The World Bank Report No: ISR9516 Implementation Status & Results Uruguay UY Non Communicable Diseases Prevention Project (P050716) Public Disclosure Copy Operation Name: UY Non Communicable Diseases Prevention Project Project Stage: Implementation Seq.No: 10 Status: ARCHIVED Archive Date: 20-Mar-2013 (P050716) Country: Uruguay Approval FY: 2008 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 28-Aug-2007 Original Closing Date 31-Dec-2012 Planned Mid Term Review Date 06-Dec-2010 Last Archived ISR Date 13-Aug-2012 Effectiveness Date 09-Jan-2008 Revised Closing Date 29-Aug-2014 Actual Mid Term Review Date 10-Dec-2010 Project Development Objectives Project Development Objective (from Project Appraisal Document) The operation would seek to support the Government's efforts to further strengthen its health delivery services and the current health policy framework for NCD. In this context, the specific development objectives of the proposed operation would be: (i) To expand accessibility and quality of primary health care services related to selected NCD s early detection and medical care; and (ii) To avoid and reduce exposure to selected NCDs risk factors as well as their health effects Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Strengthening of the MSP's Capacity to Address the Country's Changing Epidemiological Profile 6.10 Improving Access to Quality Health Care Services for Prevalent NCDs in Public Care Facilities 15.80 Implementation of the Previniendo Pilot Program 3.80 Project Management 2.10 Public Disclosure Copy Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview Project implementation has maintained good performance since the last supervision mission. The main achievements for this period are related to advances in the implementation of the National Integrated Health Information System (NIHIS), including progress in implementation of electronic medical records (EMR) in primary care in the State Health Service Page 1 of 6 The World Bank Report No: ISR9516 Administration (ASSE); progress in development of a national strategy to monitor NCDs; readiness to implement the second NCD risk factors survey during 2013; progress in the implementation at departmental level of the national health promotion strategy; assurance of NCD quality care standards in primary care facilities and improved capability to diagnosis NCD in public facilities and improving screening for NCD in the National Health Insurance population. In November 2012, an international workshop on NCD with participation of international partnerships (PAHO) and Argentinian MOH authorities and discussed progress in the Uruguay NDC strategy. The project disbursed US$ 12.9 million Public Disclosure Copy (51% of the loan amount, and 84% of the total loan amount has been committed). Locations Country First Administrative Division Location Planned Actual Uruguay Not Entered Departamento de Treinta y Tres Uruguay Not Entered Departamento de Tacuarembó Uruguay Not Entered Departamento de San José Uruguay Not Entered Departamento de Río Negro Uruguay Not Entered Departamento de Montevideo Uruguay Not Entered Departamento de Canelones Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of cases diagnosed and under Percentage Value follow-up by primary health care teams for the Date 29-Dec-2006 following NCDs: a. Hypertension; b. Diabetes; Comments a. Hypertension: 54,7% Will be measured in a. Hypertension: 60% c. Obesity /overweight b. Diabetes: 63,9% 2013/2014 through the b. Diabetes: 73% c. Obesity /overweight: 13% second NCD risk factor c. Obesity /overweight: 20% survey Percentage of women 50-69 covered by the Percentage Value 9.90 7.34 20.00 public provider (ASSE), who has had a Public Disclosure Copy Date 29-Dec-2006 30-Dec-2011 mammogram in any given year. Comments 2012 result under measure, expected for June 2013. Crude mortality rate from Diseases of the Number Value 75.18 68.99 67.50 Circulatory System ( I00-I99) in the population Date 29-Dec-2006 21-Dec-2012 under 70 years Comments x 100000 inhabitants Annual Indicator achieved. x 100000 inhabitants Data for December 2010 (last available) x 100000 inhabitants. Data for 2011 in Page 2 of 6 The World Bank Report No: ISR9516 process, expected for June 2013. Percentage of population 45-64 years of age Percentage Value 0.00 25.43 30.00 covered by the NIHS and screened for NCD Public Disclosure Copy Date 29-Dec-2006 28-Dec-2012 risk factors. Comments Indicator on track. Estimated with information to 3rd quarter 2012. Denominator to June 2012. Final data expected for June 2013 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target BPS, RUCAF, ASSE and FNR beneficiary Text Value BPS, RUCAF, ASSE and The main NIHIS databases BPS, RUCAF, ASSE and databases and internal MSP databases are FNR beneficiary (BPS, RUCAF, ASSE and FNR beneficiary databases integrated into the National Health Information databases and internal FNR) are integrated and and internal MSP databases System. MSP databases are not internal MOH databases are are integrated into the integrated into the in process of integration. National Health Information National Health System. Information System. Date 29-Dec-2006 28-Dec-2012 Comments Indicator on track. Proportion of Epidemiologic Surveillance Units Percentage Value 10.00 61.50 85.00 (ESUs) in compliance with information Date 29-Dec-2006 28-Dec-2012 reporting requirements of the health Comments Indicator on track. surveillance system Number of DIGESA key personnel trained in Number Value 0.00 42.00 50.00 SEVES, outbreak investigation and data for Date 29-Dec-2006 28-Dec-2012 decision making. Comments Indicator on track. Proportion of communicable disease outbreaks Percentage Value 10.00 99.20 90.00 reported by surveillance system that are Date 29-Dec-2006 28-Dec-2012 Public Disclosure Copy managed at local level according to norms. Comments Annual Indicator achieved Number of Health Departments that carry out Number Value 0.00 15.00 15.00 “healthy municipality strategy�, including (a) Date 29-Dec-2006 21-Dec-2012 health promotion subprojects related to NCDs Comments Indicator achieved and (b) development of healthy spaces Proportion of public schools implementing Percentage Value 0.00 20.00 ‘healthy school’ strategy. Date 29-Dec-2006 Page 3 of 6 The World Bank Report No: ISR9516 Comments Data for 2012 in process. Expected for June 2013. A National Promotion Advocacy group is Text Value The National Promotion Advocacy group working A National Promotion Public Disclosure Copy conformed. Advocacy group does not actively Advocacy group is conformed. exist. Date 29-Dec-2006 21-Dec-2012 31-Dec-2012 Comments Indicator achieved Regulatory framework affecting essential NCDs Text Value Regulatory framework Development of guidelines Regulatory framework and risk factorsi s reviewed to assess its affecting essential NCDs related to use of fat for affecting essential NCDs effectiveness. and risk factors has never cooking in restaurants and and risk factors reviewed. been reviewed. dietary carbohydrate load for NCDs completed. Date 29-Dec-2006 21-Dec-2012 Comments Indicator on track Number of primary health care establishments Number Value 0.00 78.00 100.00 that are certified and quality accredited on Date 29-Dec-2006 21-Dec-2012 NCDs medical care ambulatory procedures. Comments Indicator on track Health personnel receiving training (number) Number Value 100.00 816.00 2000.00 Date 29-Dec-2006 21-Dec-2012 Comments Number of primary Indicator on track health care team members trained in NCD prevention and care. Development of a National Training Network in Text Value Technical Team and training The training modules Technical Team and ASSE for primary healthcare workers contents have not been developed for NCD are being training contents developed developed and central used through an ASSE owned and 60 training training room has not been e-training platform (EVA). 38 rooms equipped and equipped and is not Virtual training rooms are functioning.Technical Team functioning. operative. Virtual network is and Public Disclosure Copy complemented by 33 tutors training contents developed working at department level and 60 training and 6 regional supervisors rooms equipped and financed by the project functioning. Date 29-Dec-2006 21-Dec-2012 Comments Indicator on good track Percentage of ASSE beneficiaries registered in Percentage Value 0.00 30.00 electronic medical records Date 29-Dec-2006 21-Dec-2012 Page 4 of 6 The World Bank Report No: ISR9516 Comments Data will be available in June 2013 Percentage of population between 45 to 64 Percentage Value 0.00 1.00 22.00 Public Disclosure Copy years with ASSE coverage screened for NCDs Date 29-Dec-2006 28-Dec-2012 risk factor. Comments Percentage of ASSE beneficiaries with risks for Percentage Value 0.00 0.34 10.00 NCDS detected that is receiving follow up Date 29-Dec-2006 28-Dec-2012 under Previniendo guideline Comments Indicator on track. Primary care providers under Annual Percentage Value 0.00 82.00 85.00 Performance Agreements with DHIE Date 29-Dec-2006 21-Dec-2012 31-Dec-2012 Comments Indicator on track To develop and apply a methodology to assess Text Value Methodology has been the financial impact on public finances and developed in conjunction with household budgets of alternative health care the Ministry of Finance and is reform strategies. being implemented in any given year Date 29-Dec-2006 24-May-2012 31-Dec-2012 Comments Indicator on track Data on Financial Performance (as of 18-Dec-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P050716 IBRD-74860 Effective 28-Aug-2007 13-Dec-2007 09-Jan-2008 31-Dec-2012 29-Aug-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P050716 IBRD-74860 Effective USD 25.30 25.30 0.00 12.95 12.35 51.00 Public Disclosure Copy Disbursement Graph Page 5 of 6 The World Bank Report No: ISR9516 Public Disclosure Copy Key Decisions Regarding Implementation The Project was restructured on November 2012, to: (i) adjust project indicators to reflect implementation experience; (ii) scale up some project activities; (iii) change project implementation arrangements; and (iv) extend the project’s closing date by 20 months. No changes were made to the Project Development Objective (PDO) or safeguard arrangements. The changes are expected to enhance project performance and reflect the successful outcomes of Uruguay’s Program on Non-Communicable Diseases (NCD). Restructuring History Level two Approved on 08-Nov-2012 Related Projects There are no related projects. Public Disclosure Copy Page 6 of 6