Context

The World Bank is lending up to $1 billion to help India with preparedness for future pandemics as well as to strengthen its health infrastructure. 

About:

• The lending will be divided into two complementary loans of $500 million each.
• The bank will support India’s flagship Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), launched in October 2021, to improve the public healthcare infrastructure across the country. 

• In addition to the national-level interventions, one of the loans will prioritise health service delivery in seven States including Andhra Pradesh, Kerala, Meghalaya, Odisha, Punjab, Tamil Nadu, and Uttar Pradesh.

• The $500-million Public Health Systems for Pandemic Preparedness Program (PHSPP) will support the government’s efforts to prepare India’s surveillance system to detect and report epidemics of potential international concern. 
• Another portion of funds will also be allocated for Enhanced Health Service Delivery Program (EHSDP), which will support government’s efforts to strengthen service delivery through a redesigned primary healthcare model.
  • It includes improved household access to primary healthcare facilities, stronger links between each household and its primary care facility through regular household visits and risk assessment of non-communicable diseases.

Both the PHSPP and the EHSDP utilise the Program-for-Results financing instrument that focuses on achievement of results rather than inputs.  Both the PHSPP and EHSDP loans from the International Bank for Reconstruction and Development (IBRD) have a final maturity of 18.5 years including a grace period of five years.

Need of the initiative:

• COVID-19 has underscored the need for developing capacity for core public health functions, as well as for improving the quality and comprehensiveness of health service delivery.

India’s Health sector:

• In India, the Health care sector is one of the largest sectors in terms of both revenue and employment.
• India’s performance in health has improved over time. 
• According to World Bank estimates, India’s life expectancy has increased from 58 in 1990 to 69.8 in 2020. 
• This is higher than average for the country’s income level. 
• Other indicators: 

• • The under-five mortality rate (36 per 1,000 live births), 
  • Infant mortality rate (30 per 1,000 live births), and 
  • Maternal mortality ratio (103 per 100,000 live births) is all close to the average for India’s income level.

Persistent issues in the sector	Required measures
Inadequate reach and fund Optimal Insurance No focus on Preventive Car Less emphasis on Medical Research Issue of Policymaking Shortage of Medical Workforce Inadequate outlay for health Lack of structure	Improving infrastructure Focus on efficiency enhancement Technology utilisation Awareness Effective government intervention Increased Budgetary allocation