World Bank Implementation Completion and Results Report of the National Sector Support For Health Reform Project

The Project is a US$110M loan to the Philippines in support of the country’s FOURmula ONE for Health, the national health sector reform program lodged with the Department of Health. Primary Project beneficiaries were poor households identified by the means test and enrolled in PhilHealth’s Indigent Program. Other beneficiaries included users of Government of the Philippines (GOP)-financed primary healthcare services, especially for vaccinations.

At Project-end, the following were achieved:

A. Project Development Objectives

Indicator 1: Increase coverage rate of fully immunized children by at least 10%.
Result: The target Fully Immunized Children (FIC) rate was not achieved by the final year of the project. The latest FIC rate improved slightly from the baseline, but fell below the target. The data for the FIC were drawn from the Field Health Service Information System (FHSIS).

Indicator 2: Increase TB case detection rate from 72% to at least 80%.
Result: The target TB case detection rate was not achieved by the final year of the Project. The latest TB case detection rate is the same as the baseline. The data were drawn from FHSIS.

Indicator 3: Increase TB cure rate from 81% to at least 85%.
Result: The target TB cure rate was not achieved by the final year of the project. The latest TB cure rate improved very slightly from the baseline, but fell behind the target. The data were drawn from the FHSIS.

Indicator 4: Evidence of a statistically significant improvement (wherever feasible) or validation by an alternative method of improvement, in prevention, diagnosis or treatment rates in participating LGUs for diseases or conditions subject to performance agreements and grants.
Result: No method has been finalized. Department of Health (DOH) sees that it is very difficult to come up with an evidence of a statistically significant improvement. DOH has not been able to get a third party to validate an alternative method, as planned. Nevertheless, DOH conducted a small scale self-assessment by using LGU scorecards.

B. Intermediate Outcome Indicators

Indicator 1: Increase in proportion of DOH budget allocated on the basis of criteria of need and performance (from 0 to at least 5% of existing maintenance and other operating expenses and at least 5% of any increment in DOH MOOE budget).
Result: DOH budget was allocated on the basis of need and performance. It rose gradually to 5.4% in 2007, fell to 1.8% (during the world-wide economic crisis), and reached 24% in 2010.

Indicator 2: Increase in number of development projects or programs using HSEF to plan and program their health sector support (from 0 foreign assisted project to 100% of FOURmula ONE PPAs).
Result: From 2009 onward, 100% of FOURmula ONE PPAs used HSEF to plan and program their health sector support. This target was reached well ahead of the project’s closing date.

Indicator 3: Increase in number of LGUs identifying the poor using acceptable, defined methods of means testing and enrolling them in NHIP Indigent Program (from 0 to 993 LGUs).
Result: No LGU identified the poor using an acceptable, defined method of means testing and enrolling them in the NHIP Indigent Program. With no progress on the LGU front, the project shifted to support a nationally developed means test, and was able to identify the poor using the NHTSPR, which is an acceptable, defined method of means testing. Although this enabled enrollment of 5.2 million poor households in the NHIP Indigent Program, unfortunately this change in approach was not formally specified during the project restructuring. It should also be noted that the number of “poor” households on the list adopted by LGUs was around 6-7 million. Out of these, only about 900,000 households were the same as those identified by the NHTS-PR, raising the concern that many of the households on the LGU list are not poor.

Indicator 4: Significant quantified reductions in date-expiry, stock-outs and losses of public health commodity stocks at defined levels in supply chain.
Result: Information on stock-outs was not collected by the DOH beyond the level of the Center for Health Development (CHD).

Indicator 5: LGU scorecard implemented and scores improve in convergence sites.
Result: LGU scorecards were generated in all 16 F1 provinces by 2008, and later expanded to all LGUs. There was moderate progress on scores in 16 F1 provinces.

Indicator 6: Full compliance with the Borrower’s procurement law and standards, monitored using agency procurement benchmark indicators.
Result: There was continued full compliance with the Bank’s procurement procedures and standards, monitored using agency procurement benchmark indicators.

Indicator 7: eNGAS roll out; quarterly reports to managers on performance against plan and budget under General Appropriations Act (GAA) program structure.
Result: By the end of the project, the eNGAS was used fully in 5 CHDs, while 7 CHDs were in a transition phase, and the eNGAS still needed to be rolled out in another 4 CHDs. In all CHDs, under the GAA program structure, quarterly reports were submitted to managers on performance against plan and budget. DOH should be congratulated for its persistence in expanding the eNGAS, despite COA’s decision to suspend the national roll-out of the eNGAS in 2008.

The complete report here.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s