Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) Health Sector Reform Second Phase APL (PARSS 2) (P106619) LATIN AMERICA AND CARIBBEAN | Dominican Republic | Health, Nutrition and Population Global Practice | IBRD/IDA | Adaptable Program Loan | FY 2010 | Seq No: 10 | ARCHIVED on 24-Dec-2014 | ISR17560 | Implementing Agencies: MINISTRY OF HEALTH, CERSS Key Dates Key Project Dates Board Approval date:17-Sep-2009 Effectiveness Date:19-Jan-2010 Planned Mid Term Review Date:26-Nov-2012 Actual Mid-Term Review Date:26-Nov-2012 Original Closing Date:30-Oct-2015 Revised Closing Date:30-Oct-2015 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 Objective? No PHRPDODEL Components Name Results-based financing mechanism for the first level of care:(Cost $21.49 M) Strengthening the capacity of the MOH:(Cost $10.00 M) Quality of public spending:(Cost $12.57 M) Response to Public Health Emergencies:(Cost $0.10 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory 12/24/2014 Page 1 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) Overall Risk Rating  --  Moderate Implementation Status and Key Decisions 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. As of mid-December 2014, the Project had disbursed US$20.8 million, representing 68 percent of the loan. The Project has demonstrated progress in its five development indicators, surpassing the annual targets for three of them (percentage of children less than 15 months with complete vaccination scheme based on national protocols; percentage of pregnant women from target population with risk evaluation completed before the 15th week of pregnancy; and percentage of individuals from target population diagnosed with hypertension under treatment according to national protocols) and meeting/exceeding annual targets for five of its 11 intermediate indicators: (a) Percentage of children over 14 months and under 24 months with vaccination scheme completed according to national protocol; (b) Percentage of individuals from target population screened for diabetes according to national protocol, (c) Percentage of individuals diagnosed with diabetes type II under treatment; (d) percentage of clinical files that have complete information for the external audit to verify regional health services results; and (e) 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 medicines procured and distributed by PROMESE/CAL on a regular basis. End of Project targets have already been achieved for the latter two indicators. The Bank recently approved the Government's request to activate the Public Emergency Response Component to support activities to strengthen its capacity to prevent and control Ebola. 12/24/2014 Page 2 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  --  Moderate Macroeconomic  --  --  Substantial Sector Strategies and Policies  --  --  Moderate Technical Design of Project or Program  --  --  Substantial Institutional Capacity for Implementation and Sustainability  --  --  Moderate Fiduciary  --  --  Moderate Environment and Social  --  --  Low Stakeholders  --  --  Low Other  --  --  -- Overall  --  --  Moderate Results Project Development Objective Indicators PHINDPDOTBL  Percentage of pregnant women from target population with risk evaluation completed before the 15th week of pregnancy. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.43 18.83 33.00 40.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Surpassed 2014 annual target of 30% PHINDPDOTBL  Percentage of children from target population under 15 months with vaccination scheme completed according to national protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 46.70 63.00 60.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 12/24/2014 Page 3 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) Comments Surpassed 2014 annual target of 50% and end of Project target of 60% PHINDPDOTBL  Percentage of individuals from target population diagnosed with hypertension under treatment according to national protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 37.20 22.47 26.00 35.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Surpassed 2014 annual target of 25% PHINDPDOTBL  Studies on risk factors and burden of disease has been conducted, disseminated and used by corresponding MOH units (salud colectiva) to develop operational plans for health promotion and prevention (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Baseline sudy Study results Study results being used completed and results used by MOH Value 0 by regional health shared with more MOH to develop services in planning units. annual plans Date 20-Aug-2009 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Progress made with regional health services using the study results for planning. Results shared with certain MOH units who will be using the results for planning. PHINDPDOTBL  At least 1 region is producing reports every 4 months on no. of poor individuals who were prescribed a medicine (from essential medicines list) at the 1st level of care & received medication in 48 hrs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target at least one region is Value 0 0 0 producing reports every 4 months 12/24/2014 Page 4 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) Date 20-Aug-2009 30-Aug-2013 31-Aug-2014 30-Oct-2015 Comments Two regions are piloting the information system and reports are expected to be formally generated next calendar year. Overall Comments Intermediate Results Indicators PHINDIRITBL  Percentage of clinical files with complete information for external audit to verify RHS reported MRI results (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 92.00 95.00 85.00 Date 20-Aug-2009 31-Dec-2013 01-Aug-2014 30-Oct-2015 Comments Surpassed annual target and end of Project target PHINDIRITBL  percentage of post-partum women referred from hospital to their corresponding first level of care units with proper documentation included in their clinical files at the health center (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.44 13.11 36.00 50.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments On track: 36% in August 2014 compared to annual target of 40% 12/24/2014 Page 5 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) PHINDIRITBL  Percentage of individuals from target population screened for diabetes according to national protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.07 15.74 21.00 35.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Surpassed annual target of 20% PHINDIRITBL  Percentage of children under 24 months with growth and development monitor controls according to national protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.27 25.88 25.00 50.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Progress in August 2014 already almost equal to progress made in end of 2013. PHINDIRITBL  Percentage of children over 14 months and under 24 months with vaccination scheme completed according to national protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.20 42.00 45.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Surpassed annual target of 35% 12/24/2014 Page 6 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) PHINDIRITBL  Percentage of individuals older than 18 years screened for hypertension based on national protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.89 45.24 46.00 60.00 Date 27-Jun-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 PHINDIRITBL  percentage of individuals diagnosed with diabetes type II under treatment (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.79 17.40 20.00 30.00 Date 31-Oct-2011 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Met 2014 target of 20% in August 2014 PHINDIRITBL  Percentage of individuals symptomatic of TB with results of sputum smears in clinical file of corresponding health center (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18.97 20.00 25.00 Date 31-Dec-2013 31-Dec-2013 30-Aug-2014 30-Oct-2015 Comments On track: 20% in August 2014 compared with 25% 2014 annual target PHINDIRITBL  Studies on risk factors and burden of disease surveys designed, implemented, results disseminated and used for planning public health interventions with an emphasis on health promotion and prevention. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Studies' results completed and Regional health services disseminated Report completed and using the results for and used for Value No Studies results shared with planning and planning public more MOH units programming health health services. interventions with an 12/24/2014 Page 7 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) emphasis on health promotion and prevention. Date 20-Aug-2009 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Study results being used by Regional Health Services. Results disseminated to certain MOH units and will be used by MOH Directorate of Collective Health PHINDIRITBL  The Health Management System of the MOH includes an automated/electronic module for M&I with all the information needed for monitoring results on a quarterly basis at the first level of care (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Module design Module being adjusted Results- completed and is being based on pilots in the adjusted finetuned to improve its Regional Health Capitation Value No module interoperability with Services that are Module used in rest of Health MIS participating in the regions VI and modules. Project. VIII Date 20-Aug-2009 31-Dec-2013 01-Aug-2014 30-Oct-2015 PHINDIRITBL  Percentage of accredited health centers from participating RHS that do not have a PROMESE/CAL pharmacy and receive on a regular basis medicines procured and distributed by PROMESE/CAL (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0 100 100 80 Date 20-Aug-2009 31-Dec-2013 31-Aug-2014 30-Oct-2015 Comments Surpassed annual and end of Project targets Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed 12/24/2014 Page 8 of 9 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Reform Second Phase APL (PARSS 2) (P106619) P106619 IBRD-77770 Effective USD 30.50 30.50 0.00 20.97 9.53 69% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P106619 IBRD-77770 Effective 17-Sep-2009 30-Oct-2009 19-Jan-2010 30-Oct-2015 30-Oct-2015 Cumulative Disbursements Restructuring History Level 2 Approved on 30-Jun-2014 Related Project(s) There are no related projects. 12/24/2014 Page 9 of 9 Public Disclosure Copy