| Project Name |
Urban Primary Health Care Services Delivery Project |
| Project Number |
42177-013 |
| Country / Economy |
Bangladesh
|
| Project Status |
Active |
| Project Type / Modality of Assistance |
Grant
Loan
Technical Assistance
|
| Source of Funding / Amount |
| Grant 0298-BAN: Urban Primary Health Care Services Delivery Project |
|---|
| Government of Sweden |
US$ 20.00
million
|
| Loan 2878-BAN: Urban Primary Health Care Services Delivery Project |
|---|
| Asian Development Fund |
US$ 50.00
million
|
| TA 8118-BAN: Supporting the Urban Primary Health Care Services Delivery Project |
|---|
| Technical Assistance Special Fund |
US$ 400,000.00 |
| Grant 0607-BAN: Urban Primary Health Care Services Delivery Project - Additional Financing |
|---|
| Urban Climate Change Resilience Trust Fund under the Urban Financing Partnership Facility |
US$ 2.00
million
|
| Loan 3705-BAN: Urban Primary Health Care Services Delivery Project - Additional Financing |
|---|
| Concessional ordinary capital resources lending |
US$ 110.00
million
|
|
| Strategic Agendas |
Inclusive economic growth
|
| Drivers of Change |
Gender Equity and Mainstreaming
Governance and capacity development
Partnerships
Private sector development
|
| Sector / Subsector |
Health /
Health sector development and reform
-
Health system development |
| Gender |
Gender equity theme |
| Description |
The Asian Development Bank (ADB) supported Urban Primary Health Care Project (UPHCP) is one of the largest public-private partnerships (PPP) in the delivery of primary health care (PHC) in South Asia. The Government of Bangladesh with the assistance of ADB implemented the Urban Primary Health Care Project (UPHCP) from March 1998 to June 2005. The Second Urban Primary Health Care Project (UPHCP-II), supported by ADB and the Governments of the United Kingdom and Sweden, commenced in July 2005 and was completed in December 2012. The Third Urban Primary Health Care Services Delivery Project (UPHCSDP), supported by ADB and the Government of Sweden, commenced in 2012 and was completed in 2018. Currently, the Additional Financing to UPHCSDP-AF is being implemented and it will be completed in December 2024. Bangladesh is urbanizing at a rapid pace and the country's urban population is expected to reach 89.5 million (from 39.5 million in 2005) by 2030. Currently, around 40% of the country's total population is urban. Notwithstanding higher economic growth in urban areas, the absolute number of poor households is increasing in urban Bangladesh due to migration of rural poor into urban areas. Studies have shown that the health indicators of the urban poor are as worse as those of the rural poor because of poorer living conditions, and limited urban PHC. Failure to provide urban PHC can have serious negative externalities, e.g., spread of communicable diseases, debilitating epidemics, reduction in economic productivity, among others. |
| Project Rationale and Linkage to Country/Regional Strategy |
The Project builds on the gains of UPHCP-II by strengthening the pro-poor focus, nutrition provision aspects, reproductive health services, and project implementation; and expand the service provision to other backward areas of Bangladesh. By strengthening and mainstreaming the PPP model of service delivery, the Project encourages alternative ways of public services delivery and enables greater role for the private sector. Through its large focus on women's health, the Project enables greater gender equity. Therefore, UPHCSDP is closely aligned with Bangladesh's National Strategy for Accelerated Poverty Reduction-II and ADB's Country Partnership Strategy. ADB is one of the lead development partners of the Government of Bangladesh in the domain of urban development, which involves a multidimensional approach - economic (roads), public health (water supply), environmental health (sewerage, solid waste management), and primary health care. This holistic approach to urban development also includes transforming institutions to prepare Bangladesh for the rapid urbanization process. The Project is built on the rationale of synergies (blending prevention and promotion with critical PHC) and driving more effective ways of delivering services (through PPPs). The Project continues the momentum gained by Bangladesh towards achieving child, maternal health, and communicable diseases related Millennium Development Goals (MDGs). |
| Impact |
Health of the urban population, particularly the poor, women, and children improved Overall project: Health, nutrition, and family planning status of the urban population, particularly the poor, women, and children improved (National Urban Health Strategy, 2014) |
| Project Outcome |
|---|
| Description of Outcome |
Original project (2012-2018): Sustainable good quality urban PHC services are provided in the project areas and target the poor and the needs of women and children Overall project: Sustainable good quality urban PHC services in the project areas (particularly to the poor, women and children) provided |
| Progress Toward Outcome |
Urban PHC services are provided in 45 partnership areas and target the poor, women and children. 4 ULBs signed MOU for direct management of urban PHCs. LGD has made notable progress in institutional reform actions. Health emergency plan prepared and disseminated. |
| Implementation Progress |
|---|
| Description of Project Outputs |
1. Institutional governance and local government capacity to deliver urban PHC services sustainably strengthened 2. Improved accessibility, quality, and utilization of urban PHC services, with a focus on the poor, women, and children, through PPP 3. Effective support for decentralized project management |
| Status of Implementation Progress (Outputs, Activities, and Issues) |
1. Mostly achieved. LGD had given specific responsibilities to Urban Development Wing-1 with necessary staffs to support 'Urban Primary Health Care Services Delivery Project-Phase II . Out of the designed manpower structure of the unit, one Administrative Officer and One Sr. Asst Secretary have been posted. LGD has established primary health care budget line and allocated PHC budget to ULBs. ULBs have submitted organograms to LGD for HR requirement for PHC. All project ULBs have functioning health departments, only Chattogram CC health department is fully staffed. MOUs signed with 4 ULBs in 5 PAs. Gender-responsive data collection on-going. 2. Urban PHC services are provided in 45 partnership areas and target the poor, women and children. Construction of 3 CRHCCs and 6 PHCCs on-going. 3. PMU from the original project is in place and is headed by a full-time Project Director. Total 14 individual consultants have been recruited and mobilized. FMIS is in place and PAs are generating automated financial statement. |
| Geographical Location |
Nation-wide, Barisal, Comilla, Dhaka, Gazipura, Gopalganj, Khulna, Kishorganj, Kushtia, Narayanganj, Rajshahi, Rangpur, Sirajganj, Sylhet |
| Summary of Environmental and Social Aspects |
|---|
| Environmental Aspects |
The original project's compliance with the safeguard requirements has been satisfactory and risks have been well-managed. The project remains category B for environment, and will continue to construct new health care centers, improve existing facilities, and enhance climate change resilience and medical waste management. It is not expected to have significant or irreversible negative environmental impacts during construction or operation. Any environmental risks will be effectively addressed through proper mitigation measures with the updated environmental assessment and review framework that has been prepared and disclosed because land and sites for project civil works will be identified by the time implementation begins. |
| Involuntary Resettlement |
The project remains category C for both involuntary resettlement and tribes, minor races, ethnic sects, and community peoples. Noland acquisition will be involved because land required will be either government-owned or donated voluntarily. Existing project areas do not overlap with any areas inhabited by tribes, minor races, ethnic sects, and community peoples. The project will screen new health care center sites to ensure social safeguard impacts do not occur. |
| Indigenous Peoples |
|
| Stakeholder Communication, Participation, and Consultation |
|---|
| During Project Design |
Primary stakeholders include selected staff from the Ministry of Local Government, Rural Development, and Cooperatives; Ministry of Health and Family Welfare; project implementation units of the UPHCSDP; NGOs involved in the UPHCSDP; donor consortium; community-based organizations; representatives and officers of city corporations and municipalities; and representatives of the poor and of vulnerable groups. Stakeholders include relevant line ministries and other private providers of health services. A stakeholder analysis was conducted as part of the feasibility study. The study identified key project stakeholders and planned project activities. During project implementation, participatory processes were 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 and routine display of up-to-date public information about staffing, stock, facilities, and fee rates were examined to improve accountability of the service providers and facilitate participation of service users in monitoring services. The communication, participation and consultation process were done through a number of workshops, involving NGOs, CBOs and other stakeholders. |
| During Project Implementation |
Consultations with primary and secondary stakeholders were done during implementation. |
