The World Bank Report No: ISR12429 Implementation Status & Results Bosnia and Herzegovina Health Sector Enhancement Project (P088663) Public Disclosure Copy Operation Name: Health Sector Enhancement Project (P088663) Project Stage: Implementation Seq.No: 17 Status: ARCHIVED Archive Date: 01-Dec-2013 Country: Bosnia and Herzegovina Approval FY: 2005 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 31-Mar-2005 Original Closing Date 15-Dec-2010 Planned Mid Term Review Date 15-Sep-2008 Last Archived ISR Date 13-Jul-2013 Effectiveness Date 03-Apr-2006 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 15-Sep-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of the Project are to (i) expand and enhance the family medicine model of primary health care; (ii) build managementcapacity in the sector; and (iii) strengthen the policy making process through the development and implementation of a system for monitoring and evaluating sector performance. Has the Project Development Objective been changed since Board Approval of the Project? ● Yes No Component(s) Component Name Component Cost Primary Health Care Restructuring 29.00 Improvement of Health Sector Management Capacity 3.00 Health Policy Formulation and Project Support 8.00 Overall Ratings Previous Rating Current Rating Public Disclosure Copy Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Low Low Implementation Status Overview This ISR reflects the findings of the implementation support visit conducted from October 21 to 23, 2013. All activities planned under the Additional Financing (AF), are completed or currently being implemented by both entities. Most Project Development Objective indicators are on track. Implementation of activities in the Federation of Bosnia and Herzegovina (FBiH) have shown significant progress in all components. In Component 1 – Primary Health Care Restructuring: Page 1 of 8 The World Bank Report No: ISR12429 Program of Additional Training (PAT) in Family Medicine has been provided and final examination was formally approved. Additional training on Family Medicine will continue to be delivered in accordance with contracts with Community Health Care Centers in Sarajevo, Zenica, Mostar, and Tuzla. Under the Family Medicine Specialization Program, the Family Medicine Training Centers continue to provide training for 57 Family Medicine Specialization Program residents. Pilots to incentivize preventive services for non-communicable diseases (NCD) by introducing pay-for-performance started in early January 2013; 100 family medicine teams were Public Disclosure Copy enrolled and implementation is on track. Implementation is on track. A total of 44 additional Family Medicine ambulantas (PHC clinics) have been refurbished and 55 equipped. Development of information system for Primary Health Care is also on track. In Component 2 – Health Sector Management Capacity Development. Teaching aids and IT equipment have been procured for Sarajevo and Mostar. In Component 3 – Health Policy Formulation and Project Support. A total of 17 sub-projects (out of 68 applications received) were selected and contracts were developed to implement these innovative sub-projects. The field work for the survey of the population’s health status and risk factor for NCDs is completed and final report will be ready by the end of this year. In Republica Sprska (RS), activities are also on track in accordance with the updated Procurement Plan. In Component 1. All works under this Project are completed. While only 36 FM team have valid accreditation, the training and process to accreditate the remaining FM teams was re-launched and it is expected that 240 teams would complete the process by the end of the Project. The only pending activity is the development and dissemination of clinical guidelines, which is planned by 2014. In Component 2. The training program is on track. The number of professionals being trained by the Public Health Institute’s Health Management Center is slightly larger than the number included in the contract. An additional training on hospital waste management is expected to be implemented as well. In Component 3. No further progress has been made under this component since the last implementation support mission in March 2013. The new RS PHC strategy has been updated and is now part of the overall RS Strategy, which reflects all sectors and Line Ministries’ contributions. The Strategy has been completed and sent out for comments but has not yet been formally adopted Locations Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Visegrad Bosnia and Herz Republika Srpska Trebinje Bosnia and Herz Republika Srpska Sreflije Bosnia and Herz Republika Srpska Srbac Public Disclosure Copy Bosnia and Herz Republika Srpska Sokolac Bosnia and Herz Republika Srpska Sipovo Bosnia and Herz Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herz Republika Srpska Prnjavor Bosnia and Herz Republika Srpska Prijedor Bosnia and Herz Republika Srpska Podgrab Page 2 of 8 The World Bank Report No: ISR12429 Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Pale Public Disclosure Copy Bosnia and Herz Federation of Bosnia and Herzegovina Novi Grad Bosnia and Herz Republika Srpska Mokro Bosnia and Herz Republika Srpska Modrica Bosnia and Herz Republika Srpska Milici Bosnia and Herz Republika Srpska Ljubinje Bosnia and Herz Republika Srpska Krupa na Vrbasu Bosnia and Herz Republika Srpska Gornji Ribnik Bosnia and Herz Republika Srpska Foca Bosnia and Herz Republika Srpska Branesci Donji Bosnia and Herz Republika Srpska Bosanski Samac Bosnia and Herz Republika Srpska Bosanska Gradiska Bosnia and Herz Republika Srpska Bocac Bosnia and Herz Republika Srpska Bijeljina Bosnia and Herz Republika Srpska Berkovici Bosnia and Herz Republika Srpska Banja Luka Bosnia and Herz Republika Srpska Demirovac Bosnia and Herz Republika Srpska Strojice Public Disclosure Copy Bosnia and Herz Republika Srpska Gornji Seher Bosnia and Herz Republika Srpska Celinac Bosnia and Herz Republika Srpska Laus Bosnia and Herz Republika Srpska Ugljevik Bosnia and Herz Republika Srpska Tilava Bosnia and Herz Republika Srpska Miljevina Bosnia and Herz Republika Srpska Dubrava Stara Page 3 of 8 The World Bank Report No: ISR12429 Bosnia and Herz Republika Srpska Lazarevo Results Public Disclosure Copy Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Coverage of population through family Text Value About 58% of pop.; FBH: FBiH: 1,474,000 (Sept. 2013) About 70% of pop.; FBH medicine teams 1,000,000 (2009); RS: RS: 1,167 1,500,000; RS: 1,250,000 1,200,147 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 FBiH: 1,474,000 (Sept. 2013) RS: 1,167 The census was conducted and preliminary results would be available in December 2013. Evenwhen the absolute number will likely will be lower than the expected goal, the proportion of population covered will largely surpassthe expected 70% Number of FM teams and health centers in the Text Value RS: 60/650 or about 9% and FBiH: N/A RS: 260 or 40% of FM team RS meeting rigorous accreditation standards 0 health centers RS: 36 accredited. meting accreditation standards; and 35% of health centers to meet safety standards Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track FBiH: N/A Public Disclosure Copy RS: 36 accredited. The remaining teams to achieve the goal being accredited Systemic implementation of selected Text Value No standard set of preventive FBiH: RBF pilots started on Active selected preventive preventive services (i.e., hypertension, breast services except for special January 1, 2013 and are services implemented cancer, prostate enlargement, smoking, etc.) annual programs being implemented systemically by all FM teams inat least 2 major FBiH cantons satisfactorily in at least two major cantons RS: N/A Page 4 of 8 The World Bank Report No: ISR12429 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Health management center operational with Text Value Health management center FBiH: The Health Health management center Public Disclosure Copy annual budget and regular work plan not fully operational Management Center operational developed as a unit within the Federation PH institute. FPHI signed MOU with the School of Economy – fully operational RS: The Health Management Center fully operational Date 23-Oct-2013 31-Dec-2014 Comments New since March 2011 Achieved RS and FBiH primary health care strategy Text Value First version completed and FBiH: Achieved – Operation FBH operational plan for PHC operational plan are updated based on adopted Plan for 2012 updated yearly reform for 2014 adopted by evidence of sector performance and include FBiH MoH based on evidence consultative process with stakeholders and RS: The RS Primary Health between entities Care Strategy was updated but it was not yet formally approved Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of teams operating in family medicine Text Value FBH: 652; RS: 649 FBiH: 737 FBH: 900; RS: 650 RS: 685 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Number of doctors in operating FM teams who Text Value FBH: 383; RS: 191 FBiH: 391 FBH: 523 specializations in completed specialization RS: 215 FM; RS: 250 spec. in FM Public Disclosure Copy 20 specialist are not working as FM Date 22-Mar-2011 23-Oct-2013 Comments New since March 2011 RS Target on track. FBiH will not reach target. Page 5 of 8 The World Bank Report No: ISR12429 Number of FM doctors in operating FM teams Text Value FBH: 740; RS: 342 FBiH: 895 FBH: 940; RS: 342-no further who completed PAT PAT doctor training in RS RS: N/A Public Disclosure Copy Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 FBiH will be close to target Number of nurses in operating FM teams that Text Value FBH: 1437; RS: 1031 FBiH: 1945 FBH: 1900; RS: 1300 completed PAT RS: 1273 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Number of FM educators (Cathedra Faculty of Text Value FBH: 27; RS: 5 FBiH: 31 FBH: 35; RS: 10 Education Center trainers) with a higher education (masters or PhD) in FM RS: 6 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Number of health personnel receiving training Text Value FBH: 3853; RS 2055 FBiH: 4138 FBH: 4000; RS: 3196 RS: 3425 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Health buildings (physical sites) constructed, Text Value FBH: 79; RS: 56 FBiH: 79 FBH: 129; RS: 110 reconstructed, or renovated RS: 80 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track FM ambulantas constructed, reconstructed or Text Value FBH: 335; RS: 146 FBiH: 379; FBH: 385; RS: 275 renovated (several ambulantas per DZ) RS: 213 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Family Medicine Offices / ambulantas equipped Text Value FBH: 376; RS: 320 FBiH: 430 FBiH 410; RS 470 Public Disclosure Copy with medical equipment and or furniture RS: 409 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Family Medicine Offices / ambulantas equipped Text Value FBH: 3 DZ (education centers FBiH: Sarajevo and Mostar FBH: ambulantas of 3 with IT and belonging ambulata); RS: completed (11 municipalities municipalities; RS: 510 510 RS: 157/201 (510/622) Page 6 of 8 The World Bank Report No: ISR12429 Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments FBiH achieved 12Performance Based contracts signed with Text Value FBH: 0 FBiH: 100 Contracts signed FBH: 100 Public Disclosure Copy FM teams (directly or through DZs) in the 2013. Federation RS: N/A Date 22-Mar-2011 22-Mar-2013 31-Dec-2014 Comments New since March 2011 On track Development of Federation level rules for the Text Value 0 FBiH: Rules completed FBH rules for HIS health information standards (HIS) RS: N/A Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Support the implementation of PHC information Text Value 0 FBiH: Not yet in place 3 municipalities systems in about 3 municipalities (Federation) RS: N/A Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 RS: not applicable Development of programs and monitoring tools Text Value 0 FBiH: SW application Programs completed for targeted non-communicable disease operational on pilot sites preventive programs (Federation) RS: N/A Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments New since March 2011 On track Number of trained and equipped community Text Value 0 FBiH: This activity was moved 300 nurses to support FM teams (Federation) to a different project RS: N/A Date 22-Mar-2011 23-Oct-2013 Comments New since March 2011 Number of clinical guidelines developed and Text Value 31 FBiH: N/A 51 disseminated according to needs of FM RS: 31 practitioners (RS) Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Public Disclosure Copy Comments Public Health Grants for Innovative Service Text Value FBH: 40 17 FBH:55 Delivery (Federation) Date 22-Mar-2011 23-Oct-2013 31-Dec-2014 Comments RS: not applicable Data on Financial Performance (as of 30-Sep-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date Page 7 of 8 The World Bank Report No: ISR12429 Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P088663 IDA-40470 Closed 31-Mar-2005 05-Sep-2005 03-Apr-2006 15-Dec-2010 31-Dec-2011 P088663 IDA-49120 Effective 22-Mar-2011 05-Jul-2011 27-Dec-2011 31-Dec-2014 31-Dec-2014 Public Disclosure Copy Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P088663 IDA-40470 Closed XDR 11.20 11.13 0.07 11.13 0.00 100.00 P088663 IDA-49120 Effective XDR 6.50 6.50 0.00 3.22 3.28 50.00 Disbursement Graph Key Decisions Regarding Implementation Public Disclosure Copy not applicable Restructuring History CD Approved on 05-Jun-2009, Level two Approved on 17-Nov-2010 Related Projects P120285-Health Sector Enhancement Project Additional Financing Page 8 of 8