The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Kosovo Health Project (P147402) EUROPE AND CENTRAL ASIA | Kosovo | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2014 | Seq No: 14 | ARCHIVED on 18-Dec-2019 | ISR39843 | Implementing Agencies: Republic of Kosovo, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 13-May-2014 Effectiveness Date: 20-May-2015 Planned Mid Term Review Date: 30-Oct-2017 Actual Mid-Term Review Date: 30-Oct-2017 Original Closing Date: 30-Oct-2019 Revised Closing Date: 30-Jun-2020 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To contribute to improving financial protection from health spending for the poor and quality of care for priority maternal and child health and non communicable disease services. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) The Project Development Objective is to contribute to (i) developing the building blocks to introduce Social Health Insurance; and (ii) strengthening Primary Health Care in selected municipalities. Components Table Name Support capacitiy building and establishment of building blocks for introduction of SHI:(Cost $5.82 M) Support primary health care strengthening:(Cost $9.10 M) Project management and communications:(Cost $0.77 M) Overall Ratings Name 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 and Key Decisions This ISR presents the findings of the implementation support visit during November 4-8, as well as progress until now. Overall, good progress has been achieved in the implementation of most project activities, contributing positively towards the achievement of project development objectives. Specifically, key activities have progressed as planned, including: (I) development and utilization of the Health Information 12/18/2019 Page 1 of 6 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) System for the Health Insurance Fund; (ii) finalizing the drug benefits list (currently awaiting approval) and preparing the piloting of the e- prescription and outpatient drug benefits package; (iii) successful completion of the technical assistance support on hospital management and re- organization of the University Clinical Center ; and (iv) rolling out in 29 municipalities the web-application with a simple HIS module to support the capitation-based payments to municipalities. Despite the overall good progress in project implementation, the actual capitation-based payments to municipalities (under Component 2) were stalled in 2019 (due to a mistaken allocation of funds in the Budget Law for 2019). Currently, the MoH has accommodated the amount of EUR 2.5 Million (the amount originally planned for 2019) within their budget ceiling for 2020. However, due to a mis-allocation of funds under the 2020 budget for CBPPs by the MoF, the issue is still not resolved for the coming year and will be discussed as a matter of priority immediately upon the new Government being in place. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance -- High High Macroeconomic -- Moderate Moderate Sector Strategies and Policies -- High High Technical Design of Project or Program -- Substantial Substantial Institutional Capacity for Implementation and Sustainability -- Substantial Substantial Fiduciary -- High High Environment and Social -- Low Low Stakeholders -- Substantial Substantial Other -- -- -- Overall -- Substantial Substantial Results PDO Indicators by Objectives / Outcomes To contribute to developing the building blocks to introduce Social Health Insurance IN00781222 ►Outpatient (OP) drug benefit scheme established (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target The costed list of drugs The list of drugs for The costed list of for the outpatient drug outpatient drug benefit drugs for the Value No benefit scheme is scheme adopted by outpatient drug benefit submitted to the Steering the HIF is submitted to scheme is submitted to Board of the HIF the Government 12/18/2019 Page 2 of 6 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) the Steering Board of the HIF Date 13-May-2014 29-Aug-2019 06-Dec-2019 30-Jun-2020 The approval of the list is expected to be done when the new Government will be in place. Comments: IN00781224 ►HIFIS is functional (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 13-May-2013 29-Aug-2019 06-Dec-2019 30-Jun-2020 The system is expected to be functional by end of December, 2020. Comments: To contribute to strengthening Primary Health Care IN00781223 ►Number of municipalities participating in CBPP scheme (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 6.00 6.00 18.00 20.00 Date 13-May-2013 28-Feb-2019 06-Dec-2019 30-Jun-2020 On May 24, 2019, the following municipalities have signed performance agreements with MoH: 1. Dragash, 2. Malisheva, 3. Prishtina, 4. Prizren, 5. Rahovec, 6. Suharekë, 7. Gllogoc, 8. Fushë Kosovë, 9. Comments: Lipjan , 10.Obiliq, 11.Podujevo, 12.Mamusha, 13.Gjilan, 14.Kamenica, 15.Novobërdë, 16.Viti, 17.Partesh, and 18.Ranillug Intermediate Results Indicators by Components Establishing Building Blocks for the Introduction of Social Health Insurance IN00781225 ►Health personnel receiving training (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,358.00 12,278.00 2,449.00 Date 13-May-2014 28-Feb-2019 06-Dec-2019 30-Jun-2020 Training of PHC staff for using HIS-PRA held from December 2018 to September 2019: total trainees 3,355. Training on "Primary Health Care priorities”, in total five modules completed, held from March 17, 2016 to March 29, 2017: total trainees 4,044. Medical training on access to PHC (32 municipalities) with 5 modules is continuing according to the schedule foreseen by the company that is holding the trainings; between February 11 and September 30, Comments: 2019: total trainees 4,358. Training on performance based financing “with six modules carried out between March 30, 2016 and September 02, 2018: total trainees 143. Training on "Health Insurance and Quality of Care” with seven modules completed between March 26 and November 9, 2018: trainees 167. Training on Capacity Building for Outpatient Drug Benefit Scheme, with 9 modules carried out from June 10 - 21, 2019: trainees 167. 12/18/2019 Page 3 of 6 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Capacity Building for Outpatient Drug Benefit Scheme in the Republic of Kosovo - Workshop on External Reference Price Calculation, carried out between September 30 and October 1: trainees 27. Trainings for CMS application, maintenance of HIF web site - completed between 2016 – 2019: trainees 6. Training on procurement procedures according to World Bank, held 2019, trainees 10. And training on citizen engagement organized by the World Bank, held in 2019.- trainee 1. IN00781226 ►Health facilities constructed, renovated, and/or equipped (number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11.00 11.00 11.00 Date 13-May-2014 29-Aug-2019 06-Dec-2019 30-Jun-2020 IN00781229 ►Percentage of patients using primary health care facilities who are satisfied with services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 65.80 65.80 65.80 70.00 Date 31-Dec-2017 29-Aug-2019 06-Dec-2019 30-Jun-2020 Based on the results “Expectation and Perception of Population Towards Quality of Services in Primary Health Care and their Expectation Regarding the Outpatient Drug Benefit Scheme in the Republic of Kosovo” (February 2018), 65.8% of patients using primary health care services are satisfied with the services received Comments: Strengthening Primary Health Care IN00781227 ►Number of patients registered in the HIS (Number (Thousand), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 378,975.00 378,965.00 511,074.00 Date 13-May-2013 29-Aug-2019 06-Dec-2019 30-Jun-2020 In total 378,965, out of which 56% are female. Since the MOH-HIS has introduced the HIS-PRA in 23 municipalities (as of September 30,2019, the number is expected to be higher. To be updated in next Comments: reporting. IN00781228 Of which female (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 56.00 78.00 IN00781230 ►Percentage of capitation-based performance payment budget spent at municipality level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 72.14 72.14 95.00 12/18/2019 Page 4 of 6 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Date 13-May-2014 29-Aug-2019 06-Dec-2019 30-Jun-2020 The current value is the end of 2018 value. Since then, effective capitation-based payments to Comments: municipalities were stalled in 2019. IN00781231 ►Percentage of participating municipalities with a performance improvement action plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 90.00 75.00 Date 13-May-2014 29-Aug-2019 06-Dec-2019 30-Jun-2020 Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P147402 IDA-54420 Effective USD 25.50 17.31 8.19 4.98 9.82 34% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P147402 IDA-54420 Effective 13-May-2014 15-Jan-2015 20-May-2015 30-Oct-2019 30-Jun-2020 Cumulative Disbursements 12/18/2019 Page 5 of 6 The World Bank Implementation Status & Results Report Kosovo Health Project (P147402) Restructuring History Level 2 Approved on 12-Jun-2018 ,Level 2 Approved on 24-Jul-2019 Related Project(s) There are no related projects. 12/18/2019 Page 6 of 6