The World Bank Report No: ISR3159 Implementation Status & Results Dominican Republic Public Disclosure Copy Health Sector Reform Second Phase APL (PARSS 2) (P106619) Operation Name: Health Sector Reform Second Phase APL (PARSS 2) Project Stage: Implementation Seq.No: 4 Status: ARCHIVED Last Modified Date: 21-Jul-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 14-May-2012 Last Archived ISR Date 23-Feb-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 Public Disclosure Copy Quality of public spending 12.57 Response to Public Health Emergencies 0.10 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The Project has made progress in terms of establishing the remaining missing baseline data, as well as in various key processes to help it advance toward achieving its development Page 1 of 5 The World Bank Report No: ISR3159 objectives. In particular, the Project has signed the results-based service provision contracts with the Regional Health Services (RHS) in regions VI and VIII. These contracts establish the targets to be achieved by the RHS and the financing mechanisms, as well as processes to be followed upon achieving the targets. As a result, per capita disbursements Public Disclosure Copy began in March 2011 in these regions. The Project has modified the identification method of the eligible population to cover individuals who are not registered in the contributory or subsidized health insurance regimes of the Dominican Social Security System as long as they have the required documentation or are registered in the national beneficiary system (SIUBEN). The Project has also advanced in the development of information systems/tools that will allow the Project to obtain data from other systems and in this way, effectively monitor the performance of Project components, particularly Component 1. The Project has also contracted a number of consultants to strengthen the institutional capacity of Project participating entities, such as the Ministry of Health and the National Health Insurance (SENASA) and has purchased equipment and vehicles in support of the Essential Medicines Program (PROMESE/CAL) and Ministry of Health. 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 0.43 50.00 population with risk evaluation completed before the 15th week of pregnancy. Date 27-Jun-2011 27-Jun-2011 30-Oct-2015 Comments Number is low due to limited Source: Clinical Management To be measured annually use of Clinical Management system (CMS) System (CMS) which requires doctors to follow health care protocols and enter the information electronically. Source: Clinical Management system Percentage of children from target population Percentage Value 0.00 0.00 60.00 under 15 months with vaccination scheme completed according to national protocols Date 27-Jun-2011 27-Jun-2011 30-Oct-2015 Comments Source: CMS Source: CMS To be measured annually Percentage of individuals from target Percentage Value 37.20 37.20 50.00 population diagnosed with hypertension under Date 27-Jun-2011 27-Jun-2011 30-Oct-2015 Public Disclosure Copy treatment according to national protocols Comments Source: Registry information The numerator for this from the regional health indicator will eventually be services (RHS) obtained from the CMS. Page 2 of 5 The World Bank Report No: ISR3159 Indicator Name Core Unit of Measure Baseline Current End Target Studies on risk factors and burden of disease Text Value 0 0 Study results used by MOH to Public Disclosure Copy has been conducted, disseminated and used develop annual plans by corresponding MOH units (salud colectiva) Date 20-Aug-2009 27-Jun-2011 30-Oct-2015 to develop operational plans for health Comments No studies TOR for a comprehensive promotion and prevention study prepared. Request for Proposal to be issued to consulting firm under review by the Bank. Study results expected by early 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 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 Percentage of clinical files with complete Percentage Value 0.00 0.00 85.00 information for external audit to verify RHS reported MRI results Date 20-Aug-2009 27-Jun-2011 30-Oct-2015 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 not yet taken place. It is Public Disclosure Copy expected to begin September 2011. Studies on risk factors and burden of disease Text Value No Studies Proposal developed Studies' results completed surveys designed, implemented, results 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 27-Jun-2011 30-Oct-2015 Comments Component 2 indicator. RFP under review by the World Bank procurement team. Page 3 of 5 The World Bank Report No: ISR3159 Indicator Name Core Unit of Measure Baseline Current End Target The Health Management System of the MOH Text Value No module The applications for the Results-adjusted Capitation Public Disclosure Copy includes an automated/electronic module for Family Form Module (FFM) Module used in regions VI M&I with all the information needed for and for the Morbidity and VIII monitoring results on a quarterly basis at the Subsystem (CMBD) have first level of care been developed. The Clinical Management System (CMS) has been rolled out and this needs to be consolidated or linked electronically with the two other systems. Date 20-Aug-2009 27-Jun-2011 30-Oct-2015 Comments Component 2 indicator. Both the FFM and CMBD systems are installed in the MOH servers and awaiting the installation of the data line to be placed in their permanent hosting sites in the PARSS2 servers. MOH is in the process of hiring a consultant to help improve complementarity between these two systems and the CMS. Percentage of accredited health centers from Text Value 0 36 80 participating RHS that do not have a PROMESE/CAL pharmacy and receive on a Date 20-Aug-2009 27-Jun-2011 30-Oct-2015 regular basis medicines procured and Comments Component 3 indicator. PCU distributed by PROMESE/CAL is coordinating with PROMESE/CAL and RHS in Public Disclosure Copy developing action plan. Source: PROMESE/CAL registries Data on Financial Performance (as of 27-Jun-2011) 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 Page 4 of 5 The World Bank Report No: ISR3159 P106619 IBRD-77770 Effective USD 30.50 30.50 0.00 3.63 26.87 12.00 Public Disclosure Copy Disbursement Graph Key Decisions Regarding Implementation None for this implementation period. Restructuring History There has been no restructuring to date. Related Projects Public Disclosure Copy There are no related projects. Page 5 of 5