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The World Bank Report No: ISR13455 Implementation Status & Results Armenia Health System Modernization Project (APL2) in Support of the Second Phase of the Health Sector Reform Program (P104467) Operation Name: Health System Modernization Project (APL2) in Support of Project Stage: Implementation Seq.No: 14 Status: ARCHIVED Archive Date: 30-Mar-2014 the Second Phase of the Health Sector Reform Program (P104467) Public Disclosure Authorized Country: Armenia Approval FY: 2007 Product Line:IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Adaptable Program Loan Implementing Agency(ies): Public Disclosure Copy Key Dates Board Approval Date 08-Mar-2007 Original Closing Date 31-Dec-2012 Planned Mid Term Review Date Last Archived ISR Date 06-Jul-2013 Effectiveness Date 06-Jun-2007 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 17-May-2010 Project Development Objectives Project Development Objective (from Project Appraisal Document) The overall objective of the HSRP Program remains unchanged: to improve the organization of the health care system in order to provide more accessible, quality and sustainable health care services to the population, in particular to the most vulnerable groups, and to better manage public health threats. This Project aims at: (i) scaling up family medicine based primary health care reform by expanding the renovation of primary health care facilities and upgrading of the medical equipment in the Public Disclosure Authorized remaining marzes; (ii) optimizing and upgrading hospital networks in the remaining marzes; (iii) strengthening Government's capacity to develop and monitor effective health sector policies in the area of health financing, resource allocation and provider payments; and (iii) expanding investment in human resources to include formal and continuous education in health (medical, nursing, auxiliary health professionals). Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost COMPONENT A: FAMILY MEDICINE DEVELOPMENT 10.15 COMPONENT B: HOSPITAL NETWORK OPTIMIZATION 37.77 COMPONENT C: INSTITUTIONAL STRENGTHENING 4.82 COMPONENT D: PROJECT MANAGEMENT 2.20 Public Disclosure Authorized Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Public Disclosure Copy Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Low Low Page 1 of 8 Public Disclosure Authorized The World Bank Report No: ISR13455 Implementation Status Overview All activities under the Project are on track. In addition, the State Budget has financed the retraining of 22 family physicians (one-year specialization course) and 34 nurses (six- month specialization course) from Yerevan and Marzes. This activity is linked to achieving one of the Project Development Objective indicator: Proportion of Armenian population covered by qualified Family Medicine (FM) practices. The Ministry of Health (MoH) is also aiming at including 15 young specialists in the training program for family medicine while the Yerevan State Medical University has 25 students educated to become family physicians. The MoH has adopted a new strategy on Primary Health Care; its adoption by Parliament is planned for 2014. The strategy presents the structure of primary health care delivery according to the type of facilities and catchment area. Details on implementation of licensing norms are also part of the new strategy. Regulations and implementation details of the PHC concept are expected to be ready by 2014.41. Due to savings the Project has financed further improvement of 13 rural ambulatories from the 60 remaining rural ambulatories. It is planned that additional investments for 5 rural ambulatories (construction), 1 rural ambulatory (renovation), and 1 policlinic (renovation) will take place in 2014. Implementation of activities under hospital network optimization and modernization component continues to show significant progress. The National Health Sector Performance Assessment Report (HSPA) for 2012 was published in May 2013. The final HSPA report for 2013 is ready for publication. The National Health Accounts (NHA) report for the year 2010 and 2011 was published in June 2013. The final NHA report for years 2012 and 2013 is ready for publication and will be presented in early 2014. Public Disclosure Copy Locations Country First Administrative Division Location Planned Actual Armenia Syunik'i Marz Tegh Armenia Syunik'i Marz Tat'ev Armenia Vayots' Dzori Marz Surenavan Armenia Ararati Marz Noyakert Armenia Syunik'i Marz Goris Armenia Ararati Marz Burastan Armenia Ararati Marz Aygezard Armenia Vayots' Dzori Marz Areni Armenia Ararati Marz Ararat Armenia Ararati Marz Urts'adzor Armenia Ararati Marz Ararati Marz Armenia Syunik'i Marz Syunik'i Marz Armenia Vayots' Dzori Marz Vayots' Dzori Marz Armenia Shiraki Marz Horrom Armenia Armaviri Marz Margara Public Disclosure Copy Armenia Aragatsotni Marz Zovuni Page 2 of 8 The World Bank Report No: ISR13455 Country First Administrative Division Location Planned Actual Armenia Geghark'unik'i Marz Vaghashen Armenia Aragatsotni Marz Ushi Armenia Aragatsotni Marz Ujan Armenia Geghark'unik'i Marz Tsovazard Armenia Geghark'unik'i Marz Tsovagyugh Armenia Ararati Marz Sis Public Disclosure Copy Armenia Geghark'unik'i Marz Sarukhan Armenia Armaviri Marz Samaghar Armenia Armaviri Marz Pshatavan Armenia Armaviri Marz P'arak'ar Armenia Kotayk'i Marz Nor Geghi Armenia Kotayk'i Marz Mrgashen Armenia Armaviri Marz Mrgashat Armenia Shiraki Marz Mets Mant'ash Armenia Kotayk'i Marz Meghradzor Armenia Armaviri Marz Khoronk' Armenia Aragatsotni Marz K'uch'ak Armenia Aragatsotni Marz Kosh Armenia Aragatsotni Marz Kasakh Armenia K'aghak' Yerevan K'anak'erravan Armenia Ararati Marz Kanach'ut Armenia Geghark'unik'i Marz Gavarr Armenia Tavushi Marz Ijevan Public Disclosure Copy Armenia Kotayk'i Marz Hrazdan Armenia Armaviri Marz Armavir Page 3 of 8 The World Bank Report No: ISR13455 Armenia Shiraki Marz Gyumri Armenia Lorru Marz Jrashen Armenia Armaviri Marz Dalarik Armenia Kotayk'i Marz Buzhakan Armenia Armaviri Marz Aygeshat Armenia Geghark'unik'i Marz Astghadzor Armenia Aragatsotni Marz Arteni Public Disclosure Copy Armenia Armaviri Marz Arshaluys Armenia Armaviri Marz Arevik Armenia Lorru Marz Arevashogh Armenia Kotayk'i Marz Aramus Armenia Aragatsotni Marz Aparan Armenia Armaviri Marz Apaga Armenia Shiraki Marz Akhurik Armenia Tavushi Marz Azatamut Armenia Tavushi Marz Artsvaberd Armenia Aragatsotni Marz Nor Sasunik Armenia Ararati Marz Darakert Armenia Aragatsotni Marz Aragatsotni Marz Armenia Armaviri Marz Armaviri Marz Armenia Geghark'unik'i Marz Geghark'unik'i Marz Armenia Kotayk'i Marz Kotayk'i Marz Armenia Lorru Marz Lorru Marz Armenia Shiraki Marz Shiraki Marz Public Disclosure Copy Armenia Tavushi Marz Tavushi Marz Page 4 of 8 The World Bank Report No: ISR13455 Armenia Armaviri Marz Arratashen Armenia Geghark'unik'i Marz Lusakunq Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Proportion of Armenian Population covered by Text Value 47% 91% 95% qualified family medicine practices Date 31-Dec-2006 17-May-2013 31-Dec-2014 Public Disclosure Copy Comments Exceeded against APL2 target (90%). On track against AF target Increased utilization of a) out-patient services; Text Value a) 3.9%; b) 3.1% a) 2.8%; b) 5.3% Increased Utilization and b) in-patient services by the poorest Date 22-Nov-2011 09-Jan-2014 31-Dec-2014 income quintile Comments Decrease on out-patient, but slight increase on in-patient (2012 ISLS) Health Sector Performance Report issued once Text Value HSPA for 2006 year published HSPA report for 2011/2012 HSPA published every two every two years years developed and year published in 2013 Date 01-Sep-2007 09-Jan-2014 31-Dec-2014 Comments Perceived quality of care in marzes increased Text Value 64.3% a) PHC: urban: 64.1%; rural: 75% 73.2%; b) Hospital: urban: 73.7%; rural: 66.8% Date 30-Dec-2007 17-May-2013 31-Dec-2014 Comments Both urban/rural marzes: Target on track. HSPA PHC: 53.6% in 2009; surveys to be updated in Feb Hospitals: 64.6% in 2009. or March 2014 ALOS in marz hospitals decreased close to Text Value 7.7 6.5 6.5 OECD average Date 01-Dec-2006 17-May-2013 31-Dec-2014 Comments Data for 2012. Target achieved under APL2 (target was 7.0); Target achieved under AF; 2013 annual data will be available Feb-March Public Disclosure Copy 2014 Page 5 of 8 The World Bank Report No: ISR13455 National Health Accounts report published Text Value 2006 NHA report distributed NHA report for 2010/2011 Annual annually 2007 years was developed and published in 2013 Date 31-Dec-2006 09-Jan-2014 31-Dec-2014 Comments Target achieved Public hospitals in project sites that have Text Value 0 0 13 published financial audit reports from Date 31-Dec-2006 09-Jan-2014 31-Dec-2014 independent audits Comments Local authorities are financing For FY11 and FY13 FY12 independent audit for 7 hospitals; audits ongoing Value Public Disclosure Copy Proportion of patients with a) hypertension who Text a) 42%; b) 33% a) 61%; b) 57% Increased had at least one ECG annually; b) ischemic Date 31-Dec-2006 17-May-2013 31-Dec-2014 heart disease who had at least one totalcholesterol test annually Comments 2013 annual data on performance indicators (EKG and cholesterol) will be available in Feb. 2014 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of certified FDs trained Text Value 633 1676 1750 Date 01-Dec-2006 09-Jan-2014 31-Dec-2014 Comments Target for AF is 100; Target for APL2 is 1650 Number of certified FNs trained Text Value 568 1804 1950 Date 01-Dec-2006 09-Jan-2014 31-Dec-2014 Comments Target for AF is 120; Target for APL2 is 1650 Reduction of sq. meters of hospital space Text Value 0% 70.9% 85% (percent of original) in all marzes Date 31-Dec-2006 09-Jan-2014 31-Dec-2014 Comments (74,888 sqm out of 105,609 sqm) . Gvt Decree RA N-1911 Health personnel receiving training (number) Number Value 1201.00 3480.00 3700.00 Date 01-Jan-2009 09-Jan-2014 31-Dec-2014 Comments The APL 2 continues training Exceeded for APL2.
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