The World Bank Report No: ISR15266 Implementation Status & Results Uzbekistan Health System Improvement Project (P113349) Public Disclosure Copy Operation Name: Health System Improvement Project (P113349) Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive Date: 01-Aug-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 15-Jun-2015 Last Archived ISR Date 08-Jan-2014 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 The project has made moderate progress since the last supervision mission in November 2013. Activities under each component have been initiated or on going as planned, with some delays. The current disbursement is USD25.41 million or 12.7 percent, which is lower than expected. This is mainly because the Additional Financing credit will start disbursing toward the end of 2014, when the reconstruction of health facilities is completed and procurement and installation of medical equipment to those health facilities start. The MOH implementation team is in the final stage of selecting and contracting the key international and local consultants for technical assistance (TA) and once the TA is board, the project is Page 1 of 6 The World Bank Report No: ISR15266 expected to make faster progress toward achieving the Project Development Objectives. Detailed implementation progress are summarized as below: Public Disclosure Copy (i) Within the State Investment Program, 21 RMUs were renovated in 2013. Sixty-two RMUs are planned to be renovated 2014. (ii) The custom clearance issue of medical equipment purchased under HP/ICB/12/01 and HP/ICB/12/02 was resolved through a Cabinet of Ministers Decree dated March 21, 2014. Installation of the equipment (incl. 58 sets of X-ray machines, 115 digitizers and ultrasound scanners, 355 autoclaves, 1,150 syringe pumps, etc.) is in process and will be completed by October 2014. (iii) Four new clinical protocols were developed based on WHO clinical guidelines on basic NCDs-PEN (CVD, diabetes, asthma and COPD) and are under review by MOH. A working group of 11 experts has started the development of 20 additional clinical protocols and plans to complete the drafts by October 2014. (iv) All the field work under STEPS survey was completed in early April 2014, and data is being cleaned for analysis. (v) In addition to the 1132 physicians (beneficiaries of 10-month GP training) since the last IRS, a new group of 756 GPs will complete their training in July 2014 which will increase number of GPs trained under the project to 1,888. 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 Public Disclosure Copy 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 29-Jun-2014 31-Dec-2018 facilities to RMUs, in accordance with Comments Beneficiary population survey; Will be assessed in during treatment standards baseline available within 6 September 2014 mission month of project effectiveness at which point target will be determined Page 2 of 6 The World Bank Report No: ISR15266 Improved perceived quality of PHC and Percentage Value 70.00 90.00 secondary health care services in intervention Date 02-Oct-2012 29-Jun-2014 31-Dec-2018 areas Comments same as above Not due as above Public Disclosure Copy Increased proportion of hospitals following Percentage Value 0.00 0.00 100.00 NCD treatment standards (at least 20 Date 29-Jun-2014 31-Dec-2018 treatment standards) Comments same as above not yet due. 20 more new treatment standards are being developed by a group of experts. 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 29-Jun-2014 31-Dec-2018 Comments installation of these equipment is expected to be completed by end October 2014. New treatment standards developed and Number Value 0.00 5.00 25.00 adopted by the MOH (CVD, diabetes, etc) Date 10-Mar-2011 29-Jun-2014 31-Dec-2018 Comments additional 20 is being developed by a group of experts. Urban polyclinics# doctors receiving training Number Value 670.00 1132.00 3000.00 under the 10-month training GP program Date 10-Mar-2011 29-Jun-2014 31-Dec-2018 Public Disclosure Copy Comments an additional 756 physicians will complete their studies in July 2014. The total number will increase to 1888 by end July 2014. 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 Page 3 of 6 The World Bank Report No: ISR15266 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 Public Disclosure Copy 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 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 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 Public Disclosure Copy 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 Page 4 of 6 The World Bank Report No: ISR15266 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 Public Disclosure Copy 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 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 20-Jun-2014) 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 Public Disclosure Copy P113349 IDA-48960 Effective XDR 59.60 59.60 0.00 15.15 44.45 25.00 P113349 IDA-52310 Effective XDR 60.60 60.60 0.00 0.00 60.60 0.00 Disbursement Graph Page 5 of 6 The World Bank Report No: ISR15266 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