Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) Health Sector Technology Transfer and Institutional Reform (P101928) EUROPE AND CENTRAL ASIA | Kazakhstan | Health, Nutrition and Population Global Practice | IBRD/IDA | Specific Investment Loan | FY 2008 | Seq No: 13 | ARCHIVED on 31-Dec-2014 | ISR17604 | Implementing Agencies: Ministry of Health and Social Development (MoHSD) Key Dates Key Project Dates Board Approval date:15-Jan-2008 Effectiveness Date:15-Dec-2008 Planned Mid Term Review Date:31-Oct-2011 Actual Mid-Term Review Date:31-Oct-2011 Original Closing Date:30-Jun-2013 Revised Closing Date:31-Dec-2015 Project Development Objectives Project Development Objective (from Project Appraisal Document) To introduce international standards and build long-term institutional capacity in MOH and related healthcare institutions in support of key health sector reforms pursued by the Government of Kazakhstan in the context of the State Health Care Reform and Development Program. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component A: Health Financing and Management:(Cost $20.20 M) Component B: Health Care Quality Improvement:(Cost $59.90 M) Component C: Reform of Medical Education and Medical Science:(Cost $9.40 M) Component D: Health Information System Development:(Cost $188.60 M) Component E: Pharmaceutical Policy Reform:(Cost $4.20 M) Component F: Food Safety and WTO Accession:(Cost $8.70 M) Component G: Project Management:(Cost $4.60 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory 12/31/2014 Page 1 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Unsatisfactory Overall Risk Rating  --  Substantial Implementation Status and Key Decisions Project continues to demonstrate notable achievements in the implementation of health sector reforms under most of its components. In particular, good results are being achieved in changing the mechanisms of paying health care organizations to stimulate efficient provision of good quality services, re-shaping the network of health facilities to better serve the needs of the population, developing processes to enhance relevance and quality of medical education, and implementing mechanisms to improve quality of healh services, such as annual accreditation of health facilities. At the same time, some delays in implementing the e-Health Development Concept and ensuring sustainability of the institutional capacity built over the life of the project will require continued attention and efforts both by the Government and the World Bank. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  --  Moderate Macroeconomic  --  --  Moderate Sector Strategies and Policies  --  --  Moderate Technical Design of Project or Program  --  --  Moderate Institutional Capacity for Implementation and Sustainability  --  --  Substantial Fiduciary  --  --  Substantial Environment and Social  --  --  Low 12/31/2014 Page 2 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) Stakeholders  --  --  Moderate Other  --  --  -- Overall  --  --  Substantial Results Project Development Objective Indicators PHINDPDOTBL  Increased funding for Primary Health Care (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 16.00 26.40 26.40 30.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments On track. PHINDPDOTBL  Improved financial risk protection as defined by reduced share of household health spending in total health expenditures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.90 27.30 27.30 30.00 Date 31-Dec-2010 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments Surpassed. PHINDPDOTBL  Master plans for capital investments, developed based on international best practice, used as a basis for capital investment allocations in at least 4 oblasts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.00 16.00 4.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments Surpassed. 16 regional hospital MP operationalized for use for capital investment through development of oblast-level 12/31/2014 Page 3 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) Prospective Plans for Health Infrastructure Development for 2015-2025. PHINDPDOTBL  At least two evidence-based disease management programs, which include incentives for health care providers and patients, developedand endorsed by the Ministry of Health (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments On track. Contract for Partnership on DMP development and implementation of 3 DMPs has been signed and being implemented. PHINDPDOTBL  Number of public health facilities accredited by national accreditation body in accordance with international standards (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 127.00 127.00 40.00 Date 31-Dec-2011 15-Aug-2014 05-Dec-2014 31-Dec-2015 Comments Surpassed. 211 health facilities at different levels (out of 227 candidate facilities) received either 4-year or 2-year accreditation certificates in 2014. PHINDPDOTBL  ICT standards, which conform with international standards and include interoperability standards, are endorsed by Health ICT Regulatory Body and published (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No standards 12 12 25 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 12/31/2014 Page 4 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) Comments 12 basic e-health standards approved, and 3 developed and awaiting approval Overall Comments Intermediate Results Indicators PHINDIRITBL  Increased capacity for health policy analysis (as measured by number of national analytical reports produced annually) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 4.00 4.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 PHINDIRITBL  NHA reports produced annually, disaggregated by national and sub-national levels, and disseminated among key stakeholders (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Y Y Y Y Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 PHINDIRITBL  New network planning tools and new facility standards formally adopted by the Ministry of Health (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target New network planning New network planning New tools and tools and standards for tools and standards for standards for laboratories and PHC laboratories and PHC planning New hospital planning facilities reflected in the facilities reflected in the hospitals, Value tools and standards new state standard of new state standard of laboratory and developed health facilitynetwork health facilitynetwork PHC facilities (GoK decree #114 (GoK decree #114 dated formally dated Feb.19, 2014). Feb.19, 2014). adopted Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 12/31/2014 Page 5 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) PHINDIRITBL  Master plans for capital investments developed for 16 regions based on international best practice (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 16.00 16.00 16.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments In addition to 16 master plans for hospitals, 16 master plans for PHC and 16 for lab service have been developed. PHINDIRITBL  Oblast-level health network master plans endorsed for at least 4 oblasts (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.00 15.00 4.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments Regional health facility network development plans for 2015-2025 were prepared and endorsed by 15 regional authorities. PHINDIRITBL  Evidence-based incentives for providers in disease management programs implemented (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Optimized set of evidence- based Evidence-based Evidence-based incentives and No evidence-based incentives for providers incentives for providers Value pay-for- incentives for providers not yet implemented in not yet implemented in performance practice. practice. mechanisms for providers implemented Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments The target for 2014 will not be fully achieved because of delay in implementation of DMPs due to a late start. 12/31/2014 Page 6 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) PHINDIRITBL  Incentives introduced, including revision of co-payments, for patients to comply with diseases management programs (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Optimized set Incentives for patients Incentives for patients of incentives for Value No incentives for patients not yet implemented in not yet implemented in patients practice. practice. implemented Date 31-Dec-2011 16-Oct-2013 31-Oct-2014 31-Dec-2015 Comments The target for 2014 will not be fully achieved because of delay in implementation of DMPs due to a late start. PHINDIRITBL  Criteria, procedures and standards for accreditation of health facilities developed, adopted and implemented in line with international practice (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Criteria, procedures Criteria, procedures and and standards for standards for Accreditation accreditation of health accreditation of health criteria, Health facility accreditation Value facilities implemented facilities implemented in procedures and standards developed in line with international line with international standards practice through annual practice through annual renewed accreditation process. accreditation process. Date 31-Dec-2011 15-Aug-2014 05-Dec-2014 31-Dec-2015 Comments 211 health facilities accredited in 2014 as a result of recurring annual accreditation process based on upgraded, ISQua- endorsed inpatient and outpatient standards. PHINDIRITBL  Evidence-based CPGs for selected disease management programs developed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 3 CPGs for selected disease management CPGs for 3 CPGs for selected programs disease No CPGs for disease disease management Value developed/adapted and management management programs programs 4 CPGs other programs developed/adapted. implemented in 5 pilot implemented facilities. Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 12/31/2014 Page 7 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) PHINDIRITBL  Increase in share of voluntary blood donations by 2015 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 83.00 87.00 87.40 88.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 PHINDIRITBL  Decrease in absolute number of paid donations by 2015 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38800.00 19819.00 41933.00 33400.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments Baseline for 2011 was erroneously reported (9-month value instead of annual value) while in fact the total annual number of paid donations for that year was 48,217 (as per formal letter from the Scientific and Production Center of Transfusiology dated October 28, 2014). Therefore, the target was overestimated and will not be reached by the end of the project. Nevertheless, a significant reduction in paid donations is being achieved (45,077 in 2012, 41,933 in 2013). Data for 2014 is not yet available. PHINDIRITBL  Criteria, procedures and standards for accreditation of basic medical education programs developed, adopted and implemented in linewith international practice (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Developed draft documents for Developed draft institutional documents for accreditation of institutional accreditation Educational medical universities of medical universities programs for and specialized and specialized “General No educational programs Value accreditation of accreditation of General Medicine” of accredited General Medicine educational two medical Medicineeducational program are being universities program are being reconciled with Ministry accredited reconciled with Ministry of Education and of Education and Science. Science. Date 31-Dec-2011 15-Aug-2014 15-Aug-2014 31-Dec-2015 Comments Also, draft standards for educational programs in Pharmacy and Public Health specializations and in post-graduate medical education (residency) developed. 12/31/2014 Page 8 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) PHINDIRITBL  IT-infrastructure for deployment of UHMIS in selected oblasts developed by the Ministry of Health (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target IT infrastructure IT infrastructure IT infrastructure IT infrastructure developed developed in Value developed in 290 developed in 290 health in 140 health organizations 2,000 health health organizations organizations organizations Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments Indicator will not be achieved due to change in approach (e-Health instead of Unified Health Information System). PHINDIRITBL  Functional ICT standards in line with major international functional standards developed by Health ICT Regulatory Body (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 2 functional ICT 2 functional ICT standards in place standards in place No functional ICT 5 functional ICT Value (Electronic Health (Electronic Health standards standards Record and Electronic Record and Electronic Medical Record) Medical Record) Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments 2 functional standards approved, and one more developed and awaiting approval. 12/31/2014 Page 9 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) PHINDIRITBL  Drug price reference system for drugs included in the National Formulary Book developed and adopted by the Ministry of Health (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Reference drug prices refined Drug price reference Drug price reference Value Ceiling prices for drugs set based on system not yet in place system not yet in place implementation experience Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Comments On track. Units for drug pricing and pharmacoeconomic studies established and 10 people trained in pharmacoeconomics. PHINDIRITBL  Legal and regulatory documents related to post-processing food standards revised in accordance with international standards (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Recommendations on Tehnical activities on Tehnical activities to revision of 26 food safety implementation of HACCP system initiate implementation norms and rules, 25 HACCP system at the implementation Value of HACCP system to technical regulations, and national and industry- in food industry start in September on amendments to the Law levels started in expanded 2014. on Food Safety developed September 2014. Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 PHINDIRITBL  Project work plans, procurement plans, and budget produced and approved on an annual basis as described in the Project Operational Manual (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Y Y Y Y Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 12/31/2014 Page 10 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) PHINDIRITBL  Health personnel receiving training (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 10720.00 92293.00 92400.00 63066.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 PHINDIRITBL  Health facilities constructed, renovated, and/or equipped (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 160.00 305.00 307.00 2058.00 Date 31-Dec-2011 15-Aug-2014 31-Oct-2014 31-Dec-2015 Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P101928 IBRD-48830 Effective USD 117.70 117.70 0.00 57.08 60.62 48% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P101928 IBRD-48830 Effective 15-Jan-2008 02-Feb-2008 15-Dec-2008 30-Jun-2013 31-Dec-2015 Cumulative Disbursements 12/31/2014 Page 11 of 12 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health Sector Technology Transfer and Institutional Reform (P101928) Restructuring History Level Approved on 12-Oct-2012 Related Project(s) There are no related projects. 12/31/2014 Page 12 of 12 Public Disclosure Copy