The World Bank Report No: ISR12761 Implementation Status & Results Kazakhstan Health Sector Technology Transfer and Institutional Reform (P101928) Public Disclosure Copy Operation Name: Health Sector Technology Transfer and Institutional Reform Project Stage: Implementation Seq.No: 11 Status: ARCHIVED Archive Date: 06-Mar-2014 (P101928) Country: Kazakhstan Approval FY: 2008 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 15-Jan-2008 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 31-Oct-2011 Last Archived ISR Date 10-Aug-2013 Effectiveness Date 15-Dec-2008 Revised Closing Date 31-Dec-2015 Actual Mid Term Review Date 31-Oct-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To introduce international standards and build long-term institutional capacity in MOH and related healthcare institutions in support of key health sector reforms pursued by the Government of Kazakhstan in the context of the State Health Care Reform and Development Program. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component A: Health Financing and Management 20.20 Component B: Health Care Quality Improvement 59.90 Component C: Reform of Medical Education and Medical Science 9.40 Component D: Health Information System Development 188.60 Component E: Pharmaceutical Policy Reform 4.20 Public Disclosure Copy Component F: Food Safety and WTO Accession 8.70 Component G: Project Management 4.60 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Page 1 of 9 The World Bank Report No: ISR12761 Implementation Status Overview Development of a key policy paper for eHealth, together with clear and well defined Road map for implementation and Procurement Plan is now finalized. Such policy and implementation plan is mature and feasible and represents the best practice. Process of development of these documents took almost a year and somewhat slowed the disbursement which is now expected to increase substantially in 2014. This was all planed during the restructuring process and disbursements, despite process of developing these Public Disclosure Copy concepts is on projected level. Overall rating of the project during 2013 was mainly influenced with delays in adoption of these eHealth policies and now can be upgraded. There are many other highly important results such as harmonization of legislation of food safety with EU standards and transition to HASSP (Hazard Assessment and Critical Control Points) as is in EU, which will enable Kazakhstan to access world market and influence trade in Customs Union and WTO. Progress in medical science is also remarkable and also present best practice. Key indicators are on track, some over-achieved and only few slightly delayed. Locations Country First Administrative Division Location Planned Actual Kazakhstan Not Entered Shyghys Qazaqstan Oblysy Kazakhstan Not Entered Pavlodar Oblysy Kazakhstan Not Entered Qaraghandy Oblysy Kazakhstan Not Entered Astana Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased funding for Primary Health Care Percentage Value 16.00 18.80 30.00 Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments On track (based on 9 months of 2013). A major increase of this share expected as of January 2014 as a result of significant supplementation and equalization of PHC per Public Disclosure Copy capita rate by regions. Improved financial risk protection as defined by Percentage Value 32.90 29.90 30.00 reduced share of household health spending in Date 31-Dec-2010 16-Oct-2013 31-Dec-2015 total health expenditures Comments Achieved based on recent data from NHA report for 2012. Page 2 of 9 The World Bank Report No: ISR12761 Master plans for capital investments, Number Value 0.00 3.00 4.00 developed based on international best practice, Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 used as a basis for capital investment Comments On track. Various changes allocations in at least 4 oblasts Public Disclosure Copy (reorganizations) to facility networks undertaken by local administrations in 9 oblasts. The MOH will follow up on regulatory changes that would make the use of master plans as a basis for capital investment allocations binding at the national level. At least two evidence-based disease Number Value 0.00 0.00 2.00 management programs, which include Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 incentives for health care providers and Comments On track but delayed. patients, developedand endorsed by the Ministry of Health Concept and Implementation Guideline for development of Disease Management Programs approved through MOH Order No.211 dated April 1, 2013. Preparation for development and pilot implementation of DMPs for 3 diseases (hypertension, chronic cardiac insufficiency, diabetes) in Pavlodar and North Kazakhstan oblasts underway with consulting firm (CSIH) being contracted on SSS basis. Number of public health facilities accredited by Number Value 20.00 20.00 40.00 national accreditation body in accordance with Date 31-Dec-2011 20-Nov-2013 31-Dec-2015 international standards Public Disclosure Copy Comments Exceeded. 115 public and 12 private PHC health facilities accredited by national accreditation body based on new accreditation standards for outpatient care endorsed by ISQua in February 2013. Page 3 of 9 The World Bank Report No: ISR12761 ICT standards, which conform with Text Value No standards 15 25 international standards and include Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 interoperability standards, are endorsed by Comments 10 basic e-Health standards Target value has been Health ICT Regulatory Body and published Public Disclosure Copy developed by working group determined. published at the end-2013. Draft MOH Order prepared for adoption of another 5 international standards. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased capacity for health policy analysis Number Value 0.00 3.00 4.00 (as measured by number of national analytical Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 reports produced annually) Comments 3 analytical reports are being finalized (first, on health status of Kazakhstan's population; second, analysis based on household survey; third, analysis based on NHA report for 2012). NHA reports produced annually, disaggregated Yes/No Value Yes Yes Yes by national and sub-national levels, and Date 31-Dec-2011 20-Nov-2013 31-Dec-2015 disseminated among key stakeholders Comments NHA 2010 aggregated at On track: NHA 2012 to be Four NHA reports to be national level completed in Q4. prepared by 2015. New network planning tools and new facility Text Value New hospital planning tools New network planning tools New tools and standards for standards formally adopted by the Ministry of and standards developed and standards for hospitals planning hospitals, laboratory Health were endorsed for and PHC facilities formally implementation in several adopted oblasts. Regulatory changes for their adoption at the natiional level are expected in Public Disclosure Copy 2014. New planning tools and standards for PHC and laboratory networks are expected to be finalized in December 2013. Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments On track. Page 4 of 9 The World Bank Report No: ISR12761 Master plans for capital investments developed Number Value 5.00 16.00 16.00 for 16 regions based on international best Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 practice Comments Achieved. All 16 master plans Public Disclosure Copy developed. Oblast-level health network master plans Number Value 0.00 2.00 4.00 endorsed for at least 4 oblasts Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments On track. First oblast level master plan adopted in November 2012 (East- Kazakhstan oblast). Several more oblasts on track to approve master plans. Evidence-based incentives for providers in Text Value No evidence-based incentives The approved Concept and Optimized set of evidence- disease management programs implemented for providers Guideline for Disease based incentives and pay-for- Management Programs performance mechanisms for stipulates incentives for providers implemented providers. Preparation for pilot implementation in Pavlodar and North Kazakhstan oblasts is underway. Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments On track but delayed. Incentives introduced, including revision of co- Text Value No incentives for patients The approved Concept and Optimized set of incentives for payments, for patients to comply with diseases Guideline for Disease patients implemented management programs Management Programs stipulates incentives for patients. Preparation for pilot implementation in Pavlodar and North Kazakhstan oblasts is underway. Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Public Disclosure Copy Comments On track but delayed. Criteria, procedures and standards for Text Value Health facility accreditation Criteria, procedures and Accreditation criteria, accreditation of health facilities developed, standards developed standards for accreditation of procedures and standards adopted and implemented in line with health facilities developed, renewed international practice adopted and implemented in line with international practice. Date 31-Dec-2011 20-Nov-2013 31-Dec-2015 Comments On track. New facility accreditation standards for inpatient and outpatient care Page 5 of 9 The World Bank Report No: ISR12761 as well as training program for accreditation surveyors were endorsed by ISQua. Facility accreditation conducted Public Disclosure Copy regularly (115 public and 12 private PHC facilities accredited in November 2013). Standards for blood service developed and tested. Evidence-based CPGs for selected disease Text Value No CPGs for disease Earlier developed evidence- CPGs for disease management programs developed management programs based CPGs for hypertension, management programs chronic cardiac insufficiency, implemented and diabetes will be refined as part of pilot implemetation of DMPs in Pavlodar and North Kazakhstan oblasts. Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments On track. Increase in share of voluntary blood donations Percentage Value 83.00 84.80 88.00 by 2015 Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments Based on 9 months of 2013. Slow progress due to limited involvement of the project. Decrease in absolute number of paid donations Number Value 38800.00 32709.00 33400.00 by 2015 Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments Based on 9 months of 2013. Slow progress due to limited involvement of the project. According to CDC current paid donors should be distinguished by recurrent paid donors and new ones. Public Disclosure Copy Accordingly recurrent ones are safe as their status is known. This will be reflected in new result as we make disaggregation Criteria, procedures and standards for Text Value No educational programs Technical work will start in Educational programs for accreditation of basic medical education accredited 2014 as part of the TORs for “General Medicine” of two programs developed, adopted and establishment of medical medical universities implemented in linewith international practice education quality assurance accredited system. Page 6 of 9 The World Bank Report No: ISR12761 Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments Delayed (RFP advertised recently). Public Disclosure Copy IT-infrastructure for deployment of UHMIS in Text Value IT infrastructure developed in IT infrastructure developed in IT infrastructure developed in selected oblasts developed by the Ministry of 140 health organizations 290 health organizations 2,000 health organizations Health Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments On track. 140 in Akmola and 150 in Karaganda oblast. Functional ICT standards in line with major Text Value No functional ICT standards 15 functional ICT standards 25 functional ICT standards international functional standards developed by Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Health ICT Regulatory Body Comments On track. 10 basic e-Health Standards developed and standards developed by published and used for working group approved by market. end-2013. Draft MOH Order prepared for adoption of another 5 international standards. Drug price reference system for drugs included Text Value Ceiling prices for drugs set MOH Order No.223 dated Reference drug prices refined in the National Formulary Book developed and April 12, 2013 approved rules based on implementation adopted by the Ministry of Health for monitoring and setting experience drug prices within Basic Benefits Package. Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments On track. Following the study tour on modern drug cost containment measures in Europe and forthcoming recommendations from consulting firm, refinement of the Order will be done in early 2014. Public Disclosure Copy Legal and regulatory documents related to Text Value Recommendations on Technical regulations for food HACCP system post-processing food standards revised in revision of 26 food safety safety in Customs Union implementation in food accordance with international standards norms and rules, 25 technical No.021/2011 in effect since industry expanded regulations, and on July 1, 2013 include most of amendments to the Law on TA recommendations under Food Safety developed project and aligned with European food safety regulations. 13 cases of GMO in food products identified using new food study methods. Page 7 of 9 The World Bank Report No: ISR12761 Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments Target for 2013 achieved. Project work plans, procurement plans, and Yes/No Value Yes No Yes Public Disclosure Copy budget produced and approved on an annual Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 basis as described in the Project Operational Comments Delayed. Finalization of Manual Procurement Plan delayed due to pending e-Health Road Map. Health personnel receiving training (number) Number Value 10720.00 82426.00 63066.00 Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments Exceeded. Health facilities constructed, renovated, and/or Number Value 160.00 2058.00 equipped (number) Date 31-Dec-2011 16-Oct-2013 31-Dec-2015 Comments Exact number of equipped facilities is being verified. Data on Financial Performance (as of 19-Dec-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P101928 IBRD-48830 Effective 15-Jan-2008 02-Feb-2008 15-Dec-2008 30-Jun-2013 31-Dec-2015 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P101928 IBRD-48830 Effective USD 117.70 117.70 0.00 52.57 65.13 45.00 Disbursement Graph Public Disclosure Copy Page 8 of 9 The World Bank Report No: ISR12761 Public Disclosure Copy Key Decisions Regarding Implementation Disbursement is at projected level. There is still large amount that needs to be disbursed which is expected to increase substantially in 2014. This relative slow disbursement is explained by (i) delays in implementation of the Road Map for Component D, and (ii) delays concluding other contracts and extensions as originally planned. As there are only 2 years of implementation before closing, it is essential to set very clear milestones and closely monitor implementation progress to ensure all PDOs are achieved. Despite excellent progress intensive supervision is necessary to sustain achieved progress pace. Set of key actions are presented in Aide Memoire and it was agreed to define and monitor key milestones to avoid further delays in implementation. Key pending action is revision of budget allocation for 2014 by the Government to allow procurement as presented in the Procurement Plan. Restructuring History Level two Approved on 12-Oct-2012 Related Projects Public Disclosure Copy There are no related projects. Page 9 of 9