The World Bank approved a US$672 million package of assistance to India's health sector, designed to improve reproductive and child health services, reduce mortality and morbidity due to tuberculosis, and increase utilization of essential health services in the State of Karnataka.
The three projects are the Reproductive and Child Health (RCH) II Project (US$360 million), the Second National Tuberculosis Control Project (US$170 million), and the Karnataka Health Systems Development and Reform Project (US$141.83 million).
World Bank management had earlier withheld presenting the three projects to the Board of the institution while it investigated allegations of wrong-doing in the procurement of pharmaceuticals as part of the RCH I Project, the precursor to the project which the board considered today. The investigation found instances of serious deficiencies in procurement and its practices. These findings were passed on to the Government of India which took strong action in response to this information.
"The Bank and the Government of India have agreed to implement a strong action plan aimed at addressing collusion and corruption in procurement across the health sector," said Praful Patel, World Bank Vice-President for South Asia. "These measures will help provide a larger framework to improve governance in the health sector in India and ensure that quality health services are available to millions of poor people."
The US$360 million credit for the Reproductive and Child Health II Project is targeted at improving the health of poor women and children, who live in rural and tribal areas and urban slums. By supporting the expansion and use of essential RCH services, the project aims to accelerate India's progress towards maternal and child health goals outlined in its national policies and the Millennium Development Goals (MDGs).
Despite progress made in improving health care delivery, India still has very high levels of maternal and child mortality. About 136,000 women and 2.4 million children-about a fifth of the world's total-die every year in India mostly as a result of preventable causes. Large disparities among socioeconomic groups persist, population growth remains high in a number of poor states, and there are unmet needs for contraception.
"Providing significant funding for India's health care system will have a positive impact on the lives of those who are most vulnerable: mothers and young children," said Fayez Omar, Acting World Bank Country Director for India. "These continued efforts will help the Government of India achieve the Millennium Development Goals of reducing child and maternal mortality, and improve the overall state of health care in India."
The project is part of the Government of India's multi-billion dollar RCH II Program launched last year and supported by several other donor partners. Among them the Department of International Development of the United Kingdom and the United Nations Population Fund will be pooling resources with the World Bank to encourage deeper cooperation among those engaged in the sector and avoid duplication.
The US$170 million credit for the Second National Tuberculosis Control Program aims to achieve the global targets of 70 percent case detection and 85 percent cure rate, and for the zones where Directly Observed Treatment Short course (DOTS) has been under implementation for five or more years, to decrease the incidence of smear-positive Tuberculosis (TB).
Communicable diseases continue to account for nearly half of India's disease burden, of which Tuberculosis is among the most widespread causes of morbidity, disability, and mortality. About 40 percent of the adult population is infected by Mycobacterium Tuberculosis, causing more than 1.8 million new cases and 400,000 deaths every year. Of the new cases, nearly 800,000 are infectious, and each of these infects on average 10 people.
Tuberculosis afflicts nearly all age groups although most cases are among adults aged 15 to 59 years, the most economically productive segment of society. As a result, the disease brings about enormous social and economic disruption to the patients and their dependent families, and slows India's overall economic growth. It is estimated that Tuberculosis burdens the society nearly US$3 billion annually in indirect costs.
While emphasis in the first phase of the program was on introducing DOTS in a uniform manner across the country, the program will now target the states which have below-average performance through additional technical and managerial support.
The US$141.83 million credit for the Karnataka Health System Development and Reform Project will also focus on maternal and child health and on communicable diseases to contribute to the achievement of the health-related MDGs, mainly by expanding coverage of essential services in rural and underserved areas.
Over the last decade, Karnataka has been one of the fastest growing states in India, and the increase in per capita income has led to better standards of living and improvements in priority health outcomes. However, disparities in health outcomes across different socio-economic groups and geographical areas have not been addressed adequately. Most of the activities planned under the project target the socially and demographically vulnerable on a priority basis. The Credit will also support innovations in service delivery and health financing to ensure better quality and expanded coverage.
The credits from the International Development Association, the World Bank's concessionary lending arm, carry a 0.75 service fee, a 10-year grace period, and a maturity of 35 years.
-- World Bank's work in India
-- Reproductive and Child Health Program II (RCH II)
-- Second National Tuberculosis Control Program
-- Karnataka Health System Development and Reform Project
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