Healthcare System Improvement Project (Montenegro)

Abstract*

The Health System Improvement Project aims to put in place the first phase of steps towards reform of the health system in the Republic of Montenegro, giving priority to increasing capacity for policy, planning, and regulation; stabilizing health financing; and improving primary health care service delivery. There are two main project components, beside project management: 1. Support for the Government's health reform program, through health policy... Show More

Development Objective

The objective of the proposed Health System Improvement Project is to put in place the first phase of steps towards reform of the health system in the Republic of Montenegro, giving priority to increasing capacity for policy, planning and regulation; stabilizing health financing and improving primary health care service delivery.

Key Details

Project Details

Project ID
P082223
Status
Closed
Team Leader
Carlos Bortman
Borrower 2
N/A

Country
Montenegro
Disclosure Date
October 14, 2003
Approval Date
(as of board presentation)
June 8, 2004
Effective Date
December 1, 2004

Total Project Cost 1
US$ 20.57 million
Implementing Agency
N/A
Region
Europe and Central Asia
Fiscal Year 3
2004

Commitment Amount
US$ 14.77 million
Environmental Category
B
Environmental and Social Risk
Not Applicable
Closing Date
December 31, 2012

Last Stage Reached
BANK APPROVED
Last Update Date
June 5, 2013

Associated Projects
P114275

Notes
1. Total project cost includes funding from World Bank and non-bank sources in US$ millions. Active and Closed projects show current commitments. Proposed (pipeline) and dropped projects show the forecast amount. The commitment amount for projects in the pipeline is indicative and may be modified during the project preparation.
2. Borrower refers to the Borrower of a Loan or Recipient of a Grant.
3. ”Fiscal Year” is the fiscal year in which the project was approved (or dropped if the status is dropped). The World Bank's fiscal year is from July 1 - June 30. For example, a fiscal year of 1996 corresponds to July 1, 1995 - June 30, 1996.

Sectors

Themes

FY17 - Human Development and Gender

FY17 - Disease Control17%
- FY17 - Non-communicable diseases17%
FY17 - Health Systems and Policies33%
- FY17 - Health System Strengthening33%

FY17 - Public Sector Management

FY17 - Public Administration50%
- FY17 - Administrative and Civil Service Reform33%
- FY17 - Transparency, Accountability and Good Governance17%

Project Map

Interactive Map

Finances

Financing Plan (US$ Millions)

Financier	Commitments
IDA Credit	7.00
Municipalities of Borrowing Country	0.79
Borrower/Recipient	5.01
CANADA: Canadian International Development Agency (CIDA)	0.57
International Bank for Reconstruction and Development	7.20

Total Project Financing (US$ Millions)

Product Line	IBRD/IDA
IBRD Commitment	7.20
IDA Commitment	7.00
IBRD + IDA Commitment	14.20

Lending Instrument
Grant Amount	0.57
Total Project Cost**	20.57

Summary Status of World Bank Financing (US$ Millions) as of April 30, 2025

No data available.

Detailed Financial Activity as of April 30, 2025

Download:

Period	Financier	Transaction Type	Amount (US$)
Apr 15, 2020	IDA-39180	Int Charges	3,313.82
Apr 15, 2020	IDA-39180	Loan Repay	328,094.03
Apr 15, 2020	IDA-39180	Int Charges	11,073.18
Apr 15, 2020	IDA-39180	Int Charges	11,073.18
Oct 1, 2019	IBRD-78190	Int Charges	557.89
Oct 1, 2019	IBRD-78190	Loan Repay	548,725.60
Oct 15, 2019	IDA-39180	Loan Repay	193.73
Oct 15, 2019	IDA-39180	Loan Repay	328,889.40
Oct 15, 2019	IDA-39180	Int Charges	9,016.79
Oct 15, 2019	IDA-39180	Int Charges	9,016.79
Apr 15, 2019	IDA-39180	Loan Repay	4,846.75
Apr 15, 2019	IDA-39180	Loan Repay	328,985.16
Apr 15, 2019	IDA-39180	Int Charges	13,770.55
Apr 15, 2019	IDA-39180	Int Charges	13,770.55
Apr 1, 2019	IBRD-78190	Int Charges	971.78
Apr 1, 2019	IBRD-78190	Loan Repay	565,362.94
Oct 15, 2018	IDA-39180	Int Charges	3,221.65
Oct 15, 2018	IDA-39180	Int Charges	3,221.65
Oct 15, 2018	IDA-39180	Loan Repay	335,594.10
Oct 15, 2018	IDA-39180	Int Charges	15,101.73
Oct 15, 2018	IDA-39180	Int Charges	15,101.73
Oct 1, 2018	IBRD-78190	Int Charges	1,247.68
Oct 1, 2018	IBRD-78190	Loan Repay	584,391.25
Oct 15, 2022	IDA-39180	Int Charges	5,746.14
Oct 15, 2022	IDA-39180	Int Charges	5,746.14
Apr 15, 2022	IDA-39180	Loan Repay	326,356.47
Apr 15, 2022	IDA-39180	Int Charges	1,947.61
Apr 15, 2022	IDA-39180	Int Charges	1,947.61
Apr 15, 2021	IDA-39180	Int Charges	7,049.28
Apr 15, 2021	IDA-39180	Int Charges	7,049.28
Oct 15, 2021	IDA-39180	Int Charges	1,930.94
Oct 15, 2021	IDA-39180	Int Charges	1,930.94
Oct 15, 2021	IDA-39180	Loan Repay	338,962.38
Oct 15, 2021	IDA-39180	Int Charges	5,614.26
Oct 15, 2021	IDA-39180	Int Charges	5,614.26
Apr 15, 2021	IDA-39180	Int Charges	3,194.04
Apr 15, 2021	IDA-39180	Int Charges	3,194.04
Apr 15, 2021	IDA-39180	Loan Repay	342,976.50
Oct 15, 2020	IDA-39180	Loan Repay	336,238.75
Oct 15, 2020	IDA-39180	Int Charges	7,010.40
Oct 15, 2020	IDA-39180	Int Charges	7,010.40
Oct 15, 2020	IDA-39180	Loan Repay	2,637.20
Nov 3, 2009	IBRD-78190	Loan Commitment	7,200,000.00
Jun 8, 2004	IDA-39180	Loan Commitment	7,000,000.00
Apr 15, 2024	IDA-39180	Loan Repay	316,032.40
Apr 15, 2024	IDA-39180	Int Charges	376.65
Apr 15, 2024	IDA-39180	Int Charges	376.65
Apr 15, 2024	IDA-39180	Loan Repay	4,499.21
Apr 15, 2024	IDA-39180	Int Charges	2,370.26
Apr 15, 2024	IDA-39180	Int Charges	2,370.26
Oct 15, 2023	IDA-39180	Loan Repay	303,880.00
Oct 15, 2023	IDA-39180	Loan Repay	6,126.80
Apr 15, 2023	IDA-39180	Int Charges	4,446.06
Apr 15, 2023	IDA-39180	Int Charges	4,446.06
Apr 15, 2023	IDA-39180	Loan Repay	325,208.28
Apr 15, 2023	IDA-39180	Int Charges	3,658.61
Apr 15, 2023	IDA-39180	Int Charges	3,658.61
Oct 15, 2022	IDA-39180	Loan Repay	306,460.53
Oct 15, 2022	IDA-39180	Int Charges	407.15
Oct 15, 2022	IDA-39180	Int Charges	407.15
Oct 15, 2022	IDA-39180	Loan Repay	1,576.15
Oct 1, 2014	IBRD-78190	Int Charges	0.01
Oct 1, 2014	IBRD-78190	Int Charges	20,627.79
Oct 15, 2014	IDA-39180	Int Charges	16,640.52
Oct 15, 2014	IDA-39180	Int Charges	16,640.52
Oct 15, 2014	IDA-39180	Loan Repay	96.88
Oct 15, 2014	IDA-39180	Loan Repay	356,261.62
Apr 15, 2014	IDA-39180	Int Charges	213.20
Apr 1, 2014	IBRD-78190	Int Charges	18,604.26
Apr 15, 2014	IDA-39180	Int Charges	27,660.63
Apr 15, 2014	IDA-39180	Int Charges	27,660.63
Apr 15, 2014	IDA-39180	Int Charges	213.20
Oct 15, 2013	IDA-39180	Int Charges	191.25
Oct 15, 2013	IDA-39180	Int Charges	191.25
Oct 15, 2013	IDA-39180	Int Charges	27,549.36
Oct 15, 2013	IDA-39180	Int Charges	27,549.36
Oct 1, 2013	IBRD-78190	Int Charges	34.26
Oct 1, 2013	IBRD-78190	Int Charges	16,842.38
Oct 15, 2016	IDA-39180	Int Charges	19,111.96
Oct 15, 2016	IDA-39180	Loan Repay	2,766.32
Oct 15, 2016	IDA-39180	Loan Repay	328,215.84
Oct 15, 2016	IDA-39180	Int Charges	19,111.96
Apr 1, 2016	IBRD-78190	Loan Repay	574,424.06
Apr 1, 2016	IBRD-78190	Int Charges	8,643.18
Apr 15, 2016	IDA-39180	Loan Repay	4,874.90
Apr 15, 2016	IDA-39180	Loan Repay	332,577.38
Apr 15, 2016	IDA-39180	Int Charges	21,512.61
Apr 15, 2016	IDA-39180	Int Charges	21,512.61
Oct 1, 2015	IBRD-78190	Int Charges	10,268.30
Oct 1, 2015	IBRD-78190	Loan Repay	561,109.25
Oct 15, 2015	IDA-39180	Loan Repay	340,412.47
Oct 15, 2015	IDA-39180	Int Charges	22,977.85
Oct 15, 2015	IDA-39180	Int Charges	22,977.85
Oct 15, 2015	IDA-39180	Int Charges	16,485.23
Oct 15, 2015	IDA-39180	Int Charges	16,485.23
Apr 1, 2015	IBRD-78190	Int Charges	12,318.04
Apr 1, 2015	IBRD-78190	Loan Repay	541,451.70
Apr 15, 2015	IDA-39180	Int Charges	9,327.10
Apr 15, 2015	IDA-39180	Int Charges	9,327.10
Apr 15, 2015	IDA-39180	Loan Repay	329,534.50
Apr 15, 2015	IDA-39180	Int Charges	7,520.93
Apr 15, 2015	IDA-39180	Int Charges	7,520.93
Apr 15, 2018	IDA-39180	Int Charges	13,670.27
Apr 15, 2018	IDA-39180	Int Charges	13,670.27
Apr 15, 2018	IDA-39180	Loan Repay	445.84
Apr 15, 2018	IDA-39180	Loan Repay	348,729.50
Apr 1, 2018	IBRD-78190	Int Charges	1,882.23
Apr 1, 2018	IBRD-78190	Loan Repay	620,509.90
Oct 1, 2017	IBRD-78190	Int Charges	2,871.61
Oct 1, 2017	IBRD-78190	Loan Repay	594,635.40
Oct 15, 2017	IDA-39180	Loan Repay	339,656.22
Oct 15, 2017	IDA-39180	Int Charges	63.58
Oct 15, 2017	IDA-39180	Int Charges	63.58
Apr 1, 2017	IBRD-78190	Int Charges	3,261.89
Apr 1, 2017	IBRD-78190	Loan Repay	537,676.25
Apr 15, 2017	IDA-39180	Int Charges	736.12
Apr 15, 2017	IDA-39180	Int Charges	736.12
Apr 15, 2017	IDA-39180	Loan Repay	326,168.60
Apr 15, 2017	IDA-39180	Int Charges	18,285.91
Apr 15, 2017	IDA-39180	Int Charges	18,285.91
Oct 15, 2017	IDA-39180	Int Charges	17,831.96
Oct 15, 2017	IDA-39180	Int Charges	17,831.96
Oct 1, 2016	IBRD-78190	Int Charges	4,600.04
Oct 1, 2016	IBRD-78190	Loan Repay	562,065.70
Apr 15, 2020	IDA-39180	Int Charges	3,313.82

Footnotes

Ratings

IMPLEMENTATION RATINGS

Name	Review	Date
Procurement	Moderately Satisfactory	2012-12-25
Counterpart Funding	Satisfactory	2012-12-25
Project Management	Satisfactory	2012-12-25
Financial Management	Satisfactory	2012-12-25
Overall Implementation Progress (IP)	Satisfactory	2012-12-25
Progress towards achievement of PDO	Satisfactory	2012-12-25
Monitoring and Evaluation	Satisfactory	2012-12-25

COMPLETION RATINGS

INDICATOR	IMPLEMENTATION COMPLETION & RESULTS REPORT: 06-20-2013
Outcomes	Moderately Satisfactory
Risk to Development Outcome	Modest
Bank Performance	Moderately Satisfactory
Borrower Performance	Moderately Satisfactory
Government Performance	Moderately Satisfactory
Implementing Agency	Moderately Satisfactory

INDEPENDENT EVALUATION RATINGS

INDICATOR	ICR REVIEW: 12-19-2013	PROJECT PERFORMANCE ASSESSMENT REPORT:
Outcome Rating	Moderately Satisfactory	N/a
Risk To Development Outcome	Moderate	N/a
Bank Performance	Moderately Satisfactory	N/a
Borrower Performance	Moderately Satisfactory	N/a
Government Performance	Satisfactory	N/a
Implementing Agency	Moderately Satisfactory	N/a
Icr Quality	Exemplary	N/a
M&e Quality	Modest	N/a

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

Increase satisfaction for primary health care of the general population (in Podgorica and outside of Podgorica) and specifically for the Roma	Value	In Podgorica, 62% of the population totally satisf	In Podgorica, 77% satisfied or higher and 19% part	In Podgorica, 70% of the population totally satisf
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		Partially achieved	The general population target should be slightly changed since based on HH survey, not public opinion survey. Will be discussedduring mission in May.

Referral rates from PHC to hospitals controlled	Value	Proportion of patients referred to specialists = 2	Proportion of visits referred to specialists = 25.	2009 baseline - 10% increase
	Date	December 31, 2009	October 19, 2012	December 31, 2012
	Comment	2009 data.	Achieved

Maintain or improve immunization rates (%) for DPT and measles (already high) following reform	Value	DPT (initial and follow-up): 86% MMR (initial and	DPT (initial and follow-up): 94.7%MMR (initial a	DPT (initial and follow-up): 94% MMR (initial and
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		Partially achievedRevision possible - IPH to clarify whether the 2011 data is for Podgorica or nation-wide; IPH also to try torefine the data/change the denominators)

MoH stewardship of the health system improves as measured by increases of health related information and development of key health policies	Value	The Strategy for Health Care Development in Monten	nformation available: PHC Operational Review - Eff	Secondary and Tertiary Care Reform Strategy develo
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

HIF increases its capacity to perform its functions of pooling health resources; better allocating health resources; and contracting providers towards improved performance	Value	HIF in existence and developing improved control o	The MoH procured the AR-DRG full versionGrouper t	HIF has developed the necessary groundwork for dev
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

HIF controls the increasing cost of nationally financed pharmaceuticals and medical materials	Value	Share of HIF expenditures spent on drugs: 19.2% Sh	Share of HIF expenditures spent on drugs: 20.0%Sh	Over time, the HIF has expanded the list of drugs
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

HIF annual deficit reduced	Value	0.8 million Euros surplus	Formally, zero deficit because as of 2010, HIF bec	Zero deficit (assuming possible small deficits in
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		HIF became part of Treasury budget in 2010, so formally there is zero deficits. HIF budget is not linked to the ACHIEVEDHIFrevenue. Arrears of health institutions amounted to 30 million in 2010, and 16 million in 2011

Reduced waiting time (from arrival to consultation) in primary care	Value	Podgorica patients reporting 21 minutes or more: 5	POS survey from 2012: • Podgorica patients report	Podgorica patients reporting 21 minutes or more: 3
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment	To prevent confusion with baseline dates, additional indicators from HIF admin time for wait time reported in "current".	ACHIEVED

Increased duration of PHC Consultation	Value	Podgorica patients reporting 21 minutes or more: 3	POS survey from 2012: • Podgorica patients report	Podgorica patients reporting 11 minutes or more:
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment	To prevent confusion with baseline dates, additional indicators from HIF admin time for wait time reported in "current".	Partially achieved

Increase utilization rates for primary health care for the general population (in Podgorica and outside Podgorica) and the Roma	Value	11.4% of population in Podgorica report use of PHC	NO UPDATED	Target groups (population in Podgorica, outside of
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		No updated until survey

INTERMEDIATE RESULTS INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

Adoption of bylaws and administrative documents covering health insurance, health care and pharmaceuticals	Value	Laws on Health Insurance, Health Care and Pharmace	11 new laws adopted or amended. 4 new bylaws adopt	Laws maintained, including additional sub-regulati
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Revision of policy, benefits, and standards for primary care	Value	Montenegro system of PHC inherited from former Yug	Payment mechanism continues to be fully operationa	PHC Policies (particularly the payment mechanism a
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Development of the reform for revision of policy, benefits and standards for secondary and tertiary care	Value	None	Master Plan 2010-2013 adopted. Decision on Network	Masterplan developed and adopted; benefit package
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Drugs Agency developed to better perform its functions of regulating and ensuring the quality of drugs in Montenegro	Value	None	Drugs Agency has registered 44.5% (2011) of total	Drugs Agency functional as a regulatory agency Dru
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

PHC Patients are aware of and supportive of health reform	Value	54% (in Podgorica)	89% (nationally), from Integrity POS	70% or higher (nationally)
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Operational health information systems in HIF, primary health care providers, pharmaceutical supply chain, to provide timely, accurate data on key elements of performance (expenditure, service utiliza	Value	HIF Pharma and Insuree Register System Operational	Information system between HIF, primary health car	Information system between HIF, primary health car
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Increase percentage of patients (adults and children) in Podgorica with a Chosen primary care doctor (out of total insurees)	Value	0%	95.59% (2011)	85%
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Number of facilities renovated/constructed in Podgorica	Value	0 of 10	7 of 10 (Blok 5, Stari Aerodrom, Konik, Tuzi, Golu	7 of 10 (including 2 which are being financed by t
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Number of facilities equipped with computer and medical equipment in Podgorica	Value	0	11 of 10 have medical equipment (including Medical	10 of 10 have medical equipment 10 of 10 have comp
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Decreasing in the percentage of referrals made for an injectable drug (ampoule treatment)	Value	12.87% (2008)	12.80% (2011)12.30% (9 months of 2012)	12% decrease
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment	Baseline clarified because percent is better since the number of visits may increase as utilization increases. 2006-2007 data alsounreliable because of new reporting system	ACHIEVED

Adoption of PHC Guidelines Value 0 Total of 11 Clinical Protocols and Guidelines deve 10 PHC Guidelines Adopted
Date December 31, 2004 October 19, 2012 December 31, 2012
Comment ACHIEVED

Proposal developed for the appropriate quality assurance system in Montenegro	Value	No proposal	National Strategy for Improvement of Health Care Q	Proposal well developed, including lessons learned
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Number of PHC Teams (1 Chosen Doctor + 1 Nurse) provided retraining in family Medicine Nationally	Value	Preparing Retraining Program	Retraining Program Total of 273 teams and addition	Retraining Program Completed with a total of 255 t
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Family Medicine specialization established and operational at Medical Faculty	Value	Not established	Family Medicine Additional Specialization Program	Family Medicine Specialization to be established a
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Increase percentage of patients (adults and children) outside of Podgorica with a Chosen primary care doctor (out of total insurees)	Value	0	90.7%	85%
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Number of facilities renovated/constructed outside of Podgorica Value 0 0 1 (Bijelo Polje)
Date December 31, 2004 April 18, 2012 December 31, 2012
Comment Reconstruction in progress.

Number of PHC facilities equipped with computer and medical equipment outside of Podgorica	Value	0	20 of 20 equipped with computer equipment0 of 20	20 of 20 equipped with computer equipment 20 of 20
	Date	December 31, 2008	April 18, 2012	December 31, 2012
	Comment		Partially achieved

Health personnel receiving training (number) Value 0.00 526.00 510.00
Date December 31, 2004 April 18, 2012 December 31, 2012
Comment ACHIEVED 255 Teams (1 Doctor + 1 Nurse)
Health facilities constructed, renovated, and/or equipped (number) Value 0.00 32.00 8.00
Date December 31, 2004 October 19, 2012 December 31, 2012
Comment Achieved

Adoption of PHC Guidelines	Value	0	Total of 11 Clinical Protocols and Guidelines deve	10 PHC Guidelines Adopted
	Date	December 31, 2004	October 19, 2012	December 31, 2012
	Comment		ACHIEVED

Number of facilities renovated/constructed outside of Podgorica	Value	0	0	1 (Bijelo Polje)
	Date	December 31, 2004	April 18, 2012	December 31, 2012
	Comment		Reconstruction in progress.

Health personnel receiving training (number)	Value	0.00	526.00	510.00
	Date	December 31, 2004	April 18, 2012	December 31, 2012
	Comment		ACHIEVED	255 Teams (1 Doctor + 1 Nurse)