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World Bank Sponsored Punjab Health Sector Reforms Program (PHSRP)
Posted 04-12-2017
Punjab Health Sector Reform Program (PHSRP) of The World Bank and Provincial Health Nutrition Program (PHNP) of the DFID was designed mutually in collaboration with government counterparts in post devolution scenario for the implementation of Punjab Health Sector Strategy (PHSS), by focusing on the improvement of the coverage and utilization of quality essential health services, particularly in the low performing districts of Punjab. To contribute to this objective, main focus was on building the capacity and systems to strengthen accountability and stewardship in Health Department. Initially World Bank agreed to provide financial support of US$ 121.5 Million for Punjab Health Sector Reform Project for the implementation of PHSS over a period of 4 years starting from FY 2013-14 to 2016-17. Out of this, US$ 100 Million were from the IDA (soft loan) while remaining US$ 21.5 Million grant was from the Health Results Innovation Trust Fund (HRITF). The project was approved on May 31, 2013 and became effective on January 17, 2014 whereas project Closing Date was December 31, 2017.
The project was envisaged to support the Government of Punjab Health Sector Program under the following four components:
Component 1: Improving Health Service Delivery (IDA US$28.34 million)
Component 2: Enhancing Efficiency & Effectiveness of the Health System (IDA US$34.00 million and HRITF US$10 million)
Component 3: Strengthening Provincial Health Department Management Capacity (IDA US$22.66 Million)
Component 4: Improving the Capacities in Technical Areas (IDA US$15 million and HRITF US$11.5 Million)
HRITF Grant was approved to support Component 2 (district results performance agreement) and Component 4 (facility-based financing pilot in two districts and voucher scheme for maternal and child health services).
The project was originally designed to use three disbursement modalities:
- reimbursement against the selected Eligible Expenditure Programs (EEPs) upon achievements of Disbursement Linked Indicators (DLIs) under Components 1, 2, and 3;
- performance-based financing for districts and health facilities, partly funded by the HRITF, under Components 2 and 4; and
- Statement of Expenditure based payments for TA and pilots under Component 4.
To improve primary/preventive health care, Government of Punjab started the health reforms roadmap in April 2014. Key goal for this roadmap was “saving lives of mothers and children” and it was focused on reducing IMR & MMR. Roadmap focuses on priorities which were:
(i) increasing immunization
(ii) increasing SBA rates,
(iii) strengthening basic health units,
(iv) improving district level effectiveness and
(v) increasing CPR.
Meanwhile on the direction of Chief Minister, Health Department also started work to design contracting out model with the technical assistance of team of consultant hired by TRF+ and Roadmap.
In this scenario, some of the DLIs and reforms areas mutually agreed initially by the World Bank and Health Department, like revision of PRSP contract, performance based contracts with the district EDOs (contracting in model), results based financing/incentives to health staff on the basis of agreed KPIs and voucher schemes to introduce demand side financing (DSF) seemed no longer relevant and appropriate (although an extensive amount of work had been done in terms of development of operational manual for the above mentioned initiatives and those were submitted to WB through Health department). At the same time Health Department was bifurcated into two departments namely department for Specialized Health and Medical Education and department for Primary and Secondary Health.
The issue was highlighted in a meeting held between Country Director World Bank with the Chief Minister on January 19, 2016 where it was suggested to “restructure the project to align it with new scope and bifurcation of health department as both of new departments have relevance with it”. Subsequently another meeting was held on January 26, 2016 between World Bank Country Director and Chairman P&D along with both new Secretaries in which it was decided to restructure the program into three components:
- The DLIs which are relevant in the current scenario may be retained
- Some portion of IDA (soft loan) may be converted into project mode
- Institutional / Capacity Assessment of both primary / secondary and Special care / Medical Education Department along with Technical Assistance and capacity building support
Restructuring of PHSRP
The objective of the restructuring was to realign the PHSRP with the Government of Punjab’s (GOPb) new reform priorities as well as with the structural changes in the Punjab Department of Health since project approval. Extension of the Closing Date of the project by one year until December 31, 2018.
Restructuring of PHSRP was finalized after singing of amendment to Project Agreement between Health Department & World Bank by February 15, 2017 & Amendment to Financing Agreement was approved by Economic Affair Division (EAD) by April 10, 2017 with the following modes:
| Mode of Financing | Revised Cost | Amount Released | Balance |
| US$ Million | |||
| DLI Mode | 53.18 | 28.59 | 24.59 |
| Technical Assistance | 9.00 | 1.00 | 8.00 |
| Project Mode Financing - IRMNCH |
35.82 |
16.09 |
19.73 |
| - MSN Cell | 2.00 | 0.3 | 1.7 |
| Total | 100 | 45.98 | 54.02 |