The World Bank Implementation Status & Results Report Health Sector Reform (P145174) Health Sector Reform (P145174) EUROPE AND CENTRAL ASIA | Romania | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 16 | ARCHIVED on 25-Jun-2021 | ISR47386 | Implementing Agencies: Ministry of Health, ROMANIA Key Dates Key Project Dates Bank Approval Date: 28-Mar-2014 Effectiveness Date: 22-Jan-2015 Planned Mid Term Review Date: 20-Mar-2018 Actual Mid-Term Review Date: 09-Mar-2018 Original Closing Date: 15-Dec-2020 Revised Closing Date: 31-Dec-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to improve access to, and quality and efficiency of public health services in Romania Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The Project Development Objective is to contribute to improving access to, and quality of selected public health services. Components Table Name Strengthening Health Service Delivery:(Cost $416.73 M) Health Sector Governance and Stewardship Improvement:(Cost $15.70 M) Project Management, and Monitoring and Evaluation:(Cost $7.72 M) Strenthening Public Health Emergency Response to COVID-19:(Cost $74.65 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions This Implementation Status & Results Report reflects the outcomes of the virtual implementation support visit that took place from May 17 to 21, 2021. The Project closing date was extended from March 30, 2021 to December 31, 2024 to implement activities that have been delayed. In addition, an Additional Financing to the Project of EUR 150 million to fill the financing gap due to cost overruns and the reallocation of resources to COVID- 19 interventions was approved by the Bank on June 4, 2021. 6/25/2021 Page 1 of 7 The World Bank Implementation Status & Results Report Health Sector Reform (P145174) Progress Towards Achievements of the Project Development Objective (PDO) continues to be Moderately Satisfactory (MS) as achievements with regard to the PDO Indicators are mixed. PDO Indicator 1 (average number of modern and safe radiotherapy technology available per 1 million resident population) has reached its end target value. On the other hand, the end target for PDO Indicator 2 (mortality rates in Advanced Surveillance and Treatment Unit for Critical Cardiac Patients-USTACC), which had achieved its end target value as of December 31, 2019, has worsened since then. This trend seems to be due to a mix of higher severity cases in USTACCs. PDO Indicator 3 (percentage of diagnosed COVID- 19 cases treated per approved protocol) is lower than its target value due to overly demanding protocols. PDO Indicator 4 (number of burn centers for the treatment of severe burns operational) is on track to achieve its end target value by the Project closing date. Implementation Progress (IP) remains MS mainly due to delays related to the construction of burn centers for the treatment of severe burns in Bucharest, Targu Mures and Timisoara over the past 6 months and health sector reforms under Project Component 2. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- Substantial Substantial Sector Strategies and Policies -- Moderate Moderate Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and -- Substantial Substantial Sustainability Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Low Low Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To contribute to improving access to, and quality of selected public health services IN01012213 ►Average number of modern and safe radiotherapy unit available per 1 million population (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.40 2.33 2.69 2.20 Date 11-Jul-2018 30-Sep-2020 30-Apr-2021 31-Dec-2024 6/25/2021 Page 2 of 7 The World Bank Implementation Status & Results Report Health Sector Reform (P145174) On track to achieve the end target. Comments: IN01012214 ►Advanced Surveillance and Treatment Unit of Critical Cardiac Patients (USTACC) mortality rate (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6.85 7.16 6.22 5.83 Date 11-Jul-2018 30-Sep-2020 30-Apr-2021 31-Dec-2024 End target achieved. Comments: IN01012215 ►Percentage of diagnosed COVID-19 cases treated per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 63.40 62.80 80.00 Date 01-Jan-2020 30-Sep-2020 30-Apr-2021 31-Dec-2024 IN01012216 ►Number of burn centers for the treatment of severe burns operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3.00 Date 31-Mar-2014 31-Dec-2020 30-Apr-2021 31-Dec-2024 Intermediate Results Indicators by Components Strengthening Health Service Delivery IN01012219 ►Number of regional pathology and cytology laboratories fully operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 6.00 Date 19-Dec-2013 30-Sep-2020 30-Apr-2021 31-Dec-2024 Activities directly affecting this indicator are expected to be initiated shortly. Comments: IN01012222 ►Number of mobile units for cancer screening fully functional for campaining activities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7.00 8.00 8.00 6/25/2021 Page 3 of 7 The World Bank Implementation Status & Results Report Health Sector Reform (P145174) Date 11-Jul-2018 30-Sep-2020 30-Apr-2021 31-Dec-2024 Out of 8 mobile units, 7 are functional. On track to achieve end target. Comments: IN01012224 ►Number of women using mobile cancer screening units and cancer screening centers (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 7,334.00 24,000.00 Date 31-Dec-2019 31-Dec-2019 31-Dec-2020 31-Dec-2024 IN01012226 ►Average waiting time (days) of radiotherapy treatment (LINAC) from prescription to treatment at Public Radiotherapy Centers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60-90 21.70 23.00 <45 Date 11-Jul-2018 31-Dec-2019 31-Dec-2020 31-Dec-2024 End target achieved. Comments: IN01012227 ►Number of hospitals with functional emergency telemedicine system (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 38.00 38.00 38.00 120.00 Date 11-Jul-2018 30-Sep-2020 30-Apr-2021 31-Dec-2024 End target not expected to be achieved by Project closing date. Comments: IN01012229 ►Number of Cardiology Care Unit (USTACC) equipped according to the national regulations (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 13.00 13.00 11.00 Date 11-Jul-2018 30-Sep-2020 30-Apr-2021 31-Dec-2024 End target achieved. Comments: IN01012230 ►Number of contracts signed for construction works for burn centers for the treatment of severe burns (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3.00 Date 19-Dec-2013 31-Dec-2020 30-Apr-2021 31-Dec-2024 IN01012231 6/25/2021 Page 4 of 7 The World Bank Implementation Status & Results Report Health Sector Reform (P145174) ►Number of burn centers for the treatment of severe burns equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3.00 Date 31-Dec-2020 31-Dec-2020 30-Apr-2021 31-Dec-2024 IN01012232 ►Number of health professionals trained (burn centers, radiotherapy, emergency, intensive care) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 37.00 37.00 75.00 Date 19-Dec-2013 30-Sep-2020 30-Apr-2021 31-Dec-2024 Health Sector Governance and Stewardship Improvement IN01012217 ►Number of health workers trained in HTA (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 34.00 34.00 18.00 Date 19-Dec-2013 30-Sep-2020 30-Apr-2021 31-Dec-2024 End target achieved. Comments: IN01012220 ►Number of international evidence-based standards and protocols implemented on selected public health services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 29.00 30.00 6.00 Date 11-Jul-2018 30-Sep-2020 30-Apr-2021 31-Dec-2024 International experts not hired as initial expected. However, indicator affected by Project activities. End Comments: target achieved. IN01012223 ►Share of patients satisfied or very satisfied with hospital services delivered (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81.25 81.25 81.90 82.25 Date 31-Dec-2020 31-Dec-2020 30-Apr-2021 31-Dec-2024 IN01012225 ►Development of annual action plan to improve patients' satisfaction based on patients' satisfaction survey with hospital services (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/25/2021 Page 5 of 7 The World Bank Implementation Status & Results Report Health Sector Reform (P145174) Value No No No Yes Date 11-Jul-2018 30-Sep-2020 30-Apr-2021 31-Dec-2024 Activities directly affecting the indicator expected to be completed by Project closing date. Comments: IN01012228 ►Comprehensive communication campaign implemented (Cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 10-Jul-2015 30-Sep-2020 30-Apr-2021 31-Dec-2024 End target not expected to be achieved by Project closing date. Comments: Strengthening of Public Health Emergency Response to COVID-19 IN01012218 ►Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 133.00 177.00 50.00 Date 01-Jan-2020 30-Sep-2020 30-Apr-2021 31-Dec-2024 IN01012221 ►Activation of public health Emergency Operations Centre or a coordination mechanism for COVID-19 (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jan-2020 30-Sep-2020 30-Apr-2021 31-Dec-2024 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P145174 IBRD-83620 Effective USD 338.80 338.80 0.00 169.46 140.24 55% Not P145174 IBRD-92530 USD 176.00 176.00 0.00 0.00 176.00 0% Effective Key Dates (by loan) 6/25/2021 Page 6 of 7 The World Bank Implementation Status & Results Report Health Sector Reform (P145174) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P145174 IBRD-83620 Effective 28-Mar-2014 17-Jun-2014 22-Jan-2015 15-Dec-2020 31-Dec-2024 Not P145174 IBRD-92530 04-Jun-2021 -- -- 31-Dec-2024 31-Dec-2024 Effective Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 24-Jun-2017 ,Level 2 Approved on 01-Oct-2018 ,Level 2 Approved on 23-Jun-2020 ,Level 2 Approved on 19-Nov-2020 ,Level 2 Approved on 26-Feb-2021 Related Project(s) P175632-Additional Financing to Romania Health Sector Reform Project 6/25/2021 Page 7 of 7