Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) Health System Improvement Project (P113349) EUROPE AND CENTRAL ASIA | Uzbekistan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2011 | Seq No: 14 | ARCHIVED on 07-Mar-2018 | ISR31612 | Implementing Agencies: Ministry of Health, Ministry of Health Key Dates Key Project Dates Bank Approval Date:07-Apr-2011 Effectiveness Date:02-Nov-2011 Planned Mid Term Review Date:16-Nov-2015 Actual Mid-Term Review Date:16-Nov-2015 Original Closing Date:31-Dec-2016 Revised Closing Date:31-Dec-2019 Project Development Objectives Project Development Objective (from Project Appraisal Document) The overall Project Development Objectives (PDOs) are to (1) improve access to quality health care at the primary level and atRayonMedical Unions (RMUs); and (2) strengthen the Government’s public health response to the rise in non-communicable diseases(NCDs). Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured)PHRPDODEL The revised PDO is to (a) improve access to quality health care at the primary level and at Rayon Medical Unions; and selectedCityMedical Unions (CMUs); and (b) strengthen the Government's public health response to the rise in non-communicable diseases(NCDs). Components Name Improving Health Service Delivery:(Cost $133.27 M) Strengthening Health Financing and Management Reforms:(Cost $1.48 M) Institutional Strengthening for NCD Prevention and Control:(Cost $1.88 M) Project Management:(Cost $4.37 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Moderately Satisfactory  Moderately Satisfactory Overall Implementation Progress (IP)  Moderately Satisfactory  Moderately Satisfactory 3/7/2018 Page 1 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) Overall Risk Rating  Moderate  Moderate Implementation Status and Key Decisions The project has continued to make moderate progress under all components over the past six months. The project has reached most of its intermediate results indicators while indicators linked to the Project Development Objectives are expected to be achieved by the new closing date of December 31, 2019. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  Substantial  Substantial Macroeconomic  --  Moderate  Moderate Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  --  Moderate  Moderate Fiduciary  --  Moderate  Moderate Environment and Social  --  Moderate  Moderate Stakeholders  --  Moderate  Moderate Other  --  Substantial  Substantial Overall  --  Moderate  Moderate Results Project Development Objective Indicators PHINDPDOTBL  Increased proportion of diabetic and hypertension patients referred from PHC facilities to RMUs, in accordance with treatment standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72.20 72.20 80.00 Date 28-Oct-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 3/7/2018 Page 2 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) PHINDPDOTBL  Improved perceived quality of PHC and secondary health care services in intervention areas (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 82.70 82.70 90.00 Date 02-Oct-2012 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDPDOTBL  Increased proportion (number) of hospitals following NCD clinical guidelines developed under the project (at least 20 clinical guidelines) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 90.00 90.00 172.00 Date 28-Oct-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDPDOTBL  Issuance of a profile of NCD risk factors and burden of disease (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Based on STEPS Based on STEPS report report findings the findings the MOH MOH announced a announced a mandatory At least 1 report Value 0.00 mandatory health health check-up published check-up program for program for all all population. population. Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 Overall Comments no change on the data. the project closing date is extended to December 31, 2019. Intermediate Results Indicators 3/7/2018 Page 3 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) PHINDIRITBL  Hospitals equipped with medical and waste management equipment (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 511.00 511.00 516.00 Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDIRITBL  New clinical guidelines developed and adopted by the MOH (CVD, diabetes, etc.) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 22.00 22.00 20.00 Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDIRITBL  Doctors of urban and rural PHC facilities receiving the training under the 10-month GP training program (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 670.00 3,067.00 3,067.00 3,000.00 Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDIRITBL  Health personnel at PHCs (doctors and nurses) receiving training under continuous professional education (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 9672 doctors, 26015 11603 doctors, 28502 9400 doctors, Value 0 doctors, 0 nurses nurses nurses 40500 nurses Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 3/7/2018 Page 4 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) PHINDIRITBL  Hospital core staff receiving training on waste management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 747.00 933.00 516.00 Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDIRITBL  Health personnel receiving training on clinical case management (NCDs and pediatrics) (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 2594 doctors/183 3039 doctors/6013 1002 doctors Value 0.00 nurses have been nurses have been and 2064 trained trained nurses Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDIRITBL  Health personnel receiving training (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 43,714.00 43,714.00 22,518.00 Date 01-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDIRITBL  Staff of reformed PHC and hospitals receiving training in financial management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 255.00 255.00 255.00 Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 3/7/2018 Page 5 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) PHINDIRITBL  National Health Accounts developed and published (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2 reports Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 PHINDIRITBL  Public Expenditure Review developed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 2 reports Date 10-Mar-2011 31-Jul-2017 31-Jul-2017 31-Dec-2019 Comments second report is being prepared PHINDIRITBL  Volume and Cost contract introduced in 3 hospitals in Fergana oblast (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target All 3 hospitals Value 0.00 3 in virtual mode 3 in virtual mode paid according to contract Date 10-Mar-2011 31-Jul-2017 31-Jul-2017 31-Dec-2019 PHINDIRITBL  Number of urban PHC facilities (urban family policlinics) converted to per capita financing system (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 25.00 151.00 151.00 155.00 Date 05-Feb-2013 31-Jul-2017 31-Jul-2017 31-Dec-2019 3/7/2018 Page 6 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) PHINDIRITBL  Public Health specialists (surveillance staff) and (b) health promotion specialists trained (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 181.00 143.00 140.00 Date 10-Mar-2011 31-Jul-2017 19-Feb-2018 31-Dec-2019 Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P113349 IDA-48960 Effective USD 93.00 93.00 0.00 83.32 2.09 98% P113349 IDA-52310 Effective USD 93.00 48.00 45.00 10.22 32.46 24% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P113349 IDA-48960 Effective 07-Apr-2011 16-Sep-2011 02-Nov-2011 31-Dec-2016 31-Dec-2018 P113349 IDA-52310 Effective 07-Mar-2013 18-Jul-2013 19-Sep-2013 31-Dec-2018 31-Dec-2019 Cumulative Disbursements 3/7/2018 Page 7 of 8 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Health System Improvement Project (P113349) Restructuring History Level 2 Approved on 08-Feb-2018 Related Project(s) P133187-Additional Financing to Health System Improvement Project 3/7/2018 Page 8 of 8 Public Disclosure Copy