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Overview. US $30.8 mln IDA credit Oct 2014 - March 2019 Approved by WB Executive Board on May 22,...
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Transcript of Overview. US $30.8 mln IDA credit Oct 2014 - March 2019 Approved by WB Executive Board on May 22,...
Health Transformation
ProjectOverview
US $30.8 mln IDA credit
Oct 2014 - March 2019
Approved by WB Executive Board on May 22, 2014
The Project Terms:
Objective: to reduce key risks for non-communicable diseases and improve efficiency of health services in Moldova.
Approach: A. US $28.8mln is Program-for-
Results (PforR)B. US $2mln is Technical Assistance
Project Objective and Approach
A new lending instrument of the World Bank WB and Govt to agree on a selective set of
indicators, with clear targets and verification methods
Each target links to a certain disbursement amount to the State Budget
Country uses its own budget and systems (financial management, procurement, etc.) to achieve the targets
Once targets have been achieved; money is disbursed from WB to Govt. If DLIs are partially met, then there will be partial disbursements
What is PforR?
Conceptual framework and results chain
MOH administrative budget CNAM administrative budget Primary health care (performance-based
incentive for family medicine and re-imbursement of anti-hypertensive drugs only)
Hospital care (performance-based incentive for family medicine only)
National Tobacco Control Programme
MTBF subprograms which are selected (PforR boundaries)
Challenge: In Moldova, around 10% of people with hypertension have their blood pressure under control
Indicator: increase this percentage from 10% to 15%
Verification method: two rounds with household survey with blood pressure measurement. If target is met disbursement
Example of a disbursement linked indicator
Disbursement Linked Indicators Value(US$ million)
1 Smoking prevalence in adults 4.02 Percentage of adults with hypertension whose blood pressure is under control 4.0
3 Annual acute care hospital discharges per 100 persons 3.04 Number of acute care hospital beds 4.85 Revision of the average reimbursement rate of generic, first line medications for
the three main categories of antihypertensive drugs in the drug benefit package from 50 percent to 70 percent
2.0
6 Revision and implementation of performance-based incentive scheme in primary care
2.0
7 Introduction of performance-based incentives to improve (i) efficiency and (ii) quality of care in hospitals
2.0
8 Use of DRGs for hospital payments 2.09 Proportion of public hospitals in Chisinau which are under common management 4.0
10 Approval of the new national health strategy which includes hospital rationalization measures
1.0
Total 28.8
Disbursement Linked Indicators
Focusing more on actual results thru financing of results, not inputs
Facilitating strengthening and use of country systems and procedures
Giving more flexibility to the country
Advantages of PforR
Conduct 3 assessments as part of preparation◦ Technical Assessment ◦ Fiduciary (financial management and
procurement)◦ Environmental-social assessment (ESSA)
Each assessment (i) identifies strengths, weaknesses of govt systems and (ii) proposes mitigation measures
Public consultation and disclosure of ESSA
PforR Preparation Requirements
I. Capacity building: DRG costing exercise based on country data; Optimisation of business processes and workflows for hospitals
under common management; Performance-based incentive scheme to improve quality and
efficiency in hospitals; Development a manual for quality of care management in
primary care; Development an accountability framework and mechanism for
health workers; Studies and reports: Health HBS, streamlined STEPS to verify the
PforR results
II. Institutional support: PIU to support MoH and CNAM
Technical Assistance Component(tentative activities)
For more information, please visithttp://documents.vsemirnyjbank.org/curated/ru/2014/04/19457546/moldova-health-transformation-operation-project
Health Transformation Project