The World Bank Report No: ISR5731

Implementation Status & Results Health Sector Enhancement Project (P088663)

Operation Name: Health Sector Enhancement Project (P088663) Project Stage: Implementation Seq.No: 12 Status: ARCHIVED Archive Date: 30-Oct-2011 Country: Bosnia and Herzegovina Approval FY: 2005

Public Disclosure Authorized Product Line:IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): FBiH Ministry of Health, RS Ministry Of Health Key Dates Board Approval Date 31-Mar-2005 Original Closing Date 15-Dec-2010 Planned Mid Term Review Date 15-Sep-2008 Last Archived ISR Date 30-Oct-2011 Public Disclosure Copy Effectiveness Date 03-Apr-2006 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 15-Sep-2008

Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of the Project are to (i) expand and enhance the family medicine model of primary health care; (ii) build managementcapacity in the sector; and (iii) strengthen the policy making process through the development and implementation of a system for monitoring and evaluating sector performance. Has the Project Development Objective been changed since Board Approval of the Project?

● Yes No Public Disclosure Authorized Component(s)

Component Name Component Cost Primary Health Care Restructuring 29.00 Improvement of Health Sector Management Capacity 3.00 Health Policy Formulation and Project Support 8.00

Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory

Public Disclosure Authorized Overall Risk Rating Moderate Moderate

Implementation Status Overview This is to report that the additional financing (AF) approved on March 22, 2011 in the amount of US$10.0 million equivalent has now been declared effective as of December 27, 2011. All activities under the original Credit are completed with all funds disbursed.

Public Disclosure Copy In parallel, procurement process for several activities to be financed under the AF has been launched. Four contracts with regional training sectors were signed, with activities starting using counterpart funds. The design and definition of the standards to support the IT applications have made progress. These standards will allow the accreditation of the shelf and tailored applications that will later be purchased by the cantons to implement the information system in the Federation of Bosnia & Herzegovina.

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Locations Country First Administrative Division Location Planned Actual Bosnia and Herz Visegrad

Bosnia and Herz Republika Srpska

Bosnia and Herz Republika Srpska Sreflije

Bosnia and Herz Republika Srpska Srbac

Bosnia and Herz Republika Srpska

Bosnia and Herz Republika Srpska Sipovo Public Disclosure Copy

Bosnia and Herz Federation of Bosnia and Herzegovina

Bosnia and Herz Republika Srpska Prnjavor

Bosnia and Herz Republika Srpska

Bosnia and Herz Republika Srpska Podgrab

Bosnia and Herz Republika Srpska Pale

Bosnia and Herz Federation of Bosnia and Herzegovina Novi Grad

Bosnia and Herz Republika Srpska Mokro

Bosnia and Herz Republika Srpska Modrica

Bosnia and Herz Republika Srpska Milici

Bosnia and Herz Republika Srpska

Bosnia and Herz Republika Srpska Krupa na Vrbasu

Bosnia and Herz Republika Srpska Gornji Ribnik

Bosnia and Herz Republika Srpska Foca

Bosnia and Herz Republika Srpska Branesci Donji

Bosnia and Herz Republika Srpska Bosanski Samac

Bosnia and Herz Republika Srpska Bosanska Gradiska

Bosnia and Herz Republika Srpska Bocac Public Disclosure Copy

Bosnia and Herz Republika Srpska

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Country First Administrative Division Location Planned Actual Bosnia and Herz Republika Srpska Berkovici

Bosnia and Herz Republika Srpska

Bosnia and Herz Republika Srpska Demirovac

Bosnia and Herz Republika Srpska Strojice

Bosnia and Herz Republika Srpska Gornji Seher

Bosnia and Herz Republika Srpska Celinac

Public Disclosure Copy Bosnia and Herz Republika Srpska Laus

Bosnia and Herz Republika Srpska

Bosnia and Herz Republika Srpska Tilava

Bosnia and Herz Republika Srpska Miljevina

Bosnia and Herz Republika Srpska Dubrava Stara

Bosnia and Herz Republika Srpska Lazarevo

Results

Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Coverage of population through family Text Value About 58% of pop.; FBH: FBH: no change; RS About 70% of pop.; FBH medicine teams 1,000,000 (2009); RS: 1,171,071 1,500,000; RS: 1,250,000 1,200,147 Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 on RS: HIF RS performed verification of registered pop., checking for duplicates and cases of persons registered at two or more FM teams; verification resulted with lower no. of registered pop. Public Disclosure Copy

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Number of FM teams and health centers in the Text Value RS: 60/650 or about 9% and FBH: no change; RS: 61 RS: 260 or 40% of FM team RS meeting rigorous accreditation standards 0 health centers meting accreditation standards; and 35% of health centers to meet safety standards Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 Systemic implementation of selected Text Value No standard set of preventive FBH: no change; RS: not Active selected preventive preventive services (i.e., hypertension, breast services except for special applicable services implemented cancer, prostate enlargement, smoking, etc.) annual programs systemically by all FM teams inat least 2 major FBiH cantons in at least two major cantons

Public Disclosure Copy Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 Health management center operational with Text Value Health management center FBH: no change Health management center annual budget and regular work plan not fully operational operational Date 31-Aug-2011 31-Dec-2014 Comments New since March 2011 RS and FBiH primary health care strategy Text Value First version completed and FBH: no change; RS: strategy FBH operational plan for PHC operational plan are updated based on adopted not updated reform for 2014 adopted by evidence of sector performance and include FBiH MoH based on evidence consultative process with stakeholders and Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 between entities Comments New since March 2011

Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Development of programs and monitoring tools Text Value 0 0 Programs completed for targeted non-communicable disease preventive programs (Federation) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 RS: not applicable Number of health personnel receiving training Text Value FBH: 3853; RS 2055 RS:2662 FBH: 4000; RS: 3196

Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 Family Medicine Offices / ambulantas equipped Text Value FBH: 3 DZ (education centers RS: 521 FBH: ambulantas of 3 with IT and belonging ambulata); RS: municipalities; RS: 510 510 Public Disclosure Copy Date 22-Mar-2011 31-Aug-2011 31-Dec-2014

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Indicator Name Core Unit of Measure Baseline Current End Target Comments financed by HSEP alone: first number of 157 represents no. of FM offices equipped with hardware needed to run application software for FM; the later represents no. of FM teams utilizing the offices; no. in (..) financed by synergy projects incl. HSEP; the first no. of 521 represents no. of FM offices equipped with

Public Disclosure Copy hardware needed to run application software for FM; the later represents no. ofFM teams utilizing the offices FM ambulantas constructed, reconstructed or Text Value FBH: 335; RS: 146 RS:158 FBH: 385; RS: 275 renovated (several ambulantas per DZ) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 Number of teams operating in family medicine Text Value FBH: 652; RS: 649 RS:649 FBH: 900; RS: 650

Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 No. includes FM teams with registered pop. However, 614 FM teams are operting with medical doctors who completed FM specialization or PAT Number of doctors in operating FM teams who Text Value FBH: 383; RS: 191 FBH:743; RS: 231 FBH: 523 specializations in completed specialization FM; RS: 250 spec. in FM Date 22-Mar-2011 Comments New since March 2011 Target on track Number of FM doctors in operating FM teams Text Value FBH: 740; RS: 342 FBH:769; RS: 383 FBH: 940; RS: 342-no further who completed PAT PAT doctor training in RS Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 RS: training was terminated in 2009 Number of nurses in operating FM teams that Text Value FBH: 1437; RS: 1031 FBH:1463; RS: 1073 FBH: 1900; RS: 1300

Public Disclosure Copy completed PAT Date 22-Mar-2011 31-Aug-2011 31-Dec-2014

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Comments New since March 2011 Number of FM educators (Cathedra Faculty of Text Value FBH: 27; RS: 5 FBH:31; RS: 5 FBH: 35; RS: 10 Education Center trainers) with a higher education (masters or PhD) in FM Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 Health buildings (physical sites) constructed, Text Value FBH: 79; RS: 56 RS: 60 FBH: 129; RS: 110 reconstructed, or renovated Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 Number of FM teams trained in change Text Value FBH: 600; RS: 300 RS:300 FBH: 600; RS: 350

Public Disclosure Copy management Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 Health status and risk factors indicators based Text Value Survey ongoing in the RS Survey completed Completed analysis cased on on household survey completed and publicly survey and publicly available available Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments

FBiH prepare health M&E report Text Value Indicators developed and in progress Complete M&E report on initial data collected health sector and publicly available Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments RS: not applicable RS PHC program evaluation completed Text Value Ongoing review on reform in progress Completed review of PHC progress sub-sector reform Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments

12Performance Based contracts signed with Text Value FBH: 0 FBH 0 FBH: 100 FM teams (directly or through DZs) in the Federation Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 RS: not applicable Development of Federation level rules for the Text Value 0 0 FBH rules for HIS health information standards (HIS) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011 RS: not applicable Support the implementation of PHC information Text Value 0 0 3 municipalities

Public Disclosure Copy systems in about 3 municipalities (Federation) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014

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Comments New since March 2011 RS: not applicable Number of new masters and PhDs in health Text Value FBH: 1; RS: 1 -- PhD: 1 and 7 RS: 1 PhD and 8 masters FBH: 1; RS: 6 -- PhD: 1 management masters completed completed or in progress Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments

Number of trained and equipped community Text Value 0 0 300 nurses to support FM teams (Federation) Date 22-Mar-2011 31-Aug-2011 Comments New since March 2011 RS: not applicable Number of clinical guidelines developed and Text Value 31 RS: 31 51 Public Disclosure Copy disseminated according to needs of FM practitioners (RS) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments

Number of management staff that have been Text Value FBH: 131; RS: 50 RS: 64 FBH: 131; RS: 300 trained in relevant managerial techniques Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments new since March 2011 Number of management staff in DZs that Text Value 0 0 50 completed all training modules offered by the Health Management Center (RS) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments new since March 2011 Number of management staff in DZs that Text Value 0 0 250 completed 1 or more training modules offered by the Health Management Center (RS) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments new since March 2011 Prepare program for specialists in health Text Value FBH 0 FBH 0 Program developed and one management (Federation) cohort enrolled Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments new since March 2011 RS: not applicable National summit Text Value 0 0 2

Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments

Public Health Grants for Innovative Service Text Value FBH: 40 FBH 0 FBH:55 Delivery (Federation) Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Public Disclosure Copy Comments RS: not applicable

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Family Medicine Offices / ambulantas equipped Text Value FBH: 376; RS: 320 RS 409 FBiH 410; RS 470 with medical equipment and or furniture Date 22-Mar-2011 31-Aug-2011 31-Dec-2014 Comments New since March 2011

Data on Financial Performance (as of 29-Dec-2011)

Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P088663 IDA-40470 Closed 31-Mar-2005 05-Sep-2005 03-Apr-2006 31-Dec-2011

Public Disclosure Copy P088663 IDA-49120 Effective 22-Mar-2011 05-Jul-2011 27-Dec-2011 31-Dec-2014

Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P088663 IDA-40470 Closed XDR 11.20 11.20 0.00 11.18 0.02 100.00 P088663 IDA-49120 Effective XDR 6.50 6.50 0.00 0.00 6.50 0.00

Disbursement Graph

Public Disclosure Copy Key Decisions Regarding Implementation not applicable

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Restructuring History CD Approved on 05-Jun-2009, Level two Approved on 17-Nov-2010

Related Projects P120285-Health Sector Enhancement Project Additional Financing Public Disclosure Copy Public Disclosure Copy

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