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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...

* 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 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

  • P086670

  • Closed

  • Nedim Jaganjac

  • N/A

  • North Macedonia

  • October 28, 2003

  • (as of board presentation)

    May 13, 2004

  • September 15, 2004

  • US$ 10.00 million

  • C

  • Not Applicable

  • December 31, 2010

  • BANK APPROVED

  • January 15, 2013

  • Notes

Finances

Financing Plan (US$ Millions)

No data available.
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

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

Detailed Financial Activity as of June 30, 2025

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No data available.
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

INDICATORIMPLEMENTATION COMPLETION & RESULTS REPORT: 06-03-2011
OutcomesModerately Satisfactory
Risk to Development OutcomeModest
Bank PerformanceModerately Satisfactory
Borrower PerformanceModerately Satisfactory
Government PerformanceModerately Satisfactory
Implementing AgencyModerately Satisfactory

INDEPENDENT EVALUATION RATINGS

INDICATORICR REVIEW: 03-15-2012PROJECT PERFORMANCE ASSESSMENT REPORT: 09-25-2013
Outcome RatingModerately Satisfactory Moderately Satisfactory
Risk To Development OutcomeModerateModerate
Bank PerformanceModerately SatisfactoryModerately Satisfactory
Borrower PerformanceModerately SatisfactoryModerately Satisfactory
Government PerformanceModerately SatisfactoryNot Rated
Implementing AgencyModerately SatisfactoryNot Rated
Icr QualitySatisfactoryNot Rated
M&e QualityModestNot Rated

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INDICATORBASELINECURRENTTARGET
  • Increase the amount of revenue collected (contributions) by 5% over the base year.Value14,107,883,876 Denars - Year 2003 14,887,336,977 13.2% increase5%
    DateJanuary 9, 2004December 15, 2010January 5, 2008
    CommentTarget metOVER-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.Value91,957 total contributors (2004 value): a. 45,731 12% increase5%
    DateDecember 23, 2005December 15, 2010December 31, 2010
    CommentTarget on track. Positive trend since 2007OVER-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.Value105,334 number of drugs86% decreaseYear 2008 :42,359 drugsDecrease
    DateJanuary 5, 2005December 15, 2010December 31, 2010
    CommentTarget 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.Value15 PHC and develop 3 new Clinical Guidelines.Clinical Protocols and therapeutic Guidelines have18 guidelines
    DateJanuary 5, 2005December 15, 2010December 31, 2010
    CommentTarget surpassedOVER-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.ValueReduction in the number of SAO recommendations to 9 recommendations (Year 2007)Unqualified audit reports
    DateDecember 6, 2006December 7, 2009December 31, 2010
    CommentTarget met. Audits satisfactory with minor commentsACHIEVED. 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%Value8 months in year 200338% decreasedecreased by 25% compared to baseline
    DateJanuary 1, 2005May 5, 2009December 31, 2009
    CommentTarget met. Positive trend during the entire periodOVER-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.Value0 (Year 2004) Authorization for Licensing activitiAll doctors, dentists and pharmacists100%
    DateJanuary 1, 2005January 1, 2010January 1, 2009
    CommentTarget met and new procedures in place.ACHIEVED. All are licensed following new procedures.
  • Decrease by 15% ALOS in all hospitalsValue11.5 days (year 2002)6.13 days15% reduction or 9.7 days
    DateJanuary 1, 2002May 5, 2009January 1, 2009
    CommentTarget met. 2009 data shows target surpassedOVER-ACHIEVED. ALOS has been reduced by 53%
  • Increase out-patient surgery by 20 % of total surgeries for indications selected by January 2006Value0. Draft list of indications for one-day surgical 32% increase20% increase
    DateDecember 31, 2005December 11, 2009December 31, 2010
    CommentOn 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%Value2,139,361 (public & private ) (year 2004) Number hHospital referrals 216,000;out-pat 2.3 mill.reduction by 10%
    DateJanuary 1, 2005December 11, 2009December 31, 2010
    CommentThis 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 careIndicator misleading.
  • 30% of contracted health care providers complying with newly developed clinical guidelinesValue030% of contractred providers30%
    DateJanuary 1, 2005May 5, 2009December 31, 2010
    CommentTarget 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 completedACHIEVED. 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.Value0100%75%
    DateJanuary 1, 2005October 15, 2010December 31, 2009
    CommentTarget 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)Value0 - no plans developedAll HCIs legally obliged to prepare business plansBusiness plans for all HCI's
    DateJanuary 1, 2005May 5, 2009December 31, 2010
    CommentAll HCI have prepared BPsACHIEVED. All health institutions are obliged to have annual business plans as a basis for contracts.
  • Completion of grants program and patient satisfaction with resultsValue0 - no grants program in placeAll grants implemented20 grants
    DateJanuary 1, 2005October 15, 2010January 1, 2009
    CommentAchievedACHIEVED. 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 periodValue72,226 cases; 4,84%3488 (2008)30 percent
    DateAugust 4, 2010May 5, 2009August 10, 2010
    CommentTarget surpassedOVER 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

INDICATORBASELINECURRENTTARGET
  • Medium term MOH health sector strategy developed and approved.ValueNo health sector strategy availableStrategy in phase of implementationRevised National Health Strategy
    DateMay 13, 2004May 5, 2009December 31, 2010
    CommentTarget achievedACHIEVED. 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.ValueNo strategy available2008: Strategy developed and in processof implemenStrategy developed and is being implemented.
    DateMay 13, 2004January 7, 2010December 31, 2010
    CommentOn 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.ValueHIF Board is not performing its (financial) oversiBoard structure and operations are revised. Board Board structure and operations was revised
    DateMay 13, 2004February 6, 2008December 31, 2010
    CommentTarget 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.Value17 contracts concludedLegal basis for changes in contracting methods finContracts revised
    DateMay 13, 2004January 1, 2010December 31, 2010
    Commenton trackPARTLY 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.ValueMost project activities completed, and pending oneactivities completed and evaluated
    DateDecember 11, 2009December 31, 2008
    Commenton trackPARTIALLY-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.