Health Sector Management Project

Abstract*

The Government of Macedonia's higher level objectives are economic development, poverty reduction and the promotion of social stability and harmony. By addressing the important issue cost-containment while improving quality and access, the Health Sector Management Project will contribute to these higher-level objectives. The specific objectives of this project are: (i) to upgrade the capacity of the Ministry of Health and the Health Insurance Fund... Show More

Development Objective

The specific objectives of this project are: (i) to upgrade MOH and HIFcapacity to formulate and effectively implement health polici es, healthinsurance, financ ial management and contracting of providers; and (ii)to develop and implement an efficient scheme of rest ructuring ofhospital services with emphasis on develop ing day-care services andshifting to primary care.

Key Details

Project Details

Project ID
P086670
Status
Closed
Team Leader
Nedim Jaganjac
Borrower 2
N/A

Country
North Macedonia
Disclosure Date
October 28, 2003
Approval Date
(as of board presentation)
May 13, 2004
Effective Date
September 15, 2004

Total Project Cost 1
US$ 11.24 million
Implementing Agency
N/A
Region
Europe and Central Asia
Fiscal Year 3
2004

Commitment Amount
US$ 10.00 million
Environmental Category
C
Environmental and Social Risk
Not Applicable
Closing Date
December 31, 2010

Last Stage Reached
BANK APPROVED
Last Update Date
January 15, 2013

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 - Health Systems and Policies100%
- FY17 - Health System Strengthening100%

Project Map

Interactive Map

Finances

Financing Plan (US$ Millions)

Financier	Commitments
Borrower/Recipient	1.24
International Bank for Reconstruction and Development	10.00

Total Project Financing (US$ Millions)

Product Line	IBRD/IDA
IBRD Commitment	10.00
IDA Commitment	N/A
IBRD + IDA Commitment	10.00

Lending Instrument
Grant Amount	N/A
Total Project Cost**	11.24

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

No data available.

Detailed Financial Activity as of June 30, 2025

Download:

Period	Financier	Transaction Type	Amount (US$)
Nov 15, 2014	IBRD-47330	Int Charges	16,434.54
Nov 15, 2014	IBRD-47330	Loan Repay	376,849.44
May 13, 2004	IBRD-47330	Loan Commitment	10,000,000.00
Nov 15, 2019	IBRD-47330	Loan Repay	393,283.97
Nov 15, 2019	IBRD-47330	Int Charges	25,361.38
May 15, 2020	IBRD-47330	Loan Repay	393,283.97
May 15, 2020	IBRD-47330	Int Charges	14,775.49
Nov 15, 2020	IBRD-47330	Loan Repay	393,283.97
Nov 15, 2020	IBRD-47330	Int Charges	4,888.22
May 15, 2021	IBRD-47330	Int Charges	1,604.27
May 15, 2021	IBRD-47330	Loan Repay	431,190.78
May 15, 2018	IBRD-47330	Loan Repay	393,283.97
May 15, 2018	IBRD-47330	Int Charges	29,046.23
Nov 15, 2018	IBRD-47330	Loan Repay	393,283.97
Nov 15, 2018	IBRD-47330	Int Charges	36,518.30
May 15, 2019	IBRD-47330	Loan Repay	393,283.97
May 15, 2019	IBRD-47330	Int Charges	33,658.19
Nov 15, 2017	IBRD-47330	Loan Repay	393,283.97
Nov 15, 2017	IBRD-47330	Int Charges	30,596.42
May 15, 2016	IBRD-47330	Loan Repay	393,283.97
May 15, 2016	IBRD-47330	Int Charges	20,738.85
Nov 15, 2016	IBRD-47330	Loan Repay	393,283.97
Nov 15, 2016	IBRD-47330	Int Charges	25,774.58
May 15, 2017	IBRD-47330	Loan Repay	393,283.97
Nov 15, 2014	IBRD-47330	Loan Repay	16,434.54
May 15, 2014	IBRD-47330	Int Charges	18,507.48
May 15, 2014	IBRD-47330	Loan Repay	374,776.50
May 15, 2014	IBRD-47330	Loan Repay	18,507.48
Nov 15, 2013	IBRD-47330	Int Charges	22,001.84
Nov 15, 2013	IBRD-47330	Loan Repay	371,282.12
Nov 15, 2013	IBRD-47330	Loan Repay	22,001.84
Nov 15, 2015	IBRD-47330	Loan Repay	393,283.97
Nov 15, 2015	IBRD-47330	Int Charges	17,750.06
May 15, 2015	IBRD-47330	Int Charges	16,055.56
May 15, 2015	IBRD-47330	Loan Repay	393,283.97
May 15, 2017	IBRD-47330	Int Charges	29,857.89

Footnotes

Ratings

IMPLEMENTATION RATINGS

Name	Review	Date
Counterpart Funding	Satisfactory	2010-11-08
Progress towards achievement of PDO	Moderately Satisfactory	2010-11-08
Monitoring and Evaluation	Moderately Satisfactory	2010-11-08
Overall Implementation Progress (IP)	Moderately Satisfactory	2010-11-08
Project Management	Moderately Satisfactory	2010-11-08
Financial Management	Satisfactory	2010-11-08
Procurement	Moderately Satisfactory	2010-11-08

COMPLETION RATINGS

INDICATOR	IMPLEMENTATION COMPLETION & RESULTS REPORT: 06-03-2011
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: 03-15-2012	PROJECT PERFORMANCE ASSESSMENT REPORT: 09-25-2013
Outcome Rating	Moderately Satisfactory	Moderately Satisfactory
Risk To Development Outcome	Moderate	Moderate
Bank Performance	Moderately Satisfactory	Moderately Satisfactory
Borrower Performance	Moderately Satisfactory	Moderately Satisfactory
Government Performance	Moderately Satisfactory	Not Rated
Implementing Agency	Moderately Satisfactory	Not Rated
Icr Quality	Satisfactory	Not Rated
M&e Quality	Modest	Not Rated

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

Increase the amount of revenue collected (contributions) by 5% over the base year.	Value	14,107,883,876 Denars - Year 2003 14,887,336,977	13.2% increase	5%
	Date	January 9, 2004	December 15, 2010	January 5, 2008
	Comment		Target met	OVER-ACHIEVED. Actual value is calculated on the basis of 2009 data of 19.7 billion denars over baseline of 14.9 billion denars.

Increase the number of contributors.	Value	91,957 total contributors (2004 value): a. 45,731	12% increase	5%
	Date	December 23, 2005	December 15, 2010	December 31, 2010
	Comment		Target on track. Positive trend since 2007	OVER-ACHIEVED. Actual value is calculated on the basis of 110,451 over the baseline of 91,957. The actual total number ofcontributors includes 90,146 paying contributors and 20,805 people whose contributions are being paid by the government, i.e.unemployed, people with disability, etc.

Reduction in the number of drugs reimbursed by HIF and increase of patients' satisfaction.	Value	105,334 number of drugs	86% decreaseYear 2008 :42,359 drugs	Decrease
	Date	January 5, 2005	December 15, 2010	December 31, 2010
	Comment		Target met.	ACHIEVED. Actual value represents 2009 data of 14,500 prescription drugs over the baseline of 105,334.

18 guidelines developed, according to international standards, and distributed.	Value	15 PHC and develop 3 new Clinical Guidelines.	Clinical Protocols and therapeutic Guidelines have	18 guidelines
	Date	January 5, 2005	December 15, 2010	December 31, 2010
	Comment		Target surpassed	OVER-ACHIEVED. The original 18 were updated (new methodology according to Cochran data base) and 14 additional clinical guidelineswere developed and distributed in soft and hard copies and available on line.

Improved results from the annual HIF audit reports acceptable to the WB.	Value	Reduction in the number of SAO recommendations to	9 recommendations (Year 2007)	Unqualified audit reports
	Date	December 6, 2006	December 7, 2009	December 31, 2010
	Comment		Target met. Audits satisfactory with minor comments	ACHIEVED. Audits have been satisfactory and include minor comments for improvement. From 2004 comments in management letters havedecreased in substance and in number.

Average length of drugs registration process, for all drugs, decreased by 25%	Value	8 months in year 2003	38% decrease	decreased by 25% compared to baseline
	Date	January 1, 2005	May 5, 2009	December 31, 2009
	Comment		Target met. Positive trend during the entire period	OVER-ACHIEVED. Actual value is 15 days for centralized procedure, 3 months for decentralized and mutual recognition procedure 3months, (2009 data).

All practicing doctors, dentists and pharmacists licensed in accordance with the new procedure.	Value	0 (Year 2004) Authorization for Licensing activiti	All doctors, dentists and pharmacists	100%
	Date	January 1, 2005	January 1, 2010	January 1, 2009
	Comment		Target met and new procedures in place.	ACHIEVED. All are licensed following new procedures.

Decrease by 15% ALOS in all hospitals	Value	11.5 days (year 2002)	6.13 days	15% reduction or 9.7 days
	Date	January 1, 2002	May 5, 2009	January 1, 2009
	Comment		Target met. 2009 data shows target surpassed	OVER-ACHIEVED. ALOS has been reduced by 53%

Increase out-patient surgery by 20 % of total surgeries for indications selected by January 2006	Value	0. Draft list of indications for one-day surgical	32% increase	20% increase
	Date	December 31, 2005	December 11, 2009	December 31, 2010
	Comment		On track. Despite that data on outpatient surgeries are not available reduction of in hospital surgeries used as proxy.	OVER-ACHIEVED. Actual value is calculated on the basis of 2009 data of 41,500 out-patient surgeries over baseline data of 13,151(2005 data).

Reduction in the number of referral to out-patient specialist and to hospitals by 10%	Value	2,139,361 (public & private ) (year 2004) Number h	Hospital referrals 216,000;out-pat 2.3 mill.	reduction by 10%
	Date	January 1, 2005	December 11, 2009	December 31, 2010
	Comment		This indicator may be misleading as it does not directly reflect efficiency at PHC and could be result of greater access to healthservices and efficiency at hopital care	Indicator misleading.

30% of contracted health care providers complying with newly developed clinical guidelines	Value	0	30% of contractred providers	30%
	Date	January 1, 2005	May 5, 2009	December 31, 2010
	Comment		Target met.Follow-up methodology is being developed. WG for Clinical Guidelines implementation is established, 10 guidelinesselected and action plan developed for their update and training completed	ACHIEVED. Guidelines are being used by all providers. In some cases full utilization of guidelines may be limited due to lack ofnecessary medical equipment. The IHIS will include a module to capture the adherence to clinical guidelines and prescriptionpractices.

At least 75 percent of contracted primary health care providers and hospitals are correctly collecting and analyzing data for contract compliance.	Value	0	100%	75%
	Date	January 1, 2005	October 15, 2010	December 31, 2009
	Comment		Target met.	ACHIEVED. All health providers are collecting and analyzing data. The IHIS being installed will enhance accuracy of data.

Number of business plans prepared (and according to standard) by health care institutions (HCI's)	Value	0 - no plans developed	All HCIs legally obliged to prepare business plans	Business plans for all HCI's
	Date	January 1, 2005	May 5, 2009	December 31, 2010
	Comment		All HCI have prepared BPs	ACHIEVED. All health institutions are obliged to have annual business plans as a basis for contracts.

Completion of grants program and patient satisfaction with results	Value	0 - no grants program in place	All grants implemented	20 grants
	Date	January 1, 2005	October 15, 2010	January 1, 2009
	Comment		Achieved	ACHIEVED. All grants have been implemented (14 demonstration grants and 8 competitive grants). A patient satisfaction surveycarried out at the end of the 14 demonstration grants indicated a positive attitude by users of facilities.

Decrease by 30% the number of re-admissions for same condition wirhin a 3-months time period	Value	72,226 cases; 4,84%	3488 (2008)	30 percent
	Date	August 4, 2010	May 5, 2009	August 10, 2010
	Comment		Target surpassed	OVER ACHIEVED. Introduction of DRGs created incentives to reduce re-admissions for the same diseases. Actual value is calculatedon the basis of 2008 data of 3488 over baseline of 72,226.

INTERMEDIATE RESULTS INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

Medium term MOH health sector strategy developed and approved.	Value	No health sector strategy available	Strategy in phase of implementation	Revised National Health Strategy
	Date	May 13, 2004	May 5, 2009	December 31, 2010
	Comment		Target achieved	ACHIEVED. The strategy covering the period 2005-2015 was adopted in 2006. Strategy was then extended to 2020 and adopted in June2007.

Public information strategy for health reforms developed and applied to health sector policy development.	Value	No strategy available	2008: Strategy developed and in processof implemen	Strategy developed and is being implemented.
	Date	May 13, 2004	January 7, 2010	December 31, 2010
	Comment		On track. Final strategy to support reform for 2010 in progress.	ACHIEVED. Public Information Strategy was developed and adopted in February 2007 based on public opinion poll carried out at theend of 2006. PIS and implementation plan have been revised in 2009 and 2010. PR campaign supporting ongoing health reform waslaunched.

HIF Board structure and operation revised.Internal audit unit functional.	Value	HIF Board is not performing its (financial) oversi	Board structure and operations are revised. Board	Board structure and operations was revised
	Date	May 13, 2004	February 6, 2008	December 31, 2010
	Comment		Target met.	ACHIEVED. New regulations adopted by Parliament. A new HIF Board is appointed for four years and functions according to newoperational manual. Training for Board members has taken place.

Hospital contracts revised on the basis of evaluation study of first-phased of hospital contract implementation.	Value	17 contracts concluded	Legal basis for changes in contracting methods fin	Contracts revised
	Date	May 13, 2004	January 1, 2010	December 31, 2010
	Comment		on track	PARTLY ACHIEVED. Contracts for all hospitals are being signed annually using a new provider payment mechanism. However, managerialauthonomy is not achieved.

Project deliverables are implemented and evaluated in an efficient manner and on a timely basis.	Value	Most project activities completed, and pending one	activities completed and evaluated
	Date	December 11, 2009	December 31, 2008
	Comment	on track	PARTIALLY-ACHIEVED. Although all activities have been completed, albeit with delays, quarterly progress reports for the wholeproject (as per POM) were not prepared systematically. The most important activities completed prior to project closure were thedelivery and installation of the hardware for the IHIS, and initiation of re-training of family medicine doctors.