Bangladesh: Urban Public and Environmental Health Sector Development Program (Program Loan)

Agriculture, natural resources and rural development - Agro-industry, marketing, and trade

Health - Health sector development and reform

Water and other urban infrastructure and services - Urban policy, institutional and capacity development - Urban solid waste management

Rapidly urbanizing Bangladesh has one of the highest population densities in the world. Crowded and poor hygienic living conditions have increased the vulnerability of urban poor people to economic shocks from ill-health. A burgeoning urban population is only going to make the situation for public and environmental health more challenging. Urban local bodies that are mandated to provide public and environmental health-related services have limited institutional and financial capacities. Nationally, the Local Government Division (LGD) of the Ministry of Local Government, Rural Development and Cooperatives (MOLGRDC) needs to take a stronger stewardship role in urban public and environmental health (UPEH). The Government of Bangladesh needs to make use of various instruments at its disposal such as regulations, taxation, information, and investments to address the growing challenges of UPEH with the help of the private sector and civil society.

A sector development program (SDP) will address a wide range of complex but interlinked UPEH challenges. The Asian Development Bank (ADB) in many ways is uniquely placed to help the Government address these daunting multidimensional challenges. The SDP builds on more than a decade of ADB's strong engagement in urban development in Bangladesh, and makes a concerted effort to mainstream valuable lessons learned and good practices which have evolved from ADB-supported projects, such as urban governance and infrastructure improvement projects and urban primary health care projects.

For the Project, all three consulting teams were mobilized and are now fully operational, supporting the Project Office: (i) Package A: Program Support Consultancy; (ii) Package B: Financial Management and Municipal Finance Consultant; and (iii) Package C: Design Supervision and Construction consultants. Three civil works packages on: (i) the Construction of Food Laboratories, Service Delivery and Supply of Equipment in Dhaka and Chittagong City Corporations, and Renovation of Food Laboratory Training Center in Dhaka City Corporation (Package 1); and (ii) the Construction of Secondary Transfer Stations (STSs) in seven City Corporations (Packages 2 and 3) have been awarded and ongoing. Tendering of Package 4-Construction of Controlled Landfill and Medical Waste Facility, Service Delivery and Supply of Equipment in Barisal, Rajshahi and Sylhet CCs and Construction of Medical Waste Facility in Dhaka City Corporation; and Package 5-Construction of Integrated Sanitary Landfill and Medical Facility, Service Delivery and Supply of Equipment in Khulna City Corporation have been cancelled. The Urban Development Wing under the Local Government Division was created in June 2013 and positions have been filled up.

For the Program, all three tranches were already released to the Government.

1. Strengthened institutional arrangements for urban public and environmental health (UPEH) in place (policy reform area 1)

2. Improved financial sustainability of urban public and environmental health interventions are operational (policy reform area 2 and project component C)

3. Improved public and environmental health service delivery are operational (policy reform area 3 and project components A and B)

4. Strengthened UPEH governance and management (policy reform area 4 and project component C)

1. UPEHU established. Core civil servant of UPEHU are supported from revenue budget - Ongoing. Formation of the NUPEHC is completed. Meeting of NUPEHC is an ongoing activity. City corporation health departments and city corporation conservancy departments have been initiated. Resources have been mobilized for two city corporations (Dhaka and Chittagong).

2. Collection of 2008 level of holding tax arrears increased by 25% - Achieved by six city corporations (Dhaka, Chittagong, Khulna, Rajshahi, Barisal and Sylhet). Updating of the city corporations' assessment of holding taxes is ongoing. Introduction of modernized and computerized financing management systems is an ongoing activity. Introduction of performance-based grant mechanism to all CCs done and adopted by the CCs. Operations Guidelines on Performance-Based Targeted Grant Mechanism for City Corporations circulated to CCs by LGD on 6 March 2014.

3. National waste reduce, reuse and recycle (3R) strategy and standards introduced and being implemented. Waste treatment facilities (landfill and compost) cancelled. Medical waste disposal facilities also cancelled. Inter-ministerial committee for food safety meets regularly. Model bylaws on Medical Waste Management for CCs have been finalized. LGD has approved this and sent to CCs to take necessary action for getting formal approval in the name of particular CCs. Five CCs (CCC, KCC, RCC, BCC and SCC) have already submitted the bylaws on medical waste management to LGD. Draft model bylaws on Food Safety for CCs has been prepared on the basis of Safe Food Act 2013 and sent to CCs. This will be finalized after finalizing the draft rules on safe food at the national level. All CCs have deposited an amount equivalent to 1% of their budget into their respective Urban Primary Health Care Sustainability Fund bank accounts.

4. In 2010, the Prime Minister's office issued Policy and Strategy Guidelines on Public-Private Partnership. Guidelines were circulated to all CCs for implementation. Guidelines for citizens participation in the delivery of UPEH services have also been circulated for implementation. All poor and very poor people in the city corporation areas have been provided with entitlement cards, done by the Urban Primary Health Care Service Delivery Project. Same has been done for Maternal and child health care.