fbpx 51141-002: Health Sector Development Program | Asian Development Bank

Bhutan: Health Sector Development Program

Sovereign (Public) Project | 51141-002 Status: Active

The proposed assistance will enhance Bhutan's health system's overall performance. The proposal is aligned with priorities in the National Health Policy of the Ministry of Health (MOH) and will support the implementation of the upcoming Twelfth Five-Year Plan (2018 -2022). The program is included in Asian Development Bank (ADB)''s Bhutan country operations business plan, 2016 -2018, and reinforces ADB's inclusive growth agenda in the Midterm Review of Strategy 2020.

Project Details

Project Officer
Tshewang Norbu South Asia Department Request for information
Country
  • Bhutan
Sector
  • Health
 
Project Name Health Sector Development Program
Project Number 51141-002
Country Bhutan
Project Status Active
Project Type / Modality of Assistance Grant
Technical Assistance
Source of Funding / Amount
Grant 0615-BHU: Health Sector Development Program
concessional ordinary capital resources lending / Asian Development Fund US$ 14.00 million
Grant 0616-BHU: Health Sector Development Program
concessional ordinary capital resources lending / Asian Development Fund US$ 6.00 million
TA 9606-BHU: Capacity Development of the Health Sector
Technical Assistance Special Fund US$ 500,000.00
Strategic Agendas Inclusive economic growth
Regional integration
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Partnerships
Sector / Subsector

Health / Disease control of communicable disease - Health care finance - Health system development

Gender Equity and Mainstreaming Effective gender mainstreaming
Description The proposed assistance will enhance Bhutan's health system's overall performance. The proposal is aligned with priorities in the National Health Policy of the Ministry of Health (MOH) and will support the implementation of the upcoming Twelfth Five-Year Plan (2018 -2022). The program is included in Asian Development Bank (ADB)''s Bhutan country operations business plan, 2016 -2018, and reinforces ADB's inclusive growth agenda in the Midterm Review of Strategy 2020.
Project Rationale and Linkage to Country/Regional Strategy

Bhutan has made significant investments in developing its health system from a low base and has achieved remarkable progress in key health outcomes over the past several decades. Average health indicators have vastly improved from among the poorest in the world to mostly achieving the Millennium Development Goals. Bhutan's total health expenditure is 3.8% of gross domestic product (GDP), which is predominantly government financed (approximately 75.0%). Coverage of health facilities is also extensive, with 96% of the population living within 3 hours' walk from the nearest health facility, which is a considerable feat of physical access given the challenges posed by the country's difficult terrain. Despite these impressive gains, however, there are significant challenges to further improve Bhutan's health sector performance, including emerging and resurging infectious diseases, persistent regional health disparities, and risks to sustainable health care financing.

Public health threats. Cross-border public health risks due to Bhutan's highly porous borders with India are significant but receive inadequate attention. There is a need to improve disease surveillance and response mechanisms, especially at major points of entry. Health security risks to this once-secluded landlocked country are also increasing because of direct air connectivity with large regional hubs and reliance on a broad range of expatriate workers. Bhutan's disease surveillance and reporting system the National Early Warning, Alert and Response Surveillance was introduced only in 2014 and needs improving on regularity, reliability, and quality of surveillance reporting by health facilities. The overall health care system also has limited capacity for outbreak response, lacking proper emergency and isolation rooms, quality and infection control systems, trained human resources, and coordination mechanisms.

Regional health disparities. There are wide district-level variations in service quality and coverage, and regional disparities in health outcomes. To close the disparities, health systems in periphery areas need to be improved for overall quality, efficiency, and appropriate availability of services. Strengthening primary health care, and defining and delivering an essential service package through its network of primary health clinics, is required to reduce overreliance on less cost-effective tertiary care, and thereby improve overall efficiency gains for the health system. To provide populations living in peripheral areas with closer referral access, and to decongest the national referral hospital in the capital, district and regional referral hospitals need to be improved for quality and efficiency in providing continuity of care. The need for solutions to address the critical shortage of human resources is a further challenge to improve health care quality and access especially in remote areas. With Bhutan experiencing rapid urbanization, there is also a need to improve basic health access for urban migrants.

Financial sustainability. Long-term sustainability of health care financing needs critical attention. With Bhutan's high economic growth, external assistance to the health sector is gradually phasing out. However, Bhutan is experiencing macroeconomic instability, with fiscal stresses and a large current account deficit (25% in 2013) related to hydro power debt service and construction imports. The government has tightened public spending to keep down the fiscal deficit, and relies heavily on foreign grants (mostly from India) to finance its expenditure. Correspondingly, government health expenditure as a percentage of GDP has declined over the years (5.6% in 2008 to 2.7% in 2013), while health care costs have been increasing, primarily due to the rise in noncommunicable diseases. With pressures on financial sustainability, there is a need to explore new strategic financing options and improved efficiency in Bhutan's health care financing. The Bhutan Health Trust Fund (BHTF), established with previous assistance from the ADB, is an innovative funding mechanism to sustainably finance recurrent costs of vaccines and essential drugs. However, the BHTF is still stabilizing after many years because of insufficient capital, investment strategy, and management capacity.

Impact

National health goals achieved

Self-reliance and sustainability in health service delivery achieved

Project Outcome
Description of Outcome Equitable access, efficiency, and financial sustainability of the health system improved
Progress Toward Outcome Numerous preparatory activities have been completed such as tendering process for works and goods. BHTF has finalized a report on his financial sustainability which is approved by BHTF's board. RGoB has allocated Nu. 500 million to strengthen BHTF's financial position.
Implementation Progress
Description of Project Outputs

Primary health services, especially in underserved areas, improved

Support for health sector financing enhanced

Disease surveillance and HIS enhanced

Status of Implementation Progress (Outputs, Activities, and Issues) Some of the procurement is under process such as: Procurement of cold chain and refrigerated van. Negotiaion for Bids for work packages of Dagana district (W-08) & Trashigang and Trashiyantse district (W-05) are completed and the works are awarded in August 2019. Works contract for Mongar district (W-04) was awarded in May 2019. BHSQA standard is being rolled out with women on priority list. Gender responsive design included in satellite clinics. Government allocated Nu.500 million to BHTF and delinked it from RCSC. e-Health strategy published. Executive order: MoH/PPD/PPMS-25/2018/972 dated 29 June 2018 constitutes the HIS governing body with ToR.
Geographical Location Nation-wide, Gelephu, Paro, Phuentsholing, Samdrup Jongkhar, Samtse, Thimphu
Safeguard Categories
Environment B
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects Environmental categorization is B. The construction and upgrading of facilities is not expected to have significant or irreversible negative environmental impacts either during construction or the operation phases. Construction impacts will be site-specific, and typical of small scale construction projects, and will be mitigated through implementation of the environmental management plan and as part of the civil works contract documents. The management of medical waste during the operations of facilities will follow applicable national laws and relevant provisions are incorporated into project design.
Involuntary Resettlement Involuntary resettlement category is C. New construction will be limited to establishing small urban satellite clinics (four in Thimphu, one in Phuentsholing) on existing government land. There will be no land acquisition, and no involuntary resettlement impact is expected. New construction will be limited to establishing five small urban clinics on vacant government land with no productive use. There will be neither physical nor economic displacement.
Indigenous Peoples Indigenous peoples category is C. The project has a geographic focus to strengthen disease surveillance and response capacities primarily in the southern belt bordering India, which will include Nepali-speaking monitories. There are no indigenous peoples in the project areas. The policy-based grant is also not anticipated to have social safeguards impacts.
Stakeholder Communication, Participation, and Consultation
During Project Design Primary stakeholders are the Ministry of Health, the Ministry of Finance, district health offices, civil society organizations, health workers, and project beneficiaries. During project preparatory TA, stakeholder consultations were held and their views and recommendations were incorporated when and where possible. The team will organize consultations and workshops with communities, nongovernment organizations, and other stakeholders when and as needed.
During Project Implementation The project management and policy support unit in the Policy and Planning Division of the Ministry of Health will take the lead in preparing annual reports in which the achievements will be summarized and posted on the website. These reports will also be disseminated to relevant monitoring and implementing committees, district administrators and municipalities, and relevant health facility staff. The Ministry of Health will be encouraged to actively reach out to communities living near the newly constructed satellite clinics to ensure that utilization of the new facilities is rapid and optimal.
Business Opportunities
Consulting Services For individual, 14 person-months (international) and 232 person-months (national). For the firm, 270 person-months (national).
Procurement 18 goods contracts (equipment, furniture, and vehicle) and 8 works contracts
Responsible ADB Officer Tshewang Norbu
Responsible ADB Department South Asia Department
Responsible ADB Division BHRM
Executing Agencies
Ministry of Health
PO Box 108, Kawangsa, Thimpu, Bhutan
Timetable
Concept Clearance 10 Aug 2017
Fact Finding 10 Apr 2018 to 19 Apr 2018
MRM 18 Jul 2018
Approval 05 Oct 2018
Last Review Mission -
Last PDS Update 10 Sep 2019

Grant 0615-BHU

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
05 Oct 2018 29 Nov 2018 19 Feb 2019 31 Aug 2023 - -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 35.22 Cumulative Contract Awards
ADB 14.00 05 Oct 2018 7.00 0.00 50%
Counterpart 21.22 Cumulative Disbursements
Cofinancing 0.00 05 Oct 2018 7.00 0.00 50%

Grant 0616-BHU

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
05 Oct 2018 29 Nov 2018 19 Feb 2019 28 Feb 2024 - -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 6.00 Cumulative Contract Awards
ADB 6.00 05 Oct 2018 1.08 0.00 18%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 05 Oct 2018 0.97 0.00 16%

TA 9606-BHU

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
05 Oct 2018 24 Oct 2018 24 Oct 2018 31 Aug 2020 - -
Financing Plan/TA Utilization Cumulative Disbursements
ADB Cofinancing Counterpart Total Date Amount
Gov Beneficiaries Project Sponsor Others
500,000.00 0.00 0.00 0.00 0.00 0.00 500,000.00 05 Oct 2018 32,527.34

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.

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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.


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Tenders

Tender Title Type Status Posting Date Deadline
Health Sector Development Program Individual - Consulting Closed 08 Sep 2019 14 Sep 2019
Health Sector Development Program Individual - Consulting Closed 08 Sep 2019 14 Sep 2019
Health Sector Development Program Individual - Consulting Closed 08 Sep 2019 14 Sep 2019
Health Sector Development Program Individual - Consulting Closed 08 Sep 2019 14 Sep 2019
Health Sector Development Program Individual - Consulting Closed 08 Sep 2019 14 Sep 2019
Health Sector Development Program - Web Design and Social Media Expert Individual - Consulting Closed 21 Aug 2019 13 Sep 2019
Health Sector Development Program - Finance and Investment Management Expert Individual - Consulting Closed 18 Jun 2019 24 Jun 2019
Health Sector Development Program - Fund Mobilization Expert Individual - Consulting Closed 31 May 2019 06 Jun 2019
Health Sector Development Program - Procurement Specialist Individual - Consulting Closed 17 May 2019 23 May 2019
Health Sector Development Program - Health Information System Expert Individual - Consulting Closed 08 Jan 2019 20 Jan 2019
Health Sector Development Program - Strengthening community-based structures to address under-5 nutrition (Firm) Firm - Consulting Closed 03 Jul 2018 29 Aug 2018
Health Sector Development Program - Community advocacy, Behavior Change Communication, and Gender based violence Firm - Consulting Closed 03 Jul 2018 29 Aug 2018
Health Sector Development Program - Health Care Quality Standard and Assurance Expert (Package no. S-04) Individual - Consulting Closed 20 Jun 2018 03 Jul 2018
Health Sector Development Program - Procurement Expert (Package no. S-03B) Individual - Consulting Closed 20 Jun 2018 03 Jul 2018
Health Sector Development Program - Financial Management Expert (Package no. S-03A) Individual - Consulting Closed 20 Jun 2018 03 Jul 2018
Health Sector Development Program - Behavior Change Communication Expert (Package no. S-03C) Individual - Consulting Closed 20 Jun 2018 03 Jul 2018

Contracts Awarded

No contracts awarded for this project were found

Procurement Plan

None currently available.