REPORT NO.: RES33266
RESTRUCTURING PAPER ON A
PROPOSED PROJECT RESTRUCTURING OF
HEALTH PROFESSIONALS EDUCATION AND TRAINING FOR HEALTH SYSTEM REFORMS APPROVED ON MAY 6, 2014
TO
SOCIALIST REPUBLIC OF VIETNAM
HEALTH, NUTRITION & POPULATION EAST ASIA AND PACIFIC
Regional Vice President: Victoria Kwakwa Country Director: Ousmane Dione Senior Global Practice Director: Timothy Grant Evans
Practice Manager/Manager: Toomas Palu Task Team Leader: Sang Minh Le
Public Disclosure Authorized
Public Disclosure Authorized
Public Disclosure Authorized
ABBREVIATIONS AND ACRONYMS
CK1 Level 1 specialist
CPMU Central Project Management Unit
MOH Ministry of Health
Note to Task Teams: The following sections are system generated and can only be edited online in the Portal.
BASIC DATA
Product Information
Project ID Financing Instrument
P131825 Investment Project Financing
Original EA Category Current EA Category
Partial Assessment (B) Partial Assessment (B)
Approval Date Current Closing Date
06-May-2014 31-Dec-2020
Organizations
Borrower Responsible Agency
Socialist Republic of Vietnam Ministry of Health
Project Development Objective (PDO) Original PDO
The PDOs are to improve the quality of health professionals' education, strengthen management competencies in the health sector, and improve the competencies of Primary Health Care teams at the grass-roots level.
OPS_TABLE_PDO_CURRENTPDOSummary Status of Financing
Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed UndisbursedNet IDA-54410 06-May-2014 17-Jul-2014 30-Oct-2014 31-Dec-2020 86.00 7.81 68.64 TF-A1658 28-Mar-2017 28-Mar-2017 28-Mar-2017 30-Nov-2018 8.68 4.20 4.48
Policy Waiver(s)
Does this restructuring trigger the need for any policy waiver(s)? No
1. Project status
(a) The implementation progress and achievement of PDO has been rated unsatisfactory for more than one year. Only the Component strengthening management capacities in the health sector is making progress toward achievement of the PDO, while other Components are moving at a much slower pace. This slow progress results from a lack of empowerment and capacity of the Central Project Management Unit (CPMU) and a challenging regulatory and institutional environment.
(b) The Component improving the quality of health professionals education has been affected by a shift the focus from Quality Assurance system to introduction of competency based education programs. The development, review and approval of school grants took longer than anticipated, resulting in a reduction in the number of grant recipients as well as reduced resource and timeframe for grant implementation. Only US$ 17 million are committed under the school grants program, and approximately US$ 2 million have been transferred to grant recipients, while US$12 million is unprogrammed under this component.
(c) The Component improving competencies of primary healthcare (PHC) teams has been expanding training programs at the grassroots level and making some progress towards PDO recently. However, delays in procurement of equipment will affect the provision of training service to PHC teams in targeted areas.
(d) While increasing slowly, disbursement remains low at 14.1%. After the US$20 million cancellation in March 2017, only 10.2% of the IDA resources have been disbursed. Disbursement from the EU grant of EUR 7.43 million has reached approximately 48.4%.
2. Rationale for restructuring
(a) In March of 2017, US$20 million was cancelled from the Project. A review of the Project’s indicators was undertaken with a view to determine, given the cancellation, whether the targets, as originally envisaged, were still attainable. During the March 2017 review, the World Bank and the MOH agreed on the need to formally revise the Results Framework, and a working draft was discussed at that time. It was agreed that a logical time to make a final determination on how to revise the indicators would be during the Mid-Term Review (MTR), planned for January 2018, along with a review to identify any other necessary changes and to restructure the Project. The MTR in January 2018, reviewed and confirmed that while the Development Objectives and Finance Agreement did not require any changes, the Results Framework would need to be revised due to the changing focus arising from Government’s health professionals education reform and the delays in implementation. (b) Following are the main issues relating to the original Results Framework:
(i) Relevance: Two of the PDO indicators and three intermediate result indicators were formulated to measure achievement and progress of the development of the quality assurance system. However, as the Project commenced implementation, the Ministry of Health (MOH) shifted the focus from quality assurance to the introduction of competency-based education programs. No measurement was included which captures the tremendous effort, which has gone into strengthening the policy framework and institutional capacity for health professionals education reform, made by MOH since the project effectiveness.
(ii) Attainability: Due to the delays in implementation and cost increases, it will be impossible to attain the cumulative target values set for most of intermediate result indicators associated with Component 2, including the sub-component providing basic equipment to PHC teams. However, more health staff at the grassroots level can be included in the training programs for PHC teams because the training courses are now shorter and less expensive than expected.
II. DESCRIPTION OF PROPOSED CHANGES
The Results Framework for the Project will be changed. A formal request for reaffirming the revised Result Framework was received from Ministry of Health on June 29, 2018. The Project Operational Manual will be updated and adopted by Ministry of Health to reflect proposed changes in the Result Framework. The World Bank Country Director notified Ministry of Health of using revised Result Framework to monitor and evaluate the project from July 2018 onward. The following describes proposed changes in the Result Framework:
(a) The indicators associated with Component 1 will be replaced as follows:
(i) The two original PDO indicators “Number of health professional programs that have completed the Peer Review Assessment” and “Percentage of first takers who have passed the standardized examination for their area of study” will be removed.
(ii) The addition of a single PDO indicator “Number of Grant recipient schools successfully implementing their competency-based curriculum”.
The Quality Assurance Council within Ministry of Health will evaluate the implementation of competency based curriculum (CBC) at grant recipient schools. An evaluation checklist will be developed and a passing score will be established by the Council to decide whether grant recipient schools implement their CBC successfully. During the Midterm Review Workshop on January 19, 2018, Grant recipients and council members agreed about this indicator, target and evaluation method. It is expected that the checklist and methodology will be finalized by the end of 2018.
(iii) The three original intermediate result indicators “Number of trained assessors”, “Examination blueprint ready”, and “Item Bank ready” will be removed.
(iv) A single intermediate result indicator “Number of grant recipients completing 70% of activities in their annual workplan in each year” will be added.
(b) One PDO indicator and two intermediate result indicators associated with Component 2 will be changed as follows:
(i) One original PDO indicator “Number of managers that have completed at least one management course” will be revised to “Number of managers and inspectors that have completed at least one management course”; the end-target value will be reduced from 4000 to 2300.
(ii) Two original intermediate result indicators “Number of management trainers enrolled in a graduate program” and “Number of students enrolled in a management course” will be removed.
(iii) A single intermediate result indicator “Number of young volunteer doctors that have completed the CK1 training program” will be added.
(c) All indicators associated with Component 3 will be revised, namely:
(i) The original PDO indicator “Percentage of commune health station staff per province that have improved their clinical skills in the management of selected conditions by at least 25% after training ” will be revised as “Percentage of commune health station staff that have improved their knowlege and clinical skills in the management of selected conditions by at least 20% after training”.
(ii) Target value of the original intermediate result indicator “number of health staff enrolled in a training program” will be increased from 8,500 to 15,000.
(iii) The original intermediate result indicator “Number of commune health stations provided with a set of basic equipment” will be revised to “Number of training institutions, clinical training sites and commune health stations provided with a set of basic equipment”; the target value will be reduced from 2,300 to 982. (d) A new intermediate result indicator, to measure strides in strengthening the policy framework and institutional
Note to Task Teams: The following sections are system generated and can only be edited online in the Portal.
III. SUMMARY OF CHANGES
Changed Not Changed
Change in Results Framework ✔
Change in Implementing Agency ✔
Change in DDO Status ✔
Change in Project's Development Objectives ✔
Change in Components and Cost ✔
Change in Loan Closing Date(s) ✔
Cancellations Proposed ✔
Reallocation between Disbursement Categories ✔
Change in Disbursements Arrangements ✔
Change in Disbursement Estimates ✔
Change in Overall Risk Rating ✔
Change in Safeguard Policies Triggered ✔
Change of EA category ✔
Change in Legal Covenants ✔
Change in Institutional Arrangements ✔
Change in Financial Management ✔
Change in Procurement ✔
Change in Implementation Schedule ✔
Other Change(s) ✔
Change in Economic and Financial Analysis ✔
Change in Technical Analysis ✔
Change in Social Analysis ✔
IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_RESULTS_TABLE
RESULTS FRAMEWORK
Project Development Objective Indicators PDO_IND_TABLE
Number of health professional programs that have completed the Peer Review Assessment (PRA). Unit of Measure: Text
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value none none
6 medicine; 3 nursing (4 year program), 5 nursing (3 yr program), 1 pharmacy
Marked for Deletion
Date 30-Sep-2014 31-Jan-2018 31-Dec-2020
Percentage of first takers who have passed the standardized examination for their area of study (medicine, nursing, or pharmacy).
Unit of Measure: Percentage Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 0.00 80.00 Marked for Deletion
Date 30-Sep-2014 31-Jan-2018 31-Dec-2020
Number of managers and inspectors that have completed at least one management course. Unit of Measure: Number
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 305.00 2300.00 Revised
Date 30-Sep-2014 08-Jun-2018 31-Dec-2020
Percentage of young volunteer physicians who worked in disadvantage districts during the year following completion of CK1 training.
Unit of Measure: Percentage Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 100.00 90.00 No Change
Percentage of commune health station staff that have improved their knowlege and clinical skills in management of selected conditions by at least 20% after training.
Unit of Measure: Percentage Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 3.00 80.00 Revised
Date 30-Sep-2014 08-Jun-2018 31-Dec-2020
Number of Grant recipient schools successfully implementing their competency based curriculum Unit of Measure: Number
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 0.00 12.00 New
Date 30-Sep-2014 08-Jun-2018 31-Dec-2020
Intermediate Indicators IO_IND_TABLE
Number of trained assessors. Unit of Measure: Text Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0 0 nursing; 6 pharmacy60 medicine; 30 Marked for Deletion
Date 30-Sep-2014 31-Jan-2018 30-Sep-2018
Examination blueprint ready Unit of Measure: Text Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0 0 blueprint ready Marked for Deletion
Date 30-Sep-2014 31-Jan-2018 30-Sep-2015
Item Bank ready. Unit of Measure: Text Indicator Type: Custom
Value 0 0 item bank ready Marked for Deletion
Date 30-Sep-2014 31-Jan-2018 30-Sep-2015
Number of management trainers enrolled in a graduate program. Unit of Measure: Number
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 0.00 14.00 Marked for Deletion
Date 30-Sep-2014 31-Jan-2018 30-Sep-2018
Number of students enrolled in a management course. Unit of Measure: Number
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 48.00 4500.00 Marked for Deletion
Date 30-Sep-2014 31-Jan-2018 31-Dec-2020
Number of health staff enrolled in a training program. Unit of Measure: Number
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 1959.00 15000.00 Revised
Date 30-Sep-2014 08-Jun-2018 30-Sep-2018
Number of traning institutions, clinical training sites and commune health stations provided with a set of basic equipment
Unit of Measure: Number Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 0.00 982.00 Revised
Date 30-Sep-2014 08-Jun-2018 30-Sep-2017
Number of grant recipients completing 70% of activities in their annual workplan in each year Unit of Measure: Number
Indicator Type: Custom
Value 0.00 0.00 12.00 New
Date 30-Sep-2014 08-Jun-2018 31-Dec-2018
Number of young volunteer doctors have completed CK1 training program Unit of Measure: Number
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 14.00 300.00 New
Date 30-Sep-2014 08-Jun-2018 31-Dec-2020
Number of technical documents approved Unit of Measure: Number
Indicator Type: Custom
Baseline Actual (Current) End Target Action
Value 0.00 15.00 20.00 New
Date 30-Sep-2014 08-Jun-2018 31-Dec-2020
