The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
REPORT NO.: RES45632
RESTRUCTURING PAPER
ON A
PROPOSED PROJECT RESTRUCTURING
OF THE
SOCIAL HEALTH INSURANCE PROJECT: IMPROVING ACCESS, QUALITY, EFFICIENCY AND FINANCIAL PROTECTION
APPROVED ON APRIL 27, 2016
TO THE
REPUBLIC OF KAZAKHSTAN
HEALTH, NUTRITION & POPULATION
EUROPE AND CENTRAL ASIA
Regional Vice President: Anna M. Bjerde
Country Director: Lilia Burunciuc
Regional Director: Fadia M. Saadah
Practice Manager/Manager: Tania Dmytraczenko
Task Team Leader(s): Carlos Marcelo Bortman, Baktybek Zhumadil
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
ABBREVIATIONS AND ACRONYMS
COVID-19 Coronavirus disease
GoK Government of Kazakhstan
IR Intermediate Results
MCH Maternal and child health
MoH Ministry of Health
MS Moderately Satisfactory
MSHI Mandatory Social Health Insurance
MTR Mid-term Review
PCR Polymerase chain reaction
PDO Project Development Objective
PHC Primary health care
PMU Project Management Unit
SARS-CoV-2 Severe Acute Respiratory Syndrome Coronavirus 2
SHIF Social Health Insurance Fund
TA Technical assistance
WHO World Health Organization
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
BASIC DATA
Product Information
Project ID Financing Instrument
P152625 Investment Project Financing
Original EA Category Current EA Category
Not Required (C) Not Required (C)
Approval Date Current Closing Date
27-Apr-2016 30-Jun-2021
Organizations
Borrower Responsible Agency
Republic of Kazakhstan Ministry of Health,Ministry of Health
Project Development Objective (PDO)
Original PDO
The proposed Project Development Objective is to improve accessibility, quality, and efficiency of health service
delivery, and reduce financial risks to the population that are caused by serious health problems.
OPS_TABLE_PDO_CURRENTPDO
Summary Status of Financing (US$, Millions)
Net
Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed
IBRD-86170 27-Apr-2016 01-Nov-2016 27-Jun-2017 30-Jun-2021 80.00 32.70 47.30
Policy Waiver(s)
Does this restructuring trigger the need for any policy waiver(s)?
No
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING
1. The Project was approved on April 27, 2016 and was declared effective on June 27, 2017. The Project has three
components: Component 1: Supporting implementation of the national mandatory Social Health Insurance system
(original cost: US$16.63 million); Component 2: Strengthening of health service delivery to support implementation
of the national mandatory Social Health Insurance system (original cost: US$62.94 million); and Component 3: Project
management, monitoring and evaluation, and communications strategy (original cost: US$10.43 million). The Ministry
of Health (MoH) has the overall responsibility for implementation and oversight of the Project. The Social Health
Insurance Fund (SHIF), a non-profit joint stock company subordinated to the Government of Kazakhstan (GoK), is one
of the beneficiaries and implementing entities for Component 1. As a beneficiary, the SHIF receives advisory services
and capacity building. As an implementing entity, the SHIF is involved in the design and implementation of
mechanisms, tools, and processes envisaged under the Project, with funding for these activities managed by the MoH.
The MoH is assisted by the Project Management Unit (PMU), a team of full-time local technical and fiduciary
consultants and support staff with experience in World Bank procedures who fulfill daily coordination, procurement,
financial management, and monitoring and evaluation functions.
Project Implementation Status
2. Progress towards achievement of the Project Development Objective (PDO). The PDO is to improve accessibility,
quality, and efficiency of health service delivery, and reduce financial risks to the population that are caused by serious
health problems. The progress towards achievement of PDO and overall implementation progress have been rated
Moderately Satisfactory or higher since April 2019. The PDO rating was upgraded to Satisfactory in April 2020 given
the smooth launch of the second phase of the Mandatory Social Health Insurance (MSHI) reform. However, the rating
was downgraded to Moderately Satisfactory, mainly given delays in initiating this proposed Project restructuring.
Satisfactory progress of health sector reforms and towards the achievement of the PDO is reflected in some of the
PDO-level indicators, while some reversal is observed in others given the impact of restrictions due to COVID-19.
Specifically, three out of five indicators (PDO 1, 4, and 5) have achieved their end-targets, while two indicators (PDO
2 and 3) recorded reversals. Specifically, the MoH/PMU annual implementation progress report for 2020 shows the
following:
a. PDO 1: Public expenditure share for primary health care (PHC) has increased to 45.2% (2019) from the baseline
of 35% (2016), surpassing the Project end target (40%).
b. PDO 2: Outpatient surgeries for selected cases1 has decreased from 31.9% (2019) to 28% (2021) from the baseline
of less than 5% (target: 40%). This decrease in the share of outpatient elective surgeries has been due to the
suspension of all routine health services for a few months during the COVID-19 lockdown periods.
c. PDO 3: Technical audits of inpatient services are under implementation, but have decreased from 26.6% (2019)
to 26.2% (2020) of all contracted inpatient services subject to technical audit (target: 30%), also due to a more
limited scope of technical audits during the pandemic.
d. PDO 4: The SHIF is fully functional based on predefined criteria. The SHIF is fully functional, as evidenced by the
fact that all six criteria as part of its functioning as the purchaser of health services under the State-Guaranteed
Benefits Package and MSHI have been satisfied: (i) the law on MSHI was adopted and relevant by-laws were
1For this indicator, the 5 most common outpatient surgical interventions were considered: removal of the umbilical hernia, local excision of the affected area of the
mammary gland, reposition of nasal bones, hydrocele, and drainage of soft tissue abscess.
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
updated; (ii) SHIF signed contracts with providers for a specific sets of services; (iii) the insurance package has
been approved (Government Decree No. 421, dated June 20, 2019) and is under implementation; (iv) SHIF
completed annual external financial audits for previous years; and (v) SHIF has positive balance between revenues
and expenses; (iv) while utilization of, and payments for, regular health services were adversely affected by the
COVID-19-related restrictions in Quarters 1 and 2 of 2020, the adjustments to payment terms and schedules
subsequently implemented by the SHIF have introduced flexibility that has allowed for the achievement of the
last criterion (health facilities received payments for services contracted by SHIF, in accordance with payment
schedules specified in their contracts).
e. PDO 5. The value of PDO indicator 5 (decline in the proportion of the bottom 40% of households incurring out-of-
pocket expenditures on health that exceed 10% of total non-food related household spending) has decreased
compared to the value of 13.7% in 2018 and, based on official data for 2019, reached 10.7%. The 2020 value for
this indicator will be available by September 2021.
3. Implementation status. Overall implementation progress is rated Moderately Satisfactory in line with the latest
Implementation Status and Results Report of April 2021. Despite the achievement of almost all intermediate results
(IR) indicators (except IR indicator 7 on implementation of unified register of human resources for health), the rating
reflects the continued delays in initiating the project restructuring and issues with implementation of several
contracts. These delays have mainly been related to the review of deliverables and payments by the MoH under a
few contracts, as well as some contractual disputes under three technical assistance (TA) contracts, with a potential
arbitration case under one of them. The MoH has also cancelled two contracts for goods under Component 2 that
were no longer relevant in the context of the COVID-19 pandemic and terminated eight contracts for goods and TA
under Components 2 and 3 because they were no longer relevant or due to violation of contractual provisions by the
suppliers/consultants. The remaining activities under all the three Components are expected to be completed by the
current closing date of June 30, 2021, except for a couple of TA contracts where additional tasks may need to be
undertaken.
4. Commitments and disbursements. As of June 3, 2021, US$32.7 million (or 40.9% of the Loan) has been disbursed, with
total (unpaid) commitments standing at US$13.3 million. Cumulative disbursements are expected to reach US$38.1
million (or 47.6%) by June 30, 2021. The remaining US$30.5 million, plus up to US$2.9 million in savings from ongoing
TA contracts, are planned to be used for the procurement of goods (medical and laboratory equipment) and fully
disbursed within 9 months, should the extension of the closing date be approved through this proposed restructuring.
Continued relevance of the Project
5. The Project continues to be highly relevant and fully aligned with “Kazakhstan-2050 Strategy: New Political Course of
the Established State” (Strategy 2050) which lays out Kazakhstan’s objective to join the top 30 most developed
economies in the Organization for Economic Co-Operation and Development by 2050. The PDO also echoes the
National Priority 2 in the National Development Plan until 2025, approved in February 2021, which calls for an
effective and efficient healthcare system. The Project is closely aligned with the 2018 Kazakhstan Systematic Country
Diagnostic and the FY2020-25 Country Partnership Framework, under Focus Area 2: Strengthening Human Capital
pursues Objective 5: Increase Access to Quality Health Services and Social Protection. In the context of the COVID-19
pandemic, the Project’s high relevance is reflected in the fact that it helped ensure access to quality intensive care
services by efficiently procuring the much-needed life-saving equipment. Also, as part of this proposed restructuring,
the Project would enhance quality and efficiency of laboratory diagnostic services as well as improve access to and
quality of maternal and child health (MCH) and intensive care services, as detailed in subsequent paragraphs.
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
Rationale for restructuring
6. An outbreak of the COVID-19 caused by the 2019 novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-
2) has been spreading rapidly across the world since December 2019. Since the beginning of March 2020, the number
of cases outside China has grown exponentially and the crisis has reached global scale. On March 11, 2020, the World
Health Organization (WHO) declared a global pandemic as the coronavirus rapidly spreads across the world. As of
June 3, 2021, the outbreak has resulted in an estimated 171,771,486 cases and 3,693,509 deaths in 192 countries.2The
COVID-19 pandemic has placed a renewed focus on the unfinished agenda of communicable diseases, while also
highlighting the urgent need to strengthen epidemiological surveillance, preparedness, and response to emerging
public health threats.
7. The first cases of COVID-19 were registered in Kazakhstan on March 13, 2020, and a national lockdown was imposed
on March 16, 2020 through a Presidential Decree. As of June 1, 2021, the number of registered cases that tested
positive for COVID-19 through a polymerase chain reaction (PCR) test reached a total of 390,376, of which 362,018
patients have recovered and 4,007 patients have died. In addition, out of an additional 55,477 cases with symptoms
similar to COVID-19 but negative test results, 51,457 patients have recovered, and 3,376 patients have died.
8. In response to a request from the MoH dated March 16, 2020 and to address the threats posed by the COVID-19
pandemic, the Bank and MoH have adjusted the procurement plan to direct US$27.6 million under the Project for the
COVID-19 response. This was done without a restructuring because the Project, as designed, already included
activities to strengthen public health and emergency medical services. Flexibilities offered by streamlined
procurement procedures triggered by the emergency situation were also effectively used to ensure timely and
adequate response to the pandemic. This has enabled the MoH to successfully procure 491 mechanical ventilators
and 87 kinetic therapy devices for a total of US$22 million. The remaining US$5.6 million is reserved for any additional
potential emergency procurement needs and has not been utilized so far. Upon their phased delivery, the procured
devices are distributed to hospitals across the whole country. Albeit with substantial delays due to supply chain
disruptions, to date, all the 491 ventilators and 87 kinetic therapy devices have been delivered and distributed to
hospitals, with 251 of the ventilators having not yet been formally accepted and/or paid by the MoH.
9. Kazakhstan’s COVID-19 vaccination campaign began on February 1, 2021 with priority groups specified in the national
vaccination plan.3 Currently, Kazakhstan’s main source of the COVID-19 vaccine is from Russia (Sputnik V vaccine).
Kazakhstan has a bilateral agreement with Russia for approximately 5.1 million doses. The initial batches of 22,000
and 80,000 doses were delivered from Russia, while an additional 2 million doses are being produced at Kazakhstan’s
Karaganda Pharmaceutical Plant, with plans to purchase an additional 3 million doses. These quantities are be
delivered in phases from Russia and the Karaganda Pharmaceutical Plant. In addition to Sputnik V, two local vaccine
candidates are currently undergoing clinical trials, with 100,000 doses of one of them (QazCovid-In vaccine) already
produced and distributed to the regions as of early May 2021. Kazakhstan has also received 1 million doses of
Sinopharm’s Hayat-Vax vaccine produced in United Arab Emirates and 500,000 doses of Sinovac’s CoronaVac vaccine.
Finally, the MoH is also negotiating the purchase of the Pfizer, AstraZeneca, Moderna, and Johnson & Johnson
vaccines. It is planned to vaccinate a total of 9.9 million (or 52.4 percent) of the total population by September 2021.
2Johns Hopkins University. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
3 Originally specified target groups included (in order of priority) health workers; teachers; local police officers; students; personnel and contingent of medical, social
and closed children's institutions; employees of the emergency situations service, ministries of defense, internal affairs, the Committee national security, State Security
Service of the Republic of Kazakhstan; contingent of the Administrative Department of the President of the Republic of Kazakhstan, civil servants, citizens of the Republic
Kazakhstan, who are employees of diplomatic and consular institutions accredited in Kazakhstan, members of national teams; and persons with chronic diseases
(diabetes mellitus, chronic obstructive pulmonary disease, of cardio-vascular system).
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
As of June 3, 2021, 2,158,946 people have received the first dose of the COVID-19 vaccine; while 1,117,972 have
received both doses, which represents 6% of the total population.
10. The GoK through letter # 005-DG/11751-I from the Ministry of Finance dated June 2, 2021 requested a 9-month
extension of the Loan Closing Date and a reallocation of the Loan funds among withdrawal categories to finance
additional medical equipment. The new equipment proposed to be procured as part of this restructuring to support
the existing activities under Component 2 is necessitated by emerging national priorities. Specifically, in terms of the
proposed laboratory equipment, the State Health Care Development Program of the Republic of Kazakhstan for 2020-
2025 envisages the enhancement of biological safety of laboratories for sanitary and epidemiological examination,
their provision with modern equipment, and development of a biomedical research market, including the conduct of
international and multi-center research. Therefore, equipping the National Scientific Center for Especially Dangerous
Infections with a new-generation genetic sequencer and automated systems (robotic stations) for isolation of DNA,
RNA, proteins and cells will increase the diagnostic accuracy, efficiency, and capacity and improve the quality of
laboratory studies. This will strengthen active epidemiological surveillance of various infectious diseases (COVID-19,
influenza viruses, enteroviruses) and PCR diagnostics of especially dangerous infections, thereby also contributing to
efficiency, quality, and capacity of the health system in general.
11. Along with this, MCH issues and quality of intensive care are gaining special social significance in Kazakhstan. MCH is
reflected as a high priority in all key national and sectoral strategies, including the long-term Strategy 2050 and the
State Health Care Development Program of the Republic of Kazakhstan for 2020-2025. Since Kazakhstan’s move to
the WHO-recommended criteria of live births and stillbirth in 2008-2010, the country has three-tier system of
maternal and neonatal care. Full-fledged implementation of this system had required mobilization of the best human
resources and modern equipment to enable provision of high-quality specialized care for small-for-date newborns
and complicated pregnancies. However, simultaneous provision of the necessary equipment to all MCH facilities
proved challenging for a long period of time. The President of Kazakhstan’s recent instruction to “undertake effective
measures to improve the quality of and access to health services, including to reduce the regional disbalances in
indicators of population’s health, especially in terms of maternal and infant mortality, which substantially exceed the
level of developed countries” provided an additional impetus to strengthen MCH and intensive care services.
Therefore, the protection of the health of women and children, as well as the delivery of quality and timely intensive
care have become critical areas of engagement for health authorities and health facilities in the country. Such
engagement is focused on the provision of accessible and qualified obstetrical and neonatal services and aimed at
reductions of maternal and perinatal deaths, given that exactly these indicators have the potential of substantially
influencing Kazakhstan’s future demographic situation.
12. Taking into account the remaining funds available and limited timeframe until the proposed revised closing date of
the Project, only tertiary-care institutions at the republican level providing MCH and intensive care services will be
prioritized for the provision of the necessary equipment. A comprehensive assessment of needs is currently being
conducted. The strengthening of the institutions providing MCH and intensive care services at the republican level
would enhance their role as lead institutions in their respective areas, which has lost its significance over the past
years due to the overall inadequate level and significant wear and tear of equipment and quality of human resources
available. More specifically, the proposed procurement of equipment for MCH and intensive care services will: (a)
improve access to and quality of MCH services; (b) introduce innovative health technologies into obstetrical and
neonatal practice; (c) institutionalize obstetrical and neonatal services; (d) strengthen the role of tertiary-level
research institutions at the republican level in the development of scientific and methodological bases of the health
sector; (e) enhance the effectiveness of supervisory role of the tertiary-level research institutions vis-à-vis regional
health facilities; and (f) improve the situation with maternal and infant mortality.
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
II. DESCRIPTION OF PROPOSED CHANGES
13. This is the second restructuring that seeks (i) a reallocation between disbursement categories to enable full
utilization of the currently uncommitted loan amount; (ii) a nine-month extension of the Project closing date from
June 30, 2021 to March 31, 2022 to allow for the initiation and completion of new processes to procure the
necessary laboratory and medical equipment; and (iii) adjustments to the results framework to allow for a better
measurement of PDO-level and intermediate results of the Project.4 No change to the current PDO is required, as
the proposed new procurement packages support the original PDO, further enhance the Project’s relevance, scale
up its impact, and improve sustainability of outcomes by strengthening the overall health system.
14. Reallocation between disbursement categories. This restructuring seeks a reallocation of US$8.47 million from
Component 1 (Category 1) to Component 2 (Category 2). This amount represents savings from TA and training
activities under Component 1. In addition, adjustments in the total amount of US$20.6 million will be made within
Category 2 (within Component 2, and from Component 3 to Component 2), which comprise savings and amounts
released under the cancelled/terminated contracts under Components 2 and 3. These reallocation and adjustments
of Project funds will be utilized to finance the following new procurement packages under Component 2: (a)
laboratory equipment to strengthen diagnostic capacity of laboratory services; and (b) medical equipment to
strengthen capacity of tertiary-care institutions providing MCH and intensive care services at the republican level.
15. These proposed reallocations between and within disbursement categories will enable full utilization of the
currently uncommitted loan amount. Moreover, the proposed new procurement packages do not require any
changes to be made to the Project description in the Loan Agreement, as they support, respectively, the existing
activities (sub)components 2.A (i) and 2.B (i) specified in the Loan Agreement, namely: (a) the proposed laboratory
equipment will contribute to “developing a health facility network, involving the establishment of a public health
service to increase the promotion of a healthy lifestyle, reduce risk factors for non-communicable diseases,
strengthen the epidemiological surveillance system for outbreaks, and build capacity in public health policy planning
and health services delivery; and (b) the proposed medical equipment will support managing the quality of health
care services, involving the improvement of clinical practice by developing a system for implementing, and
monitoring the introduction of, clinical protocols.
16. The reductions in amounts of Components 1 and 3 resulting from these reallocation and cost adjustments will not
affect the completion of the originally programmed activities and will not put at risk the achievement of the PDO,
because most PDO-level and IR indicators have been achieved, and addressing the most critical current priorities
will further enhance the relevance, efficacy, and impact of the Project. Detailed information on components and
costs is outlined in Table 1.
4The first restructuring (report No. RES33479, dated December 4, 2018) included only adjustments to some indicators’ definitions, target values, and timing of
achievement of targets to better reflect the updated, two-phase timeline of the MSHI implementation.
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
Table 1: Changes to Components and Costs
Original Cost Proposed Cost
Component Name Counterpart Counterpart
Total IBRD Total IBRD
Funds Funds
(US$M) (US$M) (US$M) (US$M)
(US$M) (US$M)
Supporting implementation of the national
16.63 14.68 1.95 6.92 6.21 0.71
mandatory Social Health Insurance system
Strengthening of health service delivery to
support implementation of the national 62.94 56.11 6.83 77.22 68.47 8.75
mandatory Social Health Insurance system
Project management, monitoring and
10.43 9.21 1.22 5.86 5.32 0.54
evaluation, and communications strategy
Total IBRD 90 80 10 90 80 10
17. Loan Closing Date. A nine-month extension of the Project closing date, from June 30, 2021 to March 31, 2022, is
proposed to allow for the initiation and completion of new processes to procure the necessary laboratory and
medical equipment. If approved, this would be the first extension of the original closing date.
18. Implementation Schedule. The implementation schedule has been revised to be consistent with the nine-month
extension of the Project closing date.
19. Disbursement estimates. Estimates and timeframe have been revised to update projections based on the expected
implementation pace of the ongoing activities and new procurement packages.
20. Results Framework. Adjustments to the Results Framework will allow for better measurement of PDO-level and
intermediate results of the Project and will include addition of a new intermediate results indicator and revision of
end-target values for six new intermediate results indicators, as described below.
a. A new IR indicator will be introduced to measure quality of health care: “Number of new clinical protocols
developed for intensive care in obstetrics and for neonatology”.
b. End-target values for six of the eleven IR indicators have been increased to align with the revised territorial
division of Kazakhstan (new Turkestan Oblast created as the 17th region in 2018) and/or successful
achievement of the current target values.
21. Social and Environmental Safeguards. The Project has been assigned a category “C”. The proposed restructuring
will not trigger any new safeguard policy, and the Environmental Assessment category will not change, as the
medical and laboratory equipment to be procured will comply with most up-to-date requirements for
environmental safety and efficiency. Also, while the Project will finance the equipment and related costs (training,
maintenance, etc.), the refurbishment works necessary for the installation of the equipment will be undertaken in
advance and paid for by the beneficiary institutions.
22. Financial Management and Procurement arrangements. There will be no changes in Financial Management and
Procurement arrangements. Financial Management arrangements concerning budget, accounting, flow of funds,
treasury, internal controls, and audits arrangements will remain as specified in the original Project design. Financial
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
Management performance has been adequate and there are no overdue audits or interim (unaudited) financial
reports.
23. Project Risks. The following description of project risks reflects the risk profile reflected in the latest Implementation
Status and Results Report of April 2021. The overall risk to achievement of the PDO continues to be Substantial,
though there have been some changes in sub-risks. Since 2019, sector strategies and policies, technical design, and
institutional capacity for implementation and sustainability risks have been downgraded from Substantial to
Moderate due to the sound strategies and policies pursued in implementation of the MSHI system, extensive
communications, stakeholder and beneficiary engagement and proactive feedback, among others. The
macroeconomic, stakeholders, and other (reputational) risks remain Substantial given the macroeconomic situation
related to the overall spread of COVID-19 and overall continued sensitivity of the MSHI reform, as well as public
concerns related to the epidemiological situation. Fiduciary risk was downgraded from High to Substantial in April
2020 given the launch of procurement processes for almost all of the remaining contracts and the ability of the
PMU/MoH to efficiently process procurements of the much needed mechanical ventilators in a time of significant
global supply stress. With regard to this restructuring, Fiduciary risk remains Substantial based on the possibility of
delays in preparing the technical specifications, as well as the long internal approval process within the MoH. In
addition, there are also important risks related to the packaging, specifications, supply chains, and the market
response that need to be considered before approving the final procurement plan. To mitigate these risks, an initial
procurement plan with the high-value medical equipment contracts to be executed will be finalized based on a
comprehensive market analysis. The market analysis will be completed as soon as possible by the PMU/MoH in
order to propose the best fit-for-purpose procurement approach for these critical procurements.
III. SUMMARY OF CHANGES
Changed Not Changed
Results Framework ✔
Components and Cost ✔
Loan Closing Date(s) ✔
Reallocation between Disbursement Categories ✔
Disbursement Estimates ✔
Overall Risk Rating ✔
Implementation Schedule ✔
Implementing Agency ✔
DDO Status ✔
Project's Development Objectives ✔
PBCs ✔
Cancellations Proposed ✔
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
Disbursements Arrangements ✔
Safeguard Policies Triggered ✔
EA category ✔
Legal Covenants ✔
Institutional Arrangements ✔
Financial Management ✔
Procurement ✔
Other Change(s) ✔
Economic and Financial Analysis ✔
Technical Analysis ✔
Social Analysis ✔
Environmental Analysis ✔
IV. DETAILED CHANGE(S)
OPS_DETAILEDCHANGES_COMPONENTS_TABLE
COMPONENTS
Current
Current Proposed Proposed
Cost Action
Component Name Component Name Cost (US$M)
(US$M)
Component 1. Supporting Component 1. Supporting
implementation of the national implementation of the national
16.63 Revised 6.92
mandatory Social Health mandatory Social Health
Insurance system Insurance system
Component 2. Strengthening of Component 2. Strengthening
health service delivery to support of health service delivery to
implementation of the national 62.94 Revised support implementation of the 77.22
mandatory Social Health national mandatory Social
Insurance system Health Insurance system
Component 3. Project Component 3. Project
management, monitoring and management, monitoring and
10.43 Revised 5.86
evaluation, and communications evaluation, and
strategy communications strategy
TOTAL 90.00 90.00
OPS_DETAILEDCHANGES_LOANCLOSING_TABLE
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
LOAN CLOSING DATE(S)
Original Revised Proposed Proposed Deadline
Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal
Applications
IBRD-86170 Effective 30-Jun-2021 31-Mar-2022 31-Jul-2022
OPS_DETAILEDCHANGES_REALLOCATION _TABLE
REALLOCATION BETWEEN DISBURSEMENT CATEGORIES
Financing %
Current Allocation Actuals + Committed Proposed Allocation
(Type Total)
Current Proposed
IBRD-86170-001 | Currency: USD
iLap Category Sequence No: (1) Current Expenditure Category: NON-CS, CS, TR PART 1
14,678,000.00 4,034,277.72 6,205,900.00 100.00 100.00
iLap Category Sequence No: (2) Current Expenditure Category: GO, NON-CS, CS, TR PT 2,3; OC PT 3
65,322,000.00 27,285,220.70 73,794,100.00 100.00 100.00
Total 80,000,000.00 31,319,498.42 80,000,000.00
OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE
DISBURSEMENT ESTIMATES
Change in Disbursement Estimates
Yes
Year Current Proposed
2016 0.00 0.00
2017 0.00 0.00
2018 1,092,328.00 1,090,000.00
2019 10,707,672.00 3,350,000.00
2020 29,300,000.00 12,630,000.00
2021 38,900,000.00 21,030,000.00
2022 0.00 41,900,000.00
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
OPS_DETAILEDCHANGES_SORT_TABLE
SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT)
Risk Category Rating at Approval Current Rating
Political and Governance Moderate Moderate
Macroeconomic Substantial Substantial
Sector Strategies and Policies Substantial Moderate
Technical Design of Project or Program Substantial Moderate
Institutional Capacity for Implementation and Substantial Moderate
Sustainability
Fiduciary Substantial Substantial
Environment and Social Moderate Moderate
Stakeholders Substantial Substantial
Other Substantial Substantial
Overall Substantial Substantial
.
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
.
Results framework
COUNTRY: Kazakhstan
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection
Project Development Objectives(s)
The proposed Project Development Objective is to improve accessibility, quality, and efficiency of health service delivery, and reduce financial risks to the
population that are caused by serious health problems.
Project Development Objective Indicators by Objectives/ Outcomes
RESULT_FRAME_TBL_PDO
Indicator Name PBC Baseline Intermediate Targets End Target
1 2 3 4 5
Improve accessibility, quality, and effeciency of health service delivery and reduce financial risk
Increase public expenditure
share for PHC +
consultation and diagnostic 35.00 35.00 36.00 37.00 38.00 40.00 40.00
care + outpatient drugs
(Percentage)
Percent of all surgeries
included in the “outpatient
elective surgeries” list
performed as outpatient
5.00 5.00 10.00 25.00 30.00 40.00 40.00
surgeries in project-
supported hospitals and
outpatient facilities
(Percentage)
Percent of all contracted
inpatient services subject to
20.00 20.00 20.00 20.00 25.00 30.00 30.00
technical audit (annually)
(Percentage)
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
RESULT_FRAME_TBL_PDO
Indicator Name PBC Baseline Intermediate Targets End Target
1 2 3 4 5
SHIF is fully functional
based on predefined No No No No Yes Yes Yes
criteria (Yes/No)
Proportion of the bottom
40% of households
spending 10% and more on
health services and non-
food goods in the health 10.50 11.70 12.80 13.90 13.50 12.80 12.80
sector out of total
expenditure on paid
services and non-food
goods (Percentage)
PDO Table SPACE
Intermediate Results Indicators by Components
RESULT_FRAME_TBL_IO
Indicator Name PBC Baseline Intermediate Targets End Target
1 2 3 4 5
Component 1. Supporting implementation of the National Mandatory Social Health Insurance System
Percent of population for
whom SHIF received SHI
0.00 32.00 26.00 26.00 82.00 86.00 86.00
contributions/subsidies
(Percentage)
Rationale:
Action: This indicator has
The end-target value is increased from 83% to 86% based on successful achievement of the current target values.
been Revised
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
RESULT_FRAME_TBL_IO
Indicator Name PBC Baseline Intermediate Targets End Target
1 2 3 4 5
Achievement of key
MSHI
benchmarks for functioning
No implementation Partial Partial Yes Yes Yes
social health insurance
roadmap approved
system (Text)
Key adjustments in the
contracting methods are
adopted to include No No No No Yes Yes Yes
incentives for providers to
improve quality (Yes/No)
Component 2. Strengthening of health service delivery to support implementation of the national mand
Number of fully functional
regional PHC excellence 0.00 0.00 0.00 5.00 10.00 17.00 17.00
centers (Number)
Rationale:
Action: This indicator has End-target value is increased to both align with the revised territorial division of Kazakhstan (new Turkestan Oblast created as the 17th region in 2018) and
been Revised successful achievement of the current target values.
Number of regions
implementing disease
management programs
with evidence-based
2.00 2.00 7.00 10.00 13.00 17.00 17.00
effectiveness, including
incentives for health
providers and patients
(Number)
Rationale:
Action: This indicator has
End-target value is increased to both align with the revised territorial division of Kazakhstan (new Turkestan Oblast created as the 17th region in 2018) and
been Revised
successful achievement of the current target values.
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
RESULT_FRAME_TBL_IO
Indicator Name PBC Baseline Intermediate Targets End Target
1 2 3 4 5
Number of educational
programs developed and
implemented in medical
education institutions
based on competence- 1.00 2.00 3.00 4.00 18.00 21.00 21.00
based approach and
professional standards
through strategic
partnerships (Number)
Rationale:
Action: This indicator has
Target values are increased to align with the successful achievement of the current target values.
been Revised
Unified register of human
resources for health No No No No Yes Yes Yes
implemented (Yes/No)
Health personnel receiving
0.00 0.00 785.00 8,022.00 9,511.00 9,800.00 9,800.00
training (number) (Number)
Rationale:
Action: This indicator has
Target values are increased to align with the actually achieved intermediate target values and forecasted end-target value.
been Revised
Health facilities
constructed, renovated,
0.00 0.00 0.00 20.00 100.00 250.00 250.00
and/or equipped (number)
(Number)
Action: This indicator has
Rationale:
been Revised
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)
RESULT_FRAME_TBL_IO
Indicator Name PBC Baseline Intermediate Targets End Target
1 2 3 4 5
Target values are increased to align with the successful achievement of the current target values (due to an increased number of health facilities equipped with
COVID-19 related equipment.).
Percentage of patients
Baseline value
reporting improved health n/a n/a n/a 0.05 0.10 0.10
established
services (Text)
Increase in transparency,
credibility, and
effectiveness of the 0.00 0.00 0.00 35.00 40.00 60.00 60.00
complaints handling system
(Percentage)
Number of new clinical
protocols developed for
intensive care in obstetrics 0.00 2.00 5.00
and for neonatology
(Number)
Rationale:
Action: This indicator is
This new intermediate results indicator is added as an additional measure of the quality of health care.
New
IO Table SPACE
The World Bank
Social Health Insurance Project: Improving Access, Quality, Efficiency and Financial Protection (P152625)