ADB is supporting a project in Bangladesh that expands and improves the delivery of urban primary health care services through public-private partnerships. The project will focus on increasing access of the poor, women, and children to health services. It will help local governments strengthen their policies on health issues and develop guidelines for managing private-public partnership contracts.
| Project Name | Urban Primary Health Care Services Delivery Project | ||||||||||||
| Project Number | 42177-013 | ||||||||||||
| Country | Bangladesh |
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| Project Status | Active | ||||||||||||
| Project Type / Modality of Assistance | Grant Loan Technical Assistance |
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| Source of Funding / Amount |
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| Strategic Agendas | Inclusive economic growth |
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| Drivers of Change | Governance and capacity development Partnerships Private sector development |
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| Sector / Subsector | Health - Health sector development and reform - Health system development |
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| Gender Equity and Mainstreaming | Gender equity | ||||||||||||
| 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 First Urban Primary Health Care Project (UPHCP-I) 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. A provision of $50 million has been made for the Bangladesh Urban Primary Health Care Services Delivery Project (UPHCSDP) in ADB's lending pipeline for 2012 in addition to $400,000 grant support for Supporting the Urban Primary Health Care Services Delivery Project in 2012. The UPHCSDP and the grant continue the provision of urban PHC, among others, through successful PPPs pioneered by UPHCP-I and II. With a density of 2,756 people per square kilometer (km2) in urban areas and 843 people per km2 overall, Bangladesh is the most densely populated country in the world (excluding a few city-states). 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. According to one estimate, by 2020 the urban poor figure could be as high as 40%-60% of the urban population. 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 - spread of communicable diseases, debilitating epidemics, reduction in economic productivity, among others. |
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| 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 | Improved health of the urban population, particularly the poor, women, and children | ||||||||||||
| Project Outcome | |
|---|---|
| Description of Outcome | Sustainable good quality urban PHC services are provided in the project areas and target the poor and the needs of women and children |
| Progress Toward Outcome | 24 PANGOs signed partnership agreements. CCC 5 PAs did not contract. Gopalgonj Municipal Health Department continues its services until project completion. 3 CRHCCs and 10 PHCCCs have been completed. Construction is ongoing for 7 CRHCCs and 10 PHCCs. 7 Maintenance works for CRHCCs and PHCCs are completed. |
| Implementation Progress | |
| Description of Project Outputs | 1. Strengthened institutional governance and local government capacity to sustainably deliver urban PHC services 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) | All major services are delivered free of cost to the red card holders. 7 CRHCCs and 13 PHCCCs have been completed. Construction is ongoing for 3 CRHCCs and 6 PHCCs. 7 Maintenance works for CRHCCs and PHCCs are completed. Indicators to be monitored by QA team and PPME firm. Quarterly progress reporting is being produced regularly. Urban Health Coordination Committee has been formed headed by Additional Secretary (Urban Development) Trainings on project management skills were completed in Nov. 2013. PPP contract management training pending. Present data collection format through HMIS need to improve to incorporate gender responsive data. To date, a total of BDT47.11 million has been deposited to the Urban Health Sustainability Fund. PMU recruitment process completed. However, at present, posts of Deputy Service Delivery and Program Officer (Preventive Health) at PMU; and Monitoring and Quality Assurance Officer at PIU are vacant. Accounting system has been computerized using Tally software. |
| Geographical Location | |
| Safeguard Categories | |
|---|---|
| Environment | B |
| Involuntary Resettlement | C |
| Indigenous Peoples | C |
| Summary of Environmental and Social Aspects | |
|---|---|
| Environmental Aspects | |
| Involuntary Resettlement | |
| 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 will be conducted as part of the feasibility study. The study will identify key project stakeholders and to plan the project activities. During project implementation, participatory processes will be 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 will be examined to improve accountability of the service providers and facilitate participation of service users in monitoring services. The communication, participation and consultation process will be done through a number of workshops, involving NGOs, CBOs and other stakeholders. |
| During Project Implementation | Ongoing consultations with primary and secondary stakeholders will continue during implementation. |
| Responsible ADB Officer | Chin, Brian |
| Responsible ADB Department | South Asia Department |
| Responsible ADB Division | Human and Social Development Division, SARD |
| Executing Agencies |
Local Govt Div,Min of Local Govt Rural Devt & Coop Bangladesh Secretariat Dhaka |
| Timetable | |
|---|---|
| Concept Clearance | 16 Nov 2012 |
| Fact Finding | 27 Feb 2012 to 08 Mar 2012 |
| MRM | 04 Apr 2012 |
| Approval | 18 Jul 2012 |
| Last Review Mission | - |
| Last PDS Update | 17 Mar 2017 |
Grant 0298-BAN
| Milestones | |||||
|---|---|---|---|---|---|
| Approval | Signing Date | Effectivity Date | Closing | ||
| Original | Revised | Actual | |||
| 18 Jul 2012 | 26 Sep 2012 | 03 Dec 2012 | 31 Dec 2017 | 30 Sep 2018 | - |
| Financing Plan | Grant Utilization | ||||
|---|---|---|---|---|---|
| Total (Amount in US$ million) | Date | ADB | Others | Net Percentage | |
| Project Cost | 20.00 | Cumulative Contract Awards | |||
| ADB | 0.00 | 18 Jul 2012 | 0.00 | 16.56 | 83% |
| Counterpart | 0.00 | Cumulative Disbursements | |||
| Cofinancing | 20.00 | 18 Jul 2012 | 0.00 | 14.59 | 73% |
| Status of Covenants | ||||||
|---|---|---|---|---|---|---|
| Category | Sector | Safeguards | Social | Financial | Economic | Others |
| Rating | - | - | - | Satisfactory | - | - |
Loan 2878-BAN
| Milestones | |||||
|---|---|---|---|---|---|
| Approval | Signing Date | Effectivity Date | Closing | ||
| Original | Revised | Actual | |||
| 18 Jul 2012 | 26 Sep 2012 | 03 Dec 2012 | 31 Dec 2017 | 30 Sep 2018 | - |
| Financing Plan | Loan Utilization | ||||
|---|---|---|---|---|---|
| Total (Amount in US$ million) | Date | ADB | Others | Net Percentage | |
| Project Cost | 61.00 | Cumulative Contract Awards | |||
| ADB | 50.00 | 18 Jul 2012 | 0.00 | 37.90 | 81% |
| Counterpart | 11.00 | Cumulative Disbursements | |||
| Cofinancing | 0.00 | 18 Jul 2012 | 0.00 | 34.94 | 74% |
| Status of Covenants | ||||||
|---|---|---|---|---|---|---|
| Category | Sector | Safeguards | Social | Financial | Economic | Others |
| Rating | - | - | - | Satisfactory | - | - |
TA 8118-BAN
| Milestones | |||||
|---|---|---|---|---|---|
| Approval | Signing Date | Effectivity Date | Closing | ||
| Original | Revised | Actual | |||
| 18 Jul 2012 | 02 Oct 2012 | 02 Oct 2012 | 31 Dec 2013 | 30 Jun 2014 | - |
| Financing Plan/TA Utilization | Cumulative Disbursements | |||||||
|---|---|---|---|---|---|---|---|---|
| ADB | Cofinancing | Counterpart | Total | Date | Amount | |||
| Gov | Beneficiaries | Project Sponsor | Others | |||||
| 400,000.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 400,000.00 | 18 Jul 2012 | 261,211.65 |
| Status of Covenants | ||||||
|---|---|---|---|---|---|---|
| Category | Sector | Safeguards | Social | Financial | Economic | Others |
| Rating | - | - | - | Satisfactory | - | - |
Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.
The Public Communications Policy (PCP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.
The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.
In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.
Safeguard Documents See also: Safeguards
Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.
| Title | Document Type | Document Date |
|---|---|---|
| Urban Primary Health Care Services Delivery Project | Environmental Assessment and Review Framework | Apr 2012 |
| Urban Primary Health Care Services Delivery Project | Resettlement Frameworks | Apr 2012 |
Evaluation Documents See also: Independent Evaluation
None currently available.
Related Publications
None currently available.
The Public Communications Policy (PCP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.
Requests for information may also be directed to the InfoUnit.
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Health Services for Bangladesh's Urban Poor
ADB, Sweden, and the United Nations Population Fund are supporting efforts to help urban local governments partner with non-governmental organizations and the private sector to deliver primary healthcare services in poor urban communities.