Health Care

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• Tamil Nadu Health System Reform Program

  The development objective of the Tamil Nadu Health System Reform Program Project for India is to improve quality of care, strengthen management of non-communicable diseases and injuries, and reduce inequities in reproductive and child health services in Tamil Nadu.The proposed Program contributes to the attainment of Sustainable Development Goal (SDG) 3 and the Health, Nutrition and Population Global Practice goal of ending preventable deaths and disability through Universal Health Coverage (UHC).The Government wants to enhance efficiency, effectiveness, and impact of its current health sector program, and using a Program-for-Results (PforR) instrument to support the proposed TNHSRP will provide a much greater focus on outputs and outcomes through better alignment of expenditures and incentives with results.As outlined in Vision 2023, this involves strengthening primary and secondary care centers and upgrading tertiary care hospitals. A special focus is given to Noncommunicable Disease (NCDs) using a two-pronged strategy: (a) preventing NCDs through population-based interventions to raise awareness and induce lifestyle changes and (b) improving the capacity for early screening, diagnosis, treatment, and follow-up in health facilities.The Program has three key result areas with a combination of both technical interventions specific to each result area and cross-cutting interventions that contribute to achieving results across the three result areas. These cross-cutting interventions aim to strengthen institutions and state capacity and expected outputs or intermediate results in the Program theory of change.The first result area is recognizing that there is no single silver bullet in quality of care, the Program embraces a multipronged approach to quality improvement.The second result area focuses on enhancing the management of NCDs, associated risk factors and injurie

• Program Towards Elimination of Tuberculosis

  The objective of the Program Towards Elimination of Tuberculosis Project is to improve the coverage and quality of TB control interventions in the private and public sector in targeted states of India. Growth has accelerated in the last two quarters to reach 8.2 percent in the first quarter of FY18-2019. This growth was supported by a revival in industrial activity, strong private consumption, and a rise in exports of goods and services. At the same time, the external situation has become less favorable. The current account balance has widened on the account of an increasing trade deficit (on the back of strong import demand and higher oil prices) from 0.7 percent of GDP in FY16-17 to 1.9 percent in FY17-18. Meanwhile, external headwinds, monetary policy ‘normalization’ in the US coupled with recent stress in some Emerging Market Economies, have triggered portfolio outflows from April 2018 onwards, putting additional pressure on the balance of payments. Going forward, growth is projected to reach 7.3 percent in FY18-19 and to firm up thereafter at around 7.5 percent, primarily on account of robust private and public consumption expenditure, a rise in exports of goods and services, and a gradual increase in investments. However, the current account deficit is also projected to remain elevated in FY18-19. Between FY2011-12 and 2015, poverty declined from 21.6 percent to an estimated 13.4 percent at the international poverty line (2011 PPP US dollar 1.90 per person per day), continuing the earlier trend of robust reduction in poverty. Aided by robust economic growth, more than 90 million people escaped extreme poverty and improved their living standards during this period. Despite this success, poverty remains widespread in India. In 2015, with the latest estimates, 176 million Indians were living in extreme poverty while 659 million, or half the population, were below t

• Andhra Pradesh Health Systems Strengthening Project

  The development objectives of Andhra Pradesh Health Systems Strengthening Project for India are to improve the quality and responsiveness of public health services and increase access of the population to an expanded package of primary health services. This project has three components. 1) The first component, Improve Quality of Care, aims to focus on improving the quality of care in Community Health Centers (CHCs) and Primary Health Centers (PHCs), which are often the first point of contact in the health system. 2) The second component, Improve Responsiveness of Public Health Services, aims to will complement Component 1 by focusing on making public health services more user-friendly and responsive to peoples’ feedback, which is a key element of quality. 3) The third component, Increase Access to an Expanded Package of Primary Health Services, aims to focus on expanding the package of services provided at PHCs and Subcenters (SCs) to include Noncommunicable Disease (NCD) screening, risk-stratification and management in addition to strengthening the existing Maternal and Child Health (MCH) services.

• National AIDS Control Support Project

  The objective of the National AIDS Control Support Project for India is to increase safe behaviors among high risk groups in order to contribute to the national goal of reversal of the HIV epidemic by 2017. The project has three components. (1) Scaling up targeted prevention interventions component will support the scaling up of Targeted Interventions (Tis) with the aim of reaching out to the hard to reach population groups who do not yet access and use the prevention services of the program, and saturate coverage among the High Risk Groups (HRGs). In addition, this component will support the bridge population, i.e. migrants and truckers. (2) Behavior change communications will include: (i) communication programs into society and to encourage normative changes aimed at reducing stigma and discrimination in society at large, and in health facilities specifically, as well as to increase demand and effective utilization of testing and counseling services; (ii) financing of a research and evaluation agency to assess the cost-effectiveness and program impact of behavior change communications activities; and (iii) establish and evaluate a helpline at the national and state level to further increase access to information and services. (3) Institutional strengthening component will support innovations to enhance performance management including fiduciary management, such as the use of the computerized financial management system, at national and state levels.

• Uttarakhand Health Systems Development Project

  The development objective of the Uttarakhand Health Systems Development Project for India s to improve access to quality health services, particularly in the hilly districts of the state, and to expand health financial risk protection for the residents of Uttarakhand. The project will have two components. The first component, Innovations in engaging the private sector will finance engagement with the private sector in the delivery of health care services, as well as in health care financing. This component will expand access to services by creating integrated, technology-enabled health system architecture with enhanced focus and availability of primary care, emergency care, and necessary referral services. It will also expand financial protection by defining a benefit package of primary care services for child and adolescent care and for the management of National Competitive Bidding (NCDs). The first component includes two subcomponents. (i) innovations in integrated delivery of healthcare services (primary, referral,and emergency care); (ii) innovations in healthcare financing;The second component, Stewardship and System Improvement will strengthen the Government’s capacity to engage effectively with the private sector, and therefore, enable the Government to provide effective stewardship to improve the quality of services in the entire health system, particularly in its capacity to effectively pursue the innovations being planned under this project. The component will focus on strengthening the institutional structures for stewardship and service delivery and augmenting the state’s human resource capacity, so that the necessary skillsets required for effective implementation of the project and the state’s health programs are available. The strengthened capacity will serve beyond the activities of this project, as it will contribute to the Government’s stewardship r

• Nagaland Health Project

  The objective of the Nagaland Health Project for India is to improve health services and increase their utilization by communities in targeted locations in Nagaland. There are two components to the project, the first component being community action for health and nutrition. This component is designed to empower communities to oversee, manage, and improve HNP services and their utilization. An incentive strategy will be used whereby funding will be nutrition-related services and practices. In turn, communities will use the incentives for activities and investments that are important to them and have potential impacts on health and nutrition. The component will have a major focus on knowledge and skill building of Village Health Committees and other stakeholders at the community level, including women’s groups and Village Councils. Village Health Committees will be supported in identifying existing gaps, determining the most suitable approaches to address these gaps, developing action plans, and operationalizing those plans. Finally, the second component is the health system development. This component will support improvements in the management and delivery of health services, including both facility-specific and system-wide investments.

Pipeline

• Strengthening Teaching-Learning And Results for States

• India - Bihar higher education : background report on access, equity, excellence, and finance in higher education in Bihar

  This background report was written at a time when the Government of Bihar (GoB) was launching a number of reforms in higher education. A private universities bill passed the Bihar state assembly in April 2013 paving the way for opening of private universities in the state. A strong effort to encourage universities and colleges to obtain National Assessment and Accreditation Council (NAAC) accreditation has been initiated. The objective of this background report is to provide policy-makers and stakeholders in higher education in Bihar with an overview of the opportunities and challenges that the state is facing in terms of reaching the ambitious goals in mission manav vikas. The report analyzes the data and information which is readily available on the access, equity, excellence, and finance. It can also be used as a baseline for the state higher education plan in Bihar drafted as part of the Rashtriya Uchchatar Shiksha Abhiyan (RUSA) process. The report is reflecting what has been possible to do in a short period of time with the available data and information.

• India - Measuring learning in higher education in India

  Higher education institutions (HEI) have three major functions: education, research, and service. Each HEI differs in the priority of these functions based on their mission and consists of multiple stakeholders who are all invested in performing these functions. HEIs use multiple forms of data to measure each of the three major functions. The gap in information pertains to outcomes. Most stakeholders will agree that the desired outcomes of higher education include the development of appropriate levels of knowledge and skills; the ability to integrate and apply knowledge to a variety of problems; and the acquisition of intellectual and social habits and dispositions in preparation for productive, responsible citizenship. HEIs collect information at the student level through the number of student applications, number of students admitted, and number of students accepted who enroll all of which provide basic ‘quantity’ measures. They also look at average performance on secondary school leaving exam (that is, the scholastic aptitude test (SAT) and the American college testing (ACT) in the case of the United States (U.S.)) and average performance in secondary school (that is, average high school grade point average (GPA) in the case of the U.S.) which provides basic quality measures. Typical analyses of the quality of institutions assume that HEIs with better inputs lead to better educational outputs and outcomes.

• What is happening inside classrooms in Indian secondary schools? : a time on task study in Madhya Pradesh and Tamil Nadu

  The Government of India launched Rashtriya Madhyamik Shiksha Abhiyan (RMSA) in March, 2009 which is along the lines of Sarva Shiksha Abhiyan but with the focus on secondary education. The key objectives of the scheme are to enhance access to secondary education and to improve its quality. It envisages achieving universal access to secondary level education by 2017, and improving quality of education imparted at the secondary level by making all secondary schools conform to prescribed norms. The objective of this study is to document and analyse the current use of classroom time and identify good practices to improve classroom teaching in Mathematics and Language in secondary education in support of the implementation of the RMSA scheme. This study has been carried out as part of the WorldBank’s initiative with concurrence from Ministry of Human Resource Development (MHRD), Government of India (GoI).This study builds upon an earlier study on time-on-task which was carried out by the World Bank forelementary schools in the states of Andhra Pradesh, Madhya Pradesh and Uttar Pradesh in 2006-2007.That study was instrumental in providing valuable insight on time spent and the nature of teaching in elementary classrooms. The current study aims to achieve the same in secondary schools, teacher quality is a relatively new and expanding area of research that includes several components –teacher qualifications, attendance, instructional practices, governance and accountability. While several of these areas have been investigated in the Indian context, observing teachers’ classroom practices has received little attention especially at the secondary level. This study, for the first time, gathered information on teachers’ time-on-task in secondary classrooms in India. The study systematically documented teacher practices in grade 10 classrooms across 150 schools in 6 districts in Madhya Pradesh and Tamil Nadu to better understand how teachers are spending their time on instructional and non-instructional activities,the kinds of teaching-learning materials being used for instruction and the extent to which the teaching practices used are able to engage students in these classes. The findings indicate that while the majorityof teaching time is spent on instruction, the use of materials beyond the blackboard and textbook is very limited. Further, instruction is most often directed at the entire class or a large group of students in theclass with few instances of the teacher focusing on small groups or individual students. The findings from this initial study have several implications for policy and further research. More and better evidence from classroom observations is needed to gain a more holistic picture of teachers’ instructional practices in secondary classrooms and to identify teachers’ training needs.These tools can be used by principals, district officials and teachers themselves to generate discussions on effective classroom practices and provide direct and timely feedback on practices that could potentially improve the quality of teaching and learning in secondary schools.

• Impact of STIR’s programming on teacher motivation and student learning

  The theory-of-change narrative that follows builds on STIR’s documentation as well as ID insight's understanding of the program, built through discussions and workshops with STIR (STIR Education 2015).This narrative follows the order of and is supplemented by the following detailed diagram in Table A6, we provide additional detail about the illustrated links and assumptions. Our goal in Table 5 is to allow the reader to focus in on particular links (numbered arrows) of interest, which may pinpoint specific areas for interrogating whether and how the program currently works. The links in the figure provide the connection with Table A6, with one row per link; the diamonds in the figure correspond with key measurement points for the randomized evaluation. However, the authors encourages the reader to engage with the diagram alongside the text in this section. Understanding the program is critical to the evaluation and to expectations of what could be achieved in over two years of programming. The details may also raise useful questions for future programmatic, monitoring, and evaluation work. For teachers and students, these follow a left-to-right causal sequence; for communities, STIR implementers, and education stakeholders, these are discrete attitudes and actions.

• Leveraging Patients' Social Networks to Overcome Tuberculosis Underdetection : A Field Experiment in India

  Peer referrals are a common strategy for addressing asymmetric information in contexts such as the labor market. They could be especially valuable for increasing testing and treatment of infectious diseases, where peers may have advantages over health workers in both identifying new patients and providing them credible information, but they are rare in that context. In an experiment with 3,182 patients at 128 tuberculosis (TB) treatment centers in India, authors find peers are indeed more effective than health workers in bringing in new suspects for testing, and low-cost incentives of about dollar US 3 per referral considerably increase the probability that current patients make referrals that result in the testing of new symptomatic and the identification of new TB cases. Peer outreach identifies new TB cases at 25 percent-35 percent of the cost of outreach by health workers and can be a valuable tool in combating infectious disease.

• Madhya Pradesh - Higher education reform policy options

  In October 2010, the Government of Madhya Pradesh hosted, with World Bank technical advice, a Conference on higher education reform in the State. The Governor, the Chief Minister and the Minister of Higher Education all addressed the Conference and about 150 people attended the event. Subsequently, four regional Conclaves were organized, in which a total of more than 400 people participated, representing the leadership, administrators, faculty and students at universities and colleges across the State. This represents an impressive outreach to the sector stakeholders. This report is written on the cusp of the publication of the Government of India?s 12th Five Year Plan. The indications are that the Government of India intends to push ahead with some significant reforms in the higher education sector. Of particular significance for this report is the emphasis, for the first time, on the need to support the improvement of State universities and colleges. The objective of this report is to provide policy makers in Madhya Pradesh with a menu of options for improving the equity, governance and financing of the higher education system in the State. Though the primary audience is policy makers, this report could serve as part of the continued dialogue with the higher education sector on the direction for reform.