1. Overview

2.  US $30.8 mln IDA credit  Oct 2014 - March 2019  Approved by WB Executive Board on May 22, 2014

3.  Objective: to reduce key risks for non- communicable diseases and improve efficiency of health services in Moldova.  Approach: A. US $28.8mln is Program-for- Results (PforR) B. US $2mln is Technical Assistance

4.  A new lending instrument of the World Bank  WB and Govt to agree on a selective set of indicators, with clear targets and verification methods  Each target links to a certain disbursement amount to the State Budget  Country uses its own budget and systems (financial management, procurement, etc.) to achieve the targets  Once targets have been achieved; money is disbursed from WB to Govt. If DLIs are partially met, then there will be partial disbursements

6.  MOH administrative budget  CNAM administrative budget  Primary health care (performance-based incentive for family medicine and re- imbursement of anti-hypertensive drugs only)  Hospital care (performance-based incentive for family medicine only)  National Tobacco Control Programme

7.  Challenge: In Moldova, around 10% of people with hypertension have their blood pressure under control  Indicator: increase this percentage from 10% to 15%  Verification method: two rounds with household survey with blood pressure measurement. If target is met  disbursement

8. Disbursement Linked Indicators Value (US$ million) 1 Smoking prevalence in adults 4.0 2 Percentage of adults with hypertension whose blood pressure is under control 4.0 3 Annual acute care hospital discharges per 100 persons 3.0 4 Number of acute care hospital beds 4.8 5 Revision of the average reimbursement rate of generic, first line medications for the three main categories of antihypertensive drugs in the drug benefit package from 50 percent to 70 percent 2.0 6 Revision and implementation of performance-based incentive scheme in primary care 2.0 7 Introduction of performance-based incentives to improve (i) efficiency and (ii) quality of care in hospitals 2.0 8 Use of DRGs for hospital payments 2.0 9 Proportion of public hospitals in Chisinau which are under common management 4.0 10 Approval of the new national health strategy which includes hospital rationalization measures 1.0 Total 28.8

9.  Focusing more on actual results thru financing of results, not inputs  Facilitating strengthening and use of country systems and procedures  Giving more flexibility to the country

10.  Conduct 3 assessments as part of preparation ◦ Technical Assessment ◦ Fiduciary (financial management and procurement) ◦ Environmental-social assessment (ESSA)  Each assessment (i) identifies strengths, weaknesses of govt systems and (ii) proposes mitigation measures  Public consultation and disclosure of ESSA

11. I. Capacity building:  DRG costing exercise based on country data;  Optimisation of business processes and workflows for hospitals under common management;  Performance-based incentive scheme to improve quality and efficiency in hospitals;  Development a manual for quality of care management in primary care;  Development an accountability framework and mechanism for health workers;  Studies and reports: Health HBS, streamlined STEPS to verify the PforR results II. Institutional support:  PIU to support MoH and CNAM

12.  For more information, please visit http://documents.vsemirnyjbank.org/curated/ ru/2014/04/19457546/moldova-health- transformation-operation-project