The World Bank Report No: ISR10010 Implementation Status & Results Vietnam Northern Upland Health Support Project (P082672) Public Disclosure Copy Operation Name: Northern Upland Health Support Project (P082672) Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Archive Date: 24-Apr-2013 Country: Vietnam Approval FY: 2008 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 13-Mar-2008 Original Closing Date 31-Aug-2014 Planned Mid Term Review Date 16-Jul-2012 Last Archived ISR Date 26-Mar-2012 Effectiveness Date 08-Oct-2008 Revised Closing Date 31-Aug-2014 Actual Mid Term Review Date 16-Jul-2012 Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is: Increase utilization of district health services especially among Decision 139 beneficiaries in the Northern Upland Provinces through (i) strengthening of district hospitals and (ii) reducing financial constraints to accessing health services. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Strengthening District-level Health Services 42.90 Increasing Financial Access to Healthcare Services for Decision 139 Beneficiaries 10.00 Monitoring, Evaluation, and Project Management 7.10 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Implementation Status Overview The Project is rated as satisfactory with respect to the achievement of its development objective and moderately satisfactory in terms of implementation progress. By the end of 2012, inpatient utilization of the poor and vulnerable ethnic minority was reported as 0.075 per capita up from 0.03 in 2009 (more than 2x) and outpatient utilization increased to 0.086 from 0.067 visits per capita (a 28% increase). The Midterm survey presented that the percentage of poor households suffering catastrophic health expenditures reduced from 22.1% to 13.3% (almost a 9 percentage point reduction). This latter achievement is likely due to improved insurance coverage of the state from 2009 and only some attribution towards the Project intervention. The proposed targets in these areas were about a 10-15% percentage change improvement; therefore, the Project far exceeded these targets which were Page 1 of 5 The World Bank Report No: ISR10010 established quite modestly from a low base. The Project supported district hospitals are now able to provide about 10% more of the MoH prescribed services than before which will be further increased when the large volume of medical equipment is provided at the end of 2013 and early 2014. The Project is expected to close in August 2014, and by the end of March 2013, about 90% of the Project implementation period has been completed and US$28.8 million (or 49%) of Public Disclosure Copy the $60 million IDA allocation disbursed. The 2012 activity plan was largely implemented as planned and the implementation of the 2013 plan is well underway. The 2013 procurement plan includes an estimated US$22.6 million in the procurement of medical equipment for which one has not yet been initiated, two are in the process of bid evaluation or tendering, and the remaining have received Bank no objection and are either signed or waiting for final MoH approval. The project support towards educating and training of health professional and towards providing meal and transport allowances have exceeded the original plans. Given that the project has 1.5 years of implementation left and that there is still a need to conclude the contracts for delivery of the majority of medical equipment, the implementation status at this point in time remains marginally satisfactory. Locations Country First Administrative Division Location Planned Actual Vietnam Tinh Son La Tinh Son La Vietnam Tinh Lai Chau Tinh Lai Chau Vietnam Tinh Ha Giang Tinh Ha Giang Vietnam Tinh Cao Bang Tinh Cao Bang Vietnam Huyen Dien Bien Huyen Dien Bien Vietnam Tinh Bac Kan Tinh Bac Kan Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Utilization rates of in-patient services in District Text Value 0.03 0.075 0.033 (10% increase) Hospitals among Decision 139 beneficiaries Date 30-Jun-2009 31-Dec-2012 31-Aug-2014 (per capita) Comments Administrative figure. Percent of households who experience Text Value 14.7% 13.4% 13.23% (at least 10% Public Disclosure Copy catastrophic health care expenditures in the reduction) year prior to the survey. Date 30-Jun-2008 31-Dec-2011 31-Aug-2014 Comments updated baseline (2008 Measured using 2010 VHLSS updated target VHLSS) Utilization rates of outpatient health services in Text Value 0.067 0.086 0.075 (at least 15% increase) district hospitals by Decision 139 beneficiaries Date 31-Dec-2009 31-Dec-2012 31-Aug-2014 (per capita) Comments updated baseline Administrative figure. updated target. Page 2 of 5 The World Bank Report No: ISR10010 Proportion of district hospitals that provide full Text Value 51.9% 62% 70% set of health services according to the national Date 30-Jun-2008 31-Dec-2011 31-Aug-2014 norms Comments Measured at mid-term and Public Disclosure Copy end of project. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percent of eligible district health staff who have Text Value 0 173% of long-term training 80 successfully completed training provided by the plan project. Date 30-Jun-2008 31-Dec-2011 03-Jun-2013 Comments Clarification: This not % measured as those who are "eligible" but as per the training plan that determined the quota for the numberof trainees planned per province. Percentage of Decision 139 Beneficiaries who Text Value 82.21% 90%+ 70 have recevied HI Cards. Date 30-Jun-2009 31-Dec-2012 03-Jun-2013 Comments Updated June 2009 baseline Poor, Ethnic Minority living in % results. Health insurance law difficult communes went into effect in 2009. Percent of households who identify financial Text Value 10.4% 11.3% maximum 2% barriers as a main cause for not seeing Date 30-Jun-2008 31-Dec-2011 03-Jun-2013 healthcare. Comments Updated June 2009 survey From the mid-term review The baseline was revised reports 2% but there would survey. Will update at end of since PAD after the baseline appear to be methodological project survey. survey was conducted. issues. People with access to a basic package of Number Value 20.00 70.00 health, nutrition, or reproductive health services Date 31-May-2008 17-Dec-2010 31-Aug-2014 (number) Public Disclosure Copy Comments The baseline and update Not available. Will be should be recalculated as a determined in June report. number and not as a The baseline and update percentage of the population should be recalculated as a for the purposes of IDA number and not as a reporting. percentage of the population for the purposes of IDA reporting. Health personnel receiving training (number) Number Value 0.00 2661.00 3185.00 Date 30-Jun-2008 29-Mar-2013 31-Aug-2014 Page 3 of 5 The World Bank Report No: ISR10010 Comments Est. 314 MDs (level 1 740 assistant drs.; 185 MDs; specialty training); 1281 1,041 assistant drs. and MDs assistant doctors (MD refreshed; 214 health training); 68 4-year personnel; 303 health Public Disclosure Copy pharmacist training; + short personnel; 215 health term training term training) personnel; 318 health personnel; 169 health personnel Health facilities constructed, renovated, and/or Number Value 0.00 61.00 61.00 equipped (number) Date 30-May-2008 31-Oct-2011 31-Aug-2014 Comments 18 hospitals provided with infrastructure upgrading and 61 hospital have received some equipment. Data on Financial Performance (as of 15-Mar-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P082672 IDA-43980 Effective 13-Mar-2008 10-Jul-2008 08-Oct-2008 31-Aug-2014 31-Aug-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P082672 IDA-43980 Effective XDR 38.30 38.30 0.00 18.70 19.60 49.00 Disbursement Graph Public Disclosure Copy Page 4 of 5 The World Bank Report No: ISR10010 Public Disclosure Copy Key Decisions Regarding Implementation The Ministry of Health plans to make a final push to improve equity under the achievement of the MDGs, particularly targeting the difficult districts and poor provinces. The Northern Uplands project covers a large segment of the target area. Reallocation of funds may be an option to scale up investments as necessary to further improve progress toward meeting MDG 4 or 5. The Ministry, supported by key technical agencies, is developing a proposal towards this objective by mid-summer. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 5 of 5