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(Country)India (Research)Data Collection India (COUNTRY) INDIA (RESEARCH) DATA COLLECTION SURVEY ON HEALTH SECTOR IN INDIA FINAL REPORT February 17, 2014 Japan International Cooperation Agency Dalberg Global Development Advisors/ DevelopmentEx.com 4R JR 14-025 TABLE OF CONTENTS List of abbreviations ............................................................................................................................... iv List of major reference sources [Reports and Databases] .................................................................. vi I. INTRODUCTION TO INDIA’S HEALTH SECTOR ............................................................... 1 A. Public health planning and expenditure ................................................................................ 1 B. Public health implementation ................................................................................................. 6 C. Role of the private sector ....................................................................................................... 10 D. Role of donors ......................................................................................................................... 12 II. HEALTH SECTOR PERFORMANCE IN THE ELEVENTH FIVE YEAR PLAN PERIOD (2007-2012) ................................................................................................................... 18 A. Overview: In light of MDGs .................................................................................................. 18 B. National-level findings ........................................................................................................... 26 1. Primary Health - Maternal Health ......................................................................................... 26 2. Primary Health - Child Health .............................................................................................. 30 3. Disease Control - Tuberculosis ............................................................................................. 34 4. Disease Control - HIV/AIDS ................................................................................................ 38 5. Disease Control - Malaria ..................................................................................................... 42 6. Disease Control - Non-communicable diseases .................................................................... 44 7. Enabling Environment - Water and sanitation ...................................................................... 47 8. Enabling Environment - Nutrition ........................................................................................ 48 9. Health Systems ...................................................................................................................... 52 C. State-level findings ................................................................................................................. 66 1. Mizoram ................................................................................................................................ 66 2. Madhya Pradesh .................................................................................................................... 79 3. Rajasthan ............................................................................................................................... 87 4. Tamil Nadu ........................................................................................................................... 95 III. JICA AND JAPAN’S HEALTH SECTOR PRIORITIES ..................................................... 104 A. JICA’s Health Sector Cooperation Policy ......................................................................... 104 B. Strategy on Global Health Diplomacy ................................................................................ 105 IV. JICA’s ACTIVITIES AND EXPERIENCES IN THE HEALTH SECTOR IN SOUTH ASIA ............................................................................................................................................ 107 A. Overview of JICA’s activities in the health sector in South Asia .................................... 107 B. Lessons from past projects in South Asia .......................................................................... 108 V. India’s Forward Looking Health Care Strategy ..................................................................... 111 A. 12th FYP Priorities .............................................................................................................. 111 B. Stakeholder Priorities .......................................................................................................... 117 VI. Recommendations ...................................................................................................................... 119 A. Strategic Direction ............................................................................................................... 119 ii B. Potential opportunities......................................................................................................... 123 1. Overview ............................................................................................................................. 123 2. Details on the prioritized opportunities for JICA ................................................................ 127 C. Key considerations for implementation ............................................................................. 139 Annex 1: Descriptions of Programs in States .................................................................................... 142 Annex 2: JICA’s Past Experience in South Asia .............................................................................. 159 Annex 3: Key take aways from all stakeholder outreach ................................................................. 163 iii LIST OF ABBREVIATIONS Abbreviation Full Form 12th FYP Twelfth Five Year Plan ADB Asian Development Bank AIDS Acquired Immune Deficiency Syndrome ANMs Auxiliary Nurse Midwives APL Above Poverty Line ARI Acute respiratory infections ART Anti-Retroviral Treatment ASHA Accredited Social Health Activist AYUSH Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy BCC Behavioral Change Communication BMGF Bill and Melinda Gates Foundation BOP Base of Pyramid BPL Below Poverty Line CHC Community Health Center CGHS Central Government Health Scheme DFID Department for International Development, Government of United Kingdom DH District Hospital DHR Department of Health Research DLHS District Level Household Survey (Government of India) DOT Directly Observed Treatment DPT Diphtheria, Pertussis, Tetanus DST Drug Susceptibility Test FSW Female Sex Worker GAVI Global Alliance for Vaccines and Immunization GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GOI Government of India HIV Human Immunodeficiency Virus HR Human Resource ICDS Integrated Child Development Services ICMR Indian Council of Medical Research ICTC Integrated Counseling and Testing Centre IEC Information Education and Communication IMR Infant Mortality Rate IDA International Development Agency INR Indian National Rupee IDU Injecting Drug Users IPHS Indian Public Health Standards IRS Indoor Residual Spray ITBN Insecticide treated bed nets JSY Janani Suraksha Yojana – the GOI’s flagship maternal health program LDC Least Developed Country LLIN Long lasting insecticide nets iv Abbreviation Full Form MDGs Millennium Development Goals MDMS Mid-Day Meal Scheme MMR Maternal Mortality Rate MNCH Maternal, newborn and child health MOHFW Ministry of Health and Family Welfare MSACS Mizoram State AIDS control society NACO National AIDS Control Organization NCD Non-communicable diseases NHM National Health Mission NICED National Institute of Cholera and Enteric Disease NIHFW National Institute of Health and Family Welfare NMHP National Mental Health Program National Program for Prevention and Control of Cancer, Diabetes , Cardiovascular diseases NPCDCS and Strokes NRCs Nutritional Rehabilitation Centers NRHM National Rural Health Mission NUHM National Urban Health Mission NVBDCP National Vector Borne Disease Control Program ODA Official Development Assistance OOP Out of Pocket ORS Oral rehydration salt PHC Primary Health Center PHFI Public Health Foundation of India PPP Public Private Partnerships RNTCP Revised National Tuberculosis Control Program RSBY Rashtriya Swasthya Bima Yojana (which means National Health Insurance Program) SC Sub Center SDH Sub-district Hospital SIFPSPA State Innovations in Family Planning Services Project Agency SNP Supplementary Nutrition Program STD Sexually Transmitted Disease STI Sexually Transmitted Infections TB Tuberculosis TI Targeted Interventions U5MR Under Five Mortality Rate UHC Universal Health Coverage ULB Urban Local Bodies UNAIDS Joint United Nations Program on HIV/AIDS UNICEF United Nations International Children’s Emergency Fund UNODC United Nations Office on Drugs and Crime UNPFA United Nations Population Fund USAID United States Agency for International Development USD US dollar ($) WB World Bank v Abbreviation Full Form WHO World Health Organization LIST OF MAJOR REFERENCE SOURCES [REPORTS AND DATABASES] REPORTS 1. JICA India Office newsletter [2008] 2. NACO report [2012] [2011] 3. MDG India Country Report [2011] 4. RNTCP report [2011],[2012],[2013] 5. WHO Malaria report [2012] 6. National Health Profile report [2011] 7. WHO World health statistic report [2012], [2013] th 8. Planning commission report of the working group on disease burden for
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