NEW DELHI, March 21, 2012: The Government of India, the Government of Uttar Pradesh and the World Bank today signed an IDA credit of US$ 152 million to finance efforts to help improve the efficiency, quality, and accountability of health services in the state of Uttar Pradesh, 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 overwhelming health challenges.
The Uttar Pradesh Health Systems Strengthening Project (UPHSSP) seeks to support the Government of Uttar Pradesh (GOUP) strengthen the management and systems capacity of its state 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.
Mr. Venu Rajamony, Joint Secretary Department of Economic Affairs, Ministry of Finance, Government of India, said, “The Project is expected to support the state government to 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. The Project would support the state government pilot mechanisms at the health facility and village levels to improve the responsiveness of service providers. 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 Mr. Venu Rajamony, Joint Secretary, Department of Economic Affairs, Ministry of Finance, on behalf of the Government of India; Mr.Sanjay Agarwal, Principal Secretary, Medical Health & Family Welfare on behalf of the Government of Uttar Pradesh; Mr. Lokesh Kumar, Project Director, on behalf of the UP Health Systems Strengthening Project; and Mr. Hubert Nove-Josserand, Operations Adviser, World Bank, India on behalf of World Bank.
“Today 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,” said Mr. Sanjay Agarwal, Principal Secretary, Government of Uttar Pradesh.
The Project, which focuses on institutional development will comprise of two main components. The first component 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.
The second component will support 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.
“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,” said Mr. Hubert Nove-Josserand, Operations Adviser, World Bank, India. “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.”
“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 programs,” said Vikram Rajan, Senior Health Specialist and the World Bank Team Leader of UPHSSP. “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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UP’s Health Challenges
- Maternal mortality -- 359 per 100,000 live births against a national average of 212
- Neo-natal Mortality -- 45 per 1,000 live births versus a national average of 35
- Infant Mortality -- 61 per 1000 live births against the national average of 47 per 1000
- The percentage of 24/7 PHCs offering basic services is only 18% against a national average of 35.8%
