The World Bank Report No: ISR10355 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: 7 Status: ARCHIVED Archive Date: 24-May-2013 (P106619) Country: Dominican Republic Approval FY: 2010 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Adaptable Program Loan Implementing Agency(ies): 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 02-Nov-2012 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 7 The World Bank Report No: ISR10355 As of end April, 2013, the Project has disbursed US$10.6 million, representing 35 percent of the loan. The Mid-term Review (MTR) Mission in November 2012, the technical support mission in January 28-February 1, 2013, and subsequent follow-up discussions with the Project team Public Disclosure Copy found that progress has been achieved in addressing various implementation bottlenecks, contributing to improvements in results. Enrollment rates for the population to be covered by the Project through capitation payments to the Regional Health Services for an essential package of health services at the first level of care have surpassed their targets for the year 2012. Also, the Project has advanced on most key indicators and three indicators’ targets have been attained. There is, however, a need to revise the targets for most indicators to levels that the Project can realistically achieve by its closing date. A formal request for Project restructuring is expected by end May 2013. 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 13.30 50.00 population with risk evaluation completed Date 27-Jun-2011 31-Mar-2013 30-Oct-2015 before the 15th week of pregnancy. Comments Number is low due to limited Number has notably improved To be measured annually use of Clinical Management compared to last year but System (CMS) which requires continues to be low relative to doctors to follow health care target partly because protocols and enter the although use of the CMShas information electronically. improved it is still fairly limited. Source: Clinical Management The Government is trying to system address this issue. Source: Clinical Management system (CMS) Percentage of children from target population Percentage Value 0.00 35.30 60.00 under 15 months with vaccination scheme Date 27-Jun-2011 31-Mar-2013 30-Oct-2015 completed according to national protocols Comments Source: CMS Number has significantly To be measured annually Public Disclosure Copy improved but remains low relative to target and actual practice because nurses usually deal with vaccinations while only doctors have access to the CMS. The Government is trying to address this issue. Source: CMS Page 2 of 7 The World Bank Report No: ISR10355 Percentage of individuals from target Percentage Value 37.20 21.50 50.00 population diagnosed with hypertension under Date 27-Jun-2011 31-Mar-2013 30-Oct-2015 treatment according to national protocols Comments Source: Registry information Number has improved relative Public Disclosure Copy from the regional health to previous ISR but is still low services (RHS) 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 Data analysis completed, Study results used by MOH to has been conducted, disseminated and used report being written. 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 completion has promotion and prevention been delayed and is expected by May 2013. 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 29-Mar-2013 30-Oct-2015 received medication in 48 hrs Comments No monthly reports In progress. No reports yet but the consultancy on the conceptual design of the information system for medicines and hospital inputs which will facilitate the development of the reports and the reporting system has been completed and a follow- up consultancy to support the piloting of the information system in the two RBF regions will commence in the next few months. Public Disclosure Copy Intermediate Results Indicators Page 3 of 7 The World Bank Report No: ISR10355 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-2012 30-Oct-2015 Public Disclosure Copy reported MRI results Comments Source: External technical Component 1 indicator. To be based on quarterly concurrent audit Target surpassed. Number reports presented is the average for the Project pilot regions. Source: external technicalconcurrent audit percentage of post-partum women referred Percentage Value 0.44 9.37 50.00 from hospital to their corresponding first level of Date 27-Jun-2011 30-Mar-2013 30-Oct-2015 care units with proper documentation included Comments Source: CMS Component 1 indicator. in their clinical files at the health center Indicator has improved but is much lower than current implementation year target. Source: CMS Percentage of individuals from target Percentage Value 0.07 6.07 40.00 population screened for diabetes according to Date 27-Jun-2011 30-Mar-2013 30-Oct-2015 national protocol Comments Soiurce: CMs Component 1 Indicator. Indicator has improved but is much lower than target mainly due to CMS reporting. Percentage of children under 24 months with Percentage Value 0.27 20.10 60.00 growth and development monitor controls Date 27-Jun-2011 30-Mar-2013 30-Oct-2015 according to national protocol Comments Component 1 indicator. This indicator has significantly improved since 2011 although it is still lower than yearly target of 40% Percentage of children over 14 months and Percentage Value 0.00 0.27 60.00 Public Disclosure Copy under 24 months with vaccination scheme Date 27-Jun-2011 30-Mar-2013 30-Oct-2015 completed according to national protocol Comments CMS source Component 1 indicator. Indicator has only slightly improved since 2011. This is mainly because doctors tend to handle the CMS but nurses are generally responsible for providing vaccinations; there is a need to improve Page 4 of 7 The World Bank Report No: ISR10355 coordination of information/ data inputs between nurses and doctors. Percentage of individuals older than 18 years Percentage Value 0.89 48.00 40.00 Public Disclosure Copy screened for hypertension based on national Date 27-Jun-2011 30-Mar-2013 30-Oct-2015 protocols Comments CMS source Component 1 indicator. This indicator has significantly improved, exceeding its end of project target. Source: CMS percentage of individuals diagnosed with Percentage Value 0.79 11.80 40.00 diabetes type II under treatment Date 31-Oct-2011 30-Oct-2015 Comments source: CMS Component 1 indicator. Indicator has improved but less than 20% target for the year. Source: CMS Percentage of individuals symptomatic of TB Percentage Value 0.00 11.40 40.00 with results of sputum smears in clinical file of Date 27-Jun-2011 30-Mar-2013 30-Oct-2015 corresponding health center Comments source: CMS Component 1 indicator. Indicator has improved but much less than yearly target. source: CMS Studies on risk factors and burden of disease Text Value No Studies Report being drafted 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 30-Mar-2013 30-Oct-2015 Comments Component 2 indicator. Study Public Disclosure Copy results expected by May 2013. Delays since consultant who was supposed to help complete data analysis couldn't come on board on time as originally planned. Page 5 of 7 The World Bank Report No: ISR10355 The Health Management System of the MOH Text Value No module Module exists and is being Results-adjusted Capitation includes an automated/electronic module for fine-tuned based on pilot tests Module used in regions VI M&I with all the information needed for to be functional with rest of and VIII monitoring results on a quarterly basis at the modules in the HMIS Public Disclosure Copy first level of care Date 20-Aug-2009 30-Mar-2013 30-Oct-2015 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 being fine-tuned.The information module to calculate the indicators for Component 1 is already functioning. It was agreed that efforts will be made by the 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 31-Mar-2013 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 report that they have received medicines regularly from PROMESE/CAL. Data on Financial Performance (as of 06-May-2013) Financial Agreement(s) Key Dates Public Disclosure Copy 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 10.82 19.68 35.00 Disbursement Graph Page 6 of 7 The World Bank Report No: ISR10355 Public Disclosure Copy Key Decisions Regarding Implementation The Government and World Bank teams agreed to review most of the targets. The Government is expected to send its formal request to revise indicator targets and reallocate some funds from Component 1 to Component 3 by end May 2013. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. 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