PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE REPORT NO AB1696

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PROJECT INFORMATION DOCUMENT (PID)

PROJECT INFORMATION DOCUMENT (PID)

CONCEPT STAGE

Report No.: AB1696

Project Name	West Bengal Health Systems
Region	SOUTH ASIA
Sector	Health (100%)
Project ID	P085291
Borrower(s)	GOVERNMENT OF INDIA
Implementing Agency
Environment Category	[ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined)
Date PID Prepared	June 20, 2005
Estimated Date of Appraisal Authorization	July 28, 2006
Estimated Date of Board Approval	March 15, 2007

Key development issues and rationale for Bank involvement

The Government of West Bengal (GoWB) has recently launched its Health Sector Strategy 2004-13, which is a 10-year vision for the health sector to address priority health goals, especially for the poor and the disadvantaged.

The major pillars of GoWB’s health sector reform program are:

Strengthening the stewardship role of the Department of Health and Family Welfare (DHFW) by creating capacity for strategic planning, results-oriented budgeting, using information for action and improving the coordination of all external donors.
Reorienting public spending towards primary care and selected secondary care interventions that are needed to reduce infant, child and maternal mortality, especially in rural areas, and towards non-salary expenditures.
Improving distribution and responsiveness of medical staff in public facilities.
Increasing financial capacity and authority of larger hospitals and block-level Health and Family Welfare Samitis to manage day-to-day activities and address systemic issues of assets management and maintenance.
Improving licensing, accreditation and the regulation systems for quality assurance in public and private sectors. Creating partnerships with the private sector to address government failures and equity concerns.
Improving governance and transparency by improved financial management and procurement procedures and more easily accessible information on objectives, resources and results in the health sector.

In order to deliver its objectives, GoWB has started a medium-term health sector reform program and has requested external donors to support the DHFW in carrying out its most challenging steps.

DFID has supported the health sector in West Bengal (one of the four focal states for DFID support) for many years through several operations, the most recent being the Health Sector Development Initiative (HSDI). HSDI aims at helping GoWB take forward some key aspects of its health strategy. The operation follows the structure of a Sector Programmatic Grant.^¹

The World Bank supported West Bengal through the State Health Systems Project II, which closed in March 2004, and focused mainly on secondary services. In June 2004, the World Bank completed a Health Policy Note for West Bengal, which the state government has fully endorsed and is now adopting as one of his own main strategic documents. The Bank, with DFID and other development partners, will help GoWB implement its new Health Sector Strategy. In particular, the focus will be on the preparation of a health sector reform program to achieve better priority health outcomes for the poor that is financed by several sources, including the Government of India (GOI), GoWB and external development partners. The Bank would add value by bringing experience from South Asia and other regions of Sector-wide Approaches (SWAps), public-private partnerships (PPPs) and rigorous monitoring and evaluation systems.

The proposed West Bengal Health Systems Development Project is consistent with the strategic principles and the priorities identified by the Country Assistance Strategy (CAS), September 2004:

Focus on outcomes to ensure that Bank support is geared towards achieving the MDGs,
Selective support of activities that have greatest impact on the poor,
Strengthened role of the Bank as knowledge provider and generator.

The proposed operation is also fully consistent with the recently discussed Strategy Paper on “Future Directions for the World Bank’s HNP Lending to India”, which argues that the Bank should pursue a combined strategy of accelerating achievement of better health-related MDG outcomes and assisting India to develop more effective, efficient, and sustainable health system strategies with special focus on selected states that are willing to design, implement and evaluate innovative schemes for better health outcomes.

Proposed objective(s)

The development objectives of the proposed operation are to support GoWB: (1) achieve better maternal and child health outcomes, especially for the poor and disadvantaged; and (ii) introduce systemic changes in the health sector to improve efficiency, equity and effectiveness of public spending.

Preliminary description

The proposed project would have two components, which would need to be closely harmonized with the ongoing HSDI currently supported by DFID, GTZ and the European Commission:

Component 1: Program Support. The first (main) component would co-finance (jointly with central, state, and other external funds) (i) activities in primary health; (ii) selected interventions at the secondary level, which are also necessary to achieve the MDGs; and (iii) activities in public health, especially those related to preventive health. In other words, we propose to utilize a SWAp approach. The IDA Credit would finance a time-slice of DHFW’s entire expenditure in the period. We propose two phases of 2 ½ years each. Disbursement of the IDA Credit would be report-based through Financial Monitoring Reports extracted from the released budget and adjusted (ex-post) after the executed budget information becomes available.

Preparation of the Program Support component by the Government of West Bengal would have to focus on developing the following key elements of the five-year program:

A set of Key Performance Indicators (KPIs) or intermediate outputs that the Bank, other Development Partners and the state would use to assess progress in implementing the agreed investments and monitoring the expected outputs; and to trigger IDA funding for the second half of the five-year program. The KPIs will be aligned with the HSDI milestones agreed by DFID and GoWB as a set of common performance indicators that DFID, the Bank and other Development Partners will use to track progress on the implementation of the health sector strategy.^² Specifically, the KPIs will outline the process of achieving the health targets/milestones set in the HSDI policy matrix by defining both their production process more explicitly and the associated financial and physical monitoring framework;
Specifying the costs of implementing the agreed reforms and developmental activities, which during implementation of the program will need to be explicitly reflected in the DHFW’s annual budgets;
An agreed DHFW Five-Year Expenditure Framework. Preparing this would entail reaching agreement on the expected total DHFW’s budget by year of the program, and its broad composition. During implementation of the program, there would be annual budget discussions between GoWB, the Bank and other Development Partners with a view to ensuring consistency with the agreed Five-Year Expenditure Framework, and to ensure that the cost of inputs needed for the agreed reforms and developmental activities is adequately budgeted for.

Component 2: Program Coordination, M&E, and Technical Assistance. Through this component, IDA would provide 100% financing for certain expenditures critical to the success of the five-year program (the provision of earmarked 100% financing would strengthen the incentives for the Government of West Bengal to budget for, and actually incur such expenditures). These critical expenditures would include those related to:

General program coordination. The program will be executed through existing arrangements within DHFW as it is done under HSDI. The Principal Secretary will be the program head and will be assisted by a designated person (the Special Secretary) and a unit (the Strategic Planning and Sector Reform Cell) in the management of the program. The SPSRC will support the implementation of the health strategy and dialoguing with development partners. There will be no separate program implementation unit but the Bank will support DHFW to contract additional management and technical support to implement program activities. These activities will be designed and implemented within the framework of the Technical Support that has been planned as part of HSDI;
Monitoring and evaluation, in order to provide adequate tracking of the key performance indicators and other important aspects of the program, such evaluation of the many planned innovations and reforms;
Technical assistance in the form of experienced consultants which can assist with the processes of (i) strengthening the institutional and executing capacity for public health at the state and district level and (ii) implementing of the more innovative aspects of the overall reform program, such as those related to enhancing the stewardship role of the public sector; furthering human resource development within the sector; strengthening decentralized planning through capacity building and challenge funds; and engaging the private sector in the pursuit of agreed health outcomes. This sub-component would need to be coordinated very closely with the DFID Technical Support funds available to support the HSDI.

All activities in Component 2 will be coordinated with the Technical Support that is financed by DFID.

Safeguard policies that might apply

Environmental Assessment

This project is a Category B project, because its potential adverse impacts on the environment and public health are well identified and site-specific and the required mitigatory measures are defined and implementable. Under the State Health Systems II project, basic Healthcare Waste management systems were established, but not for the primary level. Continued implementation of this component after project completion and quality of implementation will be assessed within the framework of Diagnostic Assessments, to be conducted as part of Country Systems pilot. Measures for replicability within the SWAp approach will also be determined before finalizing an Implementation Plan.

Indigenous people

Scheduled Tribes constitute about 5.5 percent of the population of West Bengal and Scheduled Castes a further 23.6 percent. Both groups are dispersed throughout the state, but some districts and administrative blocks have high concentrations. As this is a sector wide operation concerned with ensuring access of the poor and disadvantaged to health care, focused attention will be paid to these socio-economically disadvantaged groups.

Involuntary Resettlement

The extent to which this policy is triggered will depend on the amount and nature of civil construction envisaged by the GOWB during the life of the operation. We would expect the policy to be triggered if large health facilities requiring land acquisition are planned, but not if the civil works are limited to renovations or extensions of existing facilities or new construction of small facilities on government or panchayat owned land.

Safeguard Preparation Plan

This project has been selected by SAR to pilot the use of country systems under O.P./B.P. 4.00. Consequently Equivalence and Acceptability (E&A) Assessments will be carried out for the Environmental and Social Safeguards. The E&A Assessments will be started in July 2005 and are expected to be completed and disclosed by March 2006

Tentative financing

Source:	($m.)
BORROWER/RECIPIENT	5
INTERNATIONAL DEVELOPMENT ASSOCIATION	75
Total	80

Contact point

Contact: Michele Gragnolati

Title: Economist

Tel: (202) 458-5287

Fax: (202) 614-1494

Email: [email protected]

1 Financial Aid of up to £97.5 million will be made available over the 5 years of support, as budget support to the health sector. A further £2.5 million in Technical Cooperation funds will be provided for securing national and international technical assistance.

2 HSDI is intended to contribute to the achievement of some key outcomes, including the reduction by about a third in the IMR and MMR rates; the increase in the proportion of institutional deliveries, especially in the six poor performing districts; a significant increase in the coverage of child immunization; and a reduction in the share of burden of disease from communicable / maternal / neonatal factors. The HSDI milestones are about these outcomes.

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