WORLD BANK: SUPPORT FOR HEALTH SECTOR DEVELOPMENT PROGRAM 1

Questions Predictability: How Much? Effectiveness & Sustainability: How can what we do and how we do it improve in terms of results, efficiency and sustainability? 2

How Much? What is already committed Northern Uplands Region Health Support $2.4 mil By 2/16 Central North Region Health Support $18.3 mil By 8/16 $35 mil By 8/18 Tentative North East and Red River Delta Region Health Support $135.6 mil By 12/19 Hospital Waste Management System Support $111.5 mil By 8/17 Extension? Health Professionals Education and Training Project $95.8 To 12/20 3

How Much? What is the future commitment? It depends: IDA 3 year cycle through June Total Vietnam allocation is $3.5 billion of which 21% committed. More than 100% ‘planned’ but depends on readiness and prioritization. Sectors are competing. July 2017: IDA and/or IBRD? Subject to review. Will know in Value of borrowing for IBRD largely up to the Government as to whether and what value they see borrowing (technical+financing). 4

Effectiveness & Sustainability 5

What happens now? World Bank Financed Project Define a Project but little involvement in the definition of the Strategy Provide Inputs to Project objectives Project Specific Results Framework Ring-fenced Other Development Partners Project Specific Support or Separate Budget Support Separate monitoring, evaluation Other Development Partners Government implementation of Masterplan through its own resources Under-financed Government program Monitoring of Implementation and Evaluation of Masterplan Achievement Weak Country Systems not specifically strengthened 6 Government Sector Development Plan, Strategy or Masterplan “Coordination” supposed to happen

What happens now? World Bank Financed Project Define a Project but little involvement in the definition of the Strategy Provide Inputs to Project objectives Project Specific Results Framework Ring-fenced Other Development Partners Project Specific Support Separate monitoring, evaluation Other Development Partners Government implementation of Masterplan through its own resources Under-financed Government program Monitoring of Implementation and Evaluation of Masterplan Achievement Weak Country Systems not specifically strengthened 7 Government Sector Development Plan, Strategy or Masterplan “Coordination” supposed to happen

What could happen? Government implementation of Masterplan according to its own Country Systems and with own and external resources 8 Government Sector Development Plan, Strategy or Masterplan World Bank Other financiers Technical Agencies

Why Programmatic in Vietnam? Development Effectiveness and Client Demand – Government is requesting Development Partner support for a better designed, implemented, budgeted, monitored and evaluated Government programs and not ‘projects’. Focus on Results – Put attention on results through more direct linkage of funding to the achievement of verifiable results and performance actions. Less time and attention on inputs. Demonstrate the progress of Government Programs to National Assembly, public, etc…. Institutional and Capacity Building – By using Government program institutions and systems (and less “parallel systems”), strengthen institutions/capacity of the whole program. Enhanced Partnerships – Provide an opportunity to improve coordination among development partners in government programs. Address Implementation Bottlenecks – Overcome slow disbursement and implementation. 9

Why Not Programmatic? High risk projects where the attention to the details of the inputs require the most careful attention, i.e. large infrastructure projects. Not pragmatic, i.e. Government priority but technically sound strategy, with clearly defined on-budget expenditures does not exist and/or use of country systems not possible. Emergency operations, pilot or other types of experimental projects 10

Existing Bank lending instruments 11 Implementation Mechanism Funds for specific expenditures Funds for un-earmarked budget support Funds for un-earmarked budget support Funds for a specific Government expenditure program Bank IL rules and procedures Country policy processes Project Lending (IPF)* Development Policy Lending (DPL) Program Lending (PforR) Program (country) systems

Three instruments illustrated 12 Results Oriented Investment Project or Program for Results: Support IMPLEMENTATION Link disbursements to RESULTS Traditional IPFs Disburse against inputs Policy Reforms Inputs Outputs Intermediate Outcomes Outcome DPLs Establish policy framework (focus on reforms)

Value Added of the World Bank an other DP financing to an On Budget* Program Upstream A better designed, economically justifiable and well-costed strategy Convening different development partners to support the implementation of a single strategy Defined institutional support necessary for the achievement of the strategy During Provide technical support and incentivize the progress in implementation of the program Assess, monitor and ensure verified results The program size may or may not be larger or more regular than originally planned with the Bank financing (degree of “additionality”) Use of relatively inexpensive Bank financing for financing a Government program good debt management strategy 13

Moldova: Health Transformation Operation (PforR w/ IPF component) 14 National Health Care Strategy National Health Care Strategy sets out development directions for the health sector and is the framework for making policy and operational decisions, including the distribution of budgetary resources Costed at Euro 409 million total or Euro 51 million per year, including capital and recurrent expenditures to achieve reform objectives. Strategy defines 8 priority areas, each individually costed Definition of the “program” In order to improve the quality and efficiency of health services, the World Bank agreed to support 5 of the priority areas in the first 5 year phase of the strategy. This was defined as the “program”. Specific “masterplans” informed the priority reforms Program costs EURO 180 million including civil works, equipment, TA, salaries, payment for services and operating costs. IBRD Lending in the amount of EURO $75 million towards the Government on-budget expenditures linked to the program. Other funds may be mobilized by the EU. Action Plans, Capacity Building, M&E framework Bank Supported Development of an action plan with 10 defined actions to ensure achievement of the priority results. Interim actions defined over the 5 year period. - i.e. percentage of hospitals accredited by national accreditation agency; percentage of hospitals quality and safety related surveillance schemes. Specifically it was agreed that the MOF would allocate $7.5 million of the program budget to implement priority TA. Clear Results Framework agreed.

Vietnam School Readiness Support Project (IPF w/ DLIs) 15

YR1YR2YR3YR4TOTAL Results B: Improved Capacity for Preschool Quality Assurance DLI 3 [US$5m]: MOET has adopted guiding regulations for preschool quality self- assessments and external accreditation for preschools DLI 4 [US$15m]: Vietnam makes demonstrated progress in achieving its target of 90 percent of preschools have undertaken self- assessment; US$ 0.17 million to be made available up to an aggregate amount not exceeding US$15 million for each confirmed one percentage point increase in the share of schools conducting formal self-assessment over the previous school year US$35m DLI 5: [US$15m]: Vietnam makes demonstrated progress in achieving its target of 40 percent of preschools achieving accreditation at Level 1; US$ million to be made available up to an aggregate amount not exceeding US$ 15 million for each confirmed one percentage point increase in the share of schools achieving Level 1 accreditation 16

Vietnam Health: Priorities of the Next 5 Year Plan 17 What are the priorities? Defined Priority have a Technically Sound Strategy, a Roadmap for Implementation, an Expenditure Program in line with the Strategy 1 Key area has been to improve the delivery of Primary Health Care through strengthening Grass Roots Health System (Draft Strategy, Roadmaps still critically needed, partial expenditure program likely) Other Areas?

A Virtuous Direction Agreement on Details of Program and Program Implementation. Initial Results Disbursement to Budget Program Financed More Results & More Disbursement 18 Advance if needed