The World Bank Report No: ISR14043 Implementation Status & Results Bosnia and Herzegovina Health Sector Enhancement Project (P088663) Public Disclosure Copy Operation Name: Health Sector Enhancement Project (P088663) Project Stage: Implementation Seq.No: 18 Status: ARCHIVED Archive Date: 30-Mar-2014 Country: Bosnia and Herzegovina Approval FY: 2005 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 31-Mar-2005 Original Closing Date 15-Dec-2010 Planned Mid Term Review Date 15-Sep-2008 Last Archived ISR Date 01-Dec-2013 Effectiveness Date 03-Apr-2006 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 15-Sep-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of the Project are to (i) expand and enhance the family medicine model of primary health care; (ii) build managementcapacity in the sector; and (iii) strengthen the policy making process through the development and implementation of a system for monitoring and evaluating sector performance. Has the Project Development Objective been changed since Board Approval of the Project? ● Yes No Component(s) Component Name Component Cost Primary Health Care Restructuring 29.00 Improvement of Health Sector Management Capacity 3.00 Health Policy Formulation and Project Support 8.00 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Low Low Implementation Status Overview All activities planned under the Additional Financing (AF) are expected to be completed by the closing date of December 31, 2014. Project Development Objective indicators 2, 3 and 5 are on track; PDO indicators 1 and 4 have been achieved. Most of intermediate outcome indicators are also on track to be achieved. Implementation of activities in the Federation of Bosnia and Herzegovina (FBiH) have shown significant progress in all components: • The pilots to incentivize preventive services for Non Communicable Disease by introducing pay-for-performance started in early January 2013 and were completed on Page 1 of 8 The World Bank Report No: ISR14043 December 31, 2013. The final report will be submitted to the Bank by March 30, 2014. • The procurement process to rehabilitate the last group of ambulantas (phase 5) was launched. These civil works will be financed with proceeds from the CEB Loan. • Regarding the development of information system for Primary Health Care: the rulebook on Information Technology (IT) Standards was formally approved; and the Public Disclosure Copy procurement of all remaining IT equipment was launched and will be financed by both IDA and CEB funds. • The procurement of the software to be installed in the ambulantas will be launched upon completion of the accreditation of the software application. • A total of 17 sub-projects (grants) out of 68 applications received were selected; their implementation in the field is being monitored. In Republica Sprska (RS), activities are also on track in accordance with the updated Procurement Plan. All civil works are completed. While only 36 Family Medicine (FM) team have valid accreditation, the training and process to accreditate the remaining FM teams was re-launched and it is expected that 240 teams will complete the process by the end of the Project. The only pending activity is the development and dissemination of clinical guidelines, which is planned by 2014. Locations Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Visegrad Bosnia and Herz Republika Srpska Trebinje Bosnia and Herz Republika Srpska Sreflije Bosnia and Herz Republika Srpska Srbac Bosnia and Herz Republika Srpska Sokolac Bosnia and Herz Republika Srpska Sipovo Bosnia and Herz Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herz Republika Srpska Prnjavor Bosnia and Herz Republika Srpska Prijedor Bosnia and Herz Republika Srpska Podgrab Public Disclosure Copy Bosnia and Herz Republika Srpska Pale Bosnia and Herz Federation of Bosnia and Herzegovina Novi Grad Bosnia and Herz Republika Srpska Mokro Bosnia and Herz Republika Srpska Modrica Bosnia and Herz Republika Srpska Milici Bosnia and Herz Republika Srpska Ljubinje Page 2 of 8 The World Bank Report No: ISR14043 Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Krupa na Vrbasu Public Disclosure Copy Bosnia and Herz Republika Srpska Gornji Ribnik Bosnia and Herz Republika Srpska Foca Bosnia and Herz Republika Srpska Branesci Donji Bosnia and Herz Republika Srpska Bosanski Samac Bosnia and Herz Republika Srpska Bosanska Gradiska Bosnia and Herz Republika Srpska Bocac Bosnia and Herz Republika Srpska Bijeljina Bosnia and Herz Republika Srpska Berkovici Bosnia and Herz Republika Srpska Banja Luka Bosnia and Herz Republika Srpska Demirovac Bosnia and Herz Republika Srpska Strojice Bosnia and Herz Republika Srpska Gornji Seher Bosnia and Herz Republika Srpska Celinac Bosnia and Herz Republika Srpska Laus Bosnia and Herz Republika Srpska Ugljevik Bosnia and Herz Republika Srpska Tilava Bosnia and Herz Republika Srpska Miljevina Public Disclosure Copy Bosnia and Herz Republika Srpska Dubrava Stara Bosnia and Herz Republika Srpska Lazarevo Results Project Development Objective Indicators Page 3 of 8 The World Bank Report No: ISR14043 Indicator Name Core Unit of Measure Baseline Current End Target Coverage of population through family Text Value About 58% of pop.; FBH: FBiH: 1,536,000 About 70% of pop.; FBH medicine teams 1,000,000 (2009); RS: RS: 1,167,000 1,500,000; RS: 1,250,000 Public Disclosure Copy 1,200,147 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 Achieved The census was conducted preliminary numbers of inhabitants are: FBiH: 2.3 M RS: 1.2M Number of FM teams and health centers in the Text Value RS: 60/650 or about 9% and FBiH: N/A RS: 260 or 40% of FM team RS meeting rigorous accreditation standards 0 health centers RS: 40 accredited. meting accreditation The remaining teams to standards; and 35% of health achieve the goal are being centers to meet safety accredited standards Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Systemic implementation of selected Text Value No standard set of preventive FBiH: RBF pilots completed. Active selected preventive preventive services (i.e., hypertension, breast services except for special Final report to be sent services implemented cancer, prostate enlargement, smoking, etc.) annual programs systemically by all FM teams inat least 2 major FBiH cantons RS: N/A in at least two major cantons Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Health management center operational with Text Value Health management center FBiH: The Health Health management center annual budget and regular work plan not fully operational Management Center operational developed as a unit within the Federation PH institute. FPHI signed MOU with the School of Economy – fully operational Public Disclosure Copy RS: The Health Management Center fully operational Date 13-Feb-2014 31-Dec-2014 Comments New since March 2011 Achieved RS and FBiH primary health care strategy Text Value First version completed and FBiH: Achieved – Operation FBH operational plan for PHC operational plan are updated based on adopted Plan for 2014 updated reform for 2014 adopted by evidence of sector performance and include FBiH MoH based on evidence consultative process with stakeholders and RS: The RS Primary Health Page 4 of 8 The World Bank Report No: ISR14043 between entities Care Strategy was updated, but not yet formally approved Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Public Disclosure Copy Comments New since March 2011 On track Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of teams operating in family medicine Text Value FBH: 652; RS: 649 FBiH: 768 FBH: 900; RS: 650 RS: 685 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Number of doctors in operating FM teams who Text Value FBH: 383; RS: 191 FBiH: 391 FBH: 523 specializations in completed specialization RS: 215 FM; RS: 250 spec. in FM 20 specialist are not working as FM Date 22-Mar-2011 13-Feb-2014 Comments New since March 2011 RS Target on track. FBiH will not reach target. Number of FM doctors in operating FM teams Text Value FBH: 740; RS: 342 FBiH: 898 FBH: 940; RS: 342-no further who completed PAT PAT doctor training in RS RS: N/A Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 FBiH will be close to target Number of nurses in operating FM teams that Text Value FBH: 1437; RS: 1031 FBiH: 1945 FBH: 1900; RS: 1300 completed PAT RS: 1273 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Number of FM educators (Cathedra Faculty of Text Value FBH: 27; RS: 5 FBiH: 31 FBH: 35; RS: 10 Public Disclosure Copy Education Center trainers) with a higher education (masters or PhD) in FM RS: 6 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Number of health personnel receiving training Text Value FBH: 3853; RS 2055 FBiH: 4138 FBH: 4000; RS: 3196 RS: 3425 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 FBiH Achieved Page 5 of 8 The World Bank Report No: ISR14043 Health buildings (physical sites) constructed, Text Value FBH: 79; RS: 56 FBiH: 79 FBH: 129; RS: 110 reconstructed, or renovated RS: 80 Public Disclosure Copy Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track FM ambulantas constructed, reconstructed or Text Value FBH: 335; RS: 146 FBiH: 379 FBH: 385; RS: 275 renovated (several ambulantas per DZ) RS: 213 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Family Medicine Offices / ambulantas equipped Text Value FBH: 376; RS: 320 FBiH: 430 FBiH 410; RS 400 with medical equipment and or furniture RS: 409 Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 Achieved Family Medicine Offices / ambulantas equipped Text Value FBH: 3 DZ (education centers FBiH: Sarajevo and Mostar FBH: ambulantas of 3 with IT and belonging ambulata); RS: completed (300 offices -12 municipalities; RS: 510 510 municipalities RS: 157/201 (510/622) Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments FBiH achieved 12Performance Based contracts signed with Text Value FBH: 0 FBiH: 100 Contracts signed FBH: 100 FM teams (directly or through DZs) in the and implemented Federation RS: N/A Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Development of Federation level rules for the Text Value 0 FBiH: Rules completed FBH rules for HIS health information standards (HIS) RS: N/A Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Public Disclosure Copy Comments New since March 2011 On track Support the implementation of PHC information Text Value 0 FBiH: 10 municipalities 3 municipalities systems in about 3 municipalities (Federation) RS: N/A Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 RS: not applicable Page 6 of 8 The World Bank Report No: ISR14043 Development of programs and monitoring tools Text Value 0 application operational on Programs completed for targeted non-communicable disease pilot sites in 4 cantons preventive programs (Federation) RS: N/A Public Disclosure Copy Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments New since March 2011 On track Number of trained and equipped community Text Value 0 FBiH: This activity was 300 nurses to support FM teams (Federation) financed by a different project RS: N/A Date 22-Mar-2011 13-Feb-2014 Comments New since March 2011 Number of clinical guidelines developed and Text Value 31 FBiH: N/A 51 disseminated according to needs of FM RS: 31 practitioners (RS) Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments Public Health Grants for Innovative Service Text Value FBH: 40 17 FBH:55 Delivery (Federation) Date 22-Mar-2011 13-Feb-2014 31-Dec-2014 Comments RS: not applicable Data on Financial Performance (as of 11-Dec-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P088663 IDA-40470 Closed 31-Mar-2005 05-Sep-2005 03-Apr-2006 15-Dec-2010 31-Dec-2011 P088663 IDA-49120 Effective 22-Mar-2011 05-Jul-2011 27-Dec-2011 31-Dec-2014 31-Dec-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P088663 IDA-40470 Closed XDR 11.20 11.13 0.07 11.13 0.00 100.00 P088663 IDA-49120 Effective XDR 6.50 6.50 0.00 3.80 2.70 58.00 Public Disclosure Copy Disbursement Graph Page 7 of 8 The World Bank Report No: ISR14043 Public Disclosure Copy Key Decisions Regarding Implementation not applicable Restructuring History CD Approved on 05-Jun-2009, Level two Approved on 17-Nov-2010 Related Projects P120285-Health Sector Enhancement Project Additional Financing Public Disclosure Copy Page 8 of 8