end of Project reports target. Source: external technical concurrent audit percentage of post-partum women referred Percentage Value 0.44 13.11 50.00 from hospital to their corresponding first level of Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 Public Disclosure Copy care units with proper documentation included Comments Source: CMS Component 1 indicator. in their clinical files at the health center Indicator has improved but lower than annual target due to recent inclusion of Region VII in RBF-mechanism. Source: CMS Page 3 of 6 The World Bank Report No: ISR14618 Percentage of individuals from target Percentage Value 0.07 15.74 40.00 population screened for diabetes according to Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 national protocol Comments Source: CMS Component 1 Indicator. Public Disclosure Copy Indicator has improved but lower than target due to recent inclusion of Region VII. Percentage of children under 24 months with Percentage Value 0.27 25.88 60.00 growth and development monitor controls Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 according to national protocol Comments Component 1 indicator. This indicator has significantly improved but is less than yearly target due mainly to recent inclusion of Region VII in the Project. Percentage of children over 14 months and Percentage Value 0.00 1.20 60.00 under 24 months with vaccination scheme Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 completed according to national protocol Comments CMS source Component 1 indicator. Indicator has slightly improved but it is still much lower than annual target because of recent inclusion ofRegion VII, as well as insufficient recording of vaccinations in the CMS. However, it's performance is expected to improve becauseof actions being taken to improve coordination between doctors who use the CMS and nurses who tend to provide the vaccinations of children in this age group. Public Disclosure Copy Source: CMS Percentage of individuals older than 18 years Percentage Value 0.89 45.24 40.00 screened for hypertension based on national Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 protocols Comments CMS source Component 1 indicator. Exceeded annual target. Source: CMS Page 4 of 6 The World Bank Report No: ISR14618 percentage of individuals diagnosed with Percentage Value 0.79 17.40 40.00 diabetes type II under treatment Date 31-Oct-2011 31-Dec-2013 Comments source: CMS Component 1 indicator. Public Disclosure Copy Indicator has improved but did not achieve annual target mainly due to recent inclusion of Region VII. Source: CMS Percentage of individuals symptomatic of TB Percentage Value 0.00 18.97 40.00 with results of sputum smears in clinical file of Date 27-Jun-2011 31-Dec-2013 30-Oct-2015 corresponding health center Comments source: CMS Component 1 indicator. Indicator has improved and was close to reaching 20%.; but lower than target mainly due to recent inclusion of Region VII. source: CMS Studies on risk factors and burden of disease Text Value No Studies Report completed and results Studies' results completed surveys designed, implemented, results shared with more MOH units 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-Dec-2013 30-Oct-2015 Comments Component 2 indicator The Health Management System of the MOH Text Value No module Module design completed and Results-adjusted Capitation includes an automated/electronic module for is being finetuned to improve Module used in regions VI M&I with all the information needed for its interoperability with rest of and VIII monitoring results on a quarterly basis at the Health MIS modules. first level of care Date 20-Aug-2009 31-Dec-2013 30-Oct-2015 Comments Component 2 indicator. Public Disclosure Copy Percentage of accredited health centers from Text Value 0 100 80 participating RHS that do not have a Date 20-Aug-2009 31-Dec-2013 30-Oct-2015 PROMESE/CAL pharmacy and receive on a Comments Component 3 indicator. regular basis medicines procured and distributed by PROMESE/CAL Surpassed end of Project target Data on Financial Performance (as of 09-Jun-2014) Financial Agreement(s) Key Dates Page 5 of 6 The World Bank Report No: ISR14618 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) Public Disclosure Copy Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106619 IBRD-77770 Effective USD 30.50 30.50 0.00 17.57 12.93 58.00 Disbursement Graph Key Decisions Regarding Implementation The Project was restructured in order to: (i) align indicator targets to take into account the recent expansion of the Project to a new Region, including the updated target population estimates based on recent surveys and studies; (ii) increase the share of Project funds to cover the remaining financing needs of Component 1 to maintain continuity and quality of implementation while the Government strengthens the National Health Insurance's (SENASA) capacity; (iii) ) reallocate funds to key activities that would further allow the Public Disclosure Copy achievement of the Project's development objectives; and (iv) adjust disbursement estimates to reflect the expenditure projections based on the updated implementation plan. Restructuring History Level 2 CD Decision on 30-Jun-2014 Related Projects There are no related projects. Page 6 of 6