India : Supporting Universal Health Coverage for Mizoram Program

Project Name

Supporting Universal Health Coverage for Mizoram Program

Project Number

57007-001

Country / Economy

• India

Project Status

Proposed

Project Type / Modality of Assistance

• Loan

Source of Funding / Amount

Loan: Supporting Universal Health Coverage for Mizoram

Source	Amount
Ordinary capital resources	US$ 108.00 million

Operational Priorities

• OP1: Addressing remaining poverty and reducing inequalities
• OP2: Accelerating progress in gender equality
• OP3: Tackling climate change, building climate and disaster resilience, and enhancing environmental sustainability
• OP6: Strengthening governance and institutional capacity

Sector / Subsector

• Health / Health care finance - Health insurance and subsidized health programs - Health sector development and reform - Health system development

Gender

Gender equity theme

Description

India's economy grew by 7.8% in fiscal year (FY) 2024 and is projected to grow by 6.8% in FY2025, making it one of the world's best performing economies with moderate debt sustainability risk. Although India is growing rapidly, its government healthcare spending as a share of gross domestic product remains less than 1.4%. This has led to the high out-of-pocket expenditure (OOPE) on health in India, which is currently around 47% of total health expenditure and more than 80% as a percentage of total private health expenditure. High OOPE has brought significant negative socioeconomic and health impacts to the poor and vulnerable population, especially women and socially excluded minorities, and it has been the leading reason of their foregone healthcare.

The State of Mizoram is in the northeast region of India. It has a projected population of over 1,380,000 in 2023 and the schedule tribe population is dominant (94.4%). Mizoram has difficult terrain that creates physical mobility constraints which severely hinder the availability of essential goods and services including medical services. The geographic feature of Mizoram makes its population highly concentrated in few valleys and plains, which makes it one of the most urbanized states in India (52.1% population resides in urban areas). Mizoram only connects to the India mainland through few interstate highways in north and its only domestic airport near Aizawl. Despite these constraints, Mizoram is one of the fastest growing states of India. A remarkable economic growth of around 12.2% was observed in FY2023 due to the speedy recovery from the coronavirus disease (COVID-19) pandemic and the increased government investment in infrastructure. The per capita gross state domestic product of Mizoram is

175,986 in FY2023, above per capita of gross domestic product of India of

123,144.

Project Rationale and Linkage to Country/Regional Strategy

Mizoram has observed a mixed performance of key health outcomes since 2000s. The life expectancy of male and female in Mizoram is 68.3 years and 73.8 years, close to the national average of India. The infant mortality rate and under-five mortality rate in Mizoram have decreased from 34 and 53 infants per 1,000 live births in 2005 to 21 and 24 children per 1,000 live births in 2020. Institutional births in the state have also increased from 59.8% to 85.8% during the same period. On noncommunicable diseases (NCDs), Mizoram has the highest incidence rate of cancer in India, which is mainly due to its distinct culture of tobacco use, lifestyle, and dietary preferences. Cardiovascular diseases account for 16.0% of total deaths. The incidence of NCDs shows gender disparities, with men having higher cancer incidence, while women have higher incidence of diabetes, asthma and heart diseases. The incremental prevalence of NCDs and cancer has led to the increased use of secondary and tertiary care (i.e., specialist care and treatments that require hospitalization and surgery). This, in turn, caused a severe financial burden for households and existing government health financing schemes.

Mizoram is highly vulnerable to natural hazards, such as flooding, cyclones, and landslides. Additionally, changes in the temporal and spatial distribution of rainfall and temperature have been observed across the various districts. The long-term trend for average annual temperature shows an increase. Temperatures are likely to increase further and are projected to rise to 1.8

C to 2.1

C with respect to the 1970 temperature ranges. Climate variabilities can lead to higher incidences of vector-borne diseases, increase in water-borne diseases from degradation of water quality, more cases of respiratory diseases due to air pollution as well as mental health conditions due to stress. Climate change impacts women's health disproportionally as they are more affected by vector and water borne diseases and have to take care of the ill within the family due to these diseases.

Impact

Quality of life for the people of Mizoram improved by attaining the highest level of physical, mental, and spiritual health

Outcome

Equitable access to affordable and quality health care services increased

Outputs

An integrated health financing protection program, MUHCS, with expanded coverage of beneficiaries implemented

Geographical Location

Mizoram

Safeguard Categories

Environment

C

Involuntary Resettlement

C

Indigenous Peoples

B

Summary of Environmental and Social Aspects

Environmental Aspects

The environmental safeguard category is expected to be C, as the civil works will not be considered within the program boundary and eligible expenditure of the RBL. The proposed RBL program will exclude activities, if any, under the government program that are assessed as likely to have significant adverse impacts that are sensitive, diverse, or unprecedented on the environment and/or affected people, and activities in the Safeguard Policy Statements prohibited investment activities list.

Involuntary Resettlement

The involuntary resettlement category is expected to be C, as the civil works will not be considered within the program boundary and eligible expenditure of the RBL.

Indigenous Peoples

Mizoram has a high share (95%) of the indigenous peoples (scheduled tribe) population to the total state population. Preliminary assessments suggest that the proposed program will not adversely impact the dignity, human rights, livelihood systems, or culture of indigenous peoples or affects the territories or natural or cultural resources that indigenous peoples own, use, occupy, or claim as their ancestral domain. The indigenous peoples category for the program is likely to be B as the proposed program will benefit the states population by expanding accessibility and affordability of health care services; however, this will be further confirmed during the Program Safeguard System Assessment.

Stakeholder Communication, Participation, and Consultation

During Project Design

During Project Implementation

Contact

Responsible ADB Officer

Jain, Nishant

Responsible ADB Department

Sectors Group

Responsible ADB Division

Human and Social Development Sector Office (SG-HSD)

Executing Agencies

Finance Department, Government of Mizoram

Timetable

Concept Clearance

02 May 2024

Fact Finding

15 Apr 2024 to 18 Apr 2024

MRM

01 Mar 2023

Approval

-

Last Review Mission

-

Last PDS Update

19 Jul 2024

Funding