Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Kyrgyz Health Results Based Financing (P120435) EUROPE AND CENTRAL ASIA | Kyrgyz Republic | Health, Nutrition & Population Global Practice | Recipient Executed Activities | Specific Investment Loan | FY 2013 | Seq No: 8 | ARCHIVED on 01-Nov-2016 | ISR25676 | Implementing Agencies: Mandatory Health Insurance Fund, Ministry of Health Key Dates Key Project Dates Bank Approval Date:18-Apr-2013 Effectiveness Date:29-Jul-2014 Planned Mid Term Review Date:26-Sep-2016 Actual Mid-Term Review Date:26-Sep-2016 Original Closing Date:30-Jun-2017 Revised Closing Date:30-Jun-2017 Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project Development Objective is to (1) pilot performance-based payments and/or enhanced supervision for quality of maternal and neonatal care in randomly selected rayon hospitals; and (2) strengthen the Government’s and providers’ capacity in performance-based contracting and monitoring and evaluating for results. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1: Pilot Performance-Based Payments and Enhanced Supervision for Quality of Care:(Cost $9.59 M) Component 2: Strengthen the Government's and Providers' Capacity in Performance-Based Payment Reform and Monitoring and Evaluation f or Results:(Cost $1.41 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  High  High 11/1/2016 Page 1 of 6 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Implementation Status and Key Decisions The Project is in the 3rd year since its approval. The progress toward PDO remain rated as Moderately Satisfactory and the overall implementation progress as Satisfactory. The Government remains committed to the project implementation. Implementation of pilot project was successfully scaled up to all 42 hospitals since the project effectiveness on July 30, 2014. That included five rounds of quarterly peer verifications and two rounds of semiannual counter verification. It has created an interest among providers beyond the pilot hospitals. Implementation of the pilot KG HRBF project activities: Hospitals performance has improved in average from 9% to 73% (Arm 1) and 63% (Arm2) versus the control Arm 3 where no changes . However, the improvements in quality scores have started to level off. Patient satisfaction levels have shown a consistent improvement in both groups of hospitals since the start of the project. While hospitals have done remarkably well in improving the structural aspects of quality, the clinical processes and content of care are yet to see significant improvements. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  High  High Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Substantial  Substantial Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  High  High Fiduciary  --  Substantial  Substantial Environment and Social  --  High  High Stakeholders  --  Substantial  Substantial Other  --  Low  Low Overall  --  High  High Results Project Development Objective Indicators PHINDPDOTBL  Proportion of quarterly peer verification records for Groups 1 and 2 rayon hospitals submitted to MHIF within one week after the end of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 42.00 42.00 42.00 Date 25-Aug-2014 03-May-2016 31-Oct-2016 30-Jun-2017 11/1/2016 Page 2 of 6 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDPDOTBL  Proportion of eligible rayon hospitals that received the authorized performance-based payments within two weeks after the MHIF’s receipt of payment invoices (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 22.00 Date 25-Aug-2014 03-May-2016 31-Oct-2016 30-Jun-2017 PHINDPDOTBL  Number of counter-verification carried out for a subset of Group 1 rayon hospitals and Group 2 rayon hospitals every six months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 10.00 10.00 8.00 Date 25-Aug-2014 30-Oct-2015 31-Oct-2016 31-Dec-2015 PHINDPDOTBL  Impact Evaluation Surveys completed on schedule to generate evidence for policy (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Impact Evaluation Impact Evaluation At least 2 round baseline survey baseline survey of serveys completed before start completed before start Value No surveys implmented by of pilot of pilot the end of the project Date 25-Aug-2014 11-May-2015 31-Oct-2016 30-Jun-2017 Overall Comments Intermediate Results Indicators 11/1/2016 Page 3 of 6 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDIRITBL  Performance Contracts signed with the Group 1 rayon hospitals (20) and updated annually based on any modifications introduced to the Balanced Scorecard (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 20.00 Date 25-Aug-2014 02-Nov-2014 02-Nov-2014 31-Dec-2015 PHINDIRITBL  Proportion of Group 1 rayon hospitals (20) that received quarterly performance-based payments in accordance to their level of performance as per agreed Performance Contracts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 25-Aug-2014 30-Oct-2015 30-Oct-2015 31-Dec-2015 PHINDIRITBL  MOH/MHIF produce quarterly monitoring reports within 2 weeks after the end of each quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 25-Aug-2014 14-Aug-2015 31-Oct-2016 31-Dec-2015 PHINDIRITBL  National RBF Steering Committee meets at least twice a year (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 2.00 2.00 Date 25-Aug-2014 14-Aug-2015 31-Oct-2016 31-Dec-2015 11/1/2016 Page 4 of 6 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) PHINDIRITBL  Extended RBF team meets at least every 2 months (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6.00 6.00 6.00 Date 25-Aug-2014 13-May-2015 31-Oct-2016 31-Dec-2015 Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P120435 TF-13310 Effective USD 11.00 11.00 0.00 4.00 7.00 36% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P120435 TF-13310 Effective 30-Dec-2013 30-Dec-2013 29-Jul-2014 30-Jun-2017 30-Jun-2017 Cumulative Disbursements 11/1/2016 Page 5 of 6 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Kyrgyz Health Results Based Financing (P120435) Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 11/1/2016 Page 6 of 6 Public Disclosure Copy