India - Uttarakhand Health Systems Development Project

Overview & Synopsis

Ratings for the Uttarakhand Health Systems Development Project for India were as follows: outcomes were satisfactory, the Bank performance was satisfactory, and the monitoring and evaluation quality was substantial. Some lessons learned included: Increasing access to quality health care services for hard-to-reach populations requires a multi-pronged approach that concurrently leverages a few high-impact service delivery modalities. As a first health sector project implemented in a hilly state in India, its design with fewer activities was key to its success. In Uttarakhand, a focused project involving public-private partnerships, mobile health vans, and telemedicine led to greater service availability and higher utilization. Supporting NABH facility accreditation and system-wide improvements also enhanced the quality of care provided. A unique provider to provider, hub and spoke, telemedicine system can facilitate remote consultations with a necessary range of specialists across the PHCs. This system especially benefits rural and vulnerable populations. A holistic and systematic approach to health facility accreditation ensures that facilities can sustainably maintain quality standards beyond the accreditation period. This approach goes beyond merely meeting basic requirements. Beginning the accreditation processes with a gap assessment and a specific plan to fill the gaps in each facility was essential for defining a roadmap and assigning needed resources to facilities seeking accreditation in Uttarakhand. Training facility staff and setting clear expectations helped embed a culture of quality care, while investments in systems and technology for waste management built lasting capabilities. This improvement allows facilities to manage and process solid and liquid waste more effectively, reducing risks to patients and surrounding communities.