The World Bank Report No: ISR16140

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: 15 Status: ARCHIVED Archive Date: 18-Oct-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): 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 30-Mar-2014 Effectiveness Date 06-Jun-2007 Revised Closing Date 29-Feb-2016 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

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Implementation Status Overview Implementation of the project activities is proceeding as planned. The next mission is tentatively planned for end October 2014, and more details on implementation status will be provided at that time.

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

Armenia Syunik'i Marz Tat'ev

Armenia Vayots' Dzori Marz Public Disclosure Copy Armenia Ararati Marz

Armenia Syunik'i Marz Goris

Armenia Ararati Marz

Armenia Ararati Marz

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

Armenia Geghark'unik'i Marz Tsovazard Public Disclosure Copy Armenia Geghark'unik'i Marz Tsovagyugh

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Country First Administrative Division Location Planned Actual Armenia Ararati Marz Sis

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

Public Disclosure Copy 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

Armenia Armaviri Marz Dalarik

Public Disclosure Copy Armenia Kotayk'i Marz Buzhakan

Armenia Armaviri Marz Aygeshat

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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

Armenia Aragatsotni Marz Aparan Public Disclosure Copy Armenia Armaviri Marz Apaga

Armenia Shiraki Marz Akhurik

Armenia Tavushi Marz Azatamut

Armenia Tavushi Marz Artsvaberd

Armenia Aragatsotni Marz Nor Sasunik

Armenia Ararati Marz

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

Results

Public Disclosure Copy Project Development Objective Indicators

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Indicator Name Core Unit of Measure Baseline Current End Target Proportion of Armenian Population covered by Text Value 47% 95% qualified family medicine practices Date 31-Dec-2006 19-Sep-2014 29-Feb-2016 Comments Increased utilization of a) out-patient services; Text Value a) 3.9%; b) 3.1% Increased Utilization and b) in-patient services by the poorest Date 22-Nov-2011 19-Sep-2014 29-Feb-2016 income quintile Comments Health Sector Performance Report issued once Text Value HSPA for 2006 year published HSPA published every two every two years year Date 01-Sep-2007 19-Sep-2014 29-Feb-2016 Public Disclosure Copy Comments Perceived quality of care in marzes increased Text Value 64.3% 75% Date 30-Dec-2007 19-Sep-2014 29-Feb-2016 Comments Both urban/rural marzes: PHC: 53.6% in 2009; Hospitals: 64.6% in 2009. ALOS in marz hospitals decreased close to Text Value 7.7 6.5 OECD average Date 01-Dec-2006 19-Sep-2014 29-Feb-2016 Comments National Health Accounts report published Text Value 2006 NHA report distributed Annual annually 2007 Date 31-Dec-2006 19-Sep-2014 29-Feb-2016 Comments Public hospitals in project sites that have Text Value 0 13 published financial audit reports from Date 31-Dec-2006 19-Sep-2014 29-Feb-2016 independent audits Comments For FY11 and FY13 Proportion of patients with a) hypertension who Text Value a) 42%; b) 33% Increased had at least one ECG annually; b) ischemic Date 31-Dec-2006 19-Sep-2014 29-Feb-2016 heart disease who had at least one totalcholesterol test annually Comments

Intermediate Results Indicators Public Disclosure Copy

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Indicator Name Core Unit of Measure Baseline Current End Target Number of certified FDs trained Text Value 633 1750 Date 01-Dec-2006 19-Sep-2014 29-Feb-2016 Comments Target for AF is 100; Target for APL2 is 1650 Number of certified FNs trained Text Value 568 1950 Date 01-Dec-2006 19-Sep-2014 29-Feb-2016 Comments Target for AF is 120; Target for APL2 is 1650 Reduction of sq. meters of hospital space Text Value 0% 85% Public Disclosure Copy (percent of original) in all marzes Date 31-Dec-2006 09-Jan-2014 31-Dec-2014 Comments Health personnel receiving training (number) Number Value 1201.00 3700.00 Date 01-Jan-2009 19-Sep-2014 29-Feb-2016 Comments The APL 2 continues training Target for AF is 400. Target of doctors and nurses started for APL2 is 3300 under the previous two Bank's investment project. Health facilities constructed, renovated, and/or Number Value 0.00 100.00 equipped (number) Date 01-Jan-2008 19-Sep-2014 29-Feb-2016 Comments Proportion of health budget allocated to PHC Percentage Value 35.50 43.00 Date 31-Dec-2006 19-Sep-2014 29-Feb-2016 Comments All project hospitals apply updated Text Value No Yes environmental management guidelines Date 01-Jan-2007 19-Sep-2014 29-Feb-2016 Comments State Medical University has a revised students Text Value No revision has been done Yes examination system in line with EU countries Date 31-Dec-2006 19-Sep-2014 29-Feb-2016 Comments Target to be met at the closing of AF Increased number of admission in project Text Value 29,668 40,000 hospitals Date 01-May-2009 19-Sep-2014 29-Feb-2016 Comments Includes APL2 and AF Public Disclosure Copy

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Proportion of key management staff in project Text Value 0 39 key management staff or hospitals trained on financial management after 100% the results of performed independent audits Date 31-Dec-2006 19-Sep-2014 29-Feb-2016 Comments 3 staff in 13 hospitals = 39 key management staff Reduction in out-of-pocket payments for Text Value a) 35.4% (out-patient); b) Reduction essential health services 47.1% (in-patient) Date 31-Dec-2009 19-Sep-2014 29-Feb-2016 Comments Baseline data will be available in November 2011 Public Disclosure Copy Data on Financial Performance (as of 12-Sep-2014)

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 29-Feb-2016 P104467 IDA-42670 Closed 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 15.36 3.64 81.00 P104467 IDA-42670 Closed USD 22.00 21.96 0.04 22.87 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, CD Decision on 19-Mar-2010, Level 2 CD Decision on 26-Mar-2014

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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