fbpx 53121-001: Strengthening Comprehensive Primary Health Care in Urban Areas Program under Pradhan Mantri Atmanirbhar Swasth Bharat Yojana | Asian Development Bank

India: Strengthening Comprehensive Primary Health Care in Urban Areas Program under Pradhan Mantri Atmanirbhar Swasth Bharat Yojana

Sovereign (Public) Project | 53121-001 Status: Active

The proposed results-based lending will support the government in improving equitable access to comprehensive primary health care in urban areas. The government prioritizes the comprehensive primary health care as a strategy to achieve continuum of health care and resilient health systems to the COVID-19 pandemic and future health emergencies. The program outcome will be achieved through (i) expanding the number and range of primary health care services, especially noncommunicable diseases, infectious disease surveillance, and specialist services; (ii) strengthening community outreach services for easier access to health care services as well as improved health seeking behaviors among the urban poor and the vulnerable; and (iii) strengthening urban health system capacity for comprehensive, quality primary health care. The program aims to increase the number of functional health and wellness centers to cater 256 million urban dwellers including 51 million urban slum dwellers in 13 states.

Project Details

Project Officer
Khetrapal, Sonalini South Asia Department Request for information
Country
  • India
Sector
  • Health
 
Project Name Strengthening Comprehensive Primary Health Care in Urban Areas Program under Pradhan Mantri Atmanirbhar Swasth Bharat Yojana
Project Number 53121-001
Country India
Project Status Active
Project Type / Modality of Assistance Loan
Technical Assistance
Source of Funding / Amount
Loan 4032-IND: Strengthening Comprehensive Primary Health Care in Urban Areas Program under Pradhan Mantri Atmanirbhar Swasth Bharat Yojana
Ordinary capital resources US$ 300.00 million
TA 6658-IND: Strengthening Capacity for Comprehensive Primary Health Care in Urban Areas
Japan Fund for Poverty Reduction US$ 2.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Knowledge solutions
Partnerships
Private sector development
Sector / Subsector

Health / Health system development

Gender Equity and Mainstreaming Gender equity
Description The proposed results-based lending will support the government in improving equitable access to comprehensive primary health care in urban areas. The government prioritizes the comprehensive primary health care as a strategy to achieve continuum of health care and resilient health systems to the COVID-19 pandemic and future health emergencies. The program outcome will be achieved through (i) expanding the number and range of primary health care services, especially noncommunicable diseases, infectious disease surveillance, and specialist services; (ii) strengthening community outreach services for easier access to health care services as well as improved health seeking behaviors among the urban poor and the vulnerable; and (iii) strengthening urban health system capacity for comprehensive, quality primary health care. The program aims to increase the number of functional health and wellness centers to cater 256 million urban dwellers including 51 million urban slum dwellers in 13 states. The program is aligned with the government's Ayushman Bharat (Healthy India) as well as Pradhan Mantri Atmanirbhar Swasth Bharat Yojana (Epidemic / Disaster Preparedness and Response) programs.
Project Rationale and Linkage to Country/Regional Strategy

Between 1990 and 2017, India has seen substantial improvements in basic health indicators: life expectancy increased by 8.9 years to 67.8 for men and by 9.8 years to 70.2 for women. Maternal deaths per 100,000 live births declined from 408 to 160 in the same period. The greatest achievement has been the reduction of under-five mortality from 111 to 42 deaths per 1,000 live births. Tuberculosis (TB) declined by 29% and malaria incidence by 76%. Despite these achievements, India is facing a double burden of disease: persistent communicable and emerging infectious diseases, and rising NCDs. India accounts for 27% of TB and 4% of malaria cases in the world, and also has the third largest number of people living with HIV. India also faces the spread of vector-borne diseases such as dengue and chikungunya. For COVID-19, India has reported over 8.2 million confirmed cases, second largest after the United States as of 2 November 2020. Despite the countrywide lockdown for over 50 days from 25 March 2020 and increased testing capacity (over 1.16 million samples per day) to detect and isolate cases, COVID-19 cases are still increasing at an alarming rate. In addition, demographic transition due to increased life expectancy and changing lifestyles from rapid urbanization have led to a rise in NCDs. Cardiovascular diseases, respiratory diseases, and diabetes are major NCDs in India that kill around 4 million Indians annually, and most of these deaths are premature. This epidemiological transition leads to the incremental number of NCD patients with disabilities, which poses a heavy financial burden on not only the health system but also on affected households. Given the ongoing COVID-19 pandemic, those with underlying conditions, particularly NCDs, are also at increased risk of mortality during hospitalization.

In 2018, 461 million or one-third of the total Indian population were living in cities, which is the second largest urban population in the world. The urban population is growing rapidly, and by 2050 will reach 877 million-almost two-thirds of the total Indian population. Urban populations grew faster than most cities' capacity to provide basic social services for all. Despite the common perception of easier access to health services in urban areas due to the large presence of private sector providers, health indicators of the urban poor are often comparable to or worse than those of the rural population. Full immunization among children aged 12-23 months is 57.7% for the urban poor compared to 61.3% for rural population. Anemic children are 62.7% among the urban poor compared to 59.5% in rural population. Most urban poor women do not seek preventive health measures: among urban poor women aged 15-49 years, only 20% have undergone cervical examinations; 9.3% have undergone breast examinations; and 10.3% have had oral cavity examinations. The NCD burden is higher in urban areas, and the urban poor are particularly vulnerable to communicable and vector-borne diseases due to congested and poor living and health conditions. The risk of COVID-19 spread is 1.09 times higher in urban areas and 1.89 times higher in urban slums compared to rural areas based on the results of the first sero-survey conducted nationwide. More than one-third (35%) of all COVID-19 cases in India are concentrated in 20 cities or districts.

However, the large number of urban poor cannot access these services due to financial constraints or out-of-pocket expenditures when they do access these services. Drugs and diagnostics services make up 75% of out-of-pocket expenditures, which could be avoided if services were availed of in public health facilities. The national health insurance scheme for the poor and vulnerable, Pradhan Mantri Jan Arogya Yojana, significantly increased financial access to health services. However, it is limited to secondary and tertiary care, which treat more severe conditions that require specialized knowledge and more intensive health monitoring. The public sector is also far less expensive and caters to the more vulnerable population groups. In addition to costs of health services, especially from the private sector, the poor and vulnerable population's access to primary health care in urban areas is hampered by poor quality of available services, their poor health-seeking behaviors, lack of information and awareness of health care options, constraints such as working hours, mobility, and other physical and social barriers. Women's access to primary health care is inadequate due to lack of empowerment and financial barriers: 63% of married women cannot take decisions related to their own health; and only 57% of women in urban areas can freely visit a health facility alone. Further, limited availability of female doctors (17% of doctors) hinder women from seeking care.

To address the large gaps in urban primary health care, especially for the poor and vulnerable populations, the government launched the National Urban Health Mission (NUHM) in 2013, as a sub-mission of the National Health Mission (NHM). By 2019, NUHM had established over 4,500 functional urban primary health centers (UPHCs) across India, significantly improving urban population's access to maternal and child health care and implemented key mechanisms for urban health system governance and management. UPHCs have also played a crucial role in the COVID-19 response through surveillance, contact tracing, and test referrals. Overall, primary health care in India prioritizes a narrow range of services such as reproductive and child health services and selected communicable diseases. Currently, even a well-functioning primary health center provides a limited range of services that caters to less than 15% of all morbidities for which people seek health care. For other morbidities, people resort to local private care providers, distant and crowded district hospitals, or government medical college hospitals. Investment in primary health care is cost-effective and can reduce overall health costs. The public sector has also collaborated with the private sector in selected aspects of primary health care delivery such as contracting-in of specialist services, mobile medical units for improved outreach, biomedical waste management, etc. More recently, to further strengthen private sector engagement, some states have contracted out entire management and service provision of primary health service centers to the private sector, usually nonprofit entities. The UPHCs need further improvement in infrastructure, human resources, and availability of diagnostics and drugs. Outreach services also face challenges from high attrition of community health workers, inadequate community organizations, unreached pockets of vulnerable populations, and poor health-seeking behavior of the urban poor. Gaps in the health system become even more apparent during the pandemic, where significantly underfunded and patchy public health systems, coupled with large variations in quality and service delivery across states, pose challenges for India's disease containment strategy.

Impact Impact the RBL Program is Aligned with
Project Outcome
Description of Outcome Equitable access to quality comprehensive primary health care services in urban areas improved in 13 states
Progress Toward Outcome
Implementation Progress
Description of Project Outputs

Comprehensive primary health care services in urban areas strengthened

Support for improved health-seeking behavior increased

Health systems strengthened

Status of Implementation Progress (Outputs, Activities, and Issues)
Geographical Location Andhra Pradesh, Assam, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, Tamil Nadu, Telangana, West Bengal
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
During Project Implementation
Business Opportunities
Consulting Services Selection of consultants for Comprehensive Primary Health Care using country system
Procurement Procurement of drugs, consumables, furniture, equipment for Health and Wellness Centers using country system
Responsible ADB Officer Khetrapal, Sonalini
Responsible ADB Department South Asia Department
Responsible ADB Division Human and Social Development Division, SARD
Executing Agencies
Ministry of Health and Family Welfare
150 A Nirman Bhawan
New Delhi - 110 011
India
Timetable
Concept Clearance 22 Jun 2020
Fact Finding 17 Aug 2020 to 28 Sep 2020
MRM 04 Nov 2020
Approval 08 Dec 2020
Last Review Mission -
Last PDS Update 08 Jan 2021

Loan 4032-IND

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
08 Dec 2020 - - 31 Mar 2025 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 1,128.86 Cumulative Contract Awards
ADB 300.00 08 Dec 2020 0.00 0.00 0%
Counterpart 828.86 Cumulative Disbursements
Cofinancing 0.00 08 Dec 2020 0.00 0.00 0%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating Unsatisfactory Unsatisfactory Satisfactory - - Unsatisfactory

TA 6658-IND

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
08 Dec 2020 31 Dec 2020 31 Dec 2020 31 Dec 2023 - -
Financing Plan/TA Utilization Cumulative Disbursements
ADB Cofinancing Counterpart Total Date Amount
Gov Beneficiaries Project Sponsor Others
0.00 2,000,000.00 0.00 0.00 0.00 0.00 2,000,000.00 08 Dec 2020 0.00
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating Unsatisfactory Unsatisfactory Satisfactory - - Unsatisfactory

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Related Publications

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Tenders

Tender Title Type Status Posting Date Deadline
Monitoring and Evaluation Specialist Individual - Consulting Closed 28 Apr 2021 04 May 2021
Program Planning and Monitoring Specialist Individual - Consulting Closed 28 Apr 2021 04 May 2021
Program Coordinator Individual - Consulting Closed 28 Apr 2021 04 May 2021
Health Services Quality Assurance Specialist Individual - Consulting Closed 28 Apr 2021 04 May 2021
Financial Management Specialist Individual - Consulting Closed 28 Apr 2021 04 May 2021

Contracts Awarded

No contracts awarded for this project were found

Procurement Plan

None currently available.