HEALTH RESULTS-BASED FINANCING PROJECT
IDA GRANT NUMBER TF01 3310
IMPLEMENTED BY
RESULT-BASED FINANCING SECRETARIAT UNIT
UNDER THE MINISTRY OF HEALTH
OF THE KYRGYZ REPUBLIC
SPECIAL PURPOSE PROJECT FINANCIAL STATEMENTS
AND
INDEPENDENT AUDITOR'S REPORT
For the year ended 31 December 2017
BISHKEK
June 2018
HEALTH RESULTS-BASED FINANCING PROJECT
IDA GRANT NUMBER TF013310
TABLE OF CONTENTS
Page
STATEMENT OF MANAGEMENT'S RESPONSIBILITIES FOR THE PREPARATION
AND PRESENTATION OF THE SPECIAL PURPOSE FINANCIAL STATEMENTS 3
INDEPENDENT AUDITOR'S REPORT 4-5
SPECIAL PURPOSE FINANCIAL STATEMENTS
For the year ended 31 December 2017:
Statement of cash receipts and payments 6
Statement of expenditures per components 7
Notes to the special purpose financial statements 8-13
ANNEX 1. RECONCILIATION BETWEEN THE AMOUNTS SUBMITTED BY RBF SECRETARIAT AND DISBURSED
BY THE WORLD BANK 14
2
STATEMENT OF MANAGEMENT'S RESPONSIBILITIES FOR THE PREPARATION
AND PRESENTATION OF THE SPECIAL PURPOSE FINANCIAL STATEMENTS
The management of the RBF Secretariat under the Ministry of Health of Kyrgyz Republic (hereafter:
RBF Secretariat) is responsible for the preparation of the special purpose financial statements of
Health Results-Based Financing Project (hereafter: the Project) financed by IDA Grant Number
TF013310 that present fairly the Project's cash receipts and payments, expenditures per
components for the year ended 31 December 2017, in compliance with the International Public
Sector Accounting Standard "Financial Reporting under the Cash Basis of Accounting" (IPSAS-Cash
Basis) issued by the International Public Sector Accounting Standards Board (IPSASB) within the
International Federation of Accountants (IFAC) and the Financial Management Manual for World
Bank Financed Investment Operations (WB Guidelines).
In preparing the special purpose project financial statements, PIU's management is responsible for:
* Property selecting and applying accounting policies;
* Presenting information, including accounting policies, in a manner that provides relevant,
reliable, comparable and understandable information;
* Providing additional required disclosures for the year ended 31 December 2017.
PIU's Management is also responsible for:
* Designing, implementing and maintaining an effective and sound system of internal controls,
throughout the Project;
* Maintaining adequate accounting records that are sufficient to show and explain the Project's
transactions, and which enable them to ensure that the special purpose financial statements
of the Project comply with IPSAS - Cash Basis and the WB Guidelines;
* Taking such steps that are reasonably available to them to safeguard the assets of the Project
and to affirm that funds received have been used in accordance with the IDA Grant Number
TF013310 dated 30 December 2013, and World Bank related guidelines, with due attention to
economy and efficiency, and only for the purposes for which the financing was provided; and
* Preventing and detecting fraud and other errors.
The special purpose financial statemen for the year ended 31 December 2017 were authorized for
issue on 12 June 2018 by RBF Secret t un the Ministry of Health of Kyrgyz Republic.
___'Z aev Kosmosbek
Mi ster of Health of the Kyrgyz Republic
Oskombaeva Kara Esengul Kanatbek
Director Finance Manager
RBF Secretariat RBF Secretariat
3
Tel: +37410 528899 10 V. Sargsyan str.,
E-mail: bdo@bdoarmenia.am Office 114,
www.bdoarmenia.am Yerevan, Armenia
INDEPENDENT AUDITOR'S REPORT
To the Ministry of Health of the Kyrgyz Republic
Opinion
We have audited the special purpose financial statements of "Health Results-Based Financing
Project" ("Project") financed by Financing Agreement IDA Grant Number TF013310 dated 30
December 2013 ("Grant Agreement"), and implemented by RBF Secretariat under the Ministry of
Health of Kyrgyz Republic ("RBF Secretariat"), which comprise the statement of cash receipts and
payments and the statement of expenditures per components for the year ended 31 December 2017,
and notes to the special purpose financial statements, including a summary of significant accounting
policies.
In our opinion,
1. the accompanying financial statements present fairly, in all material respects, the cash
flows for the year ended 31 December 2017 in accordance with International Public Sector
Accounting Standard: Financial Reporting Under the Cash Basis of Accounting, (IPSAS-Cash
Basis);
2. funds have been used in accordance with the conditions of the Grant Agreement concluded
between the International Development Association (IDA) and the Kyrgyz Republic, and WB
Guidelines, with due attention to economy and efficiency, and only for the purposes for
which the financing was provided;
3. supporting documents, records and accounts have been maintained to support claims for
reimbursement of expenditures incurred. Expenditures included in the withdrawal
applications and reimbursed against are eligible for financing under the Grant Agreement;
Interim Unaudited Financial Statements (IFSs) issued by RBF Secretariat during the reporting
year are in agreement with the underlying books of account;
4. The Designated account used has been maintained in accordance with the provision of the
Grant Agreement, and World Bank related guidelines;
5. Goods and Services financed have been procured in accordance with the Grant Agreement
and World Bank related guidelines;
6. Financial covenants in the Part B of the Section II of the Schedule 2 of the Grant Agreement
were complied.
Basis for Opinion
We conducted our audit in accordance with International Standards on Auditing (ISAs) as issued by
International Auditing and Assurance Standards Board (IAASB) of the International Federation of
Accountants (IFAC). Our responsibilities under those standards are further described in the Auditor's
Responsibilities for the Audit of the Financial Statements section of our report.
We are independent of the Project and of the RBF Secretariat in accordance with the International
Ethics Standards Board for Accountants' Code of Ethics for Professional Accountants (IESBA Code),
and we have fulfilled our other ethical requirements in accordance with IESBA Code. We believe
that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our
opinion.
Emphasis of matter - low disbursement level
Without qualifying our opinion, we draw your attention to Note 7 of these special purpose financial
statements disclosing that though the Project closing date is extended from 30 June 2017 to 31
December 2018, cumulative expenditure accounts to only 59% of the Project total budget as at 31
December 2017; and the measures taken by the management of the RBF Secretariat.
Emphasis of Matter- Cash Basis of Accounting
We draw attention to Note 2 to the financial statements, which describes that financial statements
are prepared in accordance with cash basis framework, as a result, they may not be suitable for
another purposes. Our opinion is not modified in respect of this matter.
8DO Armenia cjsc, is a member of BDO international Limited, a UK company limited by guarantee, and forms part of the internationaL BDO network of
independent member firms.
Responsibilities of the Management for the Financial Statements
Management of the RBF Secretariat is responsible for the preparation and fair presentation of the
special purpose financial statements in accordance with IPSAS-Cash Basis issued by the International
Public Sector Accounting Standards Board (IPSASB) of the IFAC and Financial Management Manual for
World Bank Financed Investment Operations ("WB Guidelines"), and for such internal control as
management determines is necessary to enable the preparation of special purpose financial
statements that are free from material misstatement, whether due to fraud or error.
Auditor's Responsibility for the Audit of the Special Purpose Financial Statements
Our objectives are to obtain reasonable assurance about whether the special purpose financial
statements as a whole are free from material misstatement, whether due to fraud or error, and to
issue an auditor's report that includes our opinion. Reasonable assurance is high level of assurance,
but is not a guaranty that an audit conducted in accordance with ISAs will always detect a material
misstatement when it exists. Misstatements arise from fraud and error and are considered material
if, individually or in the aggregate, they could reasonably be expected to influence the economic
decisions of users taken on the basis of these special purpose financial statements.
As part of an audit in accordance with ISAs, we exercise professional judgement and maintain
professional skepticism throughout the audit. We also:
* Identify and assess the risks of material misstatement of the special purpose financial
statements, whether due to fraud or error, design and perform audit procedures responsive
to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis
for our opinion. The risk of not detecting a material misstatement resulting from fraud is
higher than for one resulting from error, as fraud may involve collusion, forgery, intentional
omissions, misrepresentations, or the override of internal control.
* Obtain an understanding of internal control relevant to the audit in order to design audit
procedures that are appropriate in the circumstances, but not for the purpose of expressing
an opinion on the effectiveness of the internal control.
* Evaluate the appropriateness of accounting policies used and the reasonableness of
accounting estimates and related disclosures made by management.
* Evaluate the overall presentation, structure and content of the special purpose financial
statements, including the disclosures, and whether the special purpose financial statements
represent the underlying transactions and events in a manner that achieves fair
presentation.
We communicate with management regarding, among other matters, the planned scope and timing
of the audit and significant audit findings, including any significant deficiencies in internal control
that we identify during our audit.
"BDO Armenia" CJSC
12 June 2018 bII
o 4 hachatryan, FCCA
A-6 'agement Partner
"IWO ARKENIA" rl
14 01569792 0
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Health Results-Based Financing Project
IDA Grant Number TF01 3310
Notes to the special purpose financial statements
For the year ended 31 December 2017
1. General information
1. 1. The Project
The Grant Agreement IDA Grant TF013310 was concluded on 30 December 2013 between the Kyrgyz
Republic and the International Development Association (IDA), according to which IDA, acting as
administrator of grant funds provided by the Mutti-Donor Trust Fund for Health Results Innovation,
provided financing in the amount of 11,000,000 United States dollars (USD) for the implementation
of "Health Results-Based Financing Project" (the Project).
The Project became effective on 29 July 2014.
The Closing date of the IDA Grant Number TF01 3310 is set 31 December 2018 (as updated).
The Grace Period for submitting withdrawal application for expenditures incurred before the Closing
date is four months following the Closing dates: 30 April 2019 (as updated).
1.2. The Project objectives
The objectives of the Project are:
1. to pilot performance-based payments and enhanced supervision for quality of maternal and
neonatal care in randomly selected rayon hospitals; and
2. to strengthen the Recipient's and healthcare providers' capacity in performance- based
contracting and monitoring and evaluating for results.
The Project consists of the following parts:
Part 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Health Care
(a) Conducting a randomized controlled trial at the rayon hospital level
(b) Supporting Incremental Operating Costs of MHIF to manage performance- based contracts
with health facilities.
Part 2: Strengthen the Government's and Health Care Providers' Capacity in Performance- Based
Payment Reform and Monitoring and Evaluation for Results
(a) Improving the capacity of MOH and MHIF through provision of technical assistance,
(b) Improving the capacity of Participating Providers through provision of technical assistance
and training,
(c) Supporting Project coordination, implementation, management and monitoring through the
provision of training, goods, and financing of MOH Incremental Operating Costs.
1.3. The Project Budget and Financing
The Project is 100% financed (inclusive of taxes) by IDA Grant Number TF013310.
Category IDA Grant Number Total
TF013310
USD USD
(1) Incentive Payments to Participating
Providers under Part 1 of the Project 8,832,230. 8,832,230
(2) Goods, Consultant Services, Incremental
Operating Costs, and Training 2,167,770 2,167,770
Total _11,000,000 1,000,000
8
Health Results-Based Financing Project
IDA Grant Number TF01 3310
Notes to the special purpose financial statements
For the year ended 31 December 2017
1.4. Project Implementation
The Ministry of Health of the Republic of Kyrgyzstan (MOH) established the RBF Secretariat to
ensure the project implementation with the following functions:
(i) providing day-to-day implementation and management of the Project, including financial
management, procurement, and fiduciary audits for service providers;
(ii) participating as observers during peer verification;
(iii) assessing the validity of reported data to ensure accuracy and reduce the ikelihood of
misreporting; and
(iv) conducting counter-verification on a semi-annual basis.
For the project purposes MOH has allocated 64 health facilities for 3 groups since commencement of
the Project:
* Group 1 (21 facilities + pilot Chui hospital): use of an enhanced supervision scheme that
utilizes a Balanced Scorecard (BSC) to assess quality of care
together with a performance-based payment made against the
level of facility performance achieved on a quarterly basis;
* Group 2 (21 facilities): use of only the enhanced supervision scheme that utilizes the BSC
without performance-based payments.
* Group 3 (21 facilities): a control group of hospitals, without any involvement under the
Project.
In 2017, the Ministry of Health and WB came to an agreement to commence result based financing
to medical centers under Group 2 and 3 since quarter 2, 2017. These 42 hospitals periodically
receive intensive monitoring / enhanced review using a balanced system of indicators with a payout
of no more than 5%.
In addition, the project included Primary Health Care (PHC) health organizations. Two pilot Centers
for Family Medicine in the North and South of the country were selected for the development and
testing of RBF tools. Currently, the RBF Secretariat, together with the MHIF Foundation, is carrying
out preparatory work for the implementation of the RBF PHC across the country with a share of
government funding.
RBF Secretariat address is: room 6, Togolok Moldo Street 1, Bishkek, Kyrgyz Republic.
9
Health Results-Based Financing Project
IDA Grant Number TF01 3310
Notes to the special purpose financial statements
For the year ended 31 December 2017
2. Summary of significant accounting policies
2.1. Preparation and presentation of financial statements
The special purpose financial statements are prepared in accordance with the International Public
Sector Accounting Standard: Financial Reporting Under the Cash Basis of Accounting (IPSAS-Cash
Basis), issued by the International Public Sector Accounting Standards Board (IPSASB) within the
International Federation of Accountants (IFAC), and presented in accordance with Financial
Management Manual for World Bank Financed Investment Operations (March 2010): RM 3 - Financial
Reporting and Auditing.
The principal accounting policies applied in the preparation of these special purpose financial
statements are set out below. These policies have been consistently applied to all the periods
presented.
2.2 Cash basis of accounting
Project financing is recognised as a source of project funds when the cash is received. Project
expenditures are recognised as a use of project funds when the payments are made.
2.3 Reporting currency
The reporting currency of these special purpose financial statements is United States dollars (USD).
The expenditures made in local currency, Kyrgyz Som (KGS), are translated into USD based at the
exchange rate prevailing at the date of the transaction.
The effect of exchange rate changes on cash held on foreign currency is reported as separate line
item in the statement of cash receipts and payments.
The exchange rate defined by the National Bank of the Kyrgyz Republic is as follows:
31 December 2016: USD 1 = 69.2301 KGS.
31 December 2017: USD 1 = 68.8395 KGS
2.4. Taxes
Taxes are paid in accordance with the tax regulations of the Kyrgyz Republic.
2.5. Budget
Expenditure budget is created based on actual accumulated expenditures for the last period plus
the updated procurement plans for the Reporting year.
10
Health Results-Based Financing Project
IDA Grant Number TF013310
Notes to the special purpose financial statements
For the year ended 31 December 2017
3. Summary of Summary Reports and SOEs
Payment categories Total
Withdrawal Withdrawal
application application (1) Incentive Payments to (2) Goods, Consultant
No value date Participating Providers Services, Incremental
under Part 1 of the Operating Costs, and
Project Training
16 19.Apr.2017 564,214.28 81,737.08 645,951.36
17 25.Jul.2017 764,876.43 107,632.62 872,509.05
19 07.Dec.2017 480,007.85 66,868.51 546,876.36
Total 1,809,098.56 256,238.21 2,065,336.77
4. Statement of Designated Account
Bank account number 1013350200002170
Bank National Bank of The Kyrgyz Republic
Bank location 101 T. Umutative Street, Bishkek, Kyrgyz Republic
Currency USD
IDA Grant No. TF01 3310
Year ended 31.Dec.2017
1. Opening balance as at 1.Jan.2017 514,049
2. Add: opening discrepancy -
3. WB advance/replenishment 2,065,337
4. Less: Refund to WB from DA -
5. Present outstanding amount advanced to DA 2,579,386
6. DA closing balance as at 31.Dec.2017 655,460
7. Add: Amount of eligible expenditures paid 1,923,926
8. Less: interest earned (if credited to DA) -
9. Total advance accounted for 2,579,386
10. Closing discrepancy (5)-(9) -
11
Health Results-Based Financing Project
IDA Grant Number TF013310
Notes to the special purpose financial statements
For the year ended 31 December 2017
5. Statement of Financial Position
The Statement of Financial Position discloses assets, liabilities and net assets of the Projects as at
reporting date. It is prepared in accrual basis that is transactions are recognized when they occur
(and not only when cash is received or paid).
Note 31 Dec 2017 31 Dec 2016
USD USD
ASSETS
Cash 6 655,460 514,049
Prepayments (operating costs) - 6,037
Total assets 655,460 520,086
LIABILITIES
Payables - -
Total liabilities - -
NET ASSETS
Cumulative income
IDA Grant No. TF013310 8 7,098,970 5,018,813
7,098,970 5,018,813
Cumulative expenses
Project expenses 7 6,443,510 4,498,728
6,443,510 4,498,728
Total net assets 655,460 520,086
6. Cash
Underlying 31 Dec 2017 31 Dec 2016
Currency USD USD
Designated Account (IDA Grant TF013310) USD 655,460 514,049
655,460 514,049
12
Health Results-Based Financing Project
IDA Grant Number TF013310
Notes to the special purpose financial statements
For the year ended 31 December 2017
7. Project Expenditures budget execution
Cumulative
Expenditures Total Project
as at 31 Dec 2017 Budget Progress (a)
Category USD USD %
(1) Incentive Payments to Participating
Providers under Part 1 of the Project 5,486,449 8,832,230 62%
(2) Goods, Consultant Services, Incremental
Operating Costs, and Training 957,061 2,167,770 44%
Total 6,443,510 11,000,000 59%
(a) The Grant Agreement IDA Grant TF013310 was concluded on 30 Dec 2013 and became
effective on 29 July 2014. The incentive payments to selected medical centers
commenced from Dec 2014. On 23 June 2017 the WB extended the Project closing date
from 30 June 2017 to 31 December 2018.
Incentive disbursements to Third group of 42 medical centers, as agreed with WB,
commenced from Dec 2017. However, only 59% of the total budget is implemented as
of 31 Dec 2017. Low rate of implementation of the Project is mainly due to significant
appreciation (about 60%) of the USD against KGS between financing period and
budgeted rate.
Related to Category 1, the disbursement for 2nd quarter and 4th quarter for 2017 in the
total amount of USD 839,540 (10% of total budget for Category 1), were done only in
2018 due to some organizational issues.
Total unused amount of Category 1 as of today is USD 2,506,241, of which USD 490,000
will be paid in June 2018 based on the results of the evaluation of health organizations
for the 1st quarter of 2018. The remaining will be disbursed in the second half of 2018,
as the number of health organizations receiving RBF funds increases, and 3rd quarterly
reviews are yet to be conducted.
In addition, in 2018, the Procurement Plan includes new items for the procurement of
goods necessary for the further institutionalization of the RBF mechanism. Procurement
processes for them have already begun or are under negotiation in the World Bank.
8. Financing IDA Grant No TF013310
Reporting Cumulative as
year at 31 Dec 2017
USD USD
Advances/ (advance recovery) - 1,160,000
Direct Payments 14,820 104,970
SOE and Summary Report 2,065,337 5,834,000
Total 2,080,157 7,098,970
Total financing budget 11,000,000
Percentage of finance provided as at 31 Dec 2017 65%
9. Events after the reporting date
The application N 21, that consists expenditures relating to the reporting year in the amount of
504,539.67 USD was submitted to WB on 15 March 2018 and approved on 16 March 2018.
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Health Results-Based Financing Project
IDA Grant Number TF01 3310
ANNEX 1. RECONCILIATION BETWEEN THE AMOUNTS SUBMITTED BY THE RBF
SECRETARIAT AND DISBURSED BY THE WORLD BANK
For the year ended 31 December 2017
(Amounts are shown in US dollars)
IDA Grant TFO 13310
Expenditure Category Appl. RBF Secretariat WB Difference
(1) Incentive Payments to 16 564,214.28 564,214.28 -
Participating Providers under Part 17 764,876.43 764,876.43 -
1 of the Project 19 480,007.85 480,007.85 -
1,809,098.56 1,809,098.56
(2) Goods, Consultant Services, 16 81,737.08 81,737.08 -
Incremental Operating Costs, and
Training 17 107,632.62 107,632.62 -
19 66,868.51 66,868.51 -
18 DP 14,820.00 14,820.00 -
271,058.21 271,058.21
Total 2,080,156.77 2,080,156.77
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