losure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Implementation Status & Results Vietnam Central North Region Health Support Project (P095275) Operation Name: Central North Region Health Support Project (P095275) Project Stage: Implementation Seq.No: 2 Status: ARCHIVED Archive : 28-Feb-2011 Country: Vietnam Approval FY: 2010 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key s Board Approval 06-Apr-2010 Original Closing 31-Aug-2016 Planned Mid Term Review 01-Aug-2013 Last Archived ISR 28-Feb-2011 Effectiveness 23-Aug-2010 Revised Closing 31-Aug-2016 Actual Mid Term Review Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project development objective is to strengthen district-level curative and preventive health services and improving their accessibility for the economically vulnerable population in the Central North Provinces. Intermediate objectives are: Increasing health insurance coverage among the near-poor population; Upgrading capacities of district hospitals and District Preventive Health Centers; Improving supply and quality of health care personnel. Has the Project Development Objective been changed since Board Approval of the Project? Yes Component(s) No Component Name Component Cost Supporting health insurance for the near poor population 9.11 Strengthening district health services 32.20 Improving supply and quality of human resources for health 15.99 Project management, monitoring and evaluation 7.71 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Moderate Page 1 of 8
Implementation Status Overview The Central North Health Support Project (CNHSP) is about 18 months away from its mid-term review. Similar to the other new projects, implementation progress was slow initially and has been increasing in pace. Effective since August 2010, the project has until August 2016 to be implemented. As of December 2011, about 22% of the Project implementation period has passed and about US$3.995 million of the US$65.00 million Credit (or about 6.1% of the Credit) has been disbursed. Main accomplishments to date include: 1. Supporting health insurance for the near poor: The Ministry of Health and Project Provinces have had a very successful effort thus far to enroll the near poor in the health insurance program. The identified number of near poor in the six project provinces is currently 1.5 million of which 1.08 million are identified as not having insurance. As of September 30, 2011, the Project has extended health insurance of the near poor to nearly 390,000 people or 36% of the target group which more than our proposed project target of covering the near poor by 20% at mid-term in 2013 and nearly the end of Project target of 40%. 2. Strengthening District Health Services: The construction of District Preventive Centers is well underway with 17 of the 30 planned centers already in the process of being constructed and the remaining 13 are all in the process of tendering. The centers are expected to be completed before the end 2012 and ready to receive equipment by end of 2012 or early 2013. 3. Improving Supply and Quality of Health Human Resources: The long term training programs (conversion of assistant doctors to doctors and pharmacists, masters programs, Level I and Level II specialists) is well in progress. For example, 96% of the planned educational quota for the conversion of full doctors and pharmacists has started their education (489 out of 510 with a couple of provinces exceeding their plan). Additionally, 55% of the planned quota for obtaining the master s degree, Level I or Level II specialization of the district hospital, district health center and the Quang Tri Provincial Hospital) have started their education. Locations Country First Administrative Division Location Planned Actual Vietnam Tinh Nghe An Tinh Nghe An Vietnam Tinh Thua Thien-Hue Tinh Thua Thien-Hue Vietnam Tinh Thanh Hoa Tinh Thanh Hoa Vietnam Tinh Quang Tri Tinh Quang Tri Vietnam Tinh Quang Binh Tinh Quang Binh Vietnam Tinh Ha Tinh Tinh Ha Tinh Vietnam Tinh Nghe An Huyen Nam Dan Vietnam Tinh Nghe An Huyen Nghi Loc Vietnam Tinh Nghe An Huyen Dien Chau Vietnam Tinh Nghe An Huyen Yen Thanh Vietnam Tinh Nghe An Huyen Thanh Chuong Vietnam Tinh Nghe An Huyen Quynh Luu Page 2 of 8
Country First Administrative Division Location Planned Actual Vietnam Tinh Nghe An Huyen Nghia Dan Vietnam Tinh Nghe An Huyen Que Phong Vietnam Tinh Nghe An Huyen Tuong Duong Vietnam Tinh Nghe An Huyen Ky Son Vietnam Tinh Thanh Hoa Huyen Tinh Gia Vietnam Tinh Thanh Hoa Huyen Nhu Xuan Vietnam Tinh Thanh Hoa Huyen Hoang Hoa Vietnam Tinh Thanh Hoa Huyen Thuong Xuan Vietnam Tinh Thanh Hoa Huyen Ngoc Lac Vietnam Tinh Thanh Hoa Huyen Lang Chanh Vietnam Tinh Thanh Hoa Huyen Cam Thuy Vietnam Tinh Thanh Hoa Huyen Hau Loc Vietnam Tinh Thanh Hoa Huyen Ba Thuoc Vietnam Tinh Thanh Hoa Huyen Quan Son Vietnam Tinh Thanh Hoa Huyen Quan Hoa Vietnam Tinh Thanh Hoa Huyen Muong Lat Vietnam Tinh Quang Tri Huyen Hai Lang Vietnam Tinh Quang Tri Huyen Gio Linh Vietnam Tinh Quang Tri Huyen Vinh Linh Vietnam Tinh Quang Binh Huyen Le Thuy Vietnam Tinh Quang Binh Huyen Bo Trach Vietnam Tinh Quang Binh Huyen Quang Trach Vietnam Tinh Quang Binh Huyen Tuyen Hoa Vietnam Tinh Quang Binh Huyen Minh Hoa Vietnam Tinh Ha Tinh Huyen Cam Xuyen Page 3 of 8
Vietnam Tinh Ha Tinh Huyen Ky Anh Vietnam Tinh Ha Tinh Huyen Huong Khe Vietnam Tinh Ha Tinh Huyen Nghi Xuan Vietnam Tinh Ha Tinh Huyen Duc Tho Vietnam Tinh Ha Tinh Huyen Huong Son Vietnam Tinh Thua Thien-Hue Thanh Pho Hue Vietnam Tinh Thua Thien-Hue Huyen Phu Vang Vietnam Tinh Thua Thien-Hue Huyen Phong Dien Vietnam Tinh Thua Thien-Hue Huyen Huong Tra Vietnam Tinh Thua Thien-Hue Huyen Phu Loc Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target 10% increase in the utilization of inpatient and outpatient services by the poor 10% increase in the utilization of inpatient and outpatient services by the near-poor Text Value inpatient - 2.35/100 outpatient - 5.26/100 Text Sub Type Breakdown 30-Nov-2009 The baseline information was collected from 2009 prior to Year 0 (2010) of the Project. The CNHSP is mobilizing technical a surveyof administrative data to reconfirm baseline information. Value inpatient - 2.39/100 outpatient - 6.14/100 Not yet due. inpatient 2.58/100 (10% increase) outpatient - 5.79/100 (10% increase) An update of the utilization is due by year 3 of the Project (2013). Not yet due. inpatient - 2.63/100 (10% increase) outpatient - 6.75/100 (10% increase) 30-Nov-2009 10-Feb-2011 Page 4 of 8
30% reduction in the referrals for deliveries, pneumonia and appendicitis from district hospitals to provincial hospitals 90% of children under age 1 fully vaccinated according with national EPI program Health facilities constructed, renovated, and/or equipped Intermediate Results Indicators The baseline information was collected from 2009 and from the 2008 VHLSS prior to Year 0 (2010) of the Project. The CNHSP is mobilizing technical a survey of administrative data to reconfirm baseline information. An update of the utilization is due by year 3 of the Project (2013). Percentage Value 6.00 6.00 4.00 30-Nov-2008 This data was collected from No new information. Not yet a sample of hospitals in 2008. due. To be measured starting The baseline is to be in year 3 of the project. confirmed through an ongoing survey. Percentage Value 70.00 70.00 90.00 06-Apr-2010 30-Jun-2016 No new information. Not available. Survey collecting available administrative data now in progress. Number Value 0.00 0.00 23-Aug-2010 06-Mar-2012 This indicator is strictly referencing the 30 district health centers being constructed and equipped under the Project. An additional 32 health facilities are being equipped. As of end 2011, 17 District Preventive Health Centers were in the process of being constructed. The other 13 centers were in the process of bidding. Progress is sufficiently underway for their equipment by end 2012 and functionality by 2013. Page 5 of 8
Indicator Name Core Unit of Measure Baseline Current End Target People with access to a basic package of Number Value 420000.00 810000.00 600000.00 health, nutrition, or population services 30-Nov-2008 The actual indicator is 40% of the near poor are covered by the health insurance program. The baseline was estimated to be 10% or 150,000. 08-Mar-2012 The share of near-poor households spending 25% of more of their non-food consumption on health is reduced to 12% or less The share of district hosptials in claims reimbursed by health insurance (VSS) is 50% or more It was estimated that 10% of the near poor were covered by health insurance. Once the Project identified the 1.5 million near poor, 28% or 420,000 were identified as beingcovered by health insurance through another progress group. 54%. 390,000 cards have been issued. Current actual figures exceed end of Project targets. Assuming the end of the Project target should 270,000 people greater since baseline miscalculated, the current results is close to the end of Project target. Percentage Value 17.00 17.00 12.00 30-Nov-2008 No new information. Not yet due. By the results framework, this information is to be reported in year 3 (2013) of the Project. Note, however, this information has to come to VHLSS for which there is about a 2 year lag on the data availability. As of March 2012, the data for year 2010 is not yet available for this analysis. This indicator will become difficult to report on a timely basis. Percentage Value 40.00 40.00 50.00 30-Nov-2008 No new information. Not yet due. Indicator is to be reported in Year 3 of the Project (2013). 40%. End target conservatively set assuming (i) baseline was 10% of the target population; and (ii) low take-up considering experience in the Mekong Region. Page 6 of 8
50% of patients satisfied with (a) overall quality of care at district hospitals, (b) reduction of waiting time, and (c) availability of services and diagnostic facilities Nghe An medical college fully meets the national standards for medical university Text Value (a) 35% (b) 35% (c) 32% 30-Nov-2008 (a) 50% (b) 50% (c) 50% Not yet due. Indicator is to be reported in Year 3 of the Project (2013). Text Value Nil Investments in Nghe An to Fully meets standards meet conditions of national standards in progress 28-Dec-2008 Health personnel receiving training Number Value 0.00 0.00 855.00 30-Nov-2008 This includes training of 175 Doctors in Level 1 Specialty. and Training of 680 Assistant Doctors as full fledged doctors. 10-Feb-2011 In progress. Education/ training not completed. At present, 96% of the planned educational quota for the conversion of full doctors and pharmacists has started their education (489 out of 510 with a couple of provinces exceeding their plan). Additionally, 55% ofthe planned quota for obtaining the master s degree, Level I or Level II specialization of the district hospital, district health center and the Quang Tri Provincial Hospital) have started their education. Data on Financial Performance (as of 22-Feb-2012) Financial Agreement(s) Key s Project Loan No. Status Approval Signing Effectiveness Closing P095275 IDA-46880 Effective 06-Apr-2010 25-May-2010 23-Aug-2010 31-Aug-2016 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P095275 IDA-46880 Effective XDR 41.50 41.50 0.00 5.08 36.42 12.00 Page 7 of 8
Disbursement Graph Key Decisions Regarding Implementation 1. Due to the well performing uptake of the subsidized health insurance for the near poor, the entire original Credit allocation for the subsidy will be fully utilized by mid-2012. The Bank and Ministry of Health agreed to continue the implementation of the subsidy scheme and even at the prevailing subsidy levels. Sufficient resources within the Project would be able to be reallocated for this purpose for the period until the end of 2012. Even though the Government generally approved to increase its subsidy from 50 to 70% to the near poor health insurance nationally, significant additional resources would need to be mobilized or reallocated for this purpose. It is necessary to consider this by July 30, 2012 prior to the guidelines for the 2013 project budget are prepared. 2. Although there has been no detrimental impact seen, the Ministry of Health's Central Project Management Unit (MoH CPMU) has agreed to recruit and environmental health / medical waste management and a sociologist for implementing the mitigation measures for Health Care Waste Management and Ethnic Minority inclusion plan. 3. A proposal for a Results Based Financing "pre-pilot pilot" is being developed between the Bank, CPMU and Nghe An in order to increase the quantity and quality of services at the communal health station level, better delivery of preventive and district health management services for district health centers, and better quality of inpatient and outpatient care by hospitals. The skeleton will be circulated to the Project stakeholders, other key informants, for their comment and feedback. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Page 8 of 8