WASHINGTON, June 27, 2000 - The World Bank today approved a US$40 million Health Sector Reform Project loan for Romania that will strengthen capacity for planning and policy development in the fields of public health, health service infrastructure, and human resources.
The loan is the first of two adaptable program loans totaling US$60 million that the Bank plans to provide over the next five years to support the Government in implementing key elements of a wider long-term health sector development strategy and reform program that is also supported by other international agencies and donors. Adaptable Program Lending is an investment approved by the Bank's Board of Executive Directors in September 1997, which allows for greater flexibility than the traditional instruments to support long-term, complex reforms and programs.
The project will finance investments in physical assets and staff training for selected primary health care, hospital, and emergency medical services based on identification of higher priorities. It will also support pilot initiatives to improve efficiency through reorganization of services to better coordinate primary and secondary health care, and improve heath status through greater investment in priority public health programs.
Today's loan begins Phase I of the program which includes investment and training in 24 hospitals, and support development of plans in at least 75 percent of judets (administrative districts in Romania). Phase I includes the following components:
- Planning and Regulation of the Health Care Delivery System. This component will provide technical assistance, training, studies, stakeholder consultation and information dissemination to support development of health service plans; and policy development and capacity building in the Ministry of Health in health service planning and regulation.
- Essential Upgrade in District Hospitals. This component will include the upgrade of operating theatres and intensive care units, and will provide training in clinical management of emergency cases in 24 district and training hospitals, as part of a strategy to reduce preventable deaths from common emergency cases.
- Primary Health Care Development. At the national level, this component will support development of national policy for vocational training, accreditation/certification, and continuing medical education for doctors and nurses working in primary health care.
- Emergency Medical Services. This component will support investment in integrated, community-based emergency medical services, coordinated with other emergency services, in order to reduce response times and improve health outcomes for accident and emergency cases.
- Public Health and Disease Control. This component includes two sub-components-strategy development and capacity building including building public health capacity in the Ministry of Health through technical and management training, development of a public health strategy, rationalization of morbidity and mortality codes and institutionalizing public health surveillance and monitoring systems; and priority interventions which will support cost-effective public health interventions in four priority areas in Phase I, measures to reduce tobacco consumption, roll-out of a modern tuberculosis control strategy, HIV/AIDS and Sexually Transmitted Disease awareness and education, and support for implementation of a new mental health legislation and development of modern, humane models for mental health services. This component will also support public information and awareness campaigns.
- Project Management. This component supports the Project Management Unit already established under the Ministry of Health.
Total project cost is US$69.84 million including US$27.59 million from the Romanian Government, and US$2.25 million from other donors.
The loan will be repayable in 20 years including a 5 year grace period at the Bank's standard rate for LIBOR-based variable spread and single currency loans in US dollars. Romania joined the Bank in 1972 and since 1990, commitments to the country total US$3 billion for 29 projects.
Adaptable Program Lending: Background
The World Bank's borrowers have requested that the Bank add to its traditional product line some new instruments that respond to changing conditions, and allow for faster approvals and disbursements, shorter project cycles, opportunities for learning by doing, and more flexibility to make changes. Adaptable Program Lending is one of such instruments. It involves a series of loans through which the Bank provides phased and sustained support for a borrower's long-term development program. Under the initial Adaptable Program Loan, the borrower and the Bank reach agreement on the program's long-term goals, the phasing and sequencing of investment activities and policy/institutional changes that would contribute to realizing these goals, and the specific objectives and milestones for each phase. Each of the phases is supported by a loan which is prepared and appraised separately. Reaching the agreed milestones during a first loan allows the commitment of funds for a second loan, and so on for each successive loan until the program goals are achieved or partners decide that the program parameters no longer hold. This allows for a quicker Bank response to borrower needs than possible with existing investment instruments while providing flexibility in program implementation.