The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Serving People, Improving Health Project (P144893) EUROPE AND CENTRAL ASIA | Ukraine | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2015 | Seq No: 9 | ARCHIVED on 26-Mar-2019 | ISR36146 | Implementing Agencies: Government of Ukraine, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 04-Mar-2015 Effectiveness Date: 15-Jun-2015 Planned Mid Term Review Date: 30-Mar-2018 Actual Mid-Term Review Date: 12-Mar-2018 Original Closing Date: 30-Sep-2020 Revised Closing Date: 30-Sep-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed “Serving People, Improving Health” Project seeks to improve the quality of health services in selected Oblasts, with special focus on primary and secondary prevention of cardiovascular diseases and cancer, and to enhance efficiency of the health caresystem. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Improving Service delivery at the local level:(Cost $189.53 M) Strengthen Ministry of Health Governance:(Cost $20.20 M) Project Implementation support and monitoring and evaluation:(Cost $4.46 M) Commission 0.25%:(Cost $0.54 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Overall, there is an improvement in project implementation. The Bank team has observed improved coordination between the central level project implementation unit and regional teams, and more hands-on coordination from the Ministry of Health, National Health Service of Ukraine and Public Health Center for activities that are carried out under the central level components. Implementation of the sub-projects in eight regions has accelerated with all major activities ongoing. The construction works, which were mostly delayed since project start-up are ongoing in all four regions. Upon approval of the proposed restructuring, the major part of financing for Component 2 supporting the regions will be reallocated to finance the achievement of a new results-based financing component with disbursement-linked indicators. This makes the project fully aligned with 3/26/2019 Page 1 of 8 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) the reform priorities. Important progress is reported on the pilot implementing diagnosis-related groups, strengthening public health and carrying out capacity building activities. Most indicators are on track to be achieved. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- Substantial Substantial Macroeconomic -- High High Sector Strategies and Policies -- Substantial Substantial Technical Design of Project or Program -- Moderate Moderate Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- Substantial Substantial Environment and Social -- Moderate Moderate Stakeholders -- Moderate Moderate Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes Improved quality of health services in selected Oblasts, with special focus on CVDs and cancer IN00674445 ►PDO Indicator 1: Early detection of cervical and breast cancer as measured: a) Ratio of new in situ to new invasive cervical cancer (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.79 0.70 0.75 0.88 Date 01-Jan-2014 14-Sep-2018 01-Mar-2019 31-Dec-2017 Target value of the indicator (a) - 0.65 (revised) – has been met. During 2018, the total number of patients diagnosed with cervical cancer, including both preinvasive and invasive carcinoma, extensive-stage cancer, continues to grow. During the reporting period, cervical cancer was detected in 503 women (430 women in 2017). Insitu cancer was detected in 215 women (158 women in 2017), the level of early diagnosis of cervical cancer is the highest (0.75) in recent years. Comments: Target value of the indicator (b) - 24 (revised) – has been met. During 2018, the number of detected breast cancer cases increased by 30% (in 2017 breast cancer was detected in 748 women, in 2018 there were 912 female breast cancer cases registered). The number of breast cancer detected at stage I and stage 0 increased 1.7 times (from 161 women in 2017 to 275 women in 2018). It should be noted that 21 patients were detected with non-invasive cancer at stage 0, who were also included in the number of detected breast cancer cases at stage I and stage 0. 3/26/2019 Page 2 of 8 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) IN00674472 b) Share of new breast cancer detected at stage I (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 21.80 30.10 30.15 30.00 IN00674473 ►PDO Indicator 2: High blood pressure under control as measured by the share of patients aged 40-60 achieving target level of blood pressure (measure is 140/90mmHg) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.40 16.50 16.50 19.00 Date 01-Jan-2014 04-Mar-2016 04-Mar-2016 31-May-2020 The indicator will be measured as part of the ongoing survey of medical records Comments: IN00674474 ►PDO Indicator 3: Improved quality management (prevention, early diagnosis and treatment) of CVDs at primary and secondary care measured as: a) reduction of hypertension-related hospitalization (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.80 2.38 4.73 4.80 Date 01-Jan-2014 14-Sep-2018 01-Mar-2019 31-May-2020 Target value of the indicator (a) - 5.0 – has been met. During 2018, there was 11% decrease in PDO 3 (a), in particular due to improved quality of primary hypertension management through controlled treatment. Supplies of equipment for the diagnosis and treatment of CVD started in 2017 in participating oblasts had a positive effect on the achievement of the indicator. Comments: Target value of the indicator (b) – 184.6 - has been met. Angiographs (9 pcs.) bought within the framework of the subproject enabled examination and stenting in a timely manner. As a result, the value of PDO 3 (b) increases (2017 - 174.4, 2018 - 272.5). IN00674475 b) number of patients who received stenting for acute myocardial infarction with ST segment elevation (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 93.60 174.40 272.46 193.70 Enhanced efficiency of the health care system IN00674471 ►PDO Indicator 4: Average in-patient length of stay in hospitals (Days, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11.70 11.00 10.90 9.50 Date 01-Jan-2014 07-Mar-2018 01-Mar-2019 31-May-2020 The indicator is based on data from 8 Project oblasts. The statistics required for the assessment of the indicator at the national level is collected by the Health Statistics Center (MoH) and is available in April following the reporting year (it will be updated after the statistics become available). Target value of the Comments: indicator (based on the data from 8 oblasts) - 10.5 – has not been met, however, the average in-patient length of stay in a hospital has a positive tendency to decrease, the process of optimizing the bed network in the oblasts participating in the Project continues. 3/26/2019 Page 3 of 8 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Intermediate Results Indicators by Components Improving Service delivery at the local level IN00674476 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 23.00 33.00 260.00 Date 01-Jan-2015 07-Mar-2018 07-Mar-2018 31-May-2020 During Project implementation, major and current repairs were carried out in 32 general practice/family medicine outpatient clinics in Dnipropetrovsk Oblast; reconstruction of the interventional cardiology department in Khust (Zakarpattia Oblast) was carried out at the expense of local budgets. In 2018, Comments: construction of a new Cardiac Center in Vinnytsia Oblast was started, and construction work in Dnipropetrovsk, Volyn and Rivne oblasts is still underway. IN00674479 ►7. % of primary health care facilities meeting the equipment norms for improved management of CVD (according to an explicit list) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 31.00 20.80 48.90 55.00 Date 01-Jan-2014 14-Sep-2018 01-Mar-2019 31-May-2020 The target value of the indicator - 45% - has been met. There is a positive tendency towards increasing the number of primary health care facilities meeting the standards for improved treatment of CVD. As of Comments: December 31, 2018, the total number of outpatient clinics fully equipped for improved treatment of CVD is 972 units or 48.9% (as of December 31, 2017 the relevant indicator was only 10.4%). IN00674481 ►8. Number of cancer screening procedures performed: a) cervical cancer tests (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 709,184.00 784,341.00 510,416.00 830,000.00 Date 01-Jan-2014 07-Mar-2018 07-Mar-2018 31-May-2018 The target value of the indicator (a) – 500,000 (revised) - has been met, the decrease of the indicator compared to the same period last year (784 341 tests) is explained by improved quality of the tests carried out and avoided unnecessary repeated tests at different levels of screening. The target value of the indicator – 80,000 (revised) – has been met. New mammography machines Comments: purchased within the framework of the subproject became operational in the oblast since June to September 2017. As a result, the number of examinations is increasing (2016 - 31832, 2017 - 67740, 2018 - 108567). All mammography machines were operating throughout 2018 without significant downtime, but there was not enough staff to operate them at full load on a double-shift basis. IN00674484 b) mammograms (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 20,893.00 67,740.00 108,867.00 150,000.00 IN00674485 ►Health personnel receiving training (number) (Number, Custom) 3/26/2019 Page 4 of 8 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8,037.00 14,129.00 24,937.00 Date 01-Jan-2015 14-Sep-2018 01-Mar-2019 31-May-2020 To date, 69% of the target has been met. In 2018, 8,320 health workers were trained. During Project implementation, training was provided to 14,129 health workers, including 13,915 in the framework of regional subprojects. The implementation of training activities in the central components still lags behind: Comments: out of the planned 4,461 health workers, only 214 health workers were trained due to delays in the implementation of scheduled cluster activities. The central level activities, specifically for the provider payment mechanisms, capacity building and public health clusters are catching up. IN00674486 ►9. Share of acute myocardial infarction with ST segment elevation diagnoses confirmed according to appropriate protocols in the previous 12 months (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.00 0.00 0.00 78.00 Date 01-Jan-2014 14-Sep-2018 14-Sep-2018 31-May-2020 The actual number for the indicator is expected from the ongoing survey of medical records (data will be Comments: available in December 2019 and reported in the next ISR) IN00674487 ►10. Share of primary care centers which have structured schools of health or similar initiatives working on educational group activities related to main NCDs’ risk factors (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 44.70 53.95 50.00 Date 01-Jan-2014 14-Sep-2018 14-Sep-2018 31-May-2020 The target indicator has been achieved. In the reporting period, 1,187 Schools of Health (53.95% of the Comments: total number of outpatient clinics) were operating in various areas of NCDs in all Project oblasts. Strengthen Ministry of Health Governance IN00674477 ►11. Critical e-Health standards approved by MoH (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jan-2014 14-Sep-2018 01-Mar-2019 31-May-2017 The reported developments towards achievement of the indicator suggests a significant progress in eHealth standardization in Ukraine. Upon receiving clarifications, the approval of the achievement can be Comments: issued. IN00674480 ►12. Communication campaign designed and implemented at central level (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jan-2014 14-Sep-2018 14-Sep-2018 31-May-2020 3/26/2019 Page 5 of 8 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) The ToR for the communication campaign has been prepared by the MoH team and reviewed by the Bank. Upon agreements on the implementation of the campaign, the procurement of the services will be Comments: launched (expected in September 2018) IN00674482 ►13. Availability of hospital beds (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 880.00 738.00 731.00 650.00 Date 01-Jan-2014 14-Sep-2018 01-Mar-2019 31-May-2020 The indicator is reported for 8 Project oblasts. The statistics required for the assessment of the indicator at the national level is collected by the Health Statistics Center (MoH) and will be available in April for 2018. Target value of the indicator (based on data from 8 oblasts) – 700 – has not been met. Compared to 2017, a positive tendency is reported towards reducing the number of in-patient hospital beds per 100 000 Comments: population. In 2018, 2,445 hospital beds were reduced in the Project oblasts. One of the main reasons for lagging behind is the delay in implementing the cluster ‘Payment Systems Reform’, in particular the introduction of the DRG-based payment systems. IN00674483 ►14. Number of Oblasts that in any given year have implemented at least one productivity enhancing reform (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4.00 5.00 8.00 Date 01-Jan-2014 07-Mar-2018 01-Mar-2019 31-May-2020 During the Project activities, five Project oblasts implemented efficiency improvement reforms, including: ‘Arterial hypertension’ by Vinnytsia Oblast, ‘Creation of a modern system of emergency care for patients with acute coronary syndrome (ACS) and violations of cerebral circulation’ by Volyn Oblast, ‘Implementation of the mechanism of differentiated wages for primary care providers depending on the volume and quality of care’ by Zaporizhzhia Oblast, ‘Optimization of the hospital network (including specialized facilities) by introducing inpatient substitutional technologies at the outpatient level’ by Lviv Comments: Oblast, ‘Reform of the system of heath care provision for patients with acute coronary pathology’ by Rivne Oblast. Five Project oblasts submitted reports on evaluation of progress in the implementation of reform efforts. As of Decemb er 31, 2018 Zakarpattia and Poltava oblasts have not completed efficiency improvement reforms. Implementation of emergency medical care reform in Zakarpattia Oblast is scheduled to be completed by the end of 2019. In Poltava Oblast, optimization of the oblast bed fund is underway. Project Implementation support and monitoring and evaluation IN00674478 ►15. Share of beneficiaries in participating oblasts reporting improvement in the access and quality of the targeted healthcare services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 14.20 10.60 20.00 Date 01-Jan-2014 30-Aug-2017 30-Aug-2017 31-May-2020 The indicator was defined using data from the study ‘Health Index. Ukraine – 2018’ conducted from March to September 2018 by the Kyiv International Institute of Sociology in cooperation with the Social Indicators Foundation, supported by the International Renaissance Foundation and the Ministry of Health of Ukraine. Comments: The target value, revised during the restructuring (at least 10% of beneficiaries in participating oblasts reporting improvement in the access and quality of the targeted healthcare services), is met. 3/26/2019 Page 6 of 8 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P144893 IBRD-84750 Effective USD 214.73 214.73 0.00 75.01 139.72 35% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P144893 IBRD-84750 Effective 04-Mar-2015 19-Mar-2015 15-Jun-2015 30-Sep-2020 30-Sep-2020 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) 3/26/2019 Page 7 of 8 The World Bank Implementation Status & Results Report Serving People, Improving Health Project (P144893) P170740-Additional Financing to Serving People, Improving Health Project 3/26/2019 Page 8 of 8