India : Supporting Strategic Interventions in the Health Sector Towards Achieving Universal Health Coverage

Project Name

Supporting Strategic Interventions in the Health Sector Towards Achieving Universal Health Coverage

Project Number

53355-001

Country / Economy

• India

Project Status

Closed

Project Type / Modality of Assistance

• Technical Assistance

Source of Funding / Amount

TA 9827-IND: Supporting Strategic Interventions in the Health Sector Towards Achieving Universal Health Coverage

Source	Amount
Technical Assistance Special Fund	US$ 225,000.00

Operational Priorities

• OP1: Addressing remaining poverty and reducing inequalities
• OP2: Accelerating progress in gender equality
• OP6: Strengthening governance and institutional capacity

Sector / Subsector

• Health / Health sector development and reform

Gender

Some gender elements

Description

The health sector in India is in a stage of transition. This presents both an opportunity and a challenge given the increasing demand for quality health services exacerbated by changing disease patterns. Health being under the state list of the constitution of India, the differential capabilities of the states to implement healthcare delivery becomes critical. Within this context and given our previous and continued engagement with the health sector, it is crucial that a strategic approach be adopted for expanding health sector engagement in India. This would draw upon the vision laid out in Strategy 2030 and align increased engagement identifying key areas of support including investment needs. It would also assess, document and support innovative practices, recognizing that India might need organic solutions developed which are scalable, yet draw from best practices.

Project Rationale and Linkage to Country/Regional Strategy

India is home to more than 1.3 billion people, the second highest in the world after China. In the health sector, India has made some improvements, notably maternal mortality ratio (MMR) has reduced by 77%, from 556 per 100,000 live births in 1990 to 130 per 100,000 live births in 2016, which is below the MDG targets. Similarly, Infant Mortality Rate has also declined to 34 per 1000 Live Births in 2016 and the Life expectancy at Birth has increased from 49.7 years in 197075 to 68.3 years in 201115. Nonetheless, several persisting issues remain. Communicable diseases continue to be a challenge and account for 27.5% of all deaths in India. TB burden is disproportionately high with more than a quarter (27%) of global TB burden from India. Furthermore, emerging and re-emerging zoonotic diseases, foodborne and waterborne diseases and diseases caused by multi-resistant organisms constitute as major threats. Antimicrobial resistance is fast becoming one of biggest health challenges, and in 2010, India recorded a staggering 12.9 billion units of antibiotic consumption, which was one of the highest consumption globally. Exacerbating the situation, India is facing changing disease pattern, where noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, respiratory, and other chronic diseases, account for over 60% of total mortality. The top three causes of death for all ages in 2017 are related to NCDs which includes ischemic heart disease, chronic obstructive pulmonary disease, and stroke. More striking, the percentage change from 2007 to 2017 of causes of deaths related to NCDs (including diabetes and chronic kidney disease) have increased by around 40% or more (except asthma with a 6.2% increase). In terms of health systems, out of total 155,069 sub-centers in rural India, 86% do not meet the Indian Public Health Standards set up by the government. Further, India has low density of health workforce; with density of physicians (7 per 10,000 population) and nurses (17.1 per 10,000 population) as against the global average of 13.9 and 28.6 respectively. To add to the complexity, interstate and regional differences in health system capacity affects implementation and access to care.

Impact

Universal Health Care (UHC) in India increased

Project Outcome

Description of Outcome

Priority areas for ADB intervention in India health sector identified

Progress Toward Outcome

Implementation Progress

Description of Project Outputs

Assessment of priority areas for improved UHC in India completed

ADB strategy for health sector in India developed

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

Activities have slowed down due to COVID 19 pandemic, but are expected to be completed in due course, as soon as the pandemic eases up.

Geographical Location

Nation-wide

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

The TA will engage five individual consultants amounting to 22 person-months (4 person-months international and 18 person-months national). ADB will engage the consultants following the ADB Procurement Policy (2017, as amended from time to time) and its associated project administration instructions.

Procurement

Not Applicable.

Contact

Responsible ADB Officer

Chen, Dai-Ling

Responsible ADB Department

South Asia Department

Responsible ADB Division

Human and Social Development Division, SARD

Executing Agencies

Ministry of Health and Family Welfare

Timetable

Concept Clearance

-

Fact Finding

-

MRM

-

Approval

17 Oct 2019

Last Review Mission

-

Last PDS Update

12 Aug 2022

Funding

TA 9827-IND