The Asian Development Bank's (ADBs) engagement in the subsector since 1998 (through first and second Urban Primary Health Care Projects [UPHCP-I and UPHCP-II]) and Urban Public and Environmental Health Sector Development Program (UPEHSDP) indicate a high degree of prior experience in the subsector for ADB to support the proposed Urban Primary Health Care Sector Development Project (UPHCSDP). However, for the reasons listed below, a project preparatory technical assistance (PPTA) is certainly warranted. Primary health care subsector consists of a number of stakeholders. More than a dozen development partners support the primary health care in rural areas through the Ministry of Health and Family Welfare (MOHFW), while some of them support primary health care in urban areas under the Local Government Division (LGD) of the Ministry of Local Government, Rural Development and Cooperatives (MOLGRDC) in partnership with ADB (DFID, SIDA, UNFPA). The relationship between the MOHFW, which has the overall mandate for health policy and setting standards in urban areas) and urban local bodies who are mandated to deliver primary health care services in urban areas under the overall stewardship of LGD is complex. The positions of various stakeholders, and creating a synergy within the legal framework of the country is a major task for the proposed PPTA.
The proposed Project will continue to be executed under the tested and acknowledged public-private partnership (PPP) model. However, there is scope further fine tuning of the PPP model to enhance its effectiveness, improve the pro-poor targeting, reduce red tape and provide adequate flexibility to the private sector. However, accountability to results, mitigation of fiduciary risks, strengthening of financial management systems, strengthening the social safeguards, empowering the poor and adolescent girls, addressing emerging challenges including climate change, among others, would need further due diligence. The proposed Project has to absorb the lessons learnt, and build on the strengths of the past designs while effectively address the design flaws noticed during the implementation of UPHCP-II. Greater value for the money should be achieved through a better thought through design. Another challenge of the proposed Project will be to conclude the contracting-out of primary health care services to private sector in a timely, transparent and efficient manner. Bridging technical assistance support will be required for setting in more effective systems to track results, especially pro-poor targeting related. All the above mentioned reasons provide strong justification for the project preparatory technical assistance.
|Project Rationale and Linkage to Country/Regional Strategy
||The Government of Bangladesh approved the second National Strategy for Accelerated Poverty Reduction (NSAPR-II) in December 2009 covering the period FY09 to FY11. The NSAPR-II reaffirms the commitment that reducing poverty and accelerating the pace of inclusive growth are the priorities of the country including halving the poverty rate by 2015 and achieving substantial improvements in all aspects of human development consistent with the MDGs. The poverty reduction strategy framework of NSAPR II is based on multidimensionality of poverty and consists of five strategic blocks and five supportive strategies. The strategic blocks are: (i) macroeconomic environment for pro-poor growth; (ii) critical areas for pro-poor growth; (iii) essential infrastructure for pro-poor growth; (iv) social protection for the vulnerable; and (v) human development. The supporting strategies are (i) ensuring participation, social inclusion, and empowerment; (ii) promoting good governance; (iii) ensuring efficient delivery of public services; (iv) caring for environment and tackling climate change; and (v) enhancing productivity and efficiency through science and technology. The government has also taken a long term vision for the country?s development. The long term Perspective Plan (2011-2021) is under preparation by the government which would provide goals for the future and chart out the course of action to achieve the goals by 2021. The key targets based on Vision 2021 pertaining to the proposed project are reduction in the maternal mortality to 1.5%, raise the use of birth control methods to 80%, and bring down infant mortality to 15 per thousand live births by 2021; and eliminate all kinds of contagious diseases and increase life expectancy of citizens to 70 years by 2021. The proposed project is consistent with the country partnership strategy, which support continuation of the innovative public private partnership (PPP) for the delivery of urban primary health care, and considers the project as important contributor to the gender equity agenda of the Country Partnership Strategy (CPS).