The World Bank Report No: ISR7352

Implementation Status & Results 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: 11 Status: ARCHIVED Archive Date: 03-Dec-2011 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 03-Dec-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 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 Moderately Satisfactory

Public Disclosure Copy Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Low Low

Page 1 of 8 Public Disclosure Authorized The World Bank Report No: ISR7352

Implementation Status Overview Civil works and procurement and delivery of equipment to health facilities are completed and or well underway. All activities planned under Phase 2 of the Project will be completed by December 31, 2012. However, several activities linked to training and technical assistance expenditures planned under the Additional Financing have not yet taken place (retraining of family doctors and nurses, production of the Health Sector Performance Assessment Report and of the National Health Account report, publication of audit reports of public hospitals, and revision of student examination system). This is due to a Government’s decision taken in 2011 to finance these types of activities from state budget funds or other financial sources rather than from the credit.

Locations Country First Administrative Division Location Planned Actual Armenia Syunik'i Marz Tegh

Public Disclosure Copy 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

Armenia Aragatsotni Marz Zovuni

Armenia Geghark'unik'i Marz Vaghashen

Armenia Aragatsotni Marz Ushi

Public Disclosure Copy Armenia Aragatsotni Marz Ujan

Armenia Geghark'unik'i Marz Tsovazard

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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

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 '

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

Armenia Shiraki Marz Gyumri

Armenia Lorru Marz Jrashen

Public Disclosure Copy Armenia Armaviri Marz

Armenia Kotayk'i Marz Buzhakan

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Armenia Armaviri Marz Aygeshat

Armenia Geghark'unik'i Marz Astghadzor

Armenia Aragatsotni Marz Arteni

Armenia Armaviri Marz

Armenia Armaviri Marz

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

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Indicator Name Core Unit of Measure Baseline Current End Target Proportion of patients with a) hypertension who Text Value a) 42%; b) 33% a) 65%; b) 59% Increased had at least one ECG annually; b) ischemic Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 heart disease who had at least one totalcholesterol test annually Comments Target met. 2011 data

Public hospitals in project sites that have Text Value 0 0 13 published financial audit reports from Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 independent audits Comments PM's office denied funding of For FY11 audits out of credit; State budget to finance. However, this is delay until Jan. 2013 Public Disclosure Copy National Health Accounts report published Text Value 2006 NHA report distributed 0 Annual annually 2007 Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 Comments Team is following up on the 2010 NHA report publication with USAID ALOS in marz hospitals decreased close to Text Value 7.7 6.7 6.5 OECD average Date 01-Dec-2006 08-Jun-2012 31-Dec-2014 Comments Achieved under APL2 (target was 7.0) Perceived quality of care in marzes increased Text Value 64.3% Improvement from baseline Date 30-Dec-2007 08-Jun-2012 31-Dec-2014 Comments Next actual value available in November 2012 Health Sector Performance Report issued once Text Value HSPA for 2006 year published every two years Date 01-Sep-2007 08-Jun-2012 31-Dec-2014 Comments Team is following up on 2010 HSPA publication with USAID Increased utilization of a) out-patient services; Text Value Increased Utilization and b) in-patient services by the poorest Date 07-Oct-2011 31-Dec-2014 income quintile Comments Baseline Value will be Data available in November available in November 2011 2012 Proportion of Armenian Population covered by Text Value 47% 89% 90% qualified family medicine practices Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 Comments On track for family doctors Public Disclosure Copy

Intermediate Results Indicators

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Indicator Name Core Unit of Measure Baseline Current End Target Reduction in out-of-pocket payments for Text Value 0 Reduction essential health services Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 Comments Baseline data will be available Data will be available in in November 2011 November 2012 Proportion of key management staff in project Text Value 0 0 39 key management staff or hospitals trained on financial management after 100% the results of performed independent audits Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 Comments Delayed due to unavailability 3 staff in 13 hospitals = 39 of funding from State budget key management staff

Public Disclosure Copy to carry out the independent audits Increased number of admission in project Text Value 0 35,248 35,000 hospitals Date 08-Jun-2012 31-Dec-2014 Comments Target met State Medical University has a revised students Text Value No revision has been done NO Yes examination system in line with EU countries Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 Comments Target to be met at the closing of AF All project hospitals apply updated Text Value No Yes Yes environmental management guidelines Date 01-Jan-2007 08-Jun-2012 31-Dec-2014 Comments Target met Proportion of health budget allocated to PHC Percentage Value 35.50 36.50 41.00 Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 Comments Approved 2012 budget Health facilities constructed, renovated, and/or Number Value 0.00 80.00 89.00 equipped (number) Date 01-Jan-2008 08-Jun-2012 31-Dec-2014 Comments Target on track Health personnel receiving training (number) Number Value 1201.00 3424.00 3700.00 Date 01-Jan-2009 08-Jun-2012 31-Dec-2014 Comments The APL 2 continues training Exceeded for APL2. This is Target for AF if 400. Target of doctors and nurses started cummulative figure for for APL2 is 3300 under the previous two Bank's physicians and nurses trained investment project. under the APL program. However, no training has

Public Disclosure Copy taken place under AF.

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Reduction of sq. meters of hospital space Text Value 0% 60% 85% (percent of original) in all marzes Date 31-Dec-2006 08-Jun-2012 31-Dec-2014 Comments (60,648 sqm out of 100,609 sqm) . Gvt Decree RA N-1911 Number of certified FNs trained Text Value 568 1770 1950 Date 01-Dec-2006 08-Jun-2012 31-Dec-2014 Comments Exceeded for APL2. Target for AF is 120; Target for APL2 is 1650 Number of certified FDs trained Text Value 633 1654 1750 Date 01-Dec-2006 08-Jun-2012 31-Dec-2014 Public Disclosure Copy Comments Exceeded for APL2. Target for AF is 100; Target for APL2 is 1650

Data on Financial Performance (as of 30-May-2012)

Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P104467 IBRD-79870 Effective 20-Dec-2010 26-Jan-2011 08-Jun-2011 31-Dec-2014 31-Dec-2014 P104467 IDA-42670 Effective 08-Mar-2007 09-Mar-2007 06-Jun-2007 31-Dec-2012 31-Dec-2012

Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P104467 IBRD-79870 Effective USD 19.00 19.00 0.00 5.68 13.32 30.00 P104467 IDA-42670 Effective USD 22.00 22.00 0.00 22.92 0.00 104.00

Disbursement Graph Public Disclosure Copy

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Key Decisions Regarding Implementation not applicable

Restructuring History Level two Approved on 11-Mar-2010, Level two Approved on 19-Mar-2010

Related Projects P121728-Additional Financing for the 2nd Health System Modernization Project (APL2) in Support of the 2nd Phase of the Health Sector Reform Public Disclosure Copy

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