The World Bank Report No: ISR9941 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: 15 Status: ARCHIVED Archive Date: 27-Apr-2013 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 21-Dec-2012 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 Implementation Status Overview This ISR reflects the findings of the implementation support visit conducted from March 18 to 22, 2013. All activities planned under the Additional Financing (AF), 15 months after its effectiveness on December 27, 2011, are currently being implemented by both entities. Most Project Development Objective indicators are on track. As previously reported, in Federation of Bosnia and Herzegovina (FBiH), significant progress has been made in all components. In Component 1 – Primary Health Care Restructuring: Page 1 of 9 The World Bank Report No: ISR9941 Program of Additional Training (PAT) in Family Medicine is being provided in accordance with the contracts executed with community health centers in Mostar, Sarajevo, Tuzla, and Zenica. The pilot to implement pay-for-performance payment for preventive and promotional activities started on January 1, 2013 in Sarajevo, Tuzla, and Zenica. Contracts for this pilot were signed with 50 teams in the intervention group and 50 teams in the control group. A specific software has been developed to report on and monitor the teams’ activities. A total of 35 additional Family Medicine ambulantas (Primary Health Care (PHC) clinics) have been refurbished and equipped. Public Disclosure Copy The main objective of the IT component is the implementation of a nationally certified information system in all community health care centers of the F BiH (78 health care centers). In Component 2 – Health Sector Management Capacity Development. Teaching aids and IT equipment have been procured for Sarajevo and Mostar. In Component 3 – Health Policy Formulation and Project Support. The field work for the survey of the population’s health status and risk factor for Non-Communicable Diseases (NCDs) is completed and the final report should be ready by September. In Republica Sprska (RS), activities are also on track in accordance with the updated Procurement Plan. In Component 1. All works under IDA financing are completed or under implementation. 51 Family Medicine (FM) Health Team has been accredited and another 50 are in the process of being accredited. In Component 2. The Public Health Institute’s Health Management Center is mplementing the training program as planned. In Component 3. The new RS PHC strategy was updated and is part of the overall RS Strategy comprised of all sectors and Line Ministries’ sub-strategies. 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 Public Disclosure Copy Bosnia and Herz Republika Srpska Podgrab 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 Page 2 of 9 The World Bank Report No: ISR9941 Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Ljubinje Public Disclosure Copy Bosnia and Herz Republika Srpska Krupa na Vrbasu 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 Public Disclosure Copy Bosnia and Herz Republika Srpska Miljevina Bosnia and Herz Republika Srpska Dubrava Stara Bosnia and Herz Republika Srpska Lazarevo Results Project Development Objective Indicators Page 3 of 9 The World Bank Report No: ISR9941 Indicator Name Core Unit of Measure Baseline Current End Target Coverage of population through family Text Value About 58% of pop.; FBH: 1,750 FM teams About 70% of pop.; FBH medicine teams 1,000,000 (2009); RS: RS: 1,034,229 1,500,000; RS: 1,250,000 Public Disclosure Copy 1,200,147 Due to job loss, the amount of insured people decreased Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track. 2013 census will provide updated targets 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 meting accreditation RS: 51 acredited. 140 FM standards; and 35% of health being strengthened. 50 centers to meet safety additional teams are planned standards for this year Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track Current activities are focus on improving ambulantas conditions to approve the accreditation process Systemic implementation of selected Text Value No standard set of preventive FBiH: RBF pilots started on Active selected preventive preventive services (i.e., hypertension, breast services except for special January 1, 2013 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 22-Mar-2013 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 Public Disclosure Copy signed MOU with the School of Economy – fully operational RS: The Health Management Center fully operational Date 22-Mar-2013 31-Dec-2014 Comments New since March 2011 Achieved Page 4 of 9 The World Bank Report No: ISR9941 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 2012 updated yearly 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 Public Disclosure Copy between entities Care Strategy was updated but it has not yet been formally approved Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 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: 710 FBH: 900; RS: 650 RS: 647 Date 22-Mar-2011 22-Mar-2013 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: 390 FBH: 523 specializations in completed specialization RS: 227 FM; RS: 250 spec. in FM Date 22-Mar-2011 22-Mar-2013 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: 773 FBH: 940; RS: 342-no further who completed PAT PAT doctor training in RS RS: 292 Date 22-Mar-2011 22-Mar-2013 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: 1702 FBH: 1900; RS: 1300 completed PAT RS: 1143 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Public Disclosure Copy 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 Education Center trainers) with a higher education (masters or PhD) in FM RS: 6 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track Page 5 of 9 The World Bank Report No: ISR9941 Number of health personnel receiving training Text Value FBH: 3853; RS 2055 FBiH: 4138 FBH: 4000; RS: 3196 RS: 2753 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Public Disclosure Copy Comments New since March 2011 On track Health buildings (physical sites) constructed, Text Value FBH: 79; RS: 56 FBiH: 79 FBH: 129; RS: 110 reconstructed, or renovated RS: 75 Date 22-Mar-2011 22-Mar-2013 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: 197 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track Family Medicine Offices / ambulantas equipped Text Value FBH: 376; RS: 320 FBiH: 426 FBiH 410; RS 470 with medical equipment and or furniture RS: 409 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track 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 (11 municipalities municipalities; RS: 510 510 RS: 157/201 (510/622) Date 22-Mar-2011 22-Mar-2013 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 2013. Federation RS: N/A Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Public Disclosure Copy Comments New since March 2011 On track Development of Federation level rules for the Text Value 0 FBiH: 5 working groups FBH rules for HIS health information standards (HIS) finalizing draft rules RS: N/A Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track Page 6 of 9 The World Bank Report No: ISR9941 Support the implementation of PHC information Text Value 0 FBiH: Not yet in place 3 municipalities systems in about 3 municipalities (Federation) RS: N/A Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Public Disclosure Copy Comments New since March 2011 RS: not applicable Development of programs and monitoring tools Text Value 0 FBiH: SW application Programs completed for targeted non-communicable disease operational on pilot sites preventive programs (Federation) RS: N/A Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track Number of trained and equipped community Text Value 0 FBiH: This activity has been 300 nurses to support FM teams (Federation) moved to a different project RS: N/A Date 22-Mar-2011 22-Mar-2013 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 22-Mar-2013 31-Dec-2014 Comments Number of management staff that have been Text Value FBH: 131; RS: 50 FBH: 131; RS: 300 trained in relevant managerial techniques Date 22-Mar-2011 23-Oct-2012 31-Dec-2014 Comments new since March 2011 FBiH achieved Number of management staff in DZs that Text Value 0 250 completed 1 or more training modules offered Date 22-Mar-2011 23-Oct-2012 31-Dec-2014 by the Health Management Center (RS) Comments new since March 2011 Number of management staff in DZs that Text Value 0 FBiH: 131 +80 50 completed all training modules offered by the Health Management Center (RS) RS: 50 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Public Disclosure Copy Comments new since March 2011 Training being implemented Number of FM teams trained in change Text Value FBH: 600; RS: 300 FBiH: 600 FBH: 600; RS: 350 management RS:315 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 FBiH achieve Page 7 of 9 The World Bank Report No: ISR9941 Number of new masters and PhDs in health Text Value FBH: 1; RS: 1 -- PhD: 1 and 7 FBiH: 1 FBH: 1; RS: 6 -- PhD: 1 management masters RS: 2 PhD and 8 masters completed or in progress completed Public Disclosure Copy Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments On track Prepare program for specialists in health Text Value FBH 0 A program for CPE on health Program developed and one management (Federation) management and rulebook cohort enrolled developed Training started in October 2012(40 trainees completed level one, 37completed level two). (80 applications) RS: N/A Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments new since March 2011 On track Health status and risk factors indicators based Text Value Survey ongoing in the RS Data collected. Results Completed analysis cased on on household survey completed and publicly expected by September 2013 survey and publicly available available RS: Survey completed Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments On track FBiH prepare health M&E report Text Value Indicators developed and FBiH: Expected by 2014 Complete M&E report on initial data collected RS: N/A health sector and publicly available Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments On track RS PHC program evaluation completed Text Value Ongoing review on reform RS: Survey completed Completed review of PHC progress sub-sector reform Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments Public Disclosure Copy National summit Text Value 0 Health Summit “ All-policies 2 Health in South-East Europe: common goal and Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments On track Public Health Grants for Innovative Service Text Value FBH: 40 FBiH: 40. Next round May FBH:55 Delivery (Federation) 2013 Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments RS: not applicable Page 8 of 9 The World Bank Report No: ISR9941 Data on Financial Performance (as of 10-Apr-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date Public Disclosure Copy 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 2.47 4.03 38.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation not applicable Restructuring History CD Approval on 05-Jun-2009, Level two Approved on 17-Nov-2010 Related Projects P120285-Health Sector Enhancement Project Additional Financing Page 9 of 9