The World Bank Report No: ISR12860 Implementation Status & Results Uzbekistan Health System Improvement Project (P113349) Public Disclosure Copy Operation Name: Health System Improvement Project (P113349) Project Stage: Implementation Seq.No: 5 Status: ARCHIVED Archive Date: 08-Jan-2014 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 08-Jun-2013 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 CityMedical 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 Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status Overview Implementation of key activities under the original Credit is in progress. The disbursement rate currently stands at 18% from the original Credit and 9% from the total amount of the original Credit and Additional Financing Credit. The implementation of Government investment program in rayon hospitals is progressing as planned. From 2011 to 2013, the Government completed the reconstruction or construction of 16 RMU. The Government plans to reconstruct an additional 49 Rayon Medical Unions (RMUs) in 2013 - 2014. Oblast Hospital Oversight Committees have been established in all Oblasts to monitor the implementation of the hospital program in the regions. Page 1 of 6 The World Bank Report No: ISR12860 The delivery of equipment to medical facilities, purchased under HP/ICB/12/01 and HP/ICB/12/02, has begun. As of November 27, 2013, the project delivered digitizers to 79 facilities, refrigerators to 161 facilities, ultrasound machines to 110 facilities, and autoclaves to 79 facilities. Public Disclosure Copy WHO has been assisting Ministry of Health 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. Five out of eight clinical protocols have been approved by the Ministry of Health: diabetes, urinary tract infections, chronic hepatitis, and gastric and duodenal ulcers which is a major step forward for NCD prevention and treatment in Uzbekistan. WHO and World Bank teams have agreed to continue cooperation in the development of 10 more clinical guidelines and protocols, development of training modules for physicians on newly-developed clinical protocols, and analysis of pilot household expenditure survey data as well as the next nationwide survey. The survey will start in December 2013 –early 2014 Under the project, 1132 physicians have completed a ten-month GP training. Another group of 756 GPs started this training in September 2013 and will complete the training in June 2014. Furthermore, 2,805 GPs and 7,041 nurses have completed continuing professional development courses on various topics. 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 Public Disclosure Copy hypertension patients referred from PHC Date 19-Dec-2013 31-Dec-2018 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 Improved perceived quality of PHC and Percentage Value 70.00 90.00 secondary health care services in intervention Date 02-Oct-2012 19-Dec-2013 31-Dec-2018 areas Comments same as above Not due until 2014 Page 2 of 6 The World Bank Report No: ISR12860 Increased proportion of hospitals following Percentage Value 0.00 0.00 100.00 NCD treatment standards (at least 20 Date 19-Dec-2013 31-Dec-2018 treatment standards) Comments same as above not yet due. Five new Public Disclosure Copy treatment standards are approved by MOH and four more will be completed 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 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Hospitals equipped with medical and waste Number Value 0.00 161.00 516.00 management equipment Date 10-Mar-2011 19-Dec-2013 31-Dec-2018 Comments 161 health facilities received medical equipment New treatment standards developed and Number Value 0.00 0.00 25.00 adopted by the MOH (CVD, diabetes, etc) Date 10-Mar-2011 19-Dec-2013 31-Dec-2018 Comments not yet due. Five new standards are approved by MOH and four more will be completed Urban polyclinics# doctors receiving training Number Value 670.00 1132.00 3000.00 under the 10-month training GP program Date 10-Mar-2011 20-Dec-2013 31-Dec-2018 Comments 643 completed training in June 2013. New group started training in September 2013. 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 Public Disclosure Copy 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 management Date 10-Mar-2011 02-Oct-2012 31-Dec-2016 Page 3 of 6 The World Bank Report No: ISR12860 Comments Training to begin next year in anticipation of delivery of hospital waste management equipment. Public Disclosure Copy 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 Comments Not yet due. Training to begin after development of new treatment guidelines. 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 Public Disclosure Copy 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 Comments ToR to contract international T/A for this activity being developed Page 4 of 6 The World Bank Report No: ISR12860 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 Public Disclosure Copy under development Percent of population in targeted Oblasts Percentage Value knowing cardiovascular risk factors Date 07-Apr-2011 02-Oct-2012 31-Dec-2016 Comments Data available within 6 month Work on developing survey of effectiveness upon which on knowledge and awareness target will be determined ongoing 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 26-Nov-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 Effective 07-Mar-2013 18-Jul-2013 19-Sep-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 13.99 45.61 23.00 P113349 IDA-52310 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: ISR12860 Public Disclosure Copy Key Decisions Regarding Implementation n/a 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