The Asian Development Bank (ADB) has approved an additional loan financing of $110 million for a project to improve urban primary healthcare services in Bangladesh through PPPs.
"ADB's support to the government-led Urban Primary Health Care Services Delivery Project approved in 2012 has been filling a vacuum created by the lack of urban public primary healthcare by increasing access to quality services, especially for poor households," said ADB Social Sector Specialist Brian Chin.
He said, "The new financing will focus on strengthening the service delivery system, building on the results of the 2012 project and two previous projects, to meet the unmet demands and develop self-reliance in running the system."
The project is recognised as an innovative model of partnership between the government, which contracts out health service delivery, and service providers (mainly nongovernment organisations), the ADB said on Wednesday.
As originally financed in 2012 with a $50 million ADB loan and $20 million cofinancing, it is one of the largest public-private partnerships (PPP) projects for primary healthcare delivery in South Asia.
Previously, the lender provided a $40 million loan and $4.5 million cofinancing for a first project to support health services in four cities during 1998-2005, reports UNB.
A second project followed in 2005-2012 backed by a $30 million loan, $10 million grant, and $30 million cofinancing widening the support to six cities and five municipalities.
As originally envisaged, the 2012 project covers 10 cities and four municipalities representing about 17 per cent of the total 57 million urban population.
According to a review in 2015, the project has been providing services to more than 23 million clients, of whom 74 per cent were female, and has constructed a network of 180 health facilities and 224 satellite clinics.
The project is also building experience in the management and contracting of health service delivery, as well as monitoring and evaluation systems.
The review concluded that the project merits continuation and expansion to ensure that the growing demand for healthcare in urban areas is met.
The additional financing will cover the cost of a 5-year extension to assist the government to strengthen local health systems and continue to expand the PPP system of contracting to service providers.
It expands coverage to an additional city and 10 municipalities and will build eight additional reproductive healthcare centers and 24 primary healthcare centers.
The sustainability of health services will be ensured through a series of management, institutional, and staffing reforms, the Bank said.
The new financing will build on previous efforts toward climate change mitigation by adopting solar panels, rainwater harvesting systems, and flood drainage.
The Urban Climate Change Resilience Trust Fund, financed by the Rockefeller Foundation and the governments of Switzerland and the United Kingdom, will provide a $2 million grant, to be administered by ADB.
The Bangladesh government will contribute $30 million toward the cost of the additional financing, while the United Nations Population Fund will provide $1.5 million in-kind technical support. The project completion date is March 2023.
