Project in Support of Restructuring of Health Sector

Abstract*

The objectives of the Health Transformation and Social Security Reform and Second Phase Adaptable Program Loan Project for Turkey are: (i) increasing the effectiveness of the Social Security Institution (SSI) and Ministry of Health (MOH) in formulating and implementing reforms in provider payments and health systems performance; and (ii) piloting output-based financing for non-communicable diseases (NCD) prevention and control. There are three components... Show More

Development Objective

The new PDO is to increase the effectiveness of the Ministry of Health in formulating and implementing reforms in provider paymentsand health systems performance.

Key Details

Project Details

Project ID
P102172
Status
Closed
Team Leader
Claudia Rokx
Borrower 2
The Republic of Turkey

Country
Turkiye
Disclosure Date
May 7, 2008
Approval Date
(as of board presentation)
June 11, 2009
Effective Date
September 29, 2009

Total Project Cost 1
US$ 71.81 million
Implementing Agency
Ministry of Health
Region
Europe and Central Asia
Fiscal Year 3
2009

Commitment Amount
US$ 71.81 million
Environmental Category
C
Last Update Date
March 28, 2024
Closing Date
September 30, 2015

Last Stage Reached
BANK APPROVED

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 Control13%
- FY17 - Non-communicable diseases13%
FY17 - Health Systems and Policies64%
- FY17 - Health System Strengthening64%

FY17 - Private Sector Development

FY17 - Public Private Partnerships10%

FY17 - Public Sector Management

FY17 - Public Administration14%
- FY17 - Administrative and Civil Service Reform12%
- FY17 - Transparency, Accountability and Good Governance2%
FY17 - Public Finance Management2%
- FY17 - Public Expenditure Management2%

Project Map

Interactive Map

Finances

Financing Plan (US$ Millions)

Financier	Commitments
International Bank for Reconstruction and Development	71.81

Total Project Financing (US$ Millions)

Product Line	IBRD/IDA
IBRD Commitment	71.81
IDA Commitment	N/A
IBRD + IDA Commitment	71.81

Lending Instrument
Grant Amount	N/A
Total Project Cost**	71.81

Summary Status of World Bank Financing (US$ Millions) as of February 28, 2025

No data available.

Detailed Financial Activity as of February 28, 2025

Download:

Period	Financier	Transaction Type	Amount (US$)
Aug 14, 2015	IBRD-77170	Loan Disb	200,520.45
Aug 26, 2015	IBRD-77170	Loan Disb	199,189.05
Jul 2, 2015	IBRD-77170	Loan Disb	489,952.00
Apr 29, 2015	IBRD-77170	Loan Disb	495,947.53
Mar 5, 2015	IBRD-77170	Loan Disb	229,950.69
Feb 15, 2023	IBRD-77170	Int Charges	188,990.52
Feb 15, 2023	IBRD-77170	Loan Repay	1,087,123.60
Aug 15, 2023	IBRD-77170	Int Charges	602,126.56
Aug 15, 2023	IBRD-77170	Loan Repay	1,109,757.20
Aug 15, 2024	IBRD-77170	Int Charges	707,304.20
Aug 15, 2024	IBRD-77170	Loan Repay	1,117,521.60
Feb 15, 2024	IBRD-77170	Int Charges	717,018.20
Feb 15, 2024	IBRD-77170	Loan Repay	1,089,661.00
Jun 11, 2009	IBRD-77170	Loan Commitment	75,125,000.00
Feb 15, 2021	IBRD-77170	Loan Repay	1,231,450.90
Dec 17, 2014	IBRD-77170	Loan Disb	420,128.06
Jul 9, 2014	IBRD-77170	Loan Disb	723,946.56
Aug 19, 2014	IBRD-77170	Loan Disb	842,316.44
Apr 15, 2015	IBRD-77170	Loan Disb	201,073.88
Jul 30, 2015	IBRD-77170	Loan Disb	198,776.06
May 29, 2015	IBRD-77170	Loan Disb	201,424.62
Sep 22, 2014	IBRD-77170	Loan Disb	231,514.40
Feb 3, 2015	IBRD-77170	Loan Disb	603,658.10
May 19, 2015	IBRD-77170	Loan Disb	153,553.55
Aug 15, 2015	IBRD-77170	Int Charges	1,000.31
Aug 15, 2021	IBRD-77170	Loan Repay	1,192,476.40
Feb 15, 2022	IBRD-77170	Loan Repay	1,151,573.50
Aug 15, 2022	IBRD-77170	Loan Repay	1,035,665.10
Aug 15, 2018	IBRD-77170	Loan Repay	1,148,833.10
Feb 15, 2019	IBRD-77170	Loan Repay	1,144,113.60
Aug 15, 2019	IBRD-77170	Loan Repay	1,132,086.40
Feb 15, 2020	IBRD-77170	Loan Repay	1,099,962.90
Aug 15, 2020	IBRD-77170	Loan Repay	1,198,617.00
Aug 15, 2017	IBRD-77170	Loan Repay	1,192,577.90
Feb 15, 2018	IBRD-77170	Loan Repay	1,265,908.80
Feb 15, 2017	IBRD-77170	Int Charges	2,465.56
Feb 15, 2017	IBRD-77170	Loan Repay	1,071,442.50
Aug 15, 2016	IBRD-77170	Int Charges	13,182.68
Aug 15, 2016	IBRD-77170	Loan Repay	1,133,710.20
Dec 23, 2013	IBRD-77170	Loan Disb	973,491.00
Nov 12, 2013	IBRD-77170	Loan Disb	1,090,547.00
Sep 30, 2013	IBRD-77170	Loan Disb	1,362,456.10
Feb 15, 2014	IBRD-77170	Int Charges	1,092.30
Feb 15, 2014	IBRD-77170	Int Charges	79,176.41
Oct 1, 2013	IBRD-77170	Loan Disb	755,700.75
Dec 15, 2014	IBRD-77170	Loan Disb	231,528.61
Nov 18, 2014	IBRD-77170	Loan Disb	233,505.36
Jul 24, 2013	IBRD-77170	Loan Disb	1,251,469.40
Aug 15, 2013	IBRD-77170	Int Charges	61,411.15
Aug 15, 2013	IBRD-77170	Int Charges	1,999.45
Jul 11, 2013	IBRD-77170	Loan Disb	971,388.06
Aug 23, 2013	IBRD-77170	Loan Disb	1,490,292.10
Dec 9, 2014	IBRD-77170	Loan Disb	428,698.75
Dec 23, 2014	IBRD-77170	Loan Disb	379,560.25
Nov 4, 2014	IBRD-77170	Loan Disb	693,375.06
Oct 29, 2014	IBRD-77170	Loan Disb	233,519.30
Sep 26, 2014	IBRD-77170	Loan Disb	546,527.25
Dec 3, 2014	IBRD-77170	Loan Disb	570,034.25
Dec 15, 2014	IBRD-77170	Loan Disb	231,528.62
Jul 16, 2014	IBRD-77170	Loan Disb	230,632.22
Aug 15, 2014	IBRD-77170	Int Charges	471.14
Aug 15, 2014	IBRD-77170	Int Charges	106,540.33
Feb 15, 2015	IBRD-77170	Loan Repay	1,019,753.00
Sep 25, 2012	IBRD-77170	Loan Cancel	3,195,369.20
Feb 15, 2015	IBRD-77170	Int Charges	378.11
Feb 15, 2015	IBRD-77170	Int Charges	89,697.11
Dec 29, 2014	IBRD-77170	Loan Disb	585,239.75
Jul 21, 2014	IBRD-77170	Loan Disb	232,131.44
Mar 3, 2015	IBRD-77170	Loan Disb	689,286.56
Sep 11, 2014	IBRD-77170	Loan Disb	232,713.12
Mar 26, 2014	IBRD-77170	Loan Disb	888,553.75
May 29, 2014	IBRD-77170	Loan Disb	231,715.19
May 20, 2014	IBRD-77170	Loan Disb	232,284.98
Jun 10, 2014	IBRD-77170	Loan Disb	455,921.38
Dec 11, 2013	IBRD-77170	Loan Disb	1,492,436.20
Apr 29, 2014	IBRD-77170	Loan Disb	1,403,480.00
Mar 10, 2014	IBRD-77170	Loan Disb	832,073.10
Mar 12, 2014	IBRD-77170	Loan Disb	231,991.10
May 5, 2014	IBRD-77170	Loan Disb	232,922.27
Feb 15, 2016	IBRD-77170	Int Charges	154.25
Feb 15, 2016	IBRD-77170	Int Charges	55,043.44
Feb 15, 2016	IBRD-77170	Loan Repay	1,148,292.00
Feb 19, 2016	IBRD-77170	Loan Cancel	4,447,239.00
Feb 19, 2016	IBRD-77170	Loan Disb	-451,690.72
Feb 1, 2016	IBRD-77170	Loan Disb	-109,759.17
Sep 8, 2015	IBRD-77170	Loan Disb	526,905.75
Oct 2, 2015	IBRD-77170	Loan Disb	118,982.07
Sep 18, 2015	IBRD-77170	Loan Disb	203,595.94
Jun 2, 2015	IBRD-77170	Loan Disb	421,137.75
May 29, 2015	IBRD-77170	Loan Disb	201,424.62
Jun 2, 2015	IBRD-77170	Loan Disb	242,485.73
Aug 15, 2015	IBRD-77170	Int Charges	57,521.83
Aug 15, 2015	IBRD-77170	Loan Repay	1,105,055.50

Footnotes

Ratings

IMPLEMENTATION RATINGS

Name	Review	Date
Progress towards achievement of PDO	Moderately Unsatisfactory	2015-09-30
Procurement	Moderately Satisfactory	2015-09-30
Project Management	Satisfactory	2015-09-30
Monitoring and Evaluation	Moderately Satisfactory	2015-09-30
Overall Implementation Progress (IP)	Moderately Satisfactory	2015-09-30
Financial Management	Satisfactory	2015-09-30

COMPLETION RATINGS

INDICATOR	IMPLEMENTATION COMPLETION & RESULTS REPORT: 03-29-2016
Outcomes	Moderately Unsatisfactory
Risk to Development Outcome	Modest
Bank Performance	Moderately Unsatisfactory
Borrower Performance	Moderately Unsatisfactory
Government Performance	Moderately Satisfactory
Implementing Agency	Moderately Unsatisfactory

INDEPENDENT EVALUATION RATINGS

INDICATOR	ICR REVIEW: 06-13-2016	PROJECT PERFORMANCE ASSESSMENT REPORT:
Outcome Rating	Moderately Unsatisfactory	N/a
Risk To Development Outcome	Modest	N/a
Bank Performance	Moderately Unsatisfactory	N/a
Borrower Performance	Moderately Unsatisfactory	N/a
Government Performance	Moderately Satisfactory	N/a
Implementing Agency	Moderately Unsatisfactory	N/a
Icr Quality	Substantial	N/a
M&e Quality	Modest	N/a

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

3. Client satisfaction with health services Value 63.4 71.2 76
Date May 31, 2009 September 15, 2015 September 30, 2015
Comment
5. Smoking prevalence among 18-29 age group in pilot provinces relative to non-pilot provinces. Value 31.20 27.10 0.00
Date July 8, 2009 December 1, 2014 July 31, 2013
Comment
6. High blood pressure in population in pilot provinces decreases more as compared to non-pilot provinces Value 0.00 0.00 0.00
Date July 8, 2009 December 1, 2014 July 31, 2013
Comment

4. Ministry of Health reorganized and focus exclusively on the health sector stewardship function	Value	MOH is a provider of health services	Target met. MOH is restructured and no longer a pr	MOH is restructured and no longer a provider of he
	Date	December 31, 2010	September 15, 2015	September 30, 2015
	Comment

1. Per-capita annual visits to family medicine physicians Value 2.00 2.76 4.00
Date May 31, 2009 September 15, 2015 September 30, 2015
Comment
2. Share of family medicine visits in total visits Value 35.00 33.35 40.00
Date May 31, 2009 September 15, 2015 September 30, 2015
Comment

INTERMEDIATE RESULTS INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

2. MOH Annual performance program prepared and submitted to the National Assembly Value 0 Annual performance programs for 2014 and 2015 were Yes
Date July 8, 2009 September 15, 2015 September 30, 2015
Comment
Component B: 1. Percentage of population of pilot provinces screened for NCD risk factors Value 0.00 0.00 30.00
Date July 8, 2009 June 12, 2014 July 31, 2012
Comment

2. Higher increase in appropriate knowledge and attitudes regarding global risk factors for NCDs in pilot provinces as compared with non-pilot provinces	Value	0.00	0.00	35.00
	Date	July 8, 2009	June 12, 2014	July 31, 2012
	Comment

3. Percentage of cases in pilot provinces diagnosed and under follow-up by family group practices for the following NCDs: hypertension, diabetes, obesity/overweight	Value	0.00	0.00	90.00
	Date		June 12, 2014	July 31, 2012
	Comment

4. 100 percent compliance with reporting on implementation of screening activities as well as patient records (through family medicine information system)	Value	0.00	0.00	80.00
	Date	July 8, 2009	June 12, 2014	July 31, 2012
	Comment

Component C: 1. Actuarial analysis of UHI updated for 2010 and 2012 based on updated macro and micro data	Value	1st actuarial analysis completed		3rd actuarial analysis of UHI done by WB and SSI
	Date	July 8, 2009	June 12, 2014	July 31, 2012
	Comment

2. Costly interventions under Benefits Package for UHI revised using cost-effectiveness criteria and guidelines developed by SSI;	Value	Review of Benefits Package and identification of i		Decrease in spending on the interventions as compa
	Date	July 8, 2009	June 12, 2014	July 31, 2012
	Comment

3. Prospective payment systems based on international evidence (capitation, global budgets, DRGs) or outpatient and acute care adopted for University, private and MOH hospitals	Value	Stock-taking and development of action plan for im		Relevant prospective payment systems implemented
	Date	July 31, 2009	June 12, 2014	July 31, 2012
	Comment

Number of provinces implementing family medicine scheme Value 31.00 81.00 81.00
Date May 31, 2009 September 15, 2015 September 30, 2015
Comment
Share of public hospitals organized in public hospital unions with performance contracts for managers and global budgets Value 0.00 100.00 100.00
Date May 31, 2009 September 15, 2015 September 30, 2015
Comment

Establishment of the Pharmaceuticals and Medical Devices Agency of Turkey	Value	No Pharmaceuticals and Medical Devices Agency of T	Agency Established and responsible for licensing a	Agency Established and responsible for licensing a
	Date	May 31, 2009	September 15, 2015	September 30, 2015
	Comment

Development of the Clinical Guideline Preparation Manual	Value	No Clinical Guideline Preparation Manual exists	Guideline prepared and disseminated	Guideline prepared and disseminated
	Date	May 31, 2009	September 15, 2015	September 30, 2015
	Comment

Establishment of Public Health Institution responsible for health promotion, disease prevention and family medicine	Value	Public Health Institution not in existence	Public Health Institution fully operational	Public Health Institution fully operational
	Date	May 31, 2009	September 15, 2015	September 30, 2015
	Comment

3. Adoption of National Action Plans for (i) Health Promotion, (ii) Healthy Aging, (iii) Diabetes, (iv) Obesity, (v) CardiovascularDiseases (CVD), (vi) Chronic Respiratory Diseases (CRD)	Value	4.00	6.00	6.00
	Date	May 31, 2009	September 15, 2015	May 31, 2015
	Comment

Number of international conferences to share Turkey’s health reform experience Value 0.00 3.00 2.00
Date May 31, 2009 September 15, 2015 September 30, 2015
Comment

3. Client satisfaction with health services	Value	63.4	71.2	76
	Date	May 31, 2009	September 15, 2015	September 30, 2015
	Comment

5. Smoking prevalence among 18-29 age group in pilot provinces relative to non-pilot provinces.	Value	31.20	27.10	0.00
	Date	July 8, 2009	December 1, 2014	July 31, 2013
	Comment

1. Per-capita annual visits to family medicine physicians	Value	2.00	2.76	4.00
	Date	May 31, 2009	September 15, 2015	September 30, 2015
	Comment

2. MOH Annual performance program prepared and submitted to the National Assembly	Value	0	Annual performance programs for 2014 and 2015 were	Yes
	Date	July 8, 2009	September 15, 2015	September 30, 2015
	Comment

Number of provinces implementing family medicine scheme	Value	31.00	81.00	81.00
	Date	May 31, 2009	September 15, 2015	September 30, 2015
	Comment