BACKGROUND INFORMATION Every year in India 2.4 million children and about 136,000 women die unnecessarily. These numbers represent about one fifth of the global total and only if a dramatic reduction in these futile losses is achieved, can India hope to reach the Millennium Development Goals on maternal and child mortality. India’s National Rural Health Mission was launched in April 2005 with a strong commitment to reduce maternal and infant mortality and provide universal access to public health services. The second phase of India’s Reproductive and Child Health Program (RCH II) is an integral and important component of this mission. The World Bank prepared a US$360 million credit (Reproductive and Child Health II Project) building in the lessons of RCH I to support this effort. When deficiencies in procurement in RCH I were uncovered, the Bank launched an investigation and worked with the Government of India to build a strong remedial plan. The Government and the Bank agreed on a comprehensive Governance and Accountability Action Plan (GAAP) to address procurement deficiencies in India health sector projects. The action plan will apply to all centrally sponsored health and family welfare programs supported by the Bank in India. The delivery of high quality health services is an extremely complex area involving a host of public and private, local and international players. The agreed plan articulates the specific roles and responsibilities of public, private, and civil society institutions engaged in the health sector to ensure timely supply of quality pharmaceuticals, health sector goods and services at a competitive price. The Government’s plan to address weaknesses in pharmaceutical quality assurance and procurement processes include five specific measures: - improving quality certification of pharmaceuticals;
- increasing competition and mitigating collusion;
- strengthening procurement implementation and contract monitoring;
- handling procurement complaints; and
- disclosing information and promoting oversight by civil society.
The same measures sought in the centrally agreed plan will also be implemented at the state level through Bank-supported state health system development and reform projects. Karnataka is one example of a state which is embracing these reforms in its Health Sector Procurement Reform Action Plan. This draws heavily on the national action plan and adds some state-specific measures, such as the strengthening of the Karnataka State Drug Logistics and Warehouse Society. To implement these measures the Ministry of Health and Family Welfare has established an Empowered Procurement Wing (EPW) to professionalize the procurement of health sector goods and services. The EPW will ensure better competition and transparency in procurement of pharmaceuticals, health sector goods and services in India, as well support the implementation of new policies and actions. In addition to implementing this action plan across the health sector, the Government of India has also agreed to a Detailed Implementation Review of five on-going health projects so that any further problem areas can be identified and the action plan refined and improved as problems are uncovered. An independent international agency with expertise in health sector procurement will do a procurement capacity review of the MOHFW and Indian States. In addition an assessment of quality and quantity of pharmaceuticals and medical goods supplied under Bank-financed health projects will be done. Based on all these findings and recommendations, the central action plan will be strengthened further as necessary. "In all, this is a comprehensive and serious approach by the Government of India to build strong systems of regulation and oversight," said World Bank Vice President for the South Asia Region Praful Patel. "Not a country in the world has a perfect handle on this complex sector with multiplicity of players but it is vital for the health of Indians – and for the economic health of India – that sunshine beam into some of the dark corners where deficiencies have been found. We commend Government for making this a priority."  World Bank Supports India’s Health Sector, three new projects worth US$672 million focus on women, children and communicable diseases, (press release), August 22, 2006
Statement on World Bank-Assisted Health Projects in India (statement), April 3, 2006 |
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