47354-002: Supporting National Urban Health Mission

Project Data Sheet (PDS): Details

Description

The proposed S-PPTA will reconfirm NUHM's relevance, rationale, and its linkage with GOI's development goals and sector strategy for urban health. The TA will examine the program's effectiveness, efficiency and economy, and sustainability. Specifically, it will review soundness of the NUHM's implementation framework and the proposed state-level program implementation guidelines. It will analyze the extent to which NUHM, with some strengthening in its design and implementation arrangements, can achieve its desired outcomes of serving health care needs of the urban poor in a sustainable manner. It will review the key components and result indicators. The S-PPTA will analyze the organizational set-up at central, state, and urban local body levels, staff capacity, and mechanisms for stakeholder consultations and grievance redressal. It will also initiate a review of NUHM's expenditure framework and financing plan, and assess the planning and budgeting process. The coverage, level, and distribution of budget allocation will also be reviewed. The S-PPTA will assess predictability and sustainability of financing, such as timeliness, amount of budget release, and capacity for budget execution.

Project Rationale and Linkage to Country/Regional Strategy

The initial assessment of NUHM, based on the two missions and a review of the NUHM documents, shows that the concept is relevant and sound, and the delivery approach is innovative. The project team assesses that the results-based lending (RBL) modality will be most suitable for supporting the NUHM for the following reasons. First, this is a government-owned program which already has a program and implementation framework, detailed organizational arrangements, key result indicators, and an expenditure framework. Second, GOI's strong preference is for external assistance to support the whole program, rather than creating multiple projects with ring-fenced external funding. Third, the multi-disciplinary nature of the program that has a diverse range of activities requires an extensive inter-sectoral convergence and coordination. This calls for a modality that strengthens accountability for results rather than focusing only on transactions. A project loan modality will not be appropriate since the transaction costs of directly monitoring each transaction would be very high. The S-PPTA will, therefore, support loan design in accordance with the RBL policy and staff guidance.

Impact

Sustainable urban health delivery system targeted to urban poor established

Project Outcome

Description of Outcome

RBL for "Supporting National Urban Health Mission" conceptualized and initial loan design developed

Implementation Progress

Description of Project Outputs

Scope of RBL program for NUHM assessed

Stakeholder Participation and Consultation

During Project Design

The development of National Urban Health Mission (NUHM) and Framework for Implementation by the Ministry of Health and Family Welfare involved extensive consultations across all levels of Government and civil society. The NUHM Technical Resource Group (TRG) further guided on key issues of reaching vulnerable sections of the society, main strategies and institutional design of NUHM, and organization of urban health service delivery and governance based on series of consultations with experts and a range of vulnerable urban poor groups and field visits to 30 cities. The ADB team also conducted stakeholder consultations and detailed field assessment of NUHM implementation in West Bengal, Madya Pradesh, and Tamil Nadu, which gave important insights into NUHM implementation challenges and capacity building requirements.

During Project Implementation

For stakeholder participation, the NUHM emphasizes community participation and processes, reaching of vulnerable groups, and capacity building of stakeholders (urban local bodies, health workers, private providers, community structures, and functionaries of other related departments) in managerial, technical, and public health competencies.

 

Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.

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