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India and the World Bank Signs an IDA Credit of US$ 152 Million

Government of India and the World Bank signed an IDA credit of US$ 152 million to finance the Government of India`s (GOI) efforts to help improve the efficiency, quality, and accountability of health services in the state of Uttar Pradesh (UP), one of India’s low-income States with some of the poorest health indicators in the country.

With a population of approximately 200 million, UP will determine the achievement of India’s own health goals and its health-related Millennium Development Goals (MDGs). Despite recent improvements, UP continues to face over-whelming health challenges.

The Uttar Pradesh Health Systems Strengthening Project (UPHSSP) seeks to help the Government of Uttar Pradesh (GOUP) strengthen the management and systems capacity of its Health department in order to improve the efficiency and effectiveness of healthcare services to its people.

The GOUP has been steadily increasing its commitment to the health sector, and public health spending in the state now stands at 1.6 percent of the gross state domestic product, which is higher than the national average of about 1 percent.

Shri Venu Rajamony, Joint Secretary, Department of Economic Affairs, Ministry of Finance, Government of India, said that the proposed Project is expected to help the State Government improve the efficiency, quality and accountability of its health services by strengthening the Health Department’s management and systems capacity, its governance and accountability mechanisms, as well as its ability to engage effectively with the private sector. He said that the Project proposes to help the State Government pilot mechanisms at the health facility and village levels to improve the responsiveness of service providers. Shri Rajamony further said that it will seek to improve the flow of information to citizens from the health system, create simple feedback mechanisms, and publicize service response standards, so that people know what they can expect from the health service providers and can hold them accountable.

The agreements for the Uttar Pradesh Health Systems Strengthening Project were signed by Shri Venu Rajamony, Joint Secretary, Department of Economic Affairs, Ministry of Finance, on behalf of the Government of India; Shri Sanjay Agarwal, Principal Secretary, on behalf of the Government of Uttar Pradesh; Shri Lokesh Kumar, Project Director, on behalf of the UP Health Systems Project; and Shri Hubert Nove-Josserand, Operations Adviser, World Bank (India) on behalf of World Bank.

Shri Sanjay Agarwal, Principal Secretary, Government of Uttar Pradesh said that institutional constraints to better health services are affecting the entire population of UP, particularly the poor. Through this Project we hope to build the necessary institutional capacity of the state to achieve sustainable health outcomes, he further said.

The Project, which focuses on institutional development will comprise of two main components. First, it will focus on strengthening the Department of Health`s management and accountability systems. In this context, the Project will improve, planning capacities, information flows and data inputs to enable policy-makers to better monitor and manage service delivery in UP.

Second, the project will help the state government improve the Department of Health’s capacity to perform its quality assurance role and engage more effectively with the private sector, which is already a significant player in the UP health system. Other quality enhancement interventions supported by the Project include the development and implementation of regulatory functions such as transparent licensing, strengthening the accreditation program and quality enhancement in public sector hospitals in order to bring quality health services to its people, especially the poor.

Mr Hubert Nove-Josserand, Operations Adviser, World Bank (India) said that inadequate health systems affect the poor most, and it is estimated that 8 percent of households in UP fell below the poverty line due to health-related out-of-pocket expenditures. He said that we hope that this Project’s focus on organizational strengthening and improving accountability will help bring better healthcare to all citizens of UP, especially to the poor who comprise one-third of its population.

Shri Vikram Rajan, Senior Health Specialist and the World Bank Team Leader of UPHSSP informed that the proposed Project supports improvement of upstream and midstream systems that would enable GOUP to better utilize funds available and is complementary to other state and federal programss. The focus on improving demand-side accountability will help public service providers become more responsive to the communities they serve.

This Project builds on the earlier Bank-financed UP Health Systems Development Project (2000-2008), which supported investment in secondary health care services and systems strengthening. Complementary investments for primary and preventive health services were supported through World Bank investments in national programs for reproductive and child health, immunization, polio eradication and disease control (TB, vector borne diseases, HIV/AIDS, cataract, leprosy).

This Project will be financed by a credit from the International Development Association (IDA) – the World Bank’s concessionary lending arm – with a final maturity of 25 years including a grace period of five years and a 1.25 percent interest rate.



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