Supplemental Letter No. 2 REPUBLIC OF MOLDOVA July 11, 2014 International Development Association 1818 H Street, N.W. Washington, D.C. 20433 United States of America Re: Program Credit No. 5469-MD Project Credit No. 5470-MD Health Transformation Operation Performance Monitoring Indicators This refers to paragraph A of Section II of Schedule 3 to the Financing Agreement of this date between the Republic of Moldova (the Recipient) and the International Development Association (the Association) for the above-captioned Operation. The Recipient hereby confirms to the Association that the indicators set forth in the attachment to this letter shall serve as a basis for the Recipient to monitor and evaluate the progress of the Operation and the achievement of the objective thereof Very truly yours, REPUBLIC OF MOLDOVA By__________ Authorized Representative Attachment Attachment to Supplemental Letter No. 2 REPUBLIC OF MOLDOVA (Health Transformation Operation) Program Development Objective: The proposed PDO is to contribute to reducing key risks for non-communicable diseases and enhancing efficiency of health services in Moldova Indicators Unit of Baseline Target Values Frequency Data Responsibility Measure Yr. I Yr. 2 Yr. 3 Yr. 4 Source/Methodology for Data Collection PDO Level/Results Indicators PDO Indicator 1: % 13.4% 12.0% 10.0% Twice Global Youth MOH Smoking prevalence (2008) during Tobacco Survey among young people program period PDO Indicator 2: % 10% 12% 15% Twice Household survey MOH Percentage of adults during with biomarker with hypertension program (streamlined STEP whose blood pressure period survey) is under control PDO Indicator 3: Number 17 17 16 16 15 Annual Administrative data Ministry of Annual hospital (2012) Health admissions for acute care per 100 persons PDO Indicator 4: Number 494 (2012) 490 480 450 420 Annual Administrative data Ministry of Number of acute Health hospital beds per 100,000 persons Intermediate Results Area 1: Reducing NCD risks Intermediate Yes/No No Yes Once Self-reported data Ministry of Results Indicator 1: Health Approval of the new tobacco control legislation Intermediate % No Yes Once Self-reported data CNAM Results Indicator 2: Revision of the outpatient drug 2 benefit package with regard to anti- hypertensive drugs Intermediate % 39% 42% 45% Twice Household survey Ministry of Results Indicator 3: (2012) Health and Percentage of adults survey firm with hypertension receiving treatment Intermediate Results Area 2: Improved efficiency of health services Intermediate g % 0% 20% 40% 60% 80% Annual Administrative data MOH Results Indicator 4: Percentage of primary care centers implementing the full feature primary care information system Intermediate Yes/No No Design of Verification Verification Verification Annual Self-reported data CNAM Results Indicator 5: scheme of results in of results in of results in Revision and revised a random a random a random implementation of the Yes/No subset of subset of FM subset of performance-based FM providers: FM incentive scheme in providers: Yes/No providers: family medicine Yes/No Yes/No Intermediate Yes/No No Incentive Pilot of the Contracts Contracts Annual Self-reported data CNAM Results Indicator 6: scheme scheme: signed with signed with Introduction of designed: Yes/No all hospitals: all performance-based Yes/No Yes/No hospitals: incentives to improve Yes/No (i) efficiency and (ii) quality of care in hospitals Intermediate * Yes/No No Updated Updated Updated Updated Annual Self-reported data CNAM Results Indicator 7: DRG using DRG DRG DRG Use of updated DRG country accounting accounting accounting prices for hospital data; for at least for at least for at least payment Yes/No 50% of total 60% of total 70% of hospital hospital total payment: payment: hospital Yes/No Yes/No payment: 3 Yes/No Intermediate * Yes/No Approval of Once Self-reported data MOH Results Indicator 8: strategy: Approval of the new Yes/No hospital rationalization strategy Intermediate % 0% 10% 20% 30% 50% Annual Self-reported data MOH Results Indicator 9: Percentage of public hospital in Chisinau which are under common management Intermediate Yes/No No University Once Self-reported data MOH Results Indicator university hospital 10: Establishment of hospital established university hospital Intermediate % 36% 38% 40% 42% 44% Annual Administrative data MOH Results Indicator (2011) 11: Percentage of annual hospitalizations through referrals by family medicine providers 4