India - Andhra Pradesh First Referral Health System Project

DaInmt of The World Bank F10 OQ CIAL USE ONLY Report No. P-6456-IN NEKORANDUN aND RECONMENDATION OF THIE PRESIDENT OF THE INTRNTIOiNAL DEVELOPMT ASSOCIATION TO TIHE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT OF SDR 90. 7 MILLION TO INDIA FOR AN ANDlRA PRADESH FIRST REFERRAL EALTH SYSTEM PROJECT NOVEMBER 2, 1994 )p1 t?rir F21 T .~~~~~~~~~~ - This document hus a restricted distrbution and may be sed by reciets only in the performane of their official daties Its contents may not odevise be disclosed withot World auorizatio  CURRENCY EOUIVALENTS (As of June 1994) Currency Unit = Rupee Rupee 32.6 US$1.00 RTpee 1.0 US$0.03 MERIC EWUIVALENTS 1 Meter (m) 3.28 Feet (ft) 1 Kilometer 0.62 Miles FISCAL YEAR April 1 - March 31 ABBREVIATIONS AND ACRONYMS AIDS Acquired Immunodeficiency Syndrome AP Andhra Pradesh AP}MHIDC AP Health & Medical Housing Infrastructre Development Corporation APWP Andhra Pradesh Vaidya Vidhana Parishad CSSM Child Survival & Safe Motherhood Project FW Family Welfare GOAP Government of Andhra Pradesh GOI Government of India IDA Internatonal Development Association IEC Information, Education and Communication MIS Management Information System NHP National Health Policy  POR OFFICIAL USE ONLY ANDHRA PRADESH FIRST REFERRAL HEALTH SYS PROJECT CREDIT AND PROJECT SUMMARY Bower: hxIndia, acting by its President 13egneiaay: State of Andhra Pradesh Poverty: One of the main objectives of the Project is to provide better quality and greater access to health care services to improve the health status of poor and underserved people, including women, scheduled tribes and scheduled castes. The Project contains specific stategies for interventions targeted for these groups. Amount: IDA Credit SDR 90.7 million (US$133.0 million equivalent) Terms: IDA Stadard with 35 years maturity LeWn terms: The Goverment of India would make the proceeds of the Credit available to the State of Andhra Pradesh (AP) under standard arrangements for development assistance to the States of India. GOI would assume foreign exchange risk. Eianing Pla: Ial Eg Tta -US$ Miion n- IDA 105.5 27.5 133.0 GOI 26.0 0.0 26.0 TOW 131.5 27. 159.0 s - U S $ ~~~USMillion- Disbursements FY95 FY96 FY97 FY98 FY99 EIQQ FY01 2YQ Annual 4.0 9.3 15.8 21.4 21.2 21.2 31.9 8.2 Cumulative 4.0 13.3 29.1 50.5 71.7 92.9 124.8 133.0 Economic Rate of Return: Not Applicable Staff Apraisal Report: Report No. 13402-IN Thfisdoment as a resticted distnulon and may be used 1 recpiewnt oiny do athe ofIther olffcnia duties. Its cosents may wto odvmse be discosed vnwihu Wold lBankc auwtzbor  MEMORANDUM AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL DEVELOPMENT ASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT TO INDIA FOR AN ANDHRA PRADESH FIRST REFERRAL HEALTH SYSTEM PROJECT 1. The following memoranum and recommendation on a proposed credit to India is submitted for approval. The credit, for SDR 90.7 million (US$133 million equivalent), would be on standard IDA terms with 35 years matuity. The credit would help finance an Andhr Pradesh First Referral Health System Project. The proceeds of the credit would be passed on by the Government of India (GOI) to the state of Andhra Pradesh (AP) in accordance with standard arrangements for development assistance to States. 2. Countr/State/Sector Bd. During the past two decades India has developed a publicly financed and managed universal basic health service ifstructure. The Government's long term strategy, as enunciated in the National Health Policy (NHP) of 1983, is to give high priority to the control of fertility, infectious diseases of public health importance and preventable causes of maternal and childhood mortality and morbidity. This is an appropriate health policy given India's burden of disease. However, investment allocations do not reflect the pnorities highlighted in the government's health policy and implementation has been weak. Key health indicators show that the health status of India's population remains low. Communicable diseases continue to be major health problems; maternal mortality is high; acute respiratory and diahrreal disea continue to be the major causes of childhood mortality; and preventable mortality and morbidity, especially among the poor, extract a high toll. Moreover, with the increasing age profile of its population, India is moving into an epidemiological transition with the double burden of significant commuDicable diseases and increasig non-communicable dieases such as cardio- vascular diseases, cancers, diabetes and cataract blindness. 3. With a population of 66.3 million (1991), AP is the fifh most popuous state in India with a health status and epidemiological profile that are about the national average for India. The public health system in AP is similar to that in the rest of India, consisting of ree tiers. At the bottom are primary health care facilities which provide basic health services, with emphasis on preventive and promotive care. In the middle are first referral or secondary hospitals at the district, area and community levels, which provide inpatient and ouatient care with diagnostic and treatment facilities not available at the primary level. At the top are tertiary hoptals, staffed and equipped to provide more specialized treatment. 4. Overall, the delivery of health services is weak and the health system suffers from a low level of efficiency and effectiveness. The man reasons for this are: (i) inadequate and suboptimal aRocation of public resources to the health sector resulting in underfundig of drugs and essential supplies, lack of mainenance of equipment and shortage of doctors and medical personmel; (ii) neglect of first referral facilities resuing from an overemphasis on terdary care; (iii) weak management at all levels and lack of an effective planning capacity; (iv) inadequate support services and infrastruce at first referral facilities; (v) a poorly functioning referral system providing weak insdtutional and technical linkages; (vi) insufficient access to health serices, especialy for the poor and underserved populatin; and (vii) insufficient capacity to enable and monitor the development of the private health sector. S. Lesons fom . Importanc lessons from the experience of social sector projects in India have been incoorated in the design and implementation of the proposed project Four completed population, health and nutrition (PHN) projects in India indicate that despite many positive outcomes, the  2 completed and ongoing projects have suffered consistently from a variety of implementation problems, These have included: late start-up, poor procurement, slow disbursement, frequent management turnover, untimely and inadequate flow of fumds, poor maintenance of buildings and equipment, and inconsistent attention to software and qualitative aspects. The design of this project takes account of these concerns and problem areas. In addition, the proposed project provides linkages with other PHN projects in AP by complementing and consolidating pevious investments and by coordinating policy and implementation. For example, the strengthening of the first level referral for obstetrics and child care in this project through the provision of essendal clinical and diagnostic services will complement the primaiy level of services being provided under Population VI, Population VIII and the Child Survival and Safe Motherhood (CSSM) projects. The Staff Appraisal Report provides details regarding these linkages. 6. IMA Strav and Rationale for lnolvemeit. This project is consistent with the World Bank Group's Country Assistant Strategy for India (May 12, 1994; Report Nos.IDA/R94-65 or P-6141-IN) which supports GOI's efforts to provide an enabling environment for broad-based, efficient private sector- led growth while accelerating the development of human resources. In the health sector, IDA's strategy is to assist India in reducing the level of mortality, morbidity and disability through a two-pronged approach. The first component of this approach is to reduce the burden of the most significant communicable diseases through national programs Scit ac the AIDS Control and Leprosy Elimiation projects. The second component is to strengthen the performance of state health systems in dealing with the evolving burden of disease by providing more efficient and effective health care which will mostly benefit the poorer sections of society who use it the most. 7. IDA investment in the proposed project is justified for the following reasons. First, the project would strengthen and upgrade first referral or secondary health facilities without which the primary health care system cannot implement the various national health progms and provide basic health care in rural areas. Second, the project will consolidate the investments made by a number of other IDA supported projects in the PHN sector in AP, and ad I incremental value to its overall health care system. Third, the proect is consistent with IDA's strategy of strengthening state health systems, since it would help the sutaes to: (i) optimize resource use; (ii) avoid duplication and wastage; and (iii) reduce overcrowding at tertiary health care institutions. Fourth, the project is in line with the overall IDA stategy of poverty reduction in India. The reason for selecting AP as the first state to develop a health systems project is its fairly representatve characteristics in terms of income level, poverty, demographic indicators and epidemiological profile. 8. Project Oblectves. The objectives of the proposed project would be to assist the Government of AP to: (i) improve efficiency in the allocation and use of health resources through policy and institutional development; and (ii) improve the performance of the health care system through improvements in the quality, effectiveness and coverage of health services at the first referral level to better serve the neediest sections of society. The ultimate goal of the project would be to improve the health stats of the people of AP, especially the poor, by reducing mortality, morbidity and disability. 9. Scoe and Approach. The proposed IDA credit would assist the Government of AP to put in place a sustiable first referral health system which would provide vital support and credibility to primary health care services and the rest of the health sector. The state's capacity to implement such a program would be based on two closely related elements. The first is an organizational strure of preventive and curative aspects of health care that would adequately integrate primary health care services with first referral hospitals. The second is a program of health sector policy reform to provide the general  3 framework for health sector development. Accordingly, die project would selectively implement some key sectoral policy reforms. Specifically, these reforms would: (i) enhance the overall size of the health budget and redress the imbalance in public expenditures between the secondary and teriary health care levels; (ii) safeguard the operations and maintenance component of the budget to ensure adequate supplies of drugs and essential medical materials and maintenance of equipment and infrastructure; (iii) implement service improvements and user charges at first referral hospitals; (v) provide greater authority to the Andhra Pradesh Vaidya Vidhana Parishad (APVVP), the inplementing agency, to select, employ and transfer staff; (vi) enhance the capacity of the state government to undertake policy analysis of health sector issues; (vii) contract-out selected services, especially supporting services; and (viii) undertake a review of the policy framework for private provision of health services in the state. 10. Project Descridtion. The three project components would be to: (i) improve the institutional framework for policy development and implementation capacity; (ii) improve service quality, access and effectiveness at district hospitals by upgrading 21 district hospitals, updating norms and standards for clinical and support service, adopting staffing norms in accordance with services provided, adopting a quality assurance piogram, and enhancing staff skills in clinical and technical areas; and (iii) improve quality, access and effectiveness at area and community hospitals by upgrading 49 area and 80 community hospitals and undertaking the improvements as in component (ii). The project would also improve the referral system by providing better linkages between different levels of health care, strengthening management of the referral system, implementing referral and clinical management protocols, and establishing an incentive system for users and staff. Overall, the quality of services provided to patients at 9,651 existing beds at first referral hospitals would be enhanced, an additional 4,349 beds providing upgraded services would be added and the quality of and access to outpatient services would be enhanced at these hospitals. 11. Prolect Costs. The total cost of the project is estimated at about Rs.6,083.2 milion or US$159.0 million equivalent, including taxes and duties esthnated at US$8.8 million equivalent. IDA would finance about US$133.0 million or about 88.6 percent of total project costs net of taxes; the balance would be fmanced by the Govermnent of AP. The direct and indirect foreign exchange cost is estimated at US$27.5 million. The project would finance civil works, equipment and furniture, vehicles, medical. and laboratory supplies, medicines, other supplies, MISIIEC supplies, professional services, tra ng, studies and evaluations, and incremental salaries and costs on a declining basis. Amounts and methods of procurement and disbursement schedule are shown in Schedule B. A timetable of key project processing events and the status of Bank Group Operations in India are presented in Schedules C and D. The Staff Appraisal Report, No. 13402-IN, dated November 2, 1994, is being distributed separately. 12. Project hnplementation. The project would be implemented by GOAP within the existing administrative structure. APVVP would be the main implementing agency and its Commissioner would be the Project Coordinator. APVVP is a Govermnent agency created in 1986 by a legislative enactment to manage and improve the functioning of first referral facilities. The initial phase of project implementation will focus on developmenal activities including project launch, monitoring mechanisms and performance indicators, strengthening the health MIS system, initiating in-service training of staff in clinical, management and equipment matters, strengthening the functions and appointing staff at the Head Office and supplying equipment to improve the quality of services at existing hospital facilities. 13. Project Sainaility. Incremental recurrent costs, including contingencies, at project completion would be about Rs.300 million (US$9.6 million at current exchange rates) annaly, a 38% increase in  4 recurrent costs from current levels. These incremental recurrent costs at project completion amount to only 0.3% of the state's overall curtent budget and about 5.6% of the state's Health and Family Welfare (FW) budget. Allocations to APVVP amount to about 13% of the state's total Health and FW budget. Assuming current allocation patterns between the three levels of health care were to remain the same, at project completion expenditures allocated to APVVP would have to increase by 7 percentage points to about 20 percent of the total health and FW budget. Fyrthermore, analysis shows that fees fron private paying wards and user charges, which the Government of AP plans to implement, would generate an estimated amount of Rs.50 million amnually at project completion. This would reduce the recurrent cost burden by an estimated 15-18%. 14. Agreements Reached. At Negotiations, the Government of AP and APWP provided assurances that they would: (a) carry out the Reform Program including: resource enhancement for the secondary and primary levels of health care; safeguarding of resource allocation for operations and maintenance purposes to provide for adequate amounts of drugs and essential supplies, and maintenance of equioment and buildings at secondary hospitals; selection, employment and transfer of staff; implementation of service improvements and user charges in accordance with an agreed program and time schedule; and retention of a third or more of user charges at collecting hospitals; (b) carry out by December 31, 1995, a review of the policy framework for private provision of health services in AP; (c) carry out, not later than July 1, 1997, jointly with GOI and IDA, a detailed mid-term review of project progress including a management review of APWP; (d) adopt within six months after upgadation of each facility, staffing and technical nonns at its district, area and community hospitals to ensure the quality of services; (e) take necessary steps to strengthen the referral system by July 1, 1995; (f) ensure that allocation of project funds each year for APWP will be additional to that in FY95, and that APVVP shall be provided resources for recurrent expenditures on a timely basis; and (g) carry out the project in tribal blocks in accordance with an agreed strategy. 15. Project Benefis. First, the policy reforms envisaged under the project would improve the efficiency and effectiveness of health care services at the community, area and district levels. The strengthening of AP's first referral health system would optimize resource use by reducing patient flow and overcrowding at teriary hospitals, where treatment per patient is more expensive, thereby avoiding duplication and waste. Second, the project will have a direct impact on improving the health status of the people of AP by reducing mortality, morbidity and disability and thus increase the potential earning capacity of the poor. Third, strengthening the first referral facilities and making them more client-friendly would also encourage patients to seek timely care resulting in higher cure rates at lower costs. Fourth, the strengthening and upgrading of first referral facilities would lend vital support and credibility to the primary health care system for implemening the various national health programs, and provide basic health care in rural areas. Finally, an adequately functioning first referral health system at the area and district levels would encourage a greater participation of the private sector in health care. 16. Prozrai Objective Categories. Povertv Aspects. A large proportion of project beneficiaries will be from the poor and underprivileged segments of the state's population. At project completion, the project is expected to benefit about 14 million outpatients and inpatients annually through quality enhancement and increased capacity. Gender lssum. In general, the project would provide much greater access to women, particularly rural women, and improve the quality of services they receive. More specifically, by strengthening the referral system and linding the community hospitals with primary health centers, the project will assist in providing timely access to emergency obstetric care, and shorten the waiting and transportation time. Eighty community hospitals, in addition to the area and district hospitals,  5 will be staffed and equipped under the project to deliver emergency perinatal care. The provision of these services are critical to reducing maternal mortality and morbidity. Indigenous Populations (Scheduled Tribes). The project's tribal strategy is aimed at increasing the demand and seeking timely care by improving the quality of services and providing effective infonnation, education and communications (IEC) to better inform tribal populations of the benefits of using fist referral facilities. Tribal peoples would be a substantial beneficiary group. The system's capacity at area and community hospitals will be increased from 270 beds to 560 beds to serve tribal areas. In addition, the project would: (i) strengthen linkages between prinmury and secondary health care services; (ii) provide an incentive package to doctors and other medical staff in tribal areas to encourage them to accept assignment in these areas: and (iii) increase the appropriate utilization of the non-tribal medical system by tribal populations and reduce the cost to tribals of utilizing the system. Enironmentai Aspects. The project does not raise any environmental issues. 17. Risks. The project carries several risks that are associated with PHN projects in general in India. These include the basic implementation problems mentioned in paragraph 5. Most of these risks have been substially reduced through careful project design. There are two additional risks associated with this project. Institutoral. Since this would be the first project to reorient a state bealth system in India, the capacity of existing institutions to undertake systemic improvements and to establish a more rational health delivery system has not been tested in India. The institutional strengthening aspects that are included in the project are expected to address this risk. Financial. Another risk would be the potental hurdles faced by the state government to instituting user charges because of the politically sensitive nature of this issue. The AP Govermment has, however, reaffirmed its commitment to instituing user charges while protectng those who cannot afford to pay. The overall financial status of the state is a risk in terms of the adequacy of fimds allocated to the health sector, especially allocations to the secondary level of health care. The Govermnent of AP, through a Health Sector Policy Letter, has committed to providing sufficient investment and recurrent resources to meet the financial needs generated by this project. 18. Reconmmedaon. I am satisfied that the proposed credit would comply with the Articles of Agreement of the Association and reconmend that the Executive Directors approve the proposed credit. Lewis Preston President Attachments WashiDngton D.C. November 2, 1994  ScbdladmaA EstiMad Prjt Coss and Financin_ Plan (Rupets Miiin (1$Milo) % tol (R 'ilbnj~~~~~~(u MDL6n) % tow COnPonen Forein Om LOl Poteign ToWl Lo Fofeign TOal change co 8 but ndl Steening Impove the Policy Frameweaf 15.93 0.67 16.60 0.5 0.0 0.5 4% 0% SaengthenlmplementatienCapaelty 1041 i1ZJl 2 21 Iii ; 1 Subtota 122U 2.2 124 .2 2121 1 Renovat&EatndDistiiotJ4oospih 781.68 141.33 923.01 24.4 4.4 28. 15% 21% Upgade Ciaiae Effwvness in Seondary Hospitals 222= 131.5 I2LZ3 2B 2l2 .ia s Subtotal 1I48.94 2224 L-761:2 9 5 5 .1 dfi 11 Im Service quality, Access and Efftives at Aea & Cmmwty hospials Renovate andExtend AnaCosnmunityHospaltus 1,074.00 194.16 1,268.16 33.6 6.1 39.6 15% 29% UpeClnamiWcal ff -venA Iea nCommHospi*ls 923.07 23877 1,161.84 28.8 7.5 363 21% 26% ]IMproveFuoetoningofRefenml 31 229s g.in .1. 09 2.Q ONi lfi Subtotal 2 032.08 O=2 9 2-424.2 I63 414 5 12 Xi a Total BASELINECOSTS 3,641.15 745.11 4,386.26 113.8 233 137.1 17% 100% Phy l Contingi 315.13 74.30 3s9.43 9.8 2.3 12.2 19% 9% Price Contingecies 1,090.00 217.52 1,307.52 7.8 1.9 9.7 V% 7% Total PROJECr COSTS 5,046.28 1,036.93 6,083.21 131.4 27.5 W5U. 17% 116% Eainan: LW g US$ Million GOAP 26.0 0.0 26.0 IDA 105.5 27.5 133.0 Total 131.5 27.5 159.0  page 1 (USS Milltkn, Prcument Method IntenatIona LOWa CompeRe Competitiv Bitddin Bidding Other /a N.B.F. Toal i WORKS CivilWor . 63.59 7.07 - 70.66 (54.05) (6.01) (60.06) GOODS VeI*es 1.82 - 0.10 1.92 (1.60) (0.08) (1.69) Furnitue- 1.88 0.63 - 231 (1.69) (0.56) (2.26) Bqupmon- 6.00 4.59 2.65 - ;3.23 (5.28) (4.04) (2.33) (11.65) MedicalLab Supplies - 0.77 0.77 1.55 (0.70) (0.70) (1.39) Medicine - 5.83 1.46 7.29 (525) (131) (6.56) OtherSupplies - 1.62 2.43 4.04 (1.46) (2.18) (3.64) MIS/JEC Marials - 0.85 0.28 1.13 (0.76) (0,25) (1.02) CONSULTANCIES project Prep & implementi Support 1.31 - 1.31 (Iacludes LA Training Senrices Workshops) (1.31) (1.31) sttion Deveopment (udes - - 8.00 - 8.00 Loal Consultant, Stuis) (8.00) (8.00) Fellovuhips - - 0.20 - 0.20 (0.20) (0.20) Salaries of Addiion Staff * * 33.04 . 33.04 (24.62) (24.62) Opeaton E ditu - - 6.95 - 6.95 (5.18) (5.18) Building Mfintennce - - 2.18 - 2.18 (1.56) (1.56) Equ_iMt Maint c - - 4.90 - 4.90 (3.65) (3.65) TOTAL 7.82 79.13 71.95 - 158.90 (6.88) (67.95) (5.17) (133.00) NOTES /a Otd method iAude iaional Shopping Local Shoppiung Force Actount, Costing Services and such non cume &nded acvities such assalaries of incrm a staff covered by the projecL lb Frgures in pmnhesb are the repecti amounts fnaced by lDA.  Schedule B Page 2 DISBURSEMENTS SDR Amount % of ill Millions Expenditures Category (US$ Million) to be Financed (1) Civil Works 37.7 85% (55.2) (2) Equipment, 100% of foreign vehicles, 17.7 expendituers, 100% of local medicines, (26.0) expenditures (ex-factory materials, cost) and 80% of local furIniture expenditures for other items procured locally (3) Consultant 100% services, 6.0 fellowships (8.8) (4) Incremental 21.9 90% of local expenditures salaries, (32.2) during the first three years incremental of Project implementation; operation and 75% during the fourth and maintenance fifth year of Project costs implementation; and 60% thereafter. (5) Unallocated 7.4 f1Q.8) TOTAL 90.7 (133.0) Estimated Disbursements IDA Fiscal year --US$ Million- --------------------- FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02 Annual 4.0 9.3 15.8 21.4 21.2 21.2 31.9 8.2 Cumulative 4.0 13.3 29.1 50.5 71.7 92.9 124.8 133.0  Schedule C INDIA. ANDHRA PRADESH FIRST REFERRAL HEALTH SYSTEM PROJECT Timetable of Ke Project Events (a) Time taken to prepare the project: 27 months (b) Prepared by: Government of Andhra Pradesh and Andhra Pradesh Vaidya Vidhana Parishad (c) First IDA mission: July, 1992 (d) Appraisal mission departure: May, 1994 (e) Negotiations: October 7, 1994 (f) Planned date of effectiveness: February, 1995 (g) List of relevant PCRs and PPARs: Credit/Loan No. Project PCR Date PPAR Date 312-IN Populadon 1 May 19, 1981 December 31, 1981 981-IN Population II June 20, 1989 June 29, 1990 1003-IN Tamil Nadu Nutrition I November 26, 1989 1426-IN Population HI August 25, 1993  8K3DUnLB D PMI 1 of 4 TME STAU OF BNK GROUP OMATIONS IN ZDA A. STATINWIT o0 RANK LOASM AND IDA CBNDrIT (As of Septmber 30, 1994) (net of canaellations) LOWam FY of ------ Credit U Appurval Purpose DRD rDA 1/ rhdised 2/ 1/ 118 Loans/ 10128.3 lt 178 credits fully disbursed/cancelled 13541.9 1356-ZN 1983 - Upper Indravati Rydr Power - 170.00 9.49 SF-20-XN 1964 Indira Sarpvar Hydroelectric - 13.84 18.34 SF-12-1N 1984 Tamil Nadu Water Supply - 36.50 2.84 1454-SN 1984 Tamil Nadu Water Supply - 36.50 10.53 1463-ZN 1984 pper Gangs Irrigation - 105.43 9.67 1613-IN 1985 Indira Sarovar Hydroelectric - 13.20 10.46 2582-Z1 1985 Kerala Poer 126.00 - 51.61 2660-ZN 1986 cement Industry 165.00 - 9.82 1643-IN 1986 Gujarat Urban - 50.34 17.57 2661-ZN 1986 ICsCI - Cemnet Industry 35.00 - 1.98 1621-SN 1986 Msharashtra Composite Irrigation - 128.82 93.52 1631-ZN 1986 National Agricultural Research II - 57.21 12.65 1737-IN 1987 Bihar Tubevells - 22.29 7.77 1750-ZN 1987 Bombay Water Supply & Sewerage III 145.00 64.46 2769-SN 1987 Bombay Water Supply & Sewerage III 30.00 - 30.00 2796-ZN 1987 Coal Mining & Quality Improvemet 323.06 - 28.79 1757-ZN 1987 Gujarat Rural Roads - 96.75 34.78 2846-ZN 1987 M"dras Water Supply 53.00 - 24.26 1754-SN 1987 National Agric. Extension irr - 66.62 13.19 2844-ZN 1987 National Capital Power 373.00 - 77.55 1770-ZN 1987 National Water Management - 114.00 17.26 278S-IN 1987 Oil India Petroleum 140.00 - 4.49 2845-ZN 1987 Talcher Thermal 367.00 - 167.11 1780-ZN 1987 Uttar Pradesh Urban Development - 120.95 S3.34 1931-ZN 1988 Bombay & Madras Population - 57.00 30.10 2928-IN 1988 Indus. Fin. & Tech. Agst. 347.97 - 21.46 2893-IN 1988 National Dairy II 200.00 - 146.45 2935-IN 1988 Railway Modernization III 260.00 - 16.90 1923-ZN 1988 Tamil Nadu Urban Dev. - 254.73 99.71 3093-ZN 1989 Blectronics Industry Dev. 8.00 - 7.50 3058-ZN 1989 Export Development 120.00 - 8.97 3096-ZN 1989 Maharashtra Power 354.00 - 252.79 3024-ZN 1989 Nathpa Jhakri Power 485.00 - 395.55 1952-ZN 1989 National Seeds III - 147.24 57.20 2022-IN 1989 National Sericulture - 133.35 66.70 2057-IN 1989 Nat'l. Pamily Welfare Trng. - 72.76 40.73 3044-ZN 1989 Petroleum Transport so.00 - Is.CI 2994-IN 1989 States Roads 115.00 - 92.37 2010-ZN 1989 Upper Krishna Irrigation II - 160.00 61.10 3050-ZN 1989 Upper Krishna Irrigation II 45.00 - 45.00 2008-IN 1989 Vocational Training - 163.85 106.19 3196-ZN 1990 Cement Industry Restructuring 293.18 - 125.84 2115-ZN 1990 Hyderabad Water Supply - 79.90 52.55 2064-ZN 1990 Industrial Technology Development - 55.00 47.46 3119-IN 1990 Industrial Technology Development 145.00 - 72.67 3237-IN 1990 Northern Region Transmission 48s.00 - 442.31 2133-ZN 1990 Population Training VII - 63.96 37.88 3239-ZN 1990 Private Power utilities I (TBC) 98.00 - 21.77 2076-IN 1990 Punjab Irrigation/Drainage - 145.28 111.14 2158-ZN 1990 Tamil Nadu Integrated Nutrition 1I - 67.52 46.96 2130-ZN 1990 Technician Education I - 210.74 147.80 2100-ZN 1990 Watershed Development (Rills) - 75.00 58.73 2131-IN 1990 Watershed Developuent (Plains) - 55.00 48.68 3325-ZN 1991 Dam Safety 23.00 - 23.00 2241-ZN 1991 Dam Safety - 130.00 125.01 3364-ZN 1991 Gas Flaring Reduction 450.00 - 21.49 2173-ZN 1991 ICDS I (Orissa & Andhra Pradesa) - 74.35 51.55 3334-IN 1991 Industrial Pollution Control 124.00 - 59.88 2252-ZN 1991 industrial Pollution Control - 31.60 32.21 2234-IN 1991 Maharashtra Rural Water Supply - 109.90 90.25 3258-ZN 1991 Petrochemicals 1I 12.00 - 11.00 3259-ZN 1991 Petrochemicals 1I 203.00 - 111.95  8CFSDUL D PAN 2 of 4 US$ Million (net of cancellations) Loan/ FTY of -----------------------------^-- Credit S Approval Purpose 1310 IDA I/ UndUsbuased 2/ _______ ___ ........__________,---------------------------____-----------_--_------_._ ---------........... .......... _ --- -- ------ ------ 3344-IN 1991 Private Power Utilities It (381) 200.00 - 64.3Q 2215-ZN 1991 Teail Xadu Agricultural Development - 92.80 66.92 3300-IN 1991 Tamil tadu Agricultural Development 20.00 - 20.00 2223-IN 1991 Technician Education II - 2S5.73 217.42 2300-IN 1992 Child Survival and Safe Motherhood - 214.50 145.78 2394-ZN 1992 Family Welfare (Urban Slums) - 79.00 80.62 2328-ZN 1992 Waharashtra Fcrestry - 124.00 116.58 2350-lN 1992 Natioaal AIDS Control - 64.00 72.28 .3436-ZN 1992 Power Utilitias Efficiency 265.00 - 250.08 3498-IN 1992 Seeond Naharashtra Power 350.00 - 314.34 3470-IN 1992 Second National Highway 153.00 - 153.00 236S-ZN 1992 Second Rational Highway - 153.00 158.48 2329-IN 1992 ShriMp and Fish Culture - 85.00 S6.66 2341-IN 1992 West Bengal Forestry - 34.00 24.99 2433-ZN 1993 Agricultural Development Rajasthan - 106.00 97.77 2439-IN 1993 Bihar Plateau Development - 117.00 111.23 24SO-ZN 1993 Jharia Mine Fire Control - 12.00 12.10 2483-ZN 1993 Karnataka Rural Water Supply - 92.00 91.64 2528-ZN 1993 National Leprosy Ulimination - 85.00 84.88 3632-ZN 1993 NTPC Power Generation 400.00 - 400.00 3630-IN 1993 Power Finance Corporation 20.00 - 20.00 3577-Zn 1993 Powergrid Syatem Development 350.00 - 323.13 3544-IN 1993 Renewable Resources Development 75.00 - 23.01 2449-ZN 1993 Renewable Resources Development - 115.00 116.60 2409-ZN 1993 Rubber - 92.00 92.63 2470-ZN 1993 Second Integrated Child Dev. - 194.00 197.88 2448-Dn 1993 Social Safety Net Sector Adjustment - S00.00 4.98 2SO9-ZN 1993 Uttear Pradesh 2asic Education - 165.00 161.92 2510-ZN 1993 Uttas Pradesh Sodic Lends Reclaa. - 54.70 55.02 2572-ZN 1994 Forestry Research Education - 47.00 49.S9 2573-ZN 1994 Andhra Pradesh Forestry - 77.40 77.55 2S92-ZN 1994 Water Resources Consolidation (Haryana) - 2S8.00 266.67 2594-IN 1994 Maharashtra Emergency Barthquake - 246.00 239.41 2611-ZN 1994 Blindness Control * - 117.80 125.15 2630-ZN 1994 Population IX (Family Welfare) - 88.60 91.99 37S3-ZN 1994 Container Transport Logistics * 94.00 - 94.00 3779-ZN 1995 Industrial Pollution Prevention * 93.00 - 93.00 3780-IN 1995 Industrial Pollution Prevention * S0.00 - 50.00 2645-ZN 1995 Industrial Pollution Prevention * - 25.00 25.97 Total 17628.54 20321.06 86S3.10 of which has been repaid 4779.3 1235.4 12849.24 19085.65 Total now outstanding Amount Sold 133.8 of which has been repaid 133.8 Total now held by Bank and IDA Total undisbursed (excluding *) 3855.4 4409.1 1/ IDA Credit amounts for SDR-denominated Credits are expressed in terms of their US dollar equivalents, as established at the time of Credit negotiations and as subsequently presented to the Board. 2/ Undisbursed amounts for SR-denominated IDA Credits are derived as the undisbursed balance expressed in SDR equivalents (in turn derived as the difference between the original principal expressed in 8M s (based on the exchange rate as established at the time of Credit negotiations) and the cumulative disbursements converted to SDR equivalents at the exchange rates prevailing at the respective dates of disbursements less cancellations expressed in SDR equivalents converted to US dollar equivalents at the SDR/US dollar exchange rate in effect on September 30, 1994. * ' Not yet effective. Source: Statement of Loans & Credits (LOALA) of September 30, 1994.  SCEEDULE D PAGE 3 OF 4 B. STATEMEXI OF lFC INVESTNfSS (as of September 30, 1994) Amount (US$ million) Fiscal Year Company Loan Equity Total 1959 Republic Forge Company Ltd. 1.S0 -- 1.50 1959-92 Kirloskar Oil angines Ltd. 0.85 -- 0.85 1960 AsSaM Sillimanite Ltd. 1.36 -- 1.36 1961 K.S.B. Pumps Ltd. 0.21 -- 0.21 1963-66 Precision Bearings India Ltd. 0.65 0.38 1.03 1964 Fort Gloster Industries Ltd. 0.81 0.40 1.21 1964 Lakshmi Machine Works Ltd. 0.96 0.35 1.31 1964-75-79/90 Mabindra Ugine Steel Co. Ltd. 11.81 2.66 14.47 1967 Indian Explosives Ltd. 8.60 2.86 11.46 1967 Jayshree Chemicals Ltd. 1.05 0.10 1.15 1969-70 Zuari Agra-Chemicals Ltd. 15.15 3.76 10.91 1977-87 Escorts Limited 15.5S -- 15.55 1978-87/91/93 Housing Development Finance Corp. 106.32 4.05 110.37 1980/82/87/89 Deepak Fertilizer and Petrochemicals Corporation Ltd. 7.50 4.23 11.73 1981-82 Nagarjuna Coated Tubes Ltd. 1.50 0.24 1.74 1981-82 Nagarjuna Steela Limited 2.88 0.24 3.12 9981-86-89 Tata Iron and Steel Company Ltd. 132.14 24.'9 156.63 1981-90-93-94 Mabindra & Mahindra Ltd. 29.71 9.68 39.39 1982 Ashok Leyland Limited 28.00 -- 28.00 1982 Coromandel Fertilizers Limited 15.88 -- 15.88 1982 The Bombay Dyeing and Manufacturing Co. Ltd. 18.80 -- 18.80 1982-87 7NV Signode 2.99 1.01 4.00 1982-87 The Indian Rayor. Corp. Ltd. 14.57 -^ 14.57 1983 Bharat Porge Company Ltd. 15.90 -- 15.90 1984-86 The Gbalior Rayon Silk Manufacturing (Weaving) Co. Ltd. 15.95 -- 15.95 1985 Bajaj Auto Ltd. 23.93 -- 23.93 1985 Modi Cement 13.05 -- 13.05 198S-86/90-91 India Lease Development Ltd. 8.50 0.78 9.28 1985/91 Bihar Sponge 1S.24 0.68 15.92 1986 BaSaj Tempo Limited 30.54 -- 30.54 1986/93 India Equipment Leasing Ltd. 5.50 0.44 5.94 1986 Larsen and Toubro Ltd. 21.78 -- 21.78 1986-87 The Great Eastern Shipping Company Ltd. 41.25 16.04 57.29 1986-87-91 Export-Import Bank of India 14.97 -- 14.97 1987 Gujarat Fusion Glass Ltd. 7.S2 1.70 9.22 1987 Gularat Narmada Valley Fertilizer 38.07 -- 38.07 1987 Hero Honda Motora Ltd. 7.74 -- 7.74 1987 Hindustan Motors Ltd. 39.14 -- 39.14 1987 The Gujarat Rural Housing Finance Corp. -- 0.19 0.19 1987 Vimco Limited 4.70 -- 4.70 1987-89/90 Titan Watches Limited 22.02 1.15 23.17 1988 Invel Transmissions Ltd. -- 1.40 1.40 1989 Abmedabad Electricity Company. Ltd. 20.03 -- 20.83 1989 WTr Advanced Technology -- 0.20 0.20 1989-90 Reltron Telephone Instruments, Ltd. -- 0.56 0.56 1989-92 Gujarat State Fertilizer 40.46 -- 40.46 1990 JSB India Securities Firms -- 0.37 0.37 1990 O= Fuel Systems Ltd. -- 0.63 0.63 1990-91 Tata Zlectric 111.88 18.75 130.63 1991 ATIC Industries Export Finance 0.28 -- 0.28 1991 Bombay Electric 68.00 -- 68.00 1991 CESC Ltd. 83.90 -- 83.90 1991 Export Finance - AFDC 0.35 0.35 1991 Herdilla Oxides and Electronics Ltd. -- 0.29 0.29 1991-94 Indiut. Credit & Imnstment Corp. of India -- 2s.8s 25.85 1991-93-95 r rr L ing & Fiancial Services 40.00 4.92 44.92 1991 TDrcr Development Finance Companies -- 2.05 2.0S 1993 TRVI -- 1.30 1.30 1991 Varun Transport, Storage & Commications 17.04 3.06 20.10 1992 Arvind Mills 22.13 19.16 41.29  SCOEDTMIL D __________ PAM 4 OF 4 Amount (USS million) Fiscal Year Company Loen Sguity Total 1991 TNS VC -- 0.01 0.01 1991 Block V3-OS-rV -- 8.20 8.20 1991 nDS Vf:F -- 1.01 1.01 1992 Kotak Mahindra 0.66 -- 0.66 1992 Nippon Denro 40.00 S.77 45.77 1992 SRF Bearings 11.50 -- 11.50 1992 creditcapital VF -- 0.51 0.51 1993 NICCO-UCO 3.00 0.25 3.25 1993 20th CENT1RY 16.00 0.80 16.80 1993 info Tech Fund -- 0.64 0.64 1993 CRDCAP Asset management -- 0.32 0.32 1993 Taurus Starshare -- 7.17 7.17 1994 Guairat Ambuja 35.14 8.23 43.37 1993-94 Ind* Rama Spinning & Weaving 35.00 9.84 44.84 1994 centurion Growth -- 2.39 2.39 1994 TCANC -- 0.16 0.16 1994 DLF Cement 36.40 -- 36.40 1994 Global Trust Cocmercial Banks -- 3.19 3.19 1994 Chowgule -- 4.58 4.58 1994 India Equipment -- 0.14 0.14 1994-9S JN Share & Stock 2.39 0.84 3.23 TOTAL GROSS C M4ITS 1328.95 208.18 1537.13 Las: Cancellation, Termination, Exchange Adjustments. Repayments, Writeoffs and Sales 711.40 81.64 793.04 Total Comitments Now leld by nFC 590.40 124.55 744.09 nieS in SSSni Undisbursed 505.02 112.07 617.08 Sourze: I