|Project Name||Universal Health Coverage for Inclusive Growth: Supporting the Implementation of the Operational Plan for Health, 2015–2020|
|Country / Economy||Regional
|Project Type / Modality of Assistance||Technical Assistance
|Source of Funding / Amount||
|Strategic Agendas||Inclusive economic growth
|Drivers of Change||Gender Equity and Mainstreaming
Governance and capacity development
Private sector development
|Sector / Subsector||
Health / Health sector development and reform
|Gender||Effective gender mainstreaming|
The TA aligns with the UN General Assembly resolution in December 2012 that urges governments to move towards providing all people with access to affordable, quality health care services, and aims for (outcome) increasing the number of developing member countries (DMC) pursuing universal health coverage (UHC) by 2020 through three main outputs: (1) analysis of knowledge gaps and key challenges in building up health systems to achieve and sustain UHC undertaken, (2) knowledge on designing, implementing and scaling up UHC interventions disseminated; and (3) investment opportunities for projects supporting the UHC identified.
|Project Rationale and Linkage to Country/Regional Strategy||
Poor health remains an obstacle to full participation in economic growth for populations throughout Asia and the Pacific. In response, ADB''s DMCs have committed to improving health outcomes and pursuing UHC which means that quality health services are available to all those in need without undue financial hardship. Commitments for UHC demand for innovative approaches to manage health care in new ways, more effectively, with better quality and for lower cost. UHC also requires increased investments in the supply and demand of health services, including investments in health infrastructure, and health financing.
Against this backdrop, the core strategic focus of ADB's Operational Plan for Health (OPH) 2015-2020 is to support countries in achieving UHC. This is in line with ADB's Mideterm review of Strategy 2020 recommendations to support inclusiveness and to reduce vulnerabilities in Asia Pacific through increasing health sector operations from the current 1%2% to 3%5% of the total portfolio in the remaining period of Strategy 2020. To this end there is a need to develop business lines for investment opportunities to partner with countries in developing responsive and effective health systems that promote inclusion, and good use of public and private resources. This includes building knowledge and lines of investment that support countries with different levels of income. As described in the OPH, ADB's strategic health sector focus lies in three areas needed for pursuing UHC: hard and soft infrastructure for health services delivery (hospitals, clinics, human resources for health, management systems); health governance (accreditation, regulation, and regional public goods); and health financing (insurance, private sector, and public budgets).
The three strategic focus areas are further underpinned by four business lines that respond strongly to existing and anticipated demand from DMCs namely a.) infrastructure for health services delivery, b.) health financing and insurance, c.) elderly care, and d.) information technology.
In these business lines, flagship programs will be developed based on ADB's past and existing health sector operational experience that will help to demonstrate ADB's strength in the health sector and that can be used to share best practices and knowledge from sector operations.
Impact the project is aligned with:
Governments to move towards providing all people with access to affordable, quality health-care services; countries, civil society and international organizations to include universal health coverage in the international development agenda (UN Resolution on Universal Health Coverage, December 2012)
|Description of Outcome||
DMCs pursuing Universal Health Coverage increased
|Progress Toward Outcome||In 2018, commitments for $515.85 million in 13 sovereign/non-sovereign health loans/grants (2.39% of 2018 commitments) were made. Most of these projects supported universal health care (UHC) efforts of developing member countries (DMCs) including the two non-sovereign projects. With regards to board approvals, of $796.05m of health loans and grants in 14 sovereign and non-sovereign projects. These include four sovereign projects totaling $195.6m leveraged by regional health security set asides worth $52.83m. The achieved committed share in 2018 meant that the sector is approaching or on track to meet its 2020 target of 3%5%. In 2019, 8 projects supporting UHC efforts are planned for board approval. With regards to health being part of country partnerships strategies (CPS) and country operations business plans (COBPs), at least 15 DMCs have now included health in their CPS and COBPs.|
|Description of Project Outputs||
1. Analysis of knowledge gaps and key challenges in building up health systems to achieve and sustain UHC undertaken
2. Knowledge on designing, implementing and scaling up UHC interventions disseminated
3. Investment opportunities for projects supporting the UHC identified
|Status of Implementation Progress (Outputs, Activities, and Issues)||
Output 1: Analysis of knowledge gaps and key challenges in building up health systems to achieve and sustain UHC undertaken.
Currently, 15 Country Partnership Strategies (CPS) developed since 2016 includes health as part of their planned support DMCs.
Currently, the paper on Overcoming public sector inefficiencies towards Universal Health Coverage (UHC): The case for National Health Insurance systems in Asia and the Pacific has been published, the review of urban health in India and Bangladesh is being completed, the papers on Projecting Health Service Requirements for Developing Member Countries: A Preliminary Regional Study, and Contracting with Healthcare Providers: The Latin American Experience are being completed.. The papers on urban health and UHC, Non-communicable diseases, and third burden of diseases are being finalized. Initial drafts of papers on health human resources (with focus on addressing elderly care needs), quality health infrastructure, and harnessing the private sector for UHC will be started by 2019.
Output 2: Knowledge on designing, implementing and scaling UHC interventions
In addition to the meetings that has been previously reported, the RETA co-organized a Savings Live Sustainably (Health and Climate Change meeting) last June 2018, the Innovations and Actions Against NCDs meeting in July 2018, a Digital Inter-operability event in October 2018 and an Experts Meeting on Forward-looking or Smart Hospitals in April 2018. It also supported a UHC panel in the G20 innovation meeting held last January 2019. Previous meetings that had been supported were an annual bi-regional workshops on health financing for UHC in 2016/17/18, the National Health Insurance for UHC Forum in 2016, the Urban Health and Universal Health Coverage (UHC) meeting took place in 2017, the Emergency Risk management in Urban Settings: What should the primary health care providers do in Jan 2018, a panel in the World Urban Forum in February 2018.
A digital health inter-operability laboratory has been established and currently based in ADB-HQ. Thirty-one (31) IT experts had been trained by the MEDIC lab or MED)C lab-trained experts. Three DMCs have being supported by SIL-A with regards to mainstreaming digital health interventions in UHC strategies and engagement with another 8 DMCs are being explored and finalized. An additional financing of $500,000 from EAKPF is being processed to support the continued support by SIL-A for these eleven DMCs.
Work on developing a marketplace for public health solutions from private health companies will commence by 2019. Meetings on information management and NHI, and health PPPs are being planned in 2019/2020.
Output 3: Investment opportunities for projects supporting the UHC identified.
Support the identification of investment projects for UHC, including investments in NHI, urban health, hospital systems, and health PPPs is ongoing through knowledge products and events that support the identification and preparation of health projects. This include the: 1) Khyber Pakhtunkhwa - Planning for Physical & Human Resources; 2) Actuarial Model for Supply and Demand Side Interventions in the Khyber Pakhtunkhwa Health Sector; 3) Financial Management Assessment: A rapid assessment of the financial management of the National Health Insurance scheme of Lao PDR; 4) Khyber Pakhtunkhwa Short Health Sector Assessment; 5) Notes on Private Sector Engagement for UHC in ADB DMCs. It also supported the conduct of the following regional and country-level UHC-related policy dialogues: 1) Prince Mahidol Awards Conference (PMAC) 2017: Vulnerable Population for an Inclusive Society, ADB side session: 21st century SMART Hospitals for Universal Health Coverage and Inclusive Growth, 29 Jan 2017, Bangkok; 2) Priority setting meeting for Health Financing and UHC in the Philippines, 12 February 2016, ADB HQ; 3) Universal Health Coverage: Perspectives, 2 March 2016, ADB HQ; 4) Joint ADB DOH PHIC Strategic Planning Organizational Meeting, 11 April 2016, ADB HQ; 5) Roundtable Discussion on the Health Thematic Paper: AmBisyon 2040, 5 May 2016; 6) International Symposium on Universal Health Coverage 2016, 13-14 June 2016, Lao PDR; 7) Fourth Global Symposium on Health Systems Research, 14-18 November 2018, Vancouver; 8) To UHC and Beyond, 12 December 2016; 9) Access to Quality Healthcare: Aspirations in the Philippines and Switzerland, 21 March 2017, ADB HQ; 10) 1st Annual Meeting of the Asian Joint Network of Senior Budget and Health Officials on Fiscal Sustainability of Health Systems, 15-16 May 2017; 11) Forum on the Philippine Health Agenda, 18 May 2017, ADB HQ; 12) Consultation-Meeting on Non-Communicable Disease (NCD) interventions, 7 April 2017; 13) In Search of the Perfect Health System, 9 Nov 2017; 14) Asia Pacific Health Observatory and Universal Health Coverage Meeting, 29 Nov- 1 Dec 2017, Fiji; 15) UHC Forum: Sustaining Universal Health Coverage, 12-15 December, Tokyo; 16) PMAC 2018: World Bank-DFAT-US CDC-ADB-WHO side session: Building sustainable financing and resilient systems for health security, 29 Jan 2018, Bangkok; 17) Myanmar Study Visit, ADB-HQ, 26 April 2018; 18) Hospitals Chief Executive Officers' Forum, ADB HQ, 19 July 2018; 19) Digital Health Enterprise Architecture workshop, 6 August 2018; 20) Digital Health (HL7 FHIR-DHIS2) workshop, 46 September 2018; and 21) SILA Blockchain workshop, 2628 September 2018.
|Summary of Environmental and Social Aspects|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design||The assistance was conceptualized based on the perceived needs of the DMCs, feedback and inputs from the regional departments and a rapid desk review of the health systems of these DMCs. The studies on health financing, budget advocacy and social health insurance were discussed with WHO-HQ. The Western Pacific region office of WHO (WPRO) provided inputs on ehealth and health financing while the United Nations Childrens Fund provided inputs on social health insurance. Asia-Pacific Observatory of which ADB is a member organization provided inputs on hospital systems and health financing. No DMC governments or nongovernment organizations had been formally consulted for this TA.|
|During Project Implementation||The TA has been implemented in consultation with DMC government officials from the Ministry of Health and other ministries. They included health officials from Armenia, Bhutan, Pakistan, Tuvalu, Lao PDR, the Philippines, Indonesia, Fiji, Kazakhstan, Viet Nam, Sri Lanka, Mongolia, India, and Myanmar. Health sector stakeholders have also been consulted in the TA implementation. They included managers of government health centers and government and private hospitals, health staff in the said health facilities, and government and private health insurance officials. Consultations were also done with digital health practitioners particularly the members of Asia's e-health network or AeHIN. Consultations were will done with academic institutions, think tanks and consulting firms who are involved in the health sector. This includes Thailand's International Health Policy Program and the United Nations University of Malaysia. The TA implementation is done in close coordination with the operational departments of ADB and the social and thematic group secretariats in the Sustainable Development and Climate Change Department. Coordination is also regularly done with WHO, JICA and other international development partners particularly with their respective country office staff.|
|Consulting Services||In relation to an approved increase in TA amount from the PRC Fund last August 2016, additional consultants will be / were engaged to support eHealth (or use of information and communication technology in health) component into the TA. All consultancy posts will be / were advertised via CSRN.|
|Responsible ADB Officer||Liu, Rui|
|Responsible ADB Department||Sustainable Development and Climate Change Department|
|Responsible ADB Division||Health Sector Group|
Asian Development Bank
|Concept Clearance||30 Jun 2015|
|Fact Finding||06 Jul 2015 to 23 Jul 2015|
|Approval||30 Oct 2015|
|Last Review Mission||-|
|Last PDS Update||28 Mar 2019|
|Approval||Signing Date||Effectivity Date||Closing|
|30 Oct 2015||-||30 Oct 2015||31 Dec 2020||30 Sep 2021||18 Apr 2022|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|2,300,000.00||1,000,000.00||0.00||0.00||0.00||0.00||3,300,000.00||11 Aug 2022||2,816,936.88|