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| Loan Name | Second Urban Primary Health Care Project | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Country | Bangladesh | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Loan Number | 2172 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Project Number | 36296- 01 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Type/Modality of Assistance[Approved] |
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| Thematic Classification |
Inclusive Social Development
Gender and Development |
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| Project Outcome | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Description of Outcome | Improved access to and use of efficient, effective, and sustainable good-quality primary health care (PHC) services for the poor in urban areas covered by the Project, with a particular focus on women and girls. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Progress Toward Outcome | It is too early to comment on develompment outcomes. However, given the quick pace at which the PHC services have been operationalized, the development outcomes are likely to be achieved. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Implementation Progress | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Description of Project Outputs | 1. I. PROVISION OF PHC SERVICES THROUGH PARTNER NGOS AND BEHAVIORAL CHANGE COMMUNICATION AND MARKETING (BCCM)
The process for the selection of partner agreement (PA) nongovernment organizations (NGOs) for 24 partnership areas concluded satisfactorily in 19 partnership areas. The PHC services are thus provided in majority of partnership areas. The consultant firm for BCCM has been awarded and signed. Activities started and ongoing satisfactorily. 2. II. STRENGTHENING URBAN PHC INFRASTRUCTURE AND ENVIRONMENTAL HEALTH The consultant firm for construction supervision and engineering design has been awarded and signed and services proceeding satisfactorily. ADB approved the list of prequalified contractors. Also, the model NCB civil works contract has been approved by ADB. Tendering of civil works contracts expected in early fourth quarter of 2008. Award of contract for the procurement of furniture for new and old PHCC/CRHCCs approved by ADB. 3.III. BUILDING CAPACITY AND POLICY SUPPORT FOR URBAN PHC The M&TS contract has been signed and activities started. Activities have picked up after consultant firm relating to management and training support has mobilized. 4. III PROJECT IMPLEMENTATION AND OPERATIONALLY RELEVANT RESEARCH Project implementation is taking place smoothly with the project management units and project implementing units in place. Operationally relevant research and training programs have started by the management and training supervision firm. |
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| Status of Implementation Progress (Outputs, Activities and Issues) | The critical contracts for provision of PHC services to NGOs has been largely accomplished. All the 24 PA contracts have been awarded. Consulting services for DSESC, BCCM, PPM&E and M&TS components have been awarded. The only consultant packages for the HMIS and QASS still stalled; will be discussed with the Government and EA during the mid-term review mission scheduled for third quarter of 2008. The first draft tender documents for civil works using national competitive bidding procedures have been approved by ADB. The client flow in the first quarter of 2008 was 763,280 of which 78% were female. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Linkage to Country/Regional Strategy | The Government of Bangladesh is committed to improving the health of its citizens, particularly the poor. Its health policy emphasizes improving the quality and efficiency of and access to public health services. However, most public primary health care (PHC) services cater to the rural population
Although the urban populations has been increasing rapidly, the Government and external funding agencies have addressed urban PHC seriously only in the last decade. The ADB-suppported UPHCP-I and United States Agency for International Development (USAID)-supported NGO services delivery program, which contract out urban PHC to NGOs, are the only major urban PHC projects in Bangladesh, leaving significant needs for urban PCH unmet. Bangladesh's health policy adopted in 2000 stresses the need to expand health services in urban areas, especially for the poor. The interim poverty reduction strategy paper and the targets sets in the Partnership Agreement on Poverty Reduction (PAPR) with ADB reflect the Government's commitment to achieving the MDGs by strengthening urban PHC, especially for the poor. ADB's country strategy supports delivery of PHC services in urban areas over the medium terms, and building local government capacity to deliver high-quality services to the urban poor, particularly women and children, in partnership with NGOs. The country assistance program evaluation (CAPE) in 2003 highlighted the need for stronger collaboration with NGOs, more effective empowerment of local communities, and support for accountable and transparent local government bodies in ADB's future programs. The Project is therefore closely aligned with: ADB's overall policy for reducing humanb poverty and helping developing member countries achieve the MDGs; Bangladesh's national poverty reduction strategy; the PAPR; the country strategy and program update; and the recommendations of the 2003 CAPE. |
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| Geographical Location | All the six city corporations---Dhaka, Chittagong, Khulna, Rajshahi, Syllhet and Barisal---and five municipalities-Bogra, Comilla, Sirajgonj, Madhabdi and Savar. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Environment | B | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Summary of Environmental and Social Issues | The Project wil support affordable health care for the poor. At least 30% of services will be provided free to them. Malnourished mothers and children will receive supplementary nutritition. Community toilets and community-based solid waste disposal will improve environmental health in slums. The Project will improve medical waste management practices, and is expected to have no adverse affect on the environment. Management and disposal of medical waste will be addressed during design of civil works. Medical staff will be trained in proper waste separation, storage and disposal. An environmental examination will be carried out for each civil works subproject once designs are finalized. Best practices for medical waste management in low-resource settings will be followed, in line with World Health Organizations (WHO) recommendations and current Ministry of Health and Family Welfare policies and procedures on hospital waste management. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Consultations Planned or Carried Out | A stakeholder analysis was conducted as part of the feasibility study. The study helped to identify key projects stakeholders and to plan the project activities. Primary stakeholders include selected staff from the Ministry of Local Government, Rural Development, and Cooperatives; Ministry of Health and Family Welfare; project implementation unit of the UPHCP-I; NGOs involved in the UPHCP-I; donor consortium; community-based organizations; representatives and officers of city corporations and municipalities; and representatives of the poor and vulnerable groups. Stakeholders include relevant line ministries and other private providers of health services. During project implementation, participatory processes will be incorporated into mapping target beneficiaries from urban slum and low-income areas, and into monitoring health services through the neighborhood and ward health committees at the health facilities. Citizen score cards routine display of up-to-date public information about staffing, stock facilities, and fee rates will improve accountability of the services providers and facilitate participation of services users in monitoring services. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Responsible ADB Officer |
Sekhar Bonu |
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| Responsible ADB Department |
South Asia Department |
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| Responsible ADB Division |
Urban Development Division, SARD |
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| Executing Agencies |
Local Govt Div,Min of Local Govt Rural Devt & Coop Mr. Jamal A. Naser Chowdhury Project Director Nagar Palika Bhawan, Dhaka pduphcp@bangla.net |
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| Timetable | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fact-finding | 22 Aug 2004 to 09 Sep 2004 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Appraisal | 13 Oct 2004 to 21 Oct 2004 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Board Approval | 31 May 2005 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Last Review Mission | 25 Aug 2008 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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