The World Bank Implementation Status & Results

Turkey Health Transformation and Social Security Reform Project (P102172)

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Operation Name: Health Transformation and Social Security Reform Project Project Stage: Implementation Approval FY: Seq.No: 5 2009 Status: ARCHIVED

Report No: ISR5686

Archive Date:

05-Jul-2011

(P102172)
Country: Turkey Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Adaptable Program Loan

Implementing Agency(ies): Ministry of Health, Social Security Institution

Key Dates
Board Approval Date Effectiveness Date

11-Jun-2009 29-Sep-2009

Original Closing Date 31-Jul-2013 Revised Closing Date 31-Jul-2013

Planned Mid Term Review Date Actual Mid Term Review Date

Last Archived ISR Date 05-Jul-2011

24-Oct-2011

Project Development Objectives

Project Development Objective (from Project Appraisal Document)

The specific objectives of the HTSSRP are: (i) increasing the effectiveness of the Social Security Institute (SSI) and the Ministry of Health (MOH) in formulating and implementing reforms in provider payments and health systems performance; and (ii) piloting output-based financing for non-communicable diseases (NCD) prevention and control.
Has the Project Development Objective been changed since Board Approval of the Project?

Yes

No

Component(s)
Component Name Component Cost

Support for MOH's Strategic Plan Output Based Financing for Preventive Health Services Capacity Building for Social Security Institution

46.17 6.84 3.09

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

Satisfactory Satisfactory Low

Satisfactory Satisfactory Low

Implementation Status Overview

The World Bank has been supporting the Government's Health Transformation program through a two-phased approach. The first phase supported the introduction of the family medicine model, and helped build capacity of the Ministry of Health and the Social Security Institute to expand health insurance coverage and improve family medicine service delivery. The second phase, through the ongoing Health Transformation and Social Security Reform Project supports reforms aimed at increasing hospital autonomy, expanding

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Report No: ISR5686

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family medicine services, and further strengthening performance management and pay-for-performance initiatives. The second phase became effective on September 29, 2009. The Project has already disbursed US$24.43 million as of December 2011 (33% of loan proceeds) and is making satisfactory progress towards achieving its objectives. Significant progress is noted with key legislations (MOH Restructuring Law and Hospital Union Law) having been passed as a decree law this November. The MOH Restructuring Law redefines the role of the MOH away from that of a provider to that of a steward for the sector focusing on policy formulation, regulation and monitoring and evaluation. The family medicine program has achieved nationwide coverage as of December 2010. Utilization of primary care services has increased and is 3.6 outpatient visits per capita in 2011 compared with 2 in 2008. Patient satisfaction with health services has increased from 38% in 2003 to 73% in 2010. Locations No Location data has been entered

Results
Project Development Objective Indicators
Indicator Name Core Unit of Measure Baseline Value Date Comments Current End Target

1. Increase in the utilization of primary health care.

Number

2.00 30-Jul-2009

3.60 20-Dec-2011

4.00 30-Jul-2013

Target on track. 3.6 Visits per 4 visits per capita capita in 2011 1.20 30-Jun-2009 1.50 20-Dec-2011 Target met. 2010 data 63.4 14-Jul-2008 percent 73.0 20-Dec-2011 Target met. 73% in 2010. 70 30-Jul-2013 percent 1.50 31-Jul-2013

2. Increase in the percentage of first-time visits to specialists that are referrals by family medicine practices 3. Increased client satisfaction with health services as compared with baseline.

Number

Value Date Comments

Text

Value Date Comments

4. Smoking prevalence among 18-29 age group in pilot provinces relative to non-pilot provinces.

Percentage

Value Date Comments

08-Jul-2009 NCD survey to be implemented in 2011.

20-Dec-2011 The OBF component is yet to be implemented as secondary legislation is being drafted to allow for this. NCD survey being analyzed.

31-Jul-2013

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Indicator Name Core Unit of Measure Baseline Value Date Comments Current

Report No: ISR5686

End Target

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5. High blood pressure in population in pilot provinces decreases more as compared to non-pilot provinces

Percentage

08-Jul-2009

20-Dec-2011

31-Jul-2013

Baseline NCD assessment to The OBF component is yet to be carried out in 2011 be implemented as secondary legislation is being drafted to allow for this. NCD survey being analyzed. 40.00 08-Jul-2009 40% of expenditures on pharmaceuticals 50% of treatment costs on inpatient 41.80 10-Jun-2011 41.8% in 2010 - SSI expenditures on pharmaceuticals as a % of SSI spending 33.00 31-Jul-2012 33% ,42%

6. Decrease in SSI expenditures on pharmaceuticals and outpatient health care

Percentage

Value Date Comments

Intermediate Results Indicators

Indicator Name Core Unit of Measure Baseline Value Date Comments Current End Target

Component A: 1. Percentage of family medicine practices that have completed second level training as compared with baseline 2. Annual performance reports on implementation of MOH Strategic Plan using information from MOH Monitoring and Evaluation system disseminated by MOH to Parliament and published on MOH website 3. Percentage of acute care public hospitals using revised clinical guidelines for secondary care as requirement of performance payment system 4. Dissemination of bi-annual HTP Tracking reports by M&E Directorate of MOH

Percentage

0.00 08-Jul-2009 0

21.00 20-Dec-2011 21% in 2011 2011 Performance program submitted to National Assembly

80.00 31-Jul-2013 80% Third Report published

Text

Value

Date Comments

08-Jul-2009

20-Dec-2011 Done.

30-Jul-2013

Text

Value Date Comments

0 31-Jul-2009 20-Dec-2011 Indicator to be revised a part of level 1 restructuring. Not available HSPA report tracks HTP performance and is currently being published. 20-Dec-2011 1 bi-annual report 31-Jul-2013

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Text

Value

Date Comments

08-Jul-2009

31-Jul-2013

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Indicator Name Core Unit of Measure Baseline Value Date Comments Current

Report No: ISR5686

End Target

5. Percentage of family physicians using rational drug prescription guidelines

Percentage

0.00 20-Dec-2010 No data available - indicator to be revised by MOH and as part of a level 1 restructuring 0.00 20-Dec-2011 This is being implemented. Indicator to be revised by MOH. 0.00 08-Jul-2009 0 percent 0.00 20-Dec-2011

30.00 31-Jul-2013 30% increase

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6. Percentage of MOH Implementing Units for HTSSRP have formed Project Offices and connected to PMSU-Net for project monitoring

Percentage

Value Date Comments

100.00

Component B: 1. Percentage of population of pilot provinces screened for NCD risk factors

Percentage

Value Date Comments

70.00 31-Jul-2013

OBF component has just 70 percent been initiated after legal changes to allow positive payments were passed. Secondary legislation is being drafted. 0.00 20-Dec-2011 OBF component has just been initiated after legal changes to allow positive payments were passed. Secondary legislation is being drafted. 0.00 20-Dec-2011 OBF component has just been initiated after legal changes to allow positive payments were passed. Secondary legislation is being drafted. 100.00 31-Jul-2013 72.00 31-Jul-2013

2. Higher increase in appropriate knowledge and attitudes regarding global risk factors for NCDs in pilot provinces as compared with nonpilot provinces

Percentage

Value Date Comments

0.00 08-Jul-2009 To be determined on the basis of baseline KAP survey in pilot provinces and selected non-pilot provinces

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3. Percentage of cases in pilot provinces diagnosed and under follow-up by family group practices for the following NCDs: hypertension, diabetes, obesity/overweight

Percentage

Value Date Comments

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4. 100 percent compliance with reporting on implementation of screening activities as well as patient records (through family medicine information system) Percentage
Value Date Comments

Report No: ISR5686

0.00 08-Jul-2009 System will be set up by the end of 2009

0.00 20-Dec-2011

100.00 31-Jul-2013

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OBF component has just 100 percent compliance been initiated after legal changes to allow positive payments were passed. Secondary legislation is being drafted. Actuarial analysis done for the 2 actuarial analysis of UHI period 2010-2035. conducted in 2010 and 2012 respectively. 20-Dec-2011 31-Jul-2013

Component C: 1. Actuarial analysis of UHI updated for 2010 and 2012 based on updated macro and micro data

Text

Value

1st actuarial analysis completed 08-Jul-2009

Date Comments

2. Costly interventions under Benefits Package for UHI revised using cost-effectiveness criteria and guidelines developed by SSI;

Text

Value

Review of Benefits Package and identification of interventions and baseline expe nditures 08-Jul-2009 20-Dec-2011 SSI consulting with NICE to begin work in this area. A TOR has been prepared for this task. Stock-taking and development of action plan for implementation of prospective payment systems

Decrease in spending on the interventions as compared to baseline 31-Jul-2013

Date Comments

3. Prospective payment systems based on international evidence (capitation, global budgets, DRGs) or outpatient and acute care adopted for University, private and MOH hospitals

Text

Value

10% of MOH hospital Relevant prospective payments based on DRG payment systems will be 100% starting January implemented 2012. DRG introdcution in private and university hospitals under discussion. 20-Dec-2011 31-Jul-2013

Date Comments

08-Jul-2009

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Data on Financial Performance (as of 14-Dec-2011)

Financial Agreement(s) Key Dates
Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date

P102172

IBRD-77170

Effective

11-Jun-2009

30-Jun-2009

29-Sep-2009

31-Jul-2013

Disbursements (in Millions)

Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed

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P102172 IBRD-77170 Effective USD 75.13 75.13 0.00 24.43

Report No: ISR5686

51.27

33.00

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Disbursement Graph

Key Decisions Regarding Implementation

There are no pending key decisions.

Restructuring History
There has been no restructuring to date.

Related Projects
P120948-Health Systems Performance Assessment

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