New Delhi 18 December 2011: A US $ 152 million credit to India’s most populous state, Uttar Pradesh (UP), was approved by the World Bank Board of Executive Directors today to help build the institutional capacity needed to improve health outcomes in this low-income state which has some of the poorest health indicators in the country.
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 -- 63 per 1000 live births against the national average of 50 per 1000
- The percentage of 24/7 PHCs offering basic services is only 18% against a national average of 35.8%
With a population of approximately 200 million, UPwill 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: More women die in childbirth here than in most parts of the country and fewer children survive infancy; only one-third of children are fully immunized by 12 months of age and; infectious diseases remain a major problem in the state. The Uttar Pradesh Health Systems Strengthening Project seeks to help 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. "The main challenge in UP is the need to endure that the full impact of these inputs is not undermined by inadequate institutional capacity and management systems of the state’s Health Department,” said Venu Rajamony, Joint Secretary Department of Economic Affairs, Ministry of Finance, Government of India. “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.”
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.
“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 Roberto Zagha, World Bank Country Director for 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 Project proposes to help 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 proposed Project supports improvement of upstream and midstream systems that would enable GOUP 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 and complementary investments for primary and preventive health service 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 IDA credit has a final maturity of 25 years including a grace period of five years with a 1.25% interest rate.