The World Bank Report No: ISR10460 Implementation Status & Results Uzbekistan Health System Improvement Project (P113349) Public Disclosure Copy Operation Name: Health System Improvement Project (P113349) Project Stage: Implementation Seq.No: 4 Status: ARCHIVED Archive Date: 08-Jun-2013 Country: Uzbekistan Approval FY: 2011 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 07-Apr-2011 Original Closing Date 31-Dec-2016 Planned Mid Term Review Date 30-Jun-2014 Last Archived ISR Date 16-Oct-2012 Effectiveness Date 02-Nov-2011 Revised Closing Date 31-Dec-2018 Actual Mid Term Review Date Project Development Objectives Project Development Objective (from Project Appraisal Document) The revised PDO is to (a) improve access to quality health care at the primary level and at Rayon Medical Unions; and selected City Medical Unions (CMUs); and (b) 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? � Yes No Component(s) Component Name Component Cost Improving Health Service Delivery 171.12 Strengthening Health Financing and Management Reforms 5.96 Institutional Strengthening for NCD Prevention and Control 3.38 Project Management 5.55 Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Substantial Implementation Status Overview The World Bank Board of Executive Directors has approved an additional financing (AF) of US$93 million for the Health System Improvement Project on March 7, 2013. The Government is currently completing internal procedures for signing and ratification that are necessary for AF effectiveness. Implementation of key activities under the ongoing credit is in progress. The implementation of Government investment program in rayon hospitals is underway as planned. The Page 1 of 6 The World Bank Report No: ISR10460 Government completed the construction of 15 hospitals in 2011-12 and plans the construction of an additional 50 Rayon Medical Unions (RMUs) in 2013. It is expected that a total of 29 RMUs will be completed by the end of the year. The contracts for delivery of X-ray equipment and laboratory equipment to the RMUs hospitals have been signed. The WHO is assisting Uzbekistan in the review of 8 clinical guidelines and protocols, conducting STEP survey and data analysis as well as in the development of the reports on National Health Accounts. The first group of more than 400 General Practitioners has completed a ten-month training program in July, 2012. 675 General Practitioners are currently participating in a Public Disclosure Copy ten-month training which will be completed in July 2013. Oblast Hospital Oversight Committees have been established in all Oblasts to monitor the implementation of the hospital program in the regions. Locations Country First Administrative Division Location Planned Actual Uzbekistan Not Entered Qoraqalpogiston Respublikasi Uzbekistan Not Entered Samarqand Viloyati Uzbekistan Not Entered Qashqadaryo Viloyati Uzbekistan Not Entered Namangan Viloyati Uzbekistan Not Entered Fargona Viloyati Uzbekistan Not Entered Andijon Viloyati Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased proportion of diabetic and Percentage Value 0.00 0.00 10.00 hypertension patients referred from PHC Date 02-Oct-2012 31-Dec-2016 facilities to RMUs, in accordance with Comments Beneficiary population survey; Will be assessed in 2014 after treatment standards baseline available within 6 new treatment standards month of project effectiveness have been in use at which point target will be determined Public Disclosure Copy Improved perceived quality of PHC and Percentage Value 70.00 90.00 secondary health care services in intervention Date 02-Oct-2012 02-Oct-2012 31-Dec-2016 areas Comments same as above Not due until 2014 Increased proportion of hospitals following Percentage Value 0.00 0.00 100.00 NCD treatment standards (at least 20 Date 31-Dec-2016 treatment standards) Comments same as above Eight new treatment standards in process of development Page 2 of 6 The World Bank Report No: ISR10460 Issuance of a profile of NCD risk factors and Text Value 0 At least 3 reports published burden of disease Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Public Disclosure Copy Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Hospitals equipped with medical and waste Number Value 0.00 0.00 100.00 management equipment Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Procurement of equipment underway New treatment standards developed and Number Value 0.00 0.00 25.00 adopted by the MOH (CVD, diabetes, etc) Date 10-Mar-2011 31-Dec-2016 Comments Eight new standards in process of development Urban polyclinics# doctors receiving training Number Value 670.00 482.00 3670.00 under the 10-month training GP program Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments 482 completed training in July 2012. New group started training in September 2012 Health personnel at PHCs (doctors and nurses) Text Value 0 doctors, 0 nurses 6000 doctors, 57000 nurses receiving training under continuous Date 10-Mar-2011 02-Oct-2012 31-Aug-2016 professional education Comments 1,300 doctors and 14,250 nurses scheduled to start training this year Hospital management staff receiving training Number Value 0.00 0.00 477.00 on hospital management Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments 50 staff to be trained this year Hospital core staff receiving training on waste Number Value 0.00 0.00 300.00 Public Disclosure Copy management Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Training to begin next year in anticipation of delivery of hospital waste management equipment. Health personnel receiving training on clinical Number Value 0.00 0.00 2200.00 case management (NCDs and pediatrics) Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Page 3 of 6 The World Bank Report No: ISR10460 Comments Not yet due. Training to begin after development of new treatment guidelines. Public Disclosure Copy People with access to a basic package of Percentage Value 0.00 0.00 100.00 health Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Will be assessed as hospitals get fully equipped and rehabilitated Staff of reformed PHC and hospitals receiving Number Value 0.00 0.00 600.00 training in financial management Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Training of 70 staff planned for this year Percent of recurrent expenditures not related to Percentage Value 6.10 7.97 20.00 salary relative to actual expenses of:a) PHCsb) Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Rayon hospitalsc) Urban polyclinics Comments 7.9% in PHC; 7.6% in rayon hospitals; 6.5% for polyclinics National Health Accounts developed and Text Value 0 2 reports published Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Public Expenditure Review developed Text Value 0 2 reports Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Volume and Cost contract introduced in 3 Text Value 0 All 3 hospitals paid according hospitals in Fergana oblast to contract Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Comments Number of video clips on health education on Number Value 0.00 0.00 6.00 cardiovascular risk factors Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Public Disclosure Copy Comments ToR to contract international T/A for this activity being developed Number of people screened for (a) Number Value 0.00 0.00 hypertension, and (b) diabetes through Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 community-based screening programs in Comments Guidelines for screening targeted areas under development Percent of population in targeted Oblasts Percentage Value knowing cardiovascular risk factors Date 07-Apr-2011 02-Oct-2012 31-Dec-2016 Page 4 of 6 The World Bank Report No: ISR10460 Comments Data available within 6 month Work on developing survey of effectiveness upon which on knowledge and awareness target will be determined ongoing Public Disclosure Copy Public Health specialists (surveillance staff) Number Value 0.00 49.00 300.00 trained in data collection and analysis, Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 including trainers, in all oblasts Comments 49 specialists trained in July 2012 on surveillance methodology Data on Financial Performance (as of 22-May-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P113349 IDA-48960 Effective 07-Apr-2011 16-Sep-2011 02-Nov-2011 31-Dec-2016 31-Dec-2016 P113349 IDA-52310 Not Effective 07-Mar-2013 31-Dec-2018 31-Dec-2018 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P113349 IDA-48960 Effective XDR 59.60 59.60 0.00 2.89 56.71 5.00 P113349 IDA-52310 Not Effective XDR 60.60 60.60 0.00 0.00 60.60 0.00 Disbursement Graph Public Disclosure Copy Page 5 of 6 The World Bank Report No: ISR10460 Key Decisions Regarding Implementation n/a Public Disclosure Copy Restructuring History There has been no restructuring to date. Related Projects P133187-Additional Financing to Health System Improvement Project Public Disclosure Copy Page 6 of 6