Program Update

Following the success of Tamil Nadu Health System Project Government of Tamil Nadu has proposed a new project named Tamil Nadu Health System Reform Program to be implemented by May 2019.

The total Project cost is estimated at Rs. 2685.91 Crores with the support of World Bank through a pioneering lending instrument in health system called Program for Results (P4R) mode, where the payments will be linked to certain pre-determined indicators – Disbursement Linked Indicators (DLI)

Along with improving the State’s already stable health indicators on par with developed countries, the project objectives are to address few of the major aims of Sustainable Development Goals (SDGs) - Goal 3.

The result areas are,

• Quality
• Non communicable diseases including Trauma and Mental health
• Equity

Activities carried out till now:

• The project report was forwarded to Health and Family Welfare Department, Government of India on 28.02.2017.
• The Health and Family Welfare Department in the Ministry of Health, Government of India had examined the project report, recommended and forwarded to Department of Economic Affairs, Ministry of Finance, Government of India.
• The Screening Committee, Department of Economic affairs recommended the project and forwarded to World Bank on 09.10.2017.
• The World Bank India Office had examined the project and has agreed to fund the project (Project ID – P 166373 and Loan number – 8934-IN) and had sent a letter dated: 07.11.2017 that the World Bank would be happy to work with Tamil Nadu.
• Project Planning Team was constituted on 10.05.2018.
• Five World Bank Missions were held each in February, June, August and September. Appraisal Mission (fifth) was conducted via video conference from 14th to 16th November 2018.
• Negotiations between Government of Tamil Nadu, World Bank and the Central Government were successfully conducted on 05.02.2019 at World Bank office, New Delhi.
• The project has been approved on 19.03.2019 by the Executive Board of the International Bank for Reconstruction & Development (World Bank). Loan Agreement (LA) is expected to be signed by last week of May / first week of June.
• Sixth World Bank Mission, Implementation Support Mission was held from 2nd to 4th April, 2019.

Indicators:

• Increased number of public facilities with quality certification (primary, secondary, and tertiary)*
• Improved scores in quality dashboard for primary, secondary, and tertiary level facilities*
• Increased screening in public sector facilities for cervical and breast cancers
• Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control*
• Improved provision of quality trauma care services*
• Increased utilization of reproductive and child health services in priority districts*
• Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities
• Piloting of patient experience questionnaire for secondary & tertiary care facilities
• Implementation of updated social and behavior change communication (SBCC) strategy
• Increased share of primary and secondary facilities with at least one staff trained on mental health
• Establishment of suicide hotline
• Better equipped ambulance system to improve pre-hospital care - number of ATLS ambulances providing Level 1 care
• Improved capacity of trauma care providers - number of emergency department providers that received Level 3 (BTLS) and Level 4 training (ATLS)
• Strengthened content, quality, accessibility, and use of data for decision making*
• Strengthened coordination, integration, performance-based management, learning, and other cross-cutting functions for better results*
• Increased transparency and accountability through citizen engagement (voice, agency and social accountability)*

* Indicates - Disbursement Linked Indicators (DLI).

Immediate Activities:

• Administrative Sanction (AS) proposal to be obtained.
• Programme Implementation Plan (PIP) being revised based on the discussions during the last WB Mission – to be placed in the SEC for approval.
• State Empowered Committee meeting to be convened.
• Next World Bank Mission expected by 1st week of June.
• First Year Activities worked out & as follows.
• Project Management Unit to be formed.

Progress as on 10.05.2019