India: Supporting Health Systems Strengthening Projects

Health / Disease control of communicable disease - Health system development

India is one of the fast-growing large economies and its growth averaged over 6.7% between 2015 and 2019. However, the coronavirus disease (COVID-19) pandemic hit the Indian economy hard. The economy faced its worse ever contraction in fiscal year (FY) 2020 since World War II, contracting at 7.3% in FY2020. Economic activity will continue to remain below the pre-pandemic level despite a strong rebound of 10.0% in FY2021 and 7.5% in FY2022. The government has significantly widened the fiscal deficit to fight the pandemic and support economic and social recovery. Fiscal deficit was revised up to 9.5% (FY2020-2021) amid falling revenue and increased expenditure, from budgeted 4.6% of gross domestic product made last year (FY2019-2020). India has reported over 32.4 million confirmed cases, second largest after the United States as of 22 August 2021. India faced a devastating second wave starting March 2021 and was reporting more the 400,000 COVID-19 positive cases daily for 4 consecutive days and peaked on 7 May 2021 with a record high of 414,188 new COVID-19 cases. Despite the containment measures and increased testing capacity (over 2.2 million samples per day) to detect and isolate cases, COVID-19 threat of impending third wave looms high. Its negative mental and physical health impacts, especially on vulnerable population groups such as urban migrant population and old persons, will require longer-term health system responses.

ADB has been a key partner in supporting pandemic response and health system strengthening efforts. ADB's country partnership strategy, 2018-2022 supports expansion of public health service delivery in urban areas with a focus on the poor and vulnerable. In December 2020, the ADB Board approved a $300 million loan to strengthen and improve access to comprehensive primary health care in urban areas in India under PM-ASBY. In addition to the loan, a $2 million technical assistance (TA) grant from ADB's Japan Fund for Poverty Reduction will support for program implementation and coordination, capacity building, and innovation. This support builds on ADB's previous support to urban health system strengthening under NHM amounting to $300 million. ADB was a key partner in supporting COVID-19 response efforts through a COVID-19 Pandemic Response Option with a loan of $1.5 billion. ADB also extended a $3 million grant to support strengthening of points of entry and enhance disease surveillance under the Asia Pacific Disaster Response Fund. In July 2021, ADB approved a TA to strengthen availability of oxygen supplies and vaccine deployment amount to $7 million, primarily in response to the second wave. ADB is in ongoing discussions with the government to support vaccine procurement efforts under the Asia Pacific Vaccine Access Facility with a support of $1.5 billion.

The government has appreciated the design and implementation of ADB's prior TA, which provided strategic technical inputs through resource persons and expert consultants. Two key lessons emanated from the previous TA implementation. First, it is important to enhance the capacity of executing and implementing agencies in ensuring quality project design, effective project implementation, and overall portfolio performance. ADB support can add value in terms of sharing lessons across projects, introducing innovative approaches, strategic planning, and implementation support in selected states. Second, ADB is in a strategic position to provide integrated and coordinated technical inputs to enhance multisectoral engagement, in line with the vision laid out in ADB strategy 2030 and in complete alignment with government COVID-19 response which adopts the whole of government approach to strengthen response. ADB can promote synergy, effective implementation, expanded private sector participation, and enhanced relevance and quality of health services, all of which will lead to the outcome of a stronger and healthy workforce to support national economic goals.