The World Bank Report No: ISR1349 Implementation Status & Results Kazakhstan Public Disclosure Copy Health Sector Technology Transfer and Institutional Reform (P101928) Operation Name: Health Sector Technology Transfer and Institutional Reform Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Last Modified Date: 27-Dec-2010 (P101928) Country: Kazakhstan Approval FY: 2008 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health Key Dates Board Approval Date 15-Jan-2008 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 05-Jan-2011 Last Archived ISR Date 30-Jun-2010 Effectiveness Date 15-Dec-2008 Revised Closing Date 30-Jun-2013 Actual Mid Term Review Date 12-Sep-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To introduce international standards and build long-term institutional capacity in MOH and related healthcare institutions in support of key health sector reforms pursued by the Government of Kazakhstan in the context of the State Health Care Reform and Development Program. 1. Improved efficiency and equity of health expenditure and better financial protection for households in oblasts that implement a comprehensive package of healthcare financing and management reforms; 2. Improved quality and efficiency of medical care through the establishment of functioning systems/ institutions for clinical practice guideline development/dissemination and health facility accreditation, and through improved performance in the laboratory and blood transfusion systems; 3. Improved quality of medical graduates and improved ability to carry out medical research through upgrading the medical/pharmacological education and research systems and introducing international standards; 4. Improved efficiency and quality in health facility management through access to reliable, timely health information from a unified health information system; 5. Improved safety, efficacy, quality and affordability of drugs through reforms in pharmaceutical procurement, pricing, prescribing monitoring, information provision, benefit package design and quality control; and 6. Improved food safety and speedier WTO accession through the introduction of international sanitary and phytosanitary norms. Public Disclosure Copy Has the Project Development Objective been changed since Board Approval of the Project? Yes No Page 1 of 6 The World Bank Report No: ISR1349 Component(s) Component Name Component Cost Public Disclosure Copy Component A: Health Financing and Management 20.20 Component B: Health Care Quality Improvement 59.90 Component C: Reform of Medical Education and Medical Science 9.40 Component D: Health Information System Development 188.60 Component E: Pharmaceutical Policy Reform 4.20 Component F: Food Safety and WTO Accession 8.70 Component G: Project Management 4.60 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Implementation Status Overview The project is making good implementation progress. Technology transfer and capacity building are underway for 9 priority technical components and subcomponents (out of 12). while such activities for the remaining 3 (medical science, blood safety and laboratory reform) are expected to commence soon. Results Project Development Objective Indicators Indicator Baseline Current End Target Indicator Name Value Value Value Improved efficiency and equity of health expenditure and better Expenditure on: - utilities as a (a) n/a Expenditure on: (a) utilities as a Public Disclosure Copy financial protection for households in oblasts that implement a proportion of total recurrent (b) partially on track: proportion of total recurrent comprehensive package of healthcare financing and management spending in hosp. that introduce 35.6% spending in hosp. should be reforms package of reforms is TBD; - reduced by 10%; (b) outpatient Date Type Unit of Measure outpatient care as a share of total hosp. care as a share of total hosp. expend. is 25.6%. 15-Nov-2010 expend. increased to 40% Custom Indicator Text Date Comment Date 01-Oct-2008 Comments: (a) delayed until March 31-Dec-2013 2011 (the timing of the first hospital Comment budget survey) Comment Comments: (a) delayed until March 2011 (the timing of the first hospital budget survey) Page 2 of 6 The World Bank Report No: ISR1349 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Improved quality & efficiency of medical care through the establishment (a) No CPGs in place and no (a) on track: Center of Health (a) At least 20 core CPGs of functioning systems/institutions for clinical practice guideline institution with capacity to develop Services Standardization and HTA developed in 5 specialties and development/dissemination & health facility accreditation them. (b) No accreditation body in place, activities for development reviewed; (b) Establishment of and (c) no health facilities have of CPGs have started with gap independent accreditation body, (c) Type Unit of Measure undergone accreditation to-date. analysis and training (b) on track: which accredits at least 20 public Custom Indicator Text Date Accreditation Center in place facilities at republican and oblast (c) partially on track: gap analysis levels. 01-Oct-2008 of pilot standards and operational Date Comment procedures conducted. 31-Dec-2013 Date Comment 15-Nov-2010 Comment Indicator Baseline Current End Target Indicator Name Value Value Value Improved quality of medical graduates & improved ability to carry out (a) Outdated curricula for medical (a) partially on track: (a) New curricula for medical and medical research through upgrading the medical/ and pharmaceutical educ.; (b) analysis of current curricula, gap pharmaceutical educ. implemented pharmaceuticaleducation & research systems & introducing Participation rates in training analysis and development of in the 6 public univ.; (b) 100% international standards. courses in EBM centers is 0%; (c) implementation strategy started participation rates in training Type Unit of Measure No physicians have been licensed Date courses in EBM centers; (c) 1500 Custom Indicator under new standards. physicians licensed under new Text 15-Nov-2010 Date standards. Comment Date 01-Oct-2008 Comment 31-Dec-2013 Comment Public Disclosure Copy Page 3 of 6 The World Bank Report No: ISR1349 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Improved efficiency and quality in health facility management through (a) There is no HMIS system in (a) on track: Health Information (a) HMIS fully designed and access to reliable, timely health information from a unified health place; (b) 0% of staff are trained Center in place, pilot operation of approved for use by MOH; (b) 75% information system. and able to use HMIS system. the HMIS in Astana completed and of key HMIS users fully trained and Date ongoing in 34 facilities in Akmola able to use the system. Type Unit of Measure oblast (b) on track: 100% in Date 01-Oct-2008 Astana, 6.8% in Akmola, 0% Custom Indicator Text 31-Dec-2013 Comment Karaganda, 0% East Kazakhstan Date Comment 15-Nov-2010 Comment Indicator Baseline Current End Target Indicator Name Value Value Value Improved safety, efficacy, quality & affordability of drugs through (a) Ratio of counterfeit drugs TBD; (a)(b)(c) n/a (a) Ratio of counterfeit drugs TBD; reforms in pharmaceutical procurement, pricing, prescribing, (b) Out-of-pocket drug expenditure (d) partially on track (b) 10% reduction in Out-of-pocket monitoring, information provision, BP design & quality control. is 54.4%; (c) Average retail and drug expend.; (c) 10% reduction in Date public procurement price for Average retail and publicproc. price Type Unit of Measure selected drugs TBD; (d) No 15-Nov-2010 for selected drugs; (d) Custom Indicator Text restructuring of pharmaceutical Comment Restructured pharma. policy policy sector. (c) to be available in December sector. Date 2010; (d) training activities on Date 01-Oct-2008 pharmaceutical policy restructuring 31-Dec-2013 started Comment Comment (b) As per NHA 2008; (c) to be available in December 2010; other special surveys to establish Public Disclosure Copy baseline values not conducted yet. Page 4 of 6 The World Bank Report No: ISR1349 Indicator Baseline Current End Target Public Disclosure Copy Indicator Name Value Value Value Improved food safety and speedier WTO accession through the (a) No safety norms in place; (b) (a)(b) n/a (a) Harmonization of 10 food safety introduction of international sanitary and phytosanitary norms No technical regulations in place. norms in accordance with int. Date Date standards; (b) Development and 15-Nov-2010 approval of 15 technical Type Unit of Measure 01-Oct-2008 Comment regulations; Custom Indicator Text Comment Technical activities have started, Date but information for such indicators 31-Dec-2013 is not yet available. Comment Additional norms and technical regulations for harmonization identified; revised target value to be confirmed by the MOH following contract negotiations. Intermediate Results Indicators Indicator Baseline Current End Target Indicator Name Value Value Value Strengthening the capacity for health policy and strategy formulation. (a) No Health Policy Unit (b) (a) on track: Strategic Planning (a) Well-functioning Health Policy National Health Accounts not fully Division and Unit (b) National Health Accounts developed/implemented Division for Health Financing developed using new household/ Date Improvement in place; (b) partially provider/client survey data. Type Unit of Measure on track: participation in Global Date 01-Oct-2008 Consultation on NHA Custom Indicator Text 31-Dec-2013 Comment institutionalization and revival of activities for data collection. Comment Date Public Disclosure Copy 15-Nov-2010 Comment Data on Financial Performance (as of 24-Nov-2010) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P101928 IBRD-48830 Effective 15-Jan-2008 02-Feb-2008 15-Dec-2008 30-Jun-2013 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Page 5 of 6 The World Bank Report No: ISR1349 P101928 IBRD-48830 Effective USD 117.70 117.70 0.00 16.59 101.11 14.00 Public Disclosure Copy Disbursement Graph Key Decisions Regarding Implementation Project mid-term review will be conducted in conjunction with the first National Health Summit in September 2011 Restructuring History There has been no restructuring to date. Related Projects Public Disclosure Copy There are no related projects. Page 6 of 6