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The World Bank Report No: ISR4940 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: 10 Status: ARCHIVED Archive Date: 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): Ministry of Health, HSMP-PIU 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 04-Oct-2011 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 Public Disclosure Authorized the medical equipment in the 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 Page 1 of 8 Public Disclosure Authorized The World Bank Report No: ISR4940 Implementation Status Overview The Project continues to show great progress in achieving its development objectives. All key performance indicators on outcome are on track. 2010 data will be made available upon completion of the Health Sector Performance Assessment Report and of the National Health Account report due early 2012. These reports are considered as best practice by WHO. All activities under Phase 2 of the Project (APL2) are expected to be completed by its closing date of December 31, 2012. Several large procurement activities have been launched over the past two months (civil works, medical equipment) under the Additional Financing (AF). Locations Country First Administrative Division Location Planned Actual Armenia Syunik'i Marz Tegh Armenia Syunik'i Marz Tat'ev Public Disclosure Copy 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 Armenia Aragatsotni Marz Zovuni Armenia Geghark'unik'i Marz Vaghashen Armenia Aragatsotni Marz Ushi Armenia Aragatsotni Marz Ujan Public Disclosure Copy Armenia Geghark'unik'i Marz Tsovazard Page 2 of 8 The World Bank Report No: ISR4940 Country First Administrative Division Location Planned Actual Armenia Geghark'unik'i Marz Tsovagyugh Armenia Ararati Marz Sis Armenia Geghark'unik'i Marz Sarukhan Armenia Armaviri Marz Samaghar Armenia Armaviri Marz Pshatavan Armenia Armaviri Marz P'arak'ar Public Disclosure Copy 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 Armenia Kotayk'i Marz Hrazdan Armenia Armaviri Marz Armavir Armenia Shiraki Marz Gyumri Armenia Lorru Marz Jrashen Public Disclosure Copy Armenia Armaviri Marz Dalarik Armenia Kotayk'i Marz Buzhakan Page 3 of 8 The World Bank Report No: ISR4940 Armenia Armaviri Marz Aygeshat Armenia Geghark'unik'i Marz Astghadzor Armenia Aragatsotni Marz Arteni Armenia Armaviri Marz Arshaluys Armenia Armaviri Marz Arevik Armenia Lorru Marz Arevashogh Armenia Kotayk'i Marz Aramus Public Disclosure Copy 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 Armenia Tavushi Marz Tavushi Marz Armenia Armaviri Marz Arratashen Armenia Geghark'unik'i Marz Lusakunq Public Disclosure Copy Results Project Development Objective Indicators Page 4 of 8 The World Bank Report No: ISR4940 Indicator Name Core Unit of Measure Baseline Current End Target Proportion of Armenian Population covered by Text Value 47% 89% 90% qualified family medicine practices Date 31-Dec-2006 07-Oct-2011 31-Dec-2012 Comments On track Increased utilization of a) out-patient services; Text Value Increased Utilization and b) in-patient services by the poorest income quintile Date 07-Oct-2011 31-Dec-2012 Comments Baseline Value will be Data available in 2012 available in November 2011 Health Sector Performance Report issued once Text Value HSPA for 2006 year published Public Disclosure Copy every two years Date 01-Sep-2007 07-Oct-2011 Comments On track. HSPA report for 2010 year will be developed by Dec. 2011 (for Lori, Tavush, Shirak marzes), but financed by USAID Perceived quality of care in marzes increased Text Value 64.3% Improvement from baseline Date 30-Dec-2007 07-Oct-2011 Comments Next actual value available in 2012 ALOS in marz hospitals decreased close to Text Value 7.7 7.0 7.0 OECD average Date 01-Dec-2006 30-Dec-2010 01-Dec-2012 Comments Achieved. 2011 data to be available by March 2012 National Health Accounts report published Text Value 2006 NHA report distributed Annual annually 2007 Date 31-Dec-2006 07-Oct-2011 31-Dec-2012 Comments On track. 2010 NHA Report will be developed by early 2012, but financed by USAID Public hospitals in project sites that have Text Value 0 0 13 published financial audit reports from independent audits Date 31-Dec-2006 07-Oct-2011 31-Dec-2012 Comments On track. FY11 audit reports For FY11 planned for publication in Public Disclosure Copy 2012 Page 5 of 8 The World Bank Report No: ISR4940 Indicator Name Core Unit of Measure Baseline Current End Target Proportion of patients with a) hypertension who Text Value a) 42%; b) 33% Increased had at least one ECG annually; b) ischemic heart disease who had at least one Date 31-Dec-2006 07-Oct-2011 31-Dec-2012 totalcholesterol test annually Comments 2011 data will be available by February 2012 Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Number of certified FDs trained Text Value 633 1654 1750 Public Disclosure Copy Date 01-Dec-2006 07-Oct-2011 31-Dec-2014 Comments Exceeded for APL2. (Total Target for AF; Target for includes 107 under retraining APL2 is 1650 to be completed with 68 FDs in Oct. 2011 and 39 FDs in March 2012) Number of certified FNs trained Text Value 568 1770 1950 Date 01-Dec-2006 07-Oct-2011 31-Dec-2014 Comments Exceeded for APL2. Target for AF; Target for APL2 is 1650 Reduction of sq. meters of hospital space Text Value 0% 50% 75% (percent of original) in all marzes Date 31-Dec-2006 07-Oct-2011 31-Dec-2012 Comments (50,386 sqm out of 100,609 sqm) . Gvt Decree RA N-1911 Health personnel receiving training Number Value 1201.00 3424.00 3700.00 Date 01-Jan-2009 07-Oct-2011 31-Dec-2014 Comments The APL 2 continues training Exceeded for APL2. This is Target for AF. Target for of doctors and nurses started cummulative figure for APL2 is 3300 under the previous two Bank's physicians and nurses trained investment project. under the APL program Health facilities constructed, renovated, and/or Number Value 0.00 78.00 89.00 equipped Date 01-Jan-2008 07-Oct-2011 31-Dec-2012 Comments Proportion of health budget allocated to PHC Percentage Value 35.50 38.30 41.00 Public Disclosure Copy Date 31-Dec-2006 07-Oct-2011 31-Dec-2012 Page 6 of 8 The World Bank Report No: ISR4940 Indicator Name Core Unit of Measure Baseline Current End Target Comments Approved 2011 budget All project hospitals apply updated Text Value No Yes Yes environmental management guidelines Date 01-Jan-2007 31-Dec-2009 31-Dec-2012 Comments State Medical