The World Bank Report No: ISR6680 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: 7 Status: ARCHIVED Archive Date: 27-Dec-2011 (P101928) Country: Kazakhstan Approval FY: 2008 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health 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 27-Dec-2011 Effectiveness Date 15-Dec-2008 Revised Closing Date 30-Jun-2013 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. 1. Improved efficiency and equity of health expenditure and better financial protection for households in oblasts that implement a comprehensive package of healthcare financing and management reforms; 2. Improved quality and efficiency of medical care through the establishment of functioning systems/ institutions for clinical practice guideline development/ dissemination and health facility accreditation, and through improved performance in the laboratory and blood transfusion systems; 3. Improved quality of medical graduates and improved ability to carry out medical research through upgrading the medical/pharmacological education and research systems and introducing international standards; 4. Improved efficiency and quality in health facility management through access to reliable, timely health information from a unified health information system; 5. Improved safety, efficacy, quality and affordability of drugs through reforms in pharmaceutical procurement, pricing, prescribing monitoring, information provision, benefit package design and quality control; and 6. Improved food safety and speedier WTO accession through the introduction of international sanitary and phytosanitary norms. Has the Project Development Objective been changed since Board Approval of the Project? Public Disclosure Copy Yes No Page 1 of 11 The World Bank Report No: ISR6680 Component(s) Component Name Component Cost Component A: Health Financing and Management 20.20 Public Disclosure Copy 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 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 Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview Overall implementation is proceeding well and pace of implementation has accelerated since Mid term review in November 2011. Much efforts were made to prepare restructuring plan and to move towards implementation of reforms as agreed during Mid Term review. Several key policy directions for the sector were agreed during a Brainstorming Session with Prime Minister in May 2012. As the project was designed to focus mostly on building capacity to develop policies through technical assistance and training, the actual implementation of reforms were not envisaged. The Project Appraisal Document recognized that adjustments could be needed depending on the pace of the reforms and evolving needs. Given the good progress made so far, it was recognized that the project should shift its focus towards implementation of a number of key reforms envisaged under Salamatti Kazakhstan. This will be possible because of considerable savings attained in the procurement of both equipment and provision of technical assistance from projections made at appraisal. Locations Country First Administrative Division Location Planned Actual Kazakhstan Not Entered Shyghys Qazaqstan Oblysy Kazakhstan Not Entered Pavlodar Oblysy Public Disclosure Copy Kazakhstan Not Entered Qaraghandy Oblysy Kazakhstan Not Entered Astana Results Project Development Objective Indicators Page 2 of 11 The World Bank Report No: ISR6680 Indicator Name Core Unit of Measure Baseline Current End Target Improved efficiency and equity of health Text Value Expenditure on: - utilities as a Expenditure on: (a) Delayed. Expenditure on: (a) utilities as expenditure and better financial protection for proportion of total recurrent Data on utilities expenditures a proportion of total recurrent Public Disclosure Copy households in oblasts that implement a spending in hosp. that by hospitals included in the spending in hosp. should be comprehensive package of healthcare introduce package of reforms Comprehensive survey of reduced by 10%; (b) financing and management reforms is TBD; - outpatient care as a facilities/providers/patients to outpatient hosp. care as a share of total expend. is be conducted in 2012 & 2013. share of total hosp. expend. 25.6%. Contract for Comprehensive increased to 40% survey signed on June 7, 2012. (b) (b) PHC as a share of total health expend. is 22.5%. Date 01-Oct-2008 14-Jun-2012 31-Dec-2013 Comments Expenditure on: (a) utilities as a proportion of total recurrent spending in hosp. that introduce package of reforms is 1.6%; (b) outpatient care as a share of total expend. is 29.9%. Improved quality & efficiency of medical care Text Value (a) No CPGs in place and no a) 59 clinical protocols (a) At least 20 core CPGs through the establishment of functioning institution with capacity to developed and implemented. developed in 5 specialties and systems/institutions for clinical practice develop them. (b) No 2 CPGs implemented and 11 reviewed; (b) Establishment guideline development/dissemination & health accreditation body and (c) no other CPGs approved; (b) 43 of independent accreditation facility accreditation health facilities have trainers and 160 inspectors body, (c) which accredits at undergone accreditation to- trained; (c) Beside hospital least 20 public facilities at date. accreditation standards, republican and oblast levels. standards for outpatient facilities also developed and -tested on 5 healthfacilities. Date 01-Oct-2008 10-May-2012 31-Dec-2013 Comments Public Disclosure Copy Improved quality of medical graduates & Text Value (a) Outdated curricula for (a) Proposals on introduction (a) New curricula for medical improved ability to carry out medical research medical and pharmaceutical of multiple mini-interview and pharmaceutical educ. through upgrading the medical/ educ.; (b) Participation rates developed and to be piloted; implemented in the 6 public pharmaceuticaleducation & research systems in training courses in EBM (b) EBM centers established, univ.; (b) 100% participation & introducing international standards. centers is 0%; (c) No 175 faculty members trained; rates in training courses in physicians have been (c) Center for independent EBM centers; (c) 1500 licensed under new assessment of knowledge physicians licensed under standards. and skills established within new standards. RCHD. Pilot online testing of internship graduates conducted in May 2011, and Page 3 of 11 The World Bank Report No: ISR6680 final computer testing in June 2011. Date 01-Oct-2008 14-Jun-2012 31-Dec-2013 Public Disclosure Copy Comments Improved efficiency and quality in health facility Text Value (a) There is no HMIS system (a) Regulatory body for e- (a) HMIS fully designed and management through access to reliable, timely in place; (b) 0% of staff are Health established and approved for use by MOH; (b) health information from a unified health trained and able to use HMIS capacity building planned. 75% of key HMIS users fully information system. system. Delivery and installation of IT trained and able to use the equipment in Karaganda system. oblast underway. Contract for East-Kazakhstan oblast delayed; (b) 52.2% (12275) of all key HMIS users in 4 pilot sites (23499) fullytrained and able to use the system, including 100% (6762) in Astana, 97.9% (5513) in Akmola oblast. Date 01-Oct-2008 14-Jun-2012 31-Dec-2013 Comments Improved safety, efficacy, quality & affordability Text Value (a) Ratio of counterfeit drugs (a) n/a; (b) Data not available. (a) Ratio of counterfeit drugs of drugs through reforms in pharmaceutical TBD; (b) Out-of-pocket drug To be completed in 2012. TBD; (b) 10% reduction in procurement, pricing, prescribing, monitoring, expenditure is 54.4%; (c) Starting January 2012, Out-of-pocket drug expend.; information provision, BP design & quality Average retail and public outpatient drug benefits (c) 10% reduction in Average control. procurement price for provided to eligible categories retail and publicproc. price for selected drugs TBD; (d) No free of charge within BBP; (c) selected drugs; (d) restructuring of Second round of drug price Restructured pharma. policy pharmaceutical policy sector. survey (WHO/HAI) underway. sector. MOH WG developing price setting methodology. Price regulation mechanism using reference prices considered by MOH in May 2012. Close Public Disclosure Copy coordination with Customs Committee, andfixing prices at drug registration stage; (d) Updated National Formulary approved by the Republican Formulary Commission in May 2011. Date 01-Oct-2008 23-May-2012 31-Dec-2013 Comments (b) As per NHA 2008; (c) to be available in December Page 4 of 11 The World Bank Report No: ISR6680 2010; other special surveys to establish baseline values not conducted yet. Improved food safety and speedier WTO Text Value (a) No safety norms in place; (a) 26 sanitary norms and (a) Harmonization of 10 food Public Disclosure Copy accession through the introduction of (b) No technical regulations in rules and 25 technical safety norms in accordance international sanitary and phytosanitary norms place. regulations upgraded to with int. standards; (b) international standards for Development and approval of approval by MOH; 15 technical regulations; Development of Handbook of international-standard sanitary norms and rules for local food industry underway. Date 01-Oct-2008 14-Jun-2012 31-Dec-2013 Comments Additional norms and technical regulations for harmonization identified; revised target value to be confirmed by the MOH following contract negotiations. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Accreditation of medical education Text Value National standards for On track: Implementation of International accreditation institutional accreditation twining agency standards adopted on basic developed and approved recommendations on medical education for medical based on WFME standards upgrading national universities for basic medical education accreditation standards to and tailored to Ministry of comply with international Education and Scienc WFME standards for basic National Accreditation Center education underway. (NAC MOES) requirements and national specifications. Public Disclosure Copy Date 31-Dec-2008 14-Jun-2012 30-Jun-2013 Comments Improvements of medical research Text Value Delayed: twining agency Mechanism developed for the started technical activities in prioritization and review of May 2012. medical research and the issuance of competitive grants, according to international principles Page 5 of 11 The World Bank Report No: ISR6680 Date 16-May-2012 30-Jun-2011 Comments restructuring of the pharmaceutical policy Text Value On track: draft Progressive restructuring of Public Disclosure Copy sector Pharmaceutical Policy the pharmaceutical policy Concept developed and being sector as evidenced by publicly discussed. finalization and publication of a national drug policy by 2010 Date 24-May-2012 31-Dec-2010 Comments Drug approval system updated, based on Text Value On track: Updated National Drug approval system international standards Formulary approved by the updated, based on Republican Formulary international standards by Commission in May 2011. 2009, including removal from the market of some older drugs by 2012 Date 14-Jun-2012 Comments Establishment of drug price regulations Text Value On track: Second round of Establishment of drug price drug price survey (WHO/HAI) regulations by 2009 that underway. MOH WG decrease the average retail developing price setting and procurement price for methodology. Price regulation selected drugs by 2010 mechanism using reference prices considered by MOH in May 2012. Close coordination with Customs Committee, and fixing prices at drug registration stage. Date 14-Jun-2012 31-Dec-2009 Comments Technical food regulations to international Text Value On track: Recommendations Development and approval of Public Disclosure Copy standards provided on harmonization 15 technical regulations to with international international standards requirements of 25 technical regulations. Date 14-Jun-2012 30-Jun-2013 Comments Decrease in out-of-pocket drug expenditures Percentage Value 54.00 44.00 Date 14-Jun-2012 30-Jun-2011 Comments Data not available 10 % decrease Page 6 of 11 The World Bank Report No: ISR6680 Harmonization of food safety norms and rules Text Value On track: Development of Harmonization of 10 food in accordance with international standards Handbook of international- safety norms and rules in standard sanitary norms and accordance with international rules for local food industry standards Public Disclosure Copy underway Date 14-Jun-2012 30-Jun-2013 Comments Regulation of food standards and processing Text Value On track: draft amendments Harmonize regulations with to Law on food safety WTO standards developed according to international standards. Date 25-May-2012 30-Jun-2013 Comments Establishment of a well-functioning Health Text Value No policy unit in place In addition to Strategic Establishment and operation Policy Unit Planning Division, Health of a well-functioning Health Policy Analysis Division Policy Unit with at least five created within DSD in April staff possessing an 2012. appropriate skill-mix Date 01-Dec-2008 14-Jun-2012 30-Jun-2013 Comments Implementation of National Health Accounts Yes/No Value No Yes Yes Date 31-Dec-2008 24-May-2012 30-Jun-2013 Comments NHA 2007 & 2008 were On track NHA report for 2010 developed by MOH outside was prepared in 2011jointly the Project scope, i.e., without with twining agency. using new household/ provider/client survey data improvement in allocative efficiency Text Value Delayed. Data on utilities 10 percent decrease in the expenditures by hospitals percentage of funds spent by included in the hospitals (excluding Comprehensive survey of outpatient facilities) on utilities Public Disclosure Copy facilities/providers/patients to (heat, electricity) in oblasts be conducted in 2012 & 2013. that introduce the full package Contract for Comprehensive of reforms survey signed on June 7, 2012. Date 14-Jun-2012 30-Jun-2013 Comments Users perceived quality of care Percentage Value 70.00 80.00 80.00 Date 07-Dec-2009 14-Jun-2012 Page 7 of 11 The World Bank Report No: ISR6680 Comments Based on user surveys. Delayed: Questions on users increase by 10% Source: MOH Strategic Plan perceived quality of care 2011-2015 included in Comprehensive facility/provider/patient survey Public Disclosure Copy to be conducted inearly2012& 2013. Contract for Comprehensive survey signed on June 7, 2012. Improvement in providers autonomy Percentage Value 1.00 15.30 75.00 Date 31-Dec-2007 14-Jun-2012 20130631 Comments Less than 1% (26 facilities in Partially on track: 240/1020, Not achievable 2007) 23,5% Improvement in facility planning Text Value 0 Partially on track. New 100% of newly-constructed/ hospital planning standards major renovation hospitals developed based on based on new planning tool international experience and assessment of health care needsin 10-15 year period. Master plans for first 5 oblasts developed based on new standards. Potential pilot PPP projects identified based on master plans. Date 14-Jun-2012 30-Jun-2013 Comments licensing and accreditation of healthcare Text Value no licencing. Acreditation standards for licensing and facilities innitiated accreditation of healthcare facilities developed, adopted and implemented Date 12-Dec-2004 07-Dec-2011 20130631 Comments On track. Public Disclosure Copy Improvement of Blood Safety Text Value Contract with twinning agency Increased quality and termiated in February 2012. effectiveness of donor screening at selection and laboratory screening Date 14-Jun-2012 30-Jun-2013 Comments Delayed. Increased share of voluntary to paid donor implementation of clinical practice guidelines Number Value 0.00 59.00 100.00 Date 07-Dec-2008 14-Jun-2012 Page 8 of 11 The World Bank Report No: ISR6680 Comments Delayed: 59 clinical protocols 60 percent of newly- developed and implemented. developed CPGs 2 CPGs implemented and 11 implemented including other CPGs approved. medical condition-based Public Disclosure Copy ordering and interpreting of laboratory tests Laboratory network improvements Text Value not in place Delayed: Assignment re- Laboratory network advertised, received EOIs restructuring plan developed being evaluated. including equipment and HR standards, service profiles and quality control mechanisms Date 01-Dec-2008 14-Jun-2012 20130631 Comments Improvement of medical education Text Value State standards in place for 6 On track: Proposals on New curricula for medical/ specialties of higher medical introduction of multiple mini- pharmaceutical education and pharmaceutical interview developed and to be implemented, together with a education. piloted. unified testing system and updated/upgraded criteria for admission, by all public medical universities Date 01-Dec-2008 14-Jun-2012 30-Jun-2013 Comments Improvement in continuous medical education Text Value On track: Center for Regulatory/institutional/ independent assessment of financial framework knowledge and skills developed and approved for a established within RCHD. sustainable, permanent Pilot online testing of system of continuing medical internship graduates education conducted in May 2011, and final computer testing in June 2011. Public Disclosure Copy Date 31-Dec-2008 14-Jun-2012 30-Jun-2013 Comments Utilization of IT technology Percentage Value 0.00 52.00 75.00 Date Comments On track with 52.2% (12275) 75 percent of key HMIS users of all key HMIS users in 4 fully trained and able to use pilot sites (23499) fully trained the system and able to use the system, including 100%(6762) in Page 9 of 11 The World Bank Report No: ISR6680 Astana, 97.9% (5513) in Akmola oblast. Indicator not sufficient to measure quality of IT Public Disclosure Copy services. Satisfaction with utilization of IT Text Value Delayed: Data on user 75 percent of staff who use satisfaction included in the the HMIS report average or Comprehensive survey of high levels of satisfaction facilities/providers/patients to be conducted in 2012 & 2013. Contract for Comprehensive survey signed on June 7, 2012. Date 14-Jun-2012 31-Dec-2013 Comments Full HMIS package deployed in three oblasts Text Value Partially on track: delivery and Full HMIS package deployed plus Astana City installation of IT equipment in in three oblasts plus Astana Karaganda oblast underway. City Contract for East-Kazakhstan oblast delayed Date 14-Jun-2012 30-Jun-2013 Comments Data on Financial Performance (as of 13-Jun-2012) 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 30-Jun-2013 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Public Disclosure Copy P101928 IBRD-48830 Effective USD 117.70 117.70 0.00 36.41 81.29 31.00 Disbursement Graph Page 10 of 11 The World Bank Report No: ISR6680 Public Disclosure Copy Key Decisions Regarding Implementation The Ministry of Health completed proposal for restructuring and widening the scope of work, content, duration of tasks and estimated budgets and utilize huge savings achieved during the first phase of implementation of the Project. The Minister of Finance formally requested the extension of the closing date of the Loan to coincide with the duration of Salamatti Kazakhstan which runs to December 31, 2015. The Bank is currently processing this request Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 11 of 11