India - Third State Health Systems Development Project

Report No. PID5816 Project Name India-State Health Systems Development Project III (+) Region South Asia Sector Basic Health Project ID INPA10496 Implementing Agency Department of Health and Family Welfare Government of Orissa Date Prepared November 5, 1997 Project Board Date June 9, 1998 1. Project Objectives. The objectives of the proposed project would be to assist the Government of Orissa to: (a) improve efficiency in the allocation and use of health resources through policy and institutional development; and (b) improve the performance of the health care system through improvements in the quality, effectiveness and coverage of health services at the first referral level and selective coverage at the primary level to better serve the neediest sections of society. The project would support other health programs aimed at reducing infant and maternal mortality rates which are especially high in Orissa. 2. Project Description. The proposed project would be an investment operation with policy aims. The policy content would include: (a) increasing financing and improving resource allocation for the health sector; (b) strengthening the capacity for sector analysis and management; (c) enhancing the role of the private and voluntary sectors in the delivery and management of health services; and (d) implementing a user charge policy. 3. Project investments would include: (a) Management Development and Institutional Strengthening by: (i) improving the institutional framework for policy development by creating a Policy and Planning Unit at the state level to monitor the critical issues in the health sector; (ii) strengthening the management and implementation capacity at a) the state level, by strengthening the management capacity of the implementing agency and appointing key staff in finance, engineering services, medical services, medical management, and administration and personnel; b) at the district level, by strengthening District Health Committees which would facilitate the functioning of the referral system, ensure maintenance of equipment, manage hospital waste, provide quality assurance, undertake surveillance of communicable diseases, monitor and supervise project activities and be responsible for collecting and redistributing user charges; c) strengthening the health management information system and introducing a revised medical record system for in-patient and diagnostic services; and d) providing appropriate training for all management staff at the state and district levels; and  (iii) strengthening the capacity for surveillance of major communicable diseases through the development of a community based system for early detection and reporting, with the full participation of local institutions. (b) Improving Service Quality, Access and Effectiveness at the First Referral Level, through: (i) upgrading area, subdivisional and district hospitals by renovating and extending the physical infrastructure; and (ii) upgrading effectiveness of clinical, managerial and support services at the facility level by rationalizing service norms and standards for clinical and support services; developing staffing, equipment and space norms; ensuring the adequate maintenance of existing facilities and equipment; and providing training for clinical and managerial services. (c) Improving access to Primary Health Care in Remote and Underdeveloped areas through (i) selective upgrading of community and primary health centers; and (ii) improving referral mechanisms and strengthening linkages with the secondary and tertiary health care levels. 4. Project Implementation. The project will be managed and implemented by the state's Department of Health and Family Welfare. A Project Governing Board (PGB) would be at the top of the project management structure. It will include high level representation from all relevant parts of the state Government that are associated with the project. The PGB would be fully empowered to make major policy decisions and develop the broad policy outline for the project; approve the annual budget; authorize major project revisions as necessary; formulate rules and regulations; and undertake an annual review of project implementation and monitor overall project progress. The PGB would have the responsibility for supervising the activities of project management. Project management would be supported by the use of consultancy/professional services under technical assistance, especially with regard to the management of civil works. The PGB would meet as and when necessary. The Policy and Planning Unit would report to the PGB. 5. Reporting to the PGB would be the Project Management Cell (PMC). The PMC would be headed by an Additional Secretary as the Project Administrator. This function would be assisted by medical, technical, engineering services, financial management and administration and personnel divisions. The functions of the PMC would include all aspects of routine project management, monitoring progress, maintaining flow-of-funds and project account, providing technical guidance and general administration, and preparing progress reports. 6. At the district level, District Health Committees (DHCs) would - 2 -  be established in all districts to facilitate functioning of the various activities to be carried out under the project. The DHCs would facilitate the collection and distribution of user charges, maintenance of equipment, waste management, training of technical staff, quality assurance, surveillance of major communicable diseases and monitoring and supervision of project related activities. 7. Project Cost and Financing. Preliminary project costs are estimated at US$115 million, of which Bank Group financing would be about US$90 million. Contact Point: Tawhid Nawaz, Task Manager The World Bank 1818 H Street, N.W. Washington, D.C 20433 Telephone: (202) 458-0363 Fax: (202) 522 1500 Note: This is information on an evolving project. Certain activities and/or components may not necessarily be included in the final project. Processed by the World Bank InfoShop week ending December 12, 1997. - 3 -  Annex Environmental and Social Aspects. Environmental Impact: While the project will not contribute to any sizable increase in hospital waste, it will address the issue of the management of medical waste at the facility level, including collection, storage and final disposal. Due to concern with regard to the use of incineration technology and the expressed concern that the incineration of plastics results in emissions of dioxins and furans, alternative disposal technology will be fully evaluated. The state will produce an environmental action plan and the project preparation team will review the plan and incorporate it into project design. Poverty Aspects. A large proportion of project beneficiaries will be from poor and underprivileged segments of the state's population. Indigenous Peoples. Orissa has a large scheduled tribe population, and tribal peoples are likely to be substantial project beneficiaries. The proposed project would therefore address issues related to (i) strengthening linkages between primary and first referral health services; (ii) providing an incentive package to doctors and medical staff in tribal areas to encourage them to accept the assignment; and (iii) increasing appropriate utilization of non-tribal medical systems by tribal populations and reducing the cost to tribals of doing so. Gender Issues. The project would establish linkages with the reproductive and child health (RCH) project in the state, and provide an appropriate RCH package at the first referral level. In addition, the project would promote a life-cycle approach to women's health through information, education and communication inputs. -4-