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Sri Lanka: Health System Enhancement Project

Sovereign (Public) Project | 51107-002 Status: Active

The project will contribute to the government''s development objective to ensure a healthier nation by supporting the development of a more responsive and comprehensive primary health care (PHC) system in Sri Lanka. It will enhance planning and delivering of essential PHC to geographically and socioeconomically deprived populations of Central, North Central, Sabaragamuwa, and Uva provinces. The project will (i) inform and operationalize government PHC reform initiatives, (ii) improve underserved communities'' access to primary health services, and (iii) address selected gaps in core public health capacities in line with the International Health Regulations (IHR).

Project Details

Project Officer
Jayasundara, Herathbanda South Asia Department Request for information
Country
  • Sri Lanka
Sector
  • Health
 
Project Name Health System Enhancement Project
Project Number 51107-002
Country Sri Lanka
Project Status Active
Project Type / Modality of Assistance Grant
Loan
Source of Funding / Amount
Grant 0618-SRI: Health System Enhancement Project
concessional ordinary capital resources lending / Asian Development Fund US$ 12.50 million
Loan 3727-SRI: Health System Enhancement Project
concessional ordinary capital resources lending / Asian Development Fund US$ 37.50 million
Strategic Agendas Environmentally sustainable growth
Inclusive economic growth
Regional integration
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Knowledge solutions
Partnerships
Sector / Subsector

Health / Disease control of communicable disease - Health sector development and reform

Gender Equity and Mainstreaming Effective gender mainstreaming
Description The project will contribute to the government''s development objective to ensure a healthier nation by supporting the development of a more responsive and comprehensive primary health care (PHC) system in Sri Lanka. It will enhance planning and delivering of essential PHC to geographically and socioeconomically deprived populations of Central, North Central, Sabaragamuwa, and Uva provinces. The project will (i) inform and operationalize government PHC reform initiatives, (ii) improve underserved communities'' access to primary health services, and (iii) address selected gaps in core public health capacities in line with the International Health Regulations (IHR).
Project Rationale and Linkage to Country/Regional Strategy

Sri Lanka has made impressive gains in ensuring access and quality to health services for all. Life expectancy at birth increased to 75 years in 2015 from 70 in 1990. Maternal mortality reduced from 75 to 30 per 100,000 live births and infant mortality from 17.9 to 8.0 per 1,000 live births during the same period. Sri Lanka has achieved these efficiently with low overall health spending at 3.0% of gross domestic product (GDP). Most vaccine preventable diseases are at near elimination stage with immunization coverage at about 99%. Sri Lanka has been polio-free since 1994, and malaria- and filariasis-free since 2016.

While Sri Lanka has benefited greatly from improvements in health outcomes during the Millennium Development Goals period (1990 to 2015), it is facing new health challenges related to population aging, changing disease pattern, economic and social changes, and changing lifestyles. These dynamics have resulted in a dramatic increase in noncommunicable diseases (NCDs), which are causing a surge in demand for health services and an increase in health care costs while reemerging and emerging communicable diseases remain a threat. Disparities in health outcomes, health-seeking behavior, life expectancy, and disease burden remain in lagging geographic areas especially in rural and estate sector populations, e.g., malnutrition in mothers and children is a persistent health issue and more acutely seen in the estate sector. The country is now more exposed to communicable diseases because of increased labor mobility and connectivity. Sustaining control of vaccine preventable diseases, malaria elimination efforts, and containment of global diseases will require continuous investments in the prevention and control of communicable diseases and disease surveillance in Sri Lanka.

Primary health care delivery system. The public PHC system in Sri Lanka has been instrumental in providing universal comprehensive care at no cost to the population at the point of service delivery. One of the most characteristic features of the system is preventive health care services focusing on communicable diseases control and maternal and child care. The system covers 341 geographic areas, each with a population of about 80,000. Each area is managed by a medical officer of health and served by 5 -10 field health centers with midwives, public health inspectors, and preventive health care staff. In parallel, there is an extensive network of curative services in three tiers of care (955 PHC hospitals and dispensaries, and 149 secondary and tertiary health care hospitals). The government health sector provides as much as 90% of inpatient care, nearly 100% of preventive care, and 50% of outpatient care. At present, the health system planning, policy, and stewardship functions are centrally managed while management of primary and most secondary health care services is decentralized to provincial governments.

Constraints. Since 1990, changing health challenges and population aging led to secondary and tertiary health care services being prioritized for investments at the expense of investments for primary curative and preventive care services. Deterioration of PHC facilities led to bypassing of primary curative care services for secondary and tertiary care for most health problems faced by the population. For example, secondary and tertiary health care today manage as much as 93% of childbirths, 75% of NCD patients, and 50% of outpatient services. On the preventive side, the medical officers of health continue to provide antenatal care, nutrition, and immunization services. However, the quality of services decreased because of lower investments (about 4.5% of public health spending), inadequate staffing, and other resource constraints. Expanded outreach and interventions for populations living in vulnerable and lagging areas are also hampered. Preventive health care services are limited to mothers and children and village environments. There is a need to expand the target group to include the total population (children, youth, adult men and women, and elderly) and expand coverage of NCDs.

Government initiatives. The Government of Sri Lanka is reprioritizing PHC in line with its national health policy and strategic master plan. Sector reforms aim to establish a more responsive, patient-centered, and person-focused health care system. The system will enable health seekers to access a comprehensive package of essential health services including financial risk protection. The government's most recent policy on rational health care delivery for universal health coverage provides the guiding framework to reform the existing PHC system.

The government is committed to develop a more comprehensive, accessible, and higher-quality PHC package to strengthen PHC services, reduce bypassing, and reach vulnerable groups. It is also committed to implement e-health to strengthen evidence-based health services. This includes scaling up the introduction of a patient e-health card, connecting health services for referral and better patient care, and improving information on diseases and health-seeking behavior using a geographical information system (GIS). The system will be linked to disease surveillance for national health security. To comply with International Health Regulations standards, the government aims to strengthen the health assessment of migrants and quarantine services at ports of entry (POEs). In support of efforts to strengthen PHC and the digital health information system, policy developments are in preparation for the essential services package, health human resources, family medicine, facility norms, and testing innovative approaches to strengthen PHC. Capacity building will also be implemented in management, e-health, quarantine and health security, procurement, accounting, gender, nutrition, and health care waste management.

Value added by ADB assistance. Asian Development Bank (ADB) assistance brings value by (i) supporting equity-focused health care delivery reform especially in lagging and rural areas such as the plantation and estate sectors; (ii) adopting evidence-based planning based on GIS mapping and vulnerability index to identify and target underserved districts and populations; (iii) enhancing infrastructure design to address climate change and disaster risk resilience; (iv) scaling up e-health card and its integration with the government's web-based health information system to improve continuity of care and disease surveillance; (iv) supporting GIS units in central and district planning departments to improve disease surveillance and monitor health-seeking behavior; (v) institutionalizing distance learning for training PHC staff; and (vi) helping districts develop and implement innovative solutions to integrate and improve PHC services.

Link to national development strategy and ADB sector priority. The project aligns with the government''s priorities identified in the Public Investment Programme, 2017 -2020 and Vision 2025, and with the United Nation's Sustainable Development Goal 3 on universal health coverage. The project is in line with ADB''s country partnership strategy, 2018 -2022 for Sri Lanka and paves the way for a long-term programmatic approach consistent with ADB''s health operations plan.

ADB experience and lessons learned. The project is ADB''s reentry to the health sector in Sri Lanka after a gap of about 20 years. The prior project and other recently completed and ongoing ADB-financed projects in the social sectors have been implemented successfully. These past experiences and the project preparation process indicate strong commitment by the government at the national and regional levels. The leadership provided by the Ministry of Health, Nutrition and Indigenous Medicine (MOHNIM) and the four provincial administrations during the project preparation stage is expected to continue into project implementation.

Development coordination. MOHNIM convened the donor coordination committee to ensure collaboration with and among development partners. The World Health Organization (WHO) has a leading role in policy development and sector coordination. The project will collaborate with WHO in terms of technical assistance to support selected areas related to the essential services package, health system strengthening, human resource development, and health security. The project also intends to work with the United Nations Children's Fund (UNICEF) and the World Food Programme on nutrition, as well as the International Organization for Migration on migrant issues. ADB''s support will be coordinated with the World Bank program support to strengthen PHC, and regular discussions are held to prevent duplication of efforts and to synergize on the results and outcomes.

Impact A healthier nation is ensured with a more comprehensive PHC system
Project Outcome
Description of Outcome Efficiency, equity, and responsiveness of the PHC system improved
Progress Toward Outcome

Outpatient utilization (for each female and male) at PHC facilities (PMCUs and district hospitals) reported as 64.4% as per the AHB 2017. Data disaggregated by age, sex, place of residence, district, and province is not available in the AHB-2017. Sex-disaggregated data to be collected in baseline survey. The M&E firm was recruited and preparing for the baseline survey at present.

Regarding the cluster implementation, the cluster development plans, prepared, and approved. Implementation is going on. The three implementation support consultants are fully engaged in implementation activities.

Implementation Progress
Description of Project Outputs

Primary health care enhanced in Central, North Central, Sabaragamuwa, and Uva provinces

Health information and disease surveillance capacity strengthened

Policy development, capacity building, and project management supported

Status of Implementation Progress (Outputs, Activities, and Issues)

1. Primary health care enhanced

-38 civil works contracts were awarded, and 5 contracts went for re-bidding.

D&S consultants have started designs for 90 facilities in the 9 districts and will be completed in Q2, 2020.

- Cluster support consultants recruited and fully on engaged in cluster implementation.

- The recruitment of consultancy firm to support for community empowerment and capacity building for improving the nutrition status of mothers and children under 5 years in 9 districts is in progress.

Gender consultant selection is in progress

- Gender consultant selection is in progress. Recruitment of behavior change, and community mobilization consultancy firm is in progress.

2. Health information and disease surveillance capacity strengthened

- Recruitment of HIT consultant firm to design and develop electronic patient information sharing system across clusters facilities is in progress

- Recruitment of GIS consultant completed and commenced work to develop notifiable disease surveillance information via an electronic system sent to medial officers in target provinces

- Supporting activities are in progress for core capacities to carry out quarantine services with a score of at least 4 in joint external evaluation report 2021 increased in the eight ports of entry in Sri Lanka

3. Policy development, capacity building, and project management supported

- ESP, PHC HRM, operational policy consultants recruited, and work commenced, GIS consultant completed and commenced work.

Gender consultant recruitment is in progress to develop operational policies and guidelines with gender dimensions for delivering a comprehensive package of PHC.

- Gender consultancy hiring in

progress to train at least 25% of PHC staff from PMCUs, divisional hospitals and medical officer of health areas in target provinces on family medicine. Training and objectives are finalized

- Gender consultant recruitment is in progress for 11 units of FHB integrated gender dimensions in policies and strategic plans.

- Gender consultant recruitment is in progress to train at least 25% of medical officers and other staff of PMCUs and divisional hospitals in target provinces. Training and objectives are finalized.

Geographical Location Central Province, North Central Province, Province of Sabaragamuwa, Province of Uva
Safeguard Categories
Environment B
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects

The project is classified as Category B for environment in accordance with ADB's Safeguards Policy Statement (2009).

Adverse environmental consequences of the project will be largely restricted to component 1 under which support will be provided to existing PHC facilities to upgrade 30% (135) of its primary medical care infrastructure facilities and small-scale repairs to field health centers. The nature of construction envisaged will be small-scale, simple and straightforward, mostly restricted to expansion of the outpatient departments for primary medical care facilities and repairs and refurbishment to field health centers.

Involuntary Resettlement The project is classified as C for IR based on the screening and assessment of qualitative sample survey of 29 of 135 sites. Selected PMCUs and DHs in the nine districts will be supported via infrastructure upgrades and provision of equipment. Land acquisition and resettlement is not triggered as all civil works are aligned to reconstruction on existing centers which are owed by the Government of Sri Lanka.
Indigenous Peoples The project is classified as C for IP based on ADB's guidelines. The due diligence confirms classification of C categorization for IP impacts. Screening and assessment outlined in the due diligence report show no impacts on the Indigenous Vedda population (the only IP group in the country) in both the Uva and North Central provinces (project areas with habitats).
Stakeholder Communication, Participation, and Consultation
During Project Design The Ministry of Health, Nutrition and Indigenous Medicine (MOHNIM) is the primary stakeholder together with the provincial directorates of health services in the provinces of Uva, Central, Sabaragamuwa, and North Central. Based on the ADB public communication policy and ADB safeguard policy statement, the project assisted the executing agency to prepare a stakeholder communication strategy.
During Project Implementation Stakeholder feedbacks are encouraged in stakeholder meetings, hospital civil society meetings and during review activities. Patient satisfaction surveys routinely carried out in health care institutions will be utilized to obtain feedbacks from project beneficiaries. Stakeholders will have communication access through ADB website and project website which will serve as the main information sharing channel. Direct communication with PMU and PIU is also possible for public and other stake holders.
Business Opportunities
Consulting Services A design and supervision consultant for all civil works to be carried out under the project will be engaged using the quality- and cost-based selection (QCBS) method with a standard quality cost ratio of 90:10. All consulting services will be engaged in accordance with the ADB Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time).
Procurement All procurement of goods, works, nonconsulting and consulting services for the proposed Project will be carried out in accordance with the ADB Procurement Policy and Procurement Regulations for ADB Borrowers (2017, as amended from time to time). Procurement items include civil works, medical equipment, computers, and vehicles.
Responsible ADB Officer Jayasundara, Herathbanda
Responsible ADB Department South Asia Department
Responsible ADB Division Sri Lanka Resident Mission
Executing Agencies
Ministry of Health & Indigenous Medical Services
[email protected]
Suwasiripaya, No.385, Rev.Baddegama
Wimalawansa Thero Mawatha
Timetable
Concept Clearance 05 Oct 2017
Fact Finding 23 Apr 2018 to 04 May 2018
MRM 07 Aug 2018
Approval 23 Oct 2018
Last Review Mission -
Last PDS Update 20 Mar 2020

Grant 0618-SRI

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
23 Oct 2018 26 Oct 2018 05 Feb 2019 31 May 2024 - -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 22.50 Cumulative Contract Awards
ADB 12.50 23 Oct 2018 1.95 0.00 16%
Counterpart 10.00 Cumulative Disbursements
Cofinancing 0.00 23 Oct 2018 6.71 0.00 54%

Loan 3727-SRI

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
23 Oct 2018 26 Oct 2018 05 Feb 2019 31 May 2024 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 37.50 Cumulative Contract Awards
ADB 37.50 23 Oct 2018 6.98 0.00 19%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 23 Oct 2018 13.72 0.00 37%

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 Access to Information Policy (AIP) 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.

Evaluation Documents See also: Independent Evaluation

None currently available.

Related Publications

None currently available.


The Access to Information Policy (AIP) 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.

Tenders

Tender Title Type Status Posting Date Deadline
Consultant for Project Implementation Impact on Gender Individual - Consulting Closed 08 Mar 2020 23 Mar 2020
Social Safeguards Specialist Individual - Consulting Closed 23 Feb 2020 10 Mar 2020
Financial Management Specialist Individual - Consulting Closed 26 Jan 2020 10 Feb 2020
Legal Expert for Quarantine Unit Individual - Consulting Closed 21 Jan 2020 03 Feb 2020
DESIGNING AND IMPLEMENTING A HEALTH INFORMATION SYSTEM SOLUTION IN 9 DISTRICT HEALTH FACILITY CLUSTERS IN SRI LANKA Firm - Consulting Closed 05 Jan 2020 05 Feb 2020
PROVISION OF SUPPORT FOR COMMUNITY EMPOWERMENT AND CAPACITY BUILDING FOR IMPROVING THE NUTRITION STATUS OF MOTHERS AND CHILDREN UNDER 5 YEARS IN 9 DISTRICTS COVERING THE ESTATE AND RURAL SECTORS Firm - Consulting Closed 01 Dec 2019 02 Jan 2020
BEHAVIOUR CHANGE AND COMMUNITY MOBILIZATION FOR INCREASING PRIMARY HEALTH CARE UTILIZATION Firm - Consulting Closed 01 Dec 2019 02 Jan 2020
3727 SRI: Health System Enhancement Project (HSEP/PMU//PRO/G 1/04/2018 ) Invitation for Bids Closed 13 Nov 2019 10 Dec 2019
GIS Expert to establish GIS based health planning and monitoring in 9 Districts in Sri Lanka Individual - Consulting Closed 10 Nov 2019 25 Nov 2019
Distance Education Consultant Individual - Consulting Closed 27 Oct 2019 11 Nov 2019
Consultant to support establishment and implementation of Clusters Individual - Consulting Closed 22 Sep 2019 07 Oct 2019
Support Development of Essential Service Package (ESP) within Clusters Individual - Consulting Closed 08 Sep 2019 23 Sep 2019
Consultant for Develop Primary Health Care (PHC) Human Resources for Health (HRH) plan for Cluster Work Force Plan Individual - Consulting Closed 01 Sep 2019 16 Sep 2019
Procurement of Environment Specialist Individual - Consulting Closed 07 Jul 2019 22 Jul 2019
Health System Enhancement Project (Project Engineer) Individual - Consulting Closed 16 May 2019 22 May 2019
Health Care Waste Management Consultant Individual - Consulting Closed 15 Mar 2019 25 Mar 2019
Gender and Social Safeguards Specialist Individual - Consulting Closed 14 Mar 2019 25 Mar 2019
Financial Management Specialist Individual - Consulting Closed 13 Mar 2019 25 Mar 2019
Health Advocacy Communications Expert Individual - Consulting Closed 16 Feb 2019 08 Mar 2019
Information Technology Specialist for Epidemiology Unit Individual - Consulting Closed 13 Feb 2019 08 Mar 2019
Legal Expert for Quarantine Unit Individual - Consulting Closed 13 Feb 2019 08 Mar 2019
Environment Specialist Individual - Consulting Closed 13 Feb 2019 08 Mar 2019
Consulting Service for Monitoring and Evaluation of the Health System Enhancement Project Firm - Consulting Closed 13 Dec 2018 10 Jan 2019
Design and Supervision of Construction/Renovation/ Upgradation /Refurbishment of PMCUs, Divisional Hospitals including MOHNIM Outreach Facilities in the Central, North Central, Sabaragamuwa and Uva Firm - Consulting Closed 05 Sep 2018 04 Nov 2018
51107-SRI: Health System Enhancement Project Advance Notice Active 22 Aug 2018

Contracts Awarded

Contract Title Approval Number Contract Date Contractor Contractor Address Executing Agency Contract Description Total Contract Amount (US$) Contract Amount Financed by ADB (US$)
DESIGN AND SUPERVISION CONSULTANCY FIRM FOR INFRASTRUCTURE DEVELOPMENT (S-01) Loan 3727 06 Dec 2019 RESOURCES DEVELOPMENT CONSULTANTS LTD 55/2-1, GALLE ROAD, COLOMBO 3 SRI LANKA Ministry of Health,Nutrition & Indigenous Medicine CONSULTANCY 1,768,272.63 1,768,272.63

Procurement Plan