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Development of Emergency Medical Services and Investment Planning Project

Abstract*

The development objective of the Development of the Emergency Medical Services and Investment Planning Project for Croatia is to improve the efficiency and outcomes of the emergency medical services system and to strengthen the capacity of the ministry of health and social welfare to develop and implement strategic projects. There are two components to the project. The first component of the project is development of emergency medical services. This...

* The project abstract is drawn from the PAD, SAR or PGD and may not accurately reflect the project's current nature

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Development Objective

The Project objective is to improve the efficiency and outcomes of the Emergency Medical Services system and to strengthen the capacity of the Ministry of Health and Social Welfare to develop and implement strategic projects.

Key Details

Project Details

  • P086669

  • Closed

  • Carlos Bortman

  • N/A

  • Croatia

  • May 2, 2006

  • (as of board presentation)

    September 30, 2008

  • January 15, 2009

  • US$ 28.30 million

  • B

  • Not Applicable

  • December 31, 2013

  • BANK APPROVED

  • June 18, 2014

  • Notes

Finances

Financing Plan (US$ Millions)

No data available.
Financier Commitments
Borrower/Recipient 90.19
International Bank for Reconstruction and Development 28.30
Municipalities of Borrowing Country 14.28

Total Project Financing (US$ Millions)

Product Line IBRD/IDA
IBRD Commitment 28.30
IDA Commitment N/A
IBRD + IDA Commitment 28.30
Lending Instrument
Grant Amount N/A
Total Project Cost** 132.77

Summary Status of World Bank Financing (US$ Millions) as of July 31, 2025

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No data available.
Financier Approval Date Closing Date Principal Disbursed Repayments Interest, Charges & Fees

Detailed Financial Activity as of July 31, 2025

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No data available.
Period Financier Transaction Type Amount (US$)
Oct 29, 2013 IBRD-75980 Loan Disb 5,531,575.00
Oct 15, 2021 IBRD-75980 Loan Repay 395,742.06
Oct 15, 2013 IBRD-75980 Int Charges 23,148.18
Oct 15, 2013 IBRD-75980 Loan Repay 314,051.25
Oct 15, 2014 IBRD-75980 Int Charges 48,444.63
Oct 15, 2014 IBRD-75980 Loan Repay 430,897.53
Oct 15, 2014 IBRD-75980 Int Charges 862.70
May 7, 2014 IBRD-75980 Loan Cancel 1,656,704.80
Apr 15, 2014 IBRD-75980 Int Charges 35,847.97
Apr 15, 2014 IBRD-75980 Loan Repay 434,279.10
May 7, 2014 IBRD-75980 Loan Disb -271,387.22
Feb 24, 2014 IBRD-75980 Loan Disb 1,984,924.20
Oct 15, 2015 IBRD-75980 Int Charges 12,759.81
Oct 15, 2015 IBRD-75980 Loan Repay 389,675.47
Apr 15, 2015 IBRD-75980 Int Charges 18,859.36
Apr 15, 2015 IBRD-75980 Loan Repay 360,688.80
Oct 15, 2016 IBRD-75980 Loan Repay 375,275.88
Apr 15, 2016 IBRD-75980 Loan Repay 384,392.78
Apr 15, 2016 IBRD-75980 Int Charges 7,915.70
Apr 15, 2018 IBRD-75980 Loan Repay 419,991.34
Oct 15, 2017 IBRD-75980 Loan Repay 403,052.62
Apr 15, 2017 IBRD-75980 Loan Repay 362,035.06
Apr 15, 2019 IBRD-75980 Loan Repay 385,500.44
Oct 15, 2018 IBRD-75980 Loan Repay 395,281.94
Apr 15, 2021 IBRD-75980 Loan Repay 407,772.97
Oct 15, 2020 IBRD-75980 Loan Repay 399,371.78
Apr 15, 2020 IBRD-75980 Loan Repay 371,765.44
Oct 15, 2019 IBRD-75980 Loan Repay 375,446.28
Sep 30, 2008 IBRD-75980 Loan Commitment 28,300,000.00
Apr 15, 2024 IBRD-75980 Int Charges 224,434.53
Apr 15, 2024 IBRD-75980 Loan Repay 363,210.88
Oct 15, 2023 IBRD-75980 Loan Repay 358,473.50
Oct 15, 2023 IBRD-75980 Int Charges 194,688.98
Apr 15, 2023 IBRD-75980 Int Charges 122,906.05
Apr 15, 2023 IBRD-75980 Loan Repay 376,894.75
Oct 15, 2022 IBRD-75980 Loan Repay 331,787.34
Apr 15, 2022 IBRD-75980 Loan Repay 368,391.30
Oct 15, 2013 IBRD-75980 Int Charges 972.17

Footnotes

Ratings

IMPLEMENTATION RATINGS

Name Review Date
Procurement Satisfactory 2013-12-21
Progress towards achievement of PDO Satisfactory 2013-12-21
Project Management Satisfactory 2013-12-21
Financial Management Satisfactory 2013-12-21
Monitoring and Evaluation Satisfactory 2013-12-21
Counterpart Funding Satisfactory 2013-12-21
Overall Implementation Progress (IP) Satisfactory 2013-12-21

COMPLETION RATINGS

INDICATORIMPLEMENTATION COMPLETION & RESULTS REPORT: 06-20-2014
OutcomesSubstantial
Risk to Development OutcomeModest
Bank PerformanceModerately Satisfactory
Borrower PerformanceModerately Satisfactory
Government PerformanceSubstantial
Implementing AgencyModerately Satisfactory

INDEPENDENT EVALUATION RATINGS

INDICATORICR REVIEW: 02-02-2015PROJECT PERFORMANCE ASSESSMENT REPORT:
Outcome RatingModerately Satisfactory N/a
Risk To Development OutcomeModerateN/a
Bank PerformanceModerately SatisfactoryN/a
Borrower PerformanceModerately SatisfactoryN/a
Government PerformanceModerately SatisfactoryN/a
Implementing AgencyModerately SatisfactoryN/a
Icr QualitySatisfactoryN/a
M&e QualityModestN/a

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INDICATORBASELINECURRENTTARGET
  • Field calls as percent of total calls (increase).Value9.7%100%75%
    DateSeptember 30, 2008November 22, 2013June 30, 2013
    CommentExceeded. All field calls are now related to the emergency system and no ambulances or emergency teams are being deployed formedical transportation or discharges. About 40 to 50% of these calls are classified as code red or orange which is a safe balancebetween red, orange and green calls
  • EMS teams per capita (decrease cross-county variation)ValueCoefficient of variation = 0.503 (2005)0.33Coefficient of variation=0.20 (2013)
    DateSeptember 30, 2008November 22, 2013June 30, 2013
    CommentCross-county variation would be reduced to 0.3, but it will not achieve the target (0.2) because different population densitiesandgeographical distances cannot have similar number of teams per inhabitants in all regions
  • Improved emergency care outcomes in pre-hospital emergency care (a) percentage of (a.i) poly-trauma and (a.ii) cardiac arrest caseswhich survive to hospital ER admissionValuea.i. 100%a.ii. 96.5%Polytrauma 92%Cardiac arrest 30%Trauma: 90% Cardiac: 15%
    DateJune 30, 2010November 22, 2013June 30, 2013
    CommentExceeded Project targets
  • Improved emergency care outcomes as evidenced by (b) better outcomes in in-hospital emergency care as indicated (b.i) poly-trauma and (b.ii) cardiac arrest cases which survive 48 hoursValuebi. 100%bii. 86%Polytrauma 94%Cardiac arrest 64%Trauma: 90% Cardiac: 35%
    DateJune 30, 2010November 22, 2013June 30, 2013
    CommentExceeded. Data reflects all 9 existing hospitals with integrated emergency reception area
  • Active involvement of MoH in EU funds utilization (measured through dedicated staff, Number of applications prepared by MoH, funds leveraged)ValueNone35 staff trained and 5 draft applications4 applications
    DateSeptember 30, 2008November 22, 2013June 30, 2013
    CommentAchieved. Project target in term of staff trained and draft applications developed (5 proposals); however, it should be noted thatthe number of applications approved is outside the Project’s influence. Additional training and support for PDO2 was financed withthe Project allowing the achieving of this PDO

INTERMEDIATE RESULTS INDICATORS

INDICATORBASELINECURRENTTARGET
  • Number of health professionals who have (i) begun training in EMS specialty according to national guidelines and (ii) received certificationValueNonei) 250ii) 206(i) 200 (ii) 220
    DateSeptember 30, 2008March 31, 2012June 30, 2013
    CommentOn track
  • Establishment of the enabling legislative environment for (i) EMS financing, (ii) separating of pre-hospital emergency services from PHC, (iii) establishing national management arrangementsValue0 of 5NANot Applicable
    DateSeptember 30, 2008June 24, 2010June 30, 2013
    Commentbut on track. Clear progress on the institutional and policy front.
  • Croatian Institute of EMS has been established and is functioning.ValueInstitute not establishedLegally Established in July 2009. Put into operatThe CIEMS established and andfunctioning
    DateSeptember 30, 2008June 24, 2010June 30, 2013
    CommentCIEMS functioning. Clear progress.
  • County variation in field calls per capita (decrease).ValueCoefficient of variation = 0.604 (2005)0.30Coefficient of variation = 0.35 (2013)
    DateSeptember 30, 2008July 31, 2013June 30, 2013
    CommentAll EMS units are reporting field calls
  • Percent of counties with EMS dispatch centers linked to 112 and TETRAValue4.8% (1 center, 112 only)21 EMS linked to #112.1 to TETRAContract to puNot Applicable
    DateSeptember 30, 2008November 22, 2013June 30, 2013
    Comment
  • Response times from receipt of call to time at the sceneValueAverage response time to scene is 16.8 minutes, wi10.9 minutes80% meet 10 minutes urban, 20 minutes rural
    DateSeptember 30, 2008November 22, 2013June 30, 2013
    CommentThis indicator was built using average times for “red” and “orange” priorities. It was agreed that the indicator should onlyinclude red priority cases. Given the lack of an operational definition of urban and rural areas, the system still reports theaverage time of all emergency calls. Nevertheless, the average is very close to the target for urban calls.
  • Percentage of ER visits coming by ambulance (i) for selected diagnoses (MVA, cardiac, multiple symptoms); and (ii) where symptoms began in the last 12 hoursValue(i) 38% cardiac 45% MVA 45% multiple symptoms (ii)MVA 51%cCardiac 39%(i) 46% cardiac 56% MVA 52% multiple symptoms (ii
    DateSeptember 30, 2008November 22, 2012June 30, 2013
    CommentMultiple symptoms related-indicator and b) where symptoms began in the last 12 hours are dropped given that these indicators arenot well defined and not used.
  • Elapsed time between arrival in emergency receiving area and hospital admission or dischargeValueAverage stay in emergency admittance to hospital f121 minAvg: 75 <60 mins: 80%
    DateJune 30, 2011July 31, 2013June 30, 2013
    CommentBased all 10 existing hospitals with an integrated emergency reception area
  • Number of hospitals with integrated emergency reception area.Value399
    DateSeptember 30, 2008February 28, 2013June 30, 2013
    CommentTarget achieved.
  • Strategic plans completedValueNo Baseline04
    DateSeptember 30, 2008September 7, 2012June 30, 2013
    CommentUnder development: Hospital Master plan, Outsourcing of non-medical hospital services; Public relations strategy; Applications forEU funds; Functional Review of the CIHI
  • Proposals presented by MoH to make use of EU related fundsValue04 draft proposals prepared4
    DateSeptember 30, 2008September 7, 2012June 30, 2013
    CommentAchieved. Croatia expected to access to EU in July 2013
  • Health personnel receiving training (number)Value0.00301.000.00
    DateOctober 1, 2008September 7, 2012June 30, 2013
    CommentComponent 2 - 26 people went to Romania (12), Austria (8), Estonia (6) Study Tours. 35 staff trained for developing proposals forEU funds. Component 1: 149 dispatchers