LOAN: BAN 36296-01 | Second Urban Primary Health Care Project

Bangladesh

LOAN: BAN 36296-01

Second Urban Primary Health Care Project

•	Missions
•	Loan Approval Date
•	Estimated Completion Date
•	Cost and Financing Plan
•	Description
•	Development Objectives
•	Thematic Classification
•	Target Classification
•	Rationale
•	Objectives and Scope
•	Policy Dialogue
•	Environment Category
•	Env't Impact and Mitigation
•	Social Aspects and Remedies
•	Benefits and Beneficiaries
•	Public Consultation
•	Beneficiary Participation in Formulation
•	Beneficiary Participation in Implementation
•	Consulting Services
•	Procurement
•	Contacts
•	Remarks

Location
All the six city corporations---Dhaka, Chittagong, Khulna, Rajshahi, Syllhet and Barisal---and five municipalities-Bogra, Comilla, Sirajgonj, Madhabdi and Savar.

Sector
Health, Nutrition, & Social Protection /Health Systems

Initial Listing
15 April 2003

Most Recent Update
9 February 2007

Executing Agency(ies)

Local Government Division, Ministry of Local Government, Rural Development and Cooperation

Missions

Loan Approval Date

31 May 2005

Estimated Completion Date

Cost and Financing Plan (in US$ million)

Source	Foreign Cost	Local Cost	Total
Bank	4.30	25.70	30.00
Cofinancing	0.00	0.00	0.00
Borrower	0.00	18.00	18.00
Beneficiaries	0.00	0.00	0.00
Others	0.00	0.00	0.00
Project/Program Cost	4.30	43.70	48.00

OCR ADF Total

Loan Amount 0.00 30.00 30.00

Description

The Project will held ensure the delivery of a package of preventive, promotive, and curative health services to the poor in six city corporations and five municipalities. The services will be designed to reduce child and maternal mortality and morbidity, and help the country achieve the Millenium Development Goals (MDGs). The Project will continue to contract out primary health care (PHC) services to nongovernment organizations through partnership agreements that were pioneered under the first Urban Primary Health Care Project (UPHCP-I). The Project will ensure pro-poor targeting by requiring at least 30% of the preventive, promotive, and curative services provided are for the poor. Nutritional supplements will be given to moderately serverly malnourished women and children. The Project will support construction of 64 helath facilities, upgrading of 4, and purchase of 12 apartments and/or buildings for PHC facilities in Dhaka city corporation. Community-run latrines and community-based solid-waste disposal will be piloted to improve environmental health, and clinical waste management will be supported.

Thematic Classification: Human Development / Gender and Development

Target Classification: General Intervention

Rationale

Until recently, urban PHC has been a neglected subsector in Bangladesh as in most other South Asian countries. The urban population has been growing rapidly, mostly because of rural-urban migration by the poor and the vulnerable. The absolute number of poor urban households is increasing. Studies have shown that the health indicators of the urban poor are worse than those of the rural poor because of poorer living conditions, and limited PHC. Failure to provide urban PHC can have serious negative consequences beyond urban areas because infectious diseases can spread from urban to rural areas. Rapidly growing urban slums without adequate PHC may lead to epidemics of emerging or reermerging communicable diseases. Investments in other urban services such as water and sanitation, combined with the strengthening of health services, will improve the health and well-being of the urban poor. The Project will build on the gains of UPHCP-I, and strengthen the pro-poor focus, nutrition provision, and project implementation.

Objectives and Scope

The Project will improve the health status of the urban population, especially of the poor, in all the six city corporations and five municipalities to be identified. The Project will help ensure the delivery of a package of preventive, promotive, and curative health services. At least 30% of all the services provided under the Project will be targeted at the poor. The specific project objectives are to improve (i) access to and use of urban primary health care (PHC) services in the project area, with a particular focus on extending provision to the poorest; (ii) the quality of urban PHC services in the project area; and (iii) the cost-effectiveness, efficiency, and institutional and financial sustainability of PHC to meet the needs of the urban poor. The services will be designed to reduce child and maternal mortality and morbidity, and help the country achieve the Millennium Development Goals (MDGs). The Project will continue to contract out PHC services to nongovernment organizations (NGOs) through partnership agreements that were pioneered under the first Urban Primary Health Care Project (UPHCP-I). The Project will ensure pro-poor targeting by requiring that at least 30% of the preventive, promotive, and curative services provided are for the poor. Nutritional supplements will be given to moderately to severely malnourished women and children. The Project will support construction of 64 health facilities, upgrading of 4, and purchase of 12 apartments and/or buildings for PHC facilities in Dhaka city corporation. Community-run latrines and community-based solid-waste disposal will be piloted to improve environmental health, and clinical waste management will be supported.

Policy Dialogue

Environment Category: B

Environment Impact and Mitigation

Social Aspects and Remedies

More than 50% of the project population is from four main groups: (i) slum dwellers living legally in slums; (ii) squatters living illefally onland owned by others; (iii) floating populations with no fixed residence; and (iv) other urban poor living throughout urban areas, mixed with the nonpoor. The Project will target all the four groups through mini- or satellite clinics, outreach activities, and domiciliary services. both demand- and supply-side interventions will be used to target the poor. Large slums will have mini-clinics, which will be open in the evening to maximize their use by the poor.

Benefits and Beneficiaries

The Project will improve the health status of the poor in six city corporations and five municipalities by providing an essential package of high-impact services. By reducing child and maternal mortality, the Project will help Bangladesh achieve the MDGs for child mortality and maternal health. Women and children will constitute more than 75% of all project beneficiaries. The Project will improve the efficiency of urban health services by (i) improving the spatial distribution of health center, e.g. PHC centers,, comprehensive reproductive health care (CRHC) centers, and mini-clinics, in accordance with population density and geographical factors; (ii) supporting cost-effective interventions to reduce mortality and morbidity; (iii) enabling least-cost private sector participation in the provision of preventive and promotive health care services by partner NGOs; (iv) allowing appropriate user fees; (v) improving the monitoring and supervision system; and (v) concentrating on provision of health services that will create the greatest public good, to use scarce government resources more efficiently.

Public Consultation

Arranged by

Date for Consultation :

Groups Consulted :

Beneficiary Participation in Formulation

During project preparation, discussions were held with beneficiaries, health staff, and officials through field studies, meetings, and workshops. These provided information onhealth service availability, health-seeking behaviors, and financing during disease episodes.

Beneficiary Participation in Implementation

During implementation the beneficiaries will provide advice on helath services, health promotion activities, and access to the health services for the poor. They will also be consulted through focus groups during project evaluation.

Consulting Services

Consultants and consulting firms will be recruited under ADB's Guidelines on the Use of Consultants and other arrangements satisfactory to ADB for recruitment of local consultants. The consulting firms will provide (i) management support for the PMU and management training, (ii) quality assurance training and supportive supervision, (iii) health management information systems development and implementation, (iv) behavioral change communication and marketing, (v) financial management and performance auditing, (vi) project performance monitoring and evaluation, and (vii) design and supervisory engineering services for construction.

Procurement

Procurement of ADB-financed goods, related services, and civil works will be carried out in accordance with ADB's Guidelines for Procurement. Civil Works/Goods: The Project will construct 50 PHC centers and 14 comprehensive reproductive health care (CRHC) centers, and upgrade 4 PHC centers to CRHC centers. The Project will support the purchase of 12 apartments or buildings for PHC centers in Dhaka. The Project will support, on a pilot basis, the construction and initial operation in each partnership area of at least four community toilets blocks with bathing and urinal facilities. Partnership Agreements: The Project will continue to provide PHC services through performance-based contracting out of PHC services to NGOs. Two of the three partnership areas in Chittagong will be covered by the city corporation health department, while the remaining area will be contracted out to a partner NGO. It will use partnership agreements similar to those pioneered during UPHCP-I. The partner NGOs will provide essential services package plus (ESP+) services in the partnership agreement areas. These services will consist of (i) HIV/AIDS and STI control, (ii) other communicable disease control, (iii) other ESP services, and (iv) supplementary nutrition. The Project will finance 24 partnership agreements, each covering 200,000-300,000 people. Each partnership agreement area will consist of one CRHC center, at least one PHC center per 30,000-50,000 people, and at least one satellite or mini-clinic per 10,000 people. Satellite clinics will be operated from rented buildings in poor neighborhoods in the evening to cater to those who work during the day. PHC centers will provide a full range of essential services, including basic emergency obstetric care. The CRHC centers will provide comprehensive emergency obstetric care, newborn care, and specialized ESP+ services. The Project will support CRHC-center-based voluntary testing and counseling services for HIV/AIDS through grant financing.

Contacts

Bank

Sekhar Bonu
Senior Urban Development Specialist
SAUD
Tel. No.: (632) 632-6572
E-mail: sbonu@adb.org

Executing Agency
Local Government Division, Ministry of Local Government, Rural Development and Cooperation

Contact Person : Dr. Nurul Islam, Project Director UPHCP-I
Tel. No. : 880-2-9667791
Fax. No. : 880-2-9667791
E-mail :

Contact Person :
Tel. No. :
Fax. No. :
E-mail :

Remarks

Projects