The World Bank Report No: ISR6389 Implementation Status & Results Georgia Health Sector Development Project (P040555) Public Disclosure Copy Operation Name: Health Sector Development Project (P040555) Project Stage: Implementation Seq.No: 20 Status: ARCHIVED Archive Date: 05-Feb-2012 Country: Georgia Approval FY: 2003 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Labor, Health and Social Affairs Key Dates Board Approval Date 01-Aug-2002 Original Closing Date 31-Dec-2007 Planned Mid Term Review Date Last Archived ISR Date 05-Feb-2012 Effectiveness Date 06-May-2003 Revised Closing Date 30-Jun-2012 Actual Mid Term Review Date 21-May-2007 Project Development Objectives Project Development Objective (from Project Appraisal Document) The revised PDOs are to: (i) improve coverage, utilization and quality of health care services in the territory of the Recipient, and (ii) strengthen the Government's stewardship functions in the health sector. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost 1. Strengthening PHC System 17.80 2. Support for Health Sector Reform 4.10 3. Project Management 1.60 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview The project is in its last month of implementation. Disbursement is over 95%, 5% is committed and all activities will be finalized by June 30, 2012. Although most of the activities had been finalized, with good results, by 2011, a final extension was granted to the project with the objective to finalize the Health management information system activities. Due to exchange rate change gains, the project has adequate funding left to finalize these activities. Thanks to this last extension the project has been able to finalize the development and the testing of the Social Management Information System (SIMS) which assisted the government with the implementation of its policy decision to improve and monitor access and quality to health services in Georgia. The Implementation rating is satisfactory, as all indicators have been achieved and several exceeded their targets. The Development objective Page 1 of 6 The World Bank Report No: ISR6389 rating is marginally satisfactory as it reflects the overall achievements on health outcomes, which have stagnating in Georgia over the last 2 decades. Although the project did contribute to many improvements in the health sector, more is needed to improve actual health outcomes such as life expectancy and financial protection from catastrophic health spending. Public Disclosure Copy Locations Country First Administrative Division Location Planned Actual Georgia K'alak'i T'bilisi K'alak'i T'bilisi Georgia K'alak'i T'bilisi Tbilisi Georgia Imereti K'ut'aisi Georgia Shida Kartli Gori Georgia Ajaria Bat'umi Georgia Racha-Lechkhumi and Kvemo Svaneti Ambrolauri Georgia Ajaria Ajaria Georgia Guria Guria Georgia Imereti Imereti Georgia Shida Kartli Shida Kartli Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased awareness of population on health Percentage Value 46.00 93.00 70.00 care reforms Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is exceeded Public Disclosure Copy % of public health expenditure earmarked to Percentage Value 3.60 38.40 30.00 program for poor Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments 3.6 (2006) Target is met Key health laws revised & passed (health care, Text Value 0 (2008) Law passed medical practice) Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments In 2006 and 2008 the Follow up to these and other Government introduced the Page 2 of 6 The World Bank Report No: ISR6389 Medical Insurance Program policy actions is foreseen for the Poor (MIP),which is under the second DPO series one of the main pillars of an ambitious social policy Public Disclosure Copy agenda. Set of regulations on standardization of the procedures and codes for the MIS have been submitted for approval. A generics law is pending approval in Parliament. Increased satisfaction of population with PHC Text Value 66% (2006) For 77.4% the reasons of 70% services in target areas, as measured by the treatment were completely utilization survey explained 90.3% reported that adequate time (more than 12 minutes) spent with the main medical professionals,95.4% reported clean or very clean facilities and 78.9% were involved in treatment decisions Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Increased Satisfaction Proportion of TB patients managed at the PHC Percentage Value 3.00 52.00 40.00 level according to the DOT strategy. Date 03-May-2011 31-Dec-2011 30-Jun-2012 Comments Target is exceeded % of trained rural physicians who manage Percentage Value 0.00 60.00 30.00 cases according to nationally approved Date 03-May-2009 31-Dec-2011 30-Jun-2012 treatment guidelines in project target areas Comments 0 (2008) Target is exceeded with 59.9% assuming that those trained manage cases according to guidelines. The Public Disclosure Copy latter was not measured. Increased health care service utilization as Text Value 2/pc/y for poor 2/pc/y for G. Total consultations: 2.47- for 2.6/pc/y for poor 2.3/pc/year measured by number of out-patient visits per Pop (2006) poor; 1.74 - for gen. for G. pop capita (by poor and by general population) population. WB regions total - (threshold score for accessing MAP - 70,000) 2.10. Total outpatient consultations: 2.22-forpoor, 1.49 - for gen population and WB regions: 1.82 Page 3 of 6 The World Bank Report No: ISR6389 Date 05-Mar-2009 31-Dec-2011 30-Jun-2012 Comments Target is partially achieved Increased immunization rate of (DPT3). Percentage Value 78.00 92.00 90.00 Public Disclosure Copy Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is exceeded Percentage of rural population with access to a Percentage Value 0.00 78.00 50.00 PHC clinic within 30 minutes of transportation/ Date 03-May-2009 31-Dec-2011 30-Jun-2012 walking Comments Target is exceeded % of population covered with re-trained family Percentage Value 0.60 50.00 50.00 medicine providers Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments More than 86% of the targeted doctors and 100% of the targeted nurses were trained. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Health personnel receiving training Number Value 0.00 40.00 40.00 Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Health Sector Performance Evaluation (HSPE) Text Value No available HSPE Report produced completed Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Number of physicians trained in new clinical Number Value 0.00 549.00 550.00 guidelines Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met 20 family medicine guidelines developed and Text Value 0 20/48 20/50 Public Disclosure Copy adopted, and 50 guidelines distributed Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Health Management Information System Text Value Lack of uniform plan for the Phase 3 in progress HMIS system designed (HMIS) system developed development of HMIS Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is on track Page 4 of 6 The World Bank Report No: ISR6389 Analytical studies and evaluations needed for Text Value No available Studies and analysis carried developing health care financing reforms out in accordance with completed and used to revise/redefine implementation plan strategies. supported under project. Public Disclosure Copy Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met IC campaign designed and implementation Text Value No IC campaign Implementation in progress IC Campaign carried out Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments 90% of rehabilitated facilities have trained Percentage Value 0.00 92.00 90.00 family medicine doctors, nurses and basic Date 03-May-2009 31-Dec-2011 30-Jun-2012 equipment Comments 95.9% doctors and 87.7% nurses Health personnel receiving training Number Value 5.00 59.90 50.00 Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Family Medical Faculty established, equipped, Text Value No Family medicine Completed Completed curriculum developed Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Regional Family Medicine Training Centers Number Value 0.00 5.00 5.00 rehabilitated and equipped Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Health facilities constructed, renovated, and/or Number Value 0.00 128.00 120.00 equipped Date 03-May-2009 31-Dec-2011 30-Jun-2012 Comments Target is met Center rehabilitated, equipped, and trained staff Public Disclosure Copy Data on Financial Performance (as of 08-May-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P040555 IDA-37020 Effective 01-Aug-2002 08-Nov-2002 06-May-2003 31-Dec-2007 30-Jun-2012 P040555 TF-51330 Closed 29-Oct-2003 29-Oct-2003 29-Oct-2003 30-Sep-2006 01-Oct-2007 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P040555 IDA-37020 Effective USD 20.30 20.30 0.00 22.92 1.40 113.00 Page 5 of 6 The World Bank Report No: ISR6389 P040555 TF-51330 Closed USD 0.48 0.46 0.02 0.46 0.00 100.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation Not applicable Restructuring History Board Approved on 30-Mar-2009, Level two Approved on 17-Jun-2011, Level two Approved on 18-Nov-2011 Related Projects There are no related projects. 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