2. Almost 62.5% of the population in India does not have access to any form of health protection. The government is unable to cover the full spectrum of health-care needs because of low public investment in health, limited human resources, and inadequate health infrastructure, which increase the out-of-pocket (OOP) expenditure and the financial burden of care. The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. A recent study estimated that 55 million Indians, or about 4.6% of the population, were pushed below the poverty line in 2011 12 because of catastrophic OOP expenditures on health care. Of this, approximately 38 million became poor only because they had to purchase medicines through OOP payments. Around 68% of the Indian population have limited or no access to essential medicines. Another study estimated that 8% of the Indian population had been pushed below the poverty line by high OOP payments for health care in 2014 -15.
| Project Name | Supporting National Health Authority | ||||
| Project Number | 53285-001 | ||||
| Country | India |
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| Project Status | Active | ||||
| Project Type / Modality of Assistance | 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 Knowledge solutions Private sector development |
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| Sector / Subsector | Health / Health care finance |
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| Gender Equity and Mainstreaming | No gender elements | ||||
| Description | 2. Almost 62.5% of the population in India does not have access to any form of health protection. The government is unable to cover the full spectrum of health-care needs because of low public investment in health, limited human resources, and inadequate health infrastructure, which increase the out-of-pocket (OOP) expenditure and the financial burden of care. The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. A recent study estimated that 55 million Indians, or about 4.6% of the population, were pushed below the poverty line in 2011 12 because of catastrophic OOP expenditures on health care. Of this, approximately 38 million became poor only because they had to purchase medicines through OOP payments. Around 68% of the Indian population have limited or no access to essential medicines. Another study estimated that 8% of the Indian population had been pushed below the poverty line by high OOP payments for health care in 2014 -15. Non-communicable diseases like cancer, heart diseases, and diabetes account for the largest chunk of spending by households on health. Financial protection mechanisms are needed to reduce the OOP expenditure particularly for population groups at risk. | ||||
| Project Rationale and Linkage to Country/Regional Strategy | To address the above challenges in a holistic way, in 2018, the gGovernment of India, in 2018, launched its flagship health care program, Ayushman Bharat Yojana (Scheme for Healthy India). It has two components to provide comprehensive and universal access to good health care services viz. (i) creation of health and wellness centrers for comprehensive primary health care,; and (ii) the formulation of a Prime Minister's Jan Aadhar Yojana Pradhan Mantri Jan Arogya Yojana (PM-JAY), or the Prime Minister's Health Protection Scheme, providing health insurance for secondary and tertiary health care. | ||||
| Impact | Access to universal healthcare and social protection, particularly for the poor and the vulnerable across India improved | ||||
| Project Outcome | |
|---|---|
| Description of Outcome | Strengthened process and institutional arrangements, and institutional framework for providing refinancing window to health service providers partnering with NHA for PM-JAY implementation |
| Progress Toward Outcome | Activities carried out under various outputs contribute to the outcome. This includes estimating current healthcare access gaps in secondary and tertiary care across India, overview of healthcare PPPs in India, key learnings from PPPs in healthcare globally and other sectors in India, and designing healthcare system and facility models required for solving unmet need. Work is ongoing on key guiding principles of the PPP model concession framework, and on designing and implementation arrangements for a health financing intermediary. |
| Implementation Progress | |
| Description of Project Outputs | Diagnostic appraisal of infrastructure gaps in secondary and tertiary health service provision and institutional arrangements completed and plan of actions recommended Design and implementation arrangements for a health financing intermediary completed Financial products and financial intermediation structures for expanding health financing window through a health financing intermediary developed Institutional capacity development plans developed and advisory support for PM-JAY |
| Status of Implementation Progress (Outputs, Activities, and Issues) | A coordination specialist was mobilized to provide (i) policy level implementation support to NHA and other concerned agencies; and (ii) implementation level support to delivery of program outcomes at national, state, district, and sub-district levels to participating agencies. The finance specialist was engaged to (i) provide design and implementation arrangements for a health financing intermediary, and (ii) propose financial products and financial intermediation structures for expanding health financing window through a health financial intermediary. The health infrastructure specialist was engaged to undertake a diagnostics of infrastructure gaps in provision of secondary and tertiary health services and identify critical constraints. |
| Geographical Location | Delhi |
| 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 | ADB will engage consultants through a competitive selection process on an output-based (lumpsum) or input-based basis following ADB's Technical Assistance Disbursement Handbook (2010, as amended from time to time). The consultants will be engaged by ADB in accordance with ADB's Procurement Policy (2017, as amended from time to time) and its associated project administration instructions and/or staff instructions. |
| Procurement | Not applicable |
| Responsible ADB Officer | Kumar, Utsav |
| Responsible ADB Department | South Asia Department |
| Responsible ADB Division | Public Management, Financial Sector and Trade Division, SARD |
| Timetable | |
|---|---|
| Concept Clearance | - |
| Fact Finding | 21 Jun 2019 to 21 Jun 2019 |
| MRM | - |
| Approval | 23 Oct 2019 |
| Last Review Mission | - |
| Last PDS Update | 16 Dec 2020 |
TA 9831-IND
| Milestones | |||||
|---|---|---|---|---|---|
| Approval | Signing Date | Effectivity Date | Closing | ||
| Original | Revised | Actual | |||
| 23 Oct 2019 | - | 23 Oct 2019 | 31 Dec 2020 | 30 Jun 2021 | - |
| Financing Plan/TA Utilization | Cumulative Disbursements | |||||||
|---|---|---|---|---|---|---|---|---|
| ADB | Cofinancing | Counterpart | Total | Date | Amount | |||
| Gov | Beneficiaries | Project Sponsor | Others | |||||
| 225,000.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 225,000.00 | 23 Oct 2019 | 123,493.08 |
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Tenders
| Tender Title | Type | Status | Posting Date | Deadline |
|---|---|---|---|---|
| Supporting National Health Authority (Health Infrastructure Specialist) | Individual - Consulting | Closed | 21 Mar 2020 | 27 Mar 2020 |
| Supporting National Health Authority (Financial Specialist) | Individual - Consulting | Closed | 18 Jan 2020 | 24 Jan 2020 |
| Supporting National Health Authority (Health Infrastructure Specialist) | Individual - Consulting | Closed | 18 Jan 2020 | 24 Jan 2020 |
| Supporting National Health Authority | Individual - Consulting | Closed | 22 Nov 2019 | 28 Nov 2019 |
Contracts Awarded
No contracts awarded for this project were found
Procurement Plan
None currently available.