The World Bank Report No: ISR14219 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: 12 Status: ARCHIVED Archive Date: 06-May-2014 (P050716) Country: Uruguay Approval FY: 2008 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministerio de Salud 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 22-Oct-2013 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 Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview Project implementation has continued improving its performance since October 2013 to date. The Project continues progressing to reach Project Development Objective (PDO) indicators; monitoring indicators are showing progress accordingly; and the Project’s PDOs are expected to be accomplished by the end of the Project. Page 1 of 7 The World Bank Report No: ISR14219 Among the four PDOs: Indicator 1. (decrease in the mortality rate from cardiovascular disease) is achieved, showing an important decrease trend (from 75,18 to 59,3 x100000) ; Indicator 2. (screening for NCD in the National Health Insurance population) is now achieved (31.51 % / 30 %) ; Indicator 3. (mammography for women with ASSE coverage) increased from 7.34 % to 12 % with the new implementation plan; and Indicator 4 (decrease rates in NCD risk factor prevalence) can only be measured during 2013/ 2014 through the Second NCD risk factor survey , which is already under implementation. Eight of the 16 Intermediate Indicators, have already been reached, and 8 are on track to be achieved. Public Disclosure Copy The project disbursed US$ 16.51 million (65% of the loan amount), and almost 94% 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 Not Entered 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 Maldonado Maldonado ✔ 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% Currently under measure a. Hypertension: 60% c. Obesity /overweight b. Diabetes: 63,9% through the second NCD risk b. Diabetes: 73% Public Disclosure Copy c. Obesity /overweight: 13% factor survey. Data available c. Obesity /overweight: 20% for second semester 2014. Percentage of women 50-69 covered by the Percentage Value 9.90 14.00 20.00 public provider (ASSE), who has had a Date 29-Dec-2006 31-Dec-2013 mammogram in any given year. Comments Provisional information. Final data with nominalization of patients is under final consolidation process. Page 2 of 7 The World Bank Report No: ISR14219 Crude mortality rate from Diseases of the Number Value 75.18 59.30 67.50 Circulatory System ( I00-I99) in the population Date 29-Dec-2006 31-Dec-2012 under 70 years Comments x 100000 inhabitants Annual Indicator surpassed. x 100000 inhabitants Public Disclosure Copy Data for December 2013 x 100000 inhabitants is under final process. Percentage of population 45-64 years of age Percentage Value 0.00 31.51 30.00 covered by the NIHS and screened for NCD Date 29-Dec-2006 31-Dec-2013 risk factors. Comments Indicator achieved and surpassed. 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 Indicator on track BPS, RUCAF, ASSE and databases and internal MSP databases are FNR beneficiary FNR beneficiary databases integrated into the National Health Information databases and internal and internal MSP databases System. MSP databases are not are integrated into the integrated into the National Health Information National Health System. Information System. Date 29-Dec-2006 31-Dec-2013 Comments Indicator on track. Has concluded development of a Data Warehouse in Epidemiology. Independent cubes for Vital Statistics and reportable events (DEVISA) were developed. This project is aligned with the Action Plan for Improving the Quality of Health Information on MSP Public Disclosure Copy that has the potential to interface with external systems. Proportion of Epidemiologic Surveillance Units Percentage Value 10.00 89.47 85.00 (ESUs) in compliance with information Date 29-Dec-2006 31-Dec-2013 reporting requirements of the health Comments Indicator achieved and surveillance system surpassed. Page 3 of 7 The World Bank Report No: ISR14219 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 31-Dec-2012 decision making. Comments Data for 2013 under process. Public Disclosure Copy Indicator on track. Proportion of communicable disease outbreaks Percentage Value 10.00 98.40 90.00 reported by surveillance system that are Date 29-Dec-2006 31-Dec-2013 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 31-Dec-2013 health promotion subprojects related to NCDs Comments Indicator achieved and (b) development of healthy spaces Proportion of public schools implementing Percentage Value 0.00 3.80 20.00 ‘healthy school’ strategy. Date 29-Dec-2006 31-Dec-2013 Comments Progress more slow than expected. A new strategic approach will be developed. A National Promotion Advocacy group is Text Value The National Promotion There are 60 additional A National Promotion conformed. Advocacy group does not working groups in health Advocacy group is conformed. exist. Promotion, articulated by the MOH. Date 29-Dec-2006 31-Dec-2013 31-Dec-2012 Comments Indicator achieved Regulatory framework affecting essential NCDs Text Value Regulatory framework Regulatory framework for Regulatory framework and risk factorsi s reviewed to assess its affecting essential NCDs Tobacco; Trans fat and affecting essential NCDs effectiveness. and risk factors has never dietary carbohydrate load and risk factors reviewed. been reviewed. reviewed. Law legalizing marijuana, regulating their production and consumption was approved. The Administration has prepared Public Disclosure Copy and submitted for legislative treatment a project that regulates the consumption and distribution of alcohol. Law for healthy food in schools was approved and regulated. Date 29-Dec-2006 31-Dec-2013 Comments Indicator achieved Page 4 of 7 The World Bank Report No: ISR14219 Number of primary health care establishments Number Value 0.00 94.00 100.00 that are certified and quality accredited on Date 29-Dec-2006 31-Dec-2013 NCDs medical care ambulatory procedures. Comments Indicator on track Public Disclosure Copy Health personnel receiving training (number) Number Value 100.00 2128.00 2000.00 Date 29-Dec-2006 31-Dec-2013 Comments Number of primary Indicator achieved. health care team members trained in NCD prevention and care. Development of a National Training Network in Text Value Technical Team and training Technical Team and contents Technical Team and ASSE for primary healthcare workers contents have not been for 4 annual training courses. training contents developed developed and central There are 64 training rooms and 60 training training room has not been equipped and operating. rooms equipped and equipped and is not functioning.Technical Team functioning. and training contents developed and 60 training rooms equipped and functioning. Date 29-Dec-2006 31-Dec-2013 Comments Indicator achieved Percentage of ASSE beneficiaries registered in Percentage Value 0.00 47.00 30.00 electronic medical records Date 29-Dec-2006 31-Dec-2013 Comments Indicator achieved. Percentage of population between 45 to 64 Percentage Value 0.00 1.00 22.00 years with ASSE coverage screened for NCDs Date 29-Dec-2006 31-Dec-2012 risk factor. Comments Data for 2013 is under collection and processing. Percentage of ASSE beneficiaries with risks for Percentage Value 0.00 0.34 10.00 Public Disclosure Copy NCDS detected that is receiving follow up Date 29-Dec-2006 31-Dec-2012 under Previniendo guideline Comments Data for 2013 is under collection and processing. 5. 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 Data for 2013 is under collection and processing. Page 5 of 7 The World Bank Report No: ISR14219 To develop and apply a methodology to assess Text Value Methodology has been Methodology has been the financial impact on public finances and developed developed in conjunction with household budgets of alternative health care the Ministry of Finance and is reform strategies. being implemented in any Public Disclosure Copy given year Date 29-Dec-2006 30-May-2013 31-Dec-2012 Comments Indicator on track Data on Financial Performance (as of 11-Apr-2014) 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 16.51 8.79 65.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation The Uruguay Government has formally requested a second Project extension until December 2015. Page 6 of 7 The World Bank Report No: ISR14219 Restructuring History Level two Approved on 08-Nov-2012 Public Disclosure Copy Related Projects There are no related projects. Public Disclosure Copy Page 7 of 7