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World Bank Document -4^A>- - |C= O N F I D E N T I A L Report No. PP-.5 \~~~, o§Jk.. ' Public Disclosure Authorized be returned to GENERAL FILES immediately after use. This report is available only to those members of the staff to whose work it relates. Any further release must be authorized by the department head concerned. INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT INTERNATIONAL DEVELOPMENT ASSOCIATION Public Disclosure Authorized POPULATION PROJECT REPORT OF PREAPPRAISAL MISSION INDIA ( n two volumes) Public Disclosure Authorized VOLUME I THE MAIN REPORT November 27, 1970 Public Disclosure Authorized Population Projects Department CURRENCY EQUIVALENTS US$ 1.00 7.5 Rupee Rupee 1.00 US$ 0.13 GLOSSARY ABBREVIATIONS ANM Assistant Nurse-Midwife BEE Block Extension Educator DFPB District Family Planning Bureau DFPO District Family Planning Officer DMOH District Medical Officer of Health DMOH-FP District Medical Officer of Health and Family Planning FPHA Family Planning Health Assistant FWW Family Welfare Worker IPPF International Planned Parenthood Federation IUD Intrauterine Device LHV Lady Health Visitor MCH Maternal and Child Health MIES Management-Information and Evaluation System Oxfam Oxford University Famine Relief Fund PHC Primary Health Center RFPTC Regional Family Planning Training Center RFPWC Rural Family Planning Welfare Center SFPB State Family Planning Bureau SFPO State Family Planning Officer WHO World Health Organization UFPWC Urban Family Planning Welfare Center UN United Nations UNDP United Nations Development Program UNICEF United Nations Childrens Fund U.P. Uttar Pradesh USAID United States Agency for International Development INDIA POPULATION PROJECT TABLE OF CONTENTS SUMMARY AND CONCLUSIONS ................................ i-il I. INTRODUCTION 1.......................................1 II. THE POPULATION PROBLEM 3.............................3 III. THE FAMILY PLANNING PROGRAM ........................ 5 A. Organi2Ztion 5...................................5 B. The Statistical System .......................... 8 C. Family Planning Progress ....................... 9 D. Appraisal of Recent Trends ......................... 13 IV. THE PROJECT A. Introduction ................... ................ 17 B. Urban Program .................................. 18 C. Optimal Government of India Pattern Districts .. 19 D. Intensive Rural Program Districts .............. 20 E. Basic ANM and Dai Training ...................... 24 F. The Population Centers ......................... 25 G. Physical Facilities and Equipment ............... 28 H. Costs .......................................... 30 ANNEXES 1. Organizational Chart of Family Planning Activities at the Center 2. Organizational Chart of Family Planning Activities in a State 3. Organizational Chart of Family Planning Activities in a District 4. Organizational Chart of Action/Implementation Committees 5. Management-Information and Evaluation System 6. Inputs and Results in Project Areas 7. Staff and Equipment Requirements of Service Motivation Teams 8. Location of Primary Health Centers and Number of Subcenters 9. Cost Estimates for Project 10. Addition to Annual Expenditures MAPS 1. India Population Project 2. Uttar Pradesh State: Population 3. -Mysore State: Population INDIA POP'ULATION PROJECT SUMMARY AND CONCLUSIONS i. In the past few years the international community has become increas- ingly concerned with India's family planning program. The annual growth rate of 2.5% and the addition of 14 million persons each year have been matters; of serious concern to the Government of India in their efforts at social and economic improvement. Following the Aid India Consortium meeting, especially organized by the Bank in November 1969 to consider India's program, further discussions were held with the Government of India to dcter- mine in a preliminary manner the objectives and location of a possible Bank project. The pro,ject would aim to develop a comprehensive program in the selected districts which would include the components of the Government of India program but would also have variations and improvements that are relevant to the whole Indian program. This would require a management- information system and an evaluation unit for assessing the work in the project area on a continuing, basis. It was agreed provisionally that the project area would comprise six districts in Uttar Pradesh (U.P.) and six districts in Mysore State - covering a total population of about 20 million persons. A preappraisal mission visited India from July 13 to August 21, 1970. ii. The mission found that while the achievements of the Indian program were considerable, the program is not functioning as well as it should or could. A large nrumber of persons have accepted family planning services and an extensive and complex administrative machine to implement policy decisions has been built. But performance falls short of a solution of India's population problem, of the targets set by the Government and the expectations of the Government. Over the last two years sterilizations and IUD insertions have markedly declined. Though the distribution of condoms has greatly increased, overall performance has declined. What is more disturbing is that this decline has occurred despite a great increase in resources available for family planning. iii. The mission could not determine the reasons for these trends. Though specific recommendations are made by the mission, the basic aim of the project is to provide a framework for experimentation and orderly change. Operational questions should be continuously and systematically asked and the policy implications of their answers should be speedily and effectively implemented. iv. The project consists of the following: First, the provision of family planning services in three ways: I. An Urban Program including a particular concentration on post- partum motivation and service in Lucknow (U.P.) and Bangalore City (Mysore); II. An Optimal Government of India Program to implement the Government pattern in twelve Districts - six in U.P. and six in Mysore; and III. An Intensive Rural Program including a particular concentra- tion on recently-delivered mothers in rural areas. This program will have inlputs additional to those sanctioned in the. Government plan and will be implemented in four Districts - two in U.P. and two in Mysore. v. Second, two new Population Centers in Lucknow and Bangalore to be primarily responsible for the management-information system and training. The management-information system would monitor progress in project areas, evaluate performance and recommend changes that would be relevant to other parts of India. These Centers should haye close links to the State family planning administration. Their Board waould have to be influential so that the recommendations of these Centers can be quickly implemented. vi. Third, the following Physical facilities and Equipment: (a) Two Population Centers in Lucknow and Bangalore City and nine District Family Planning Bureaus - one in each District (except Bangalore rural); (b) Two Regional Family Planning Centers - one in Lucknow and one in Bangalore; (c) Two 100-bed maternity hospitals - one in Lucknow, the other in Bangalore City; (d) Ten maternity-sterilization wards - one for each District Hospital; (e) Sixteen Maternity Homes with 15-20 beds and 14 Urban Family Welfare Centers in Lucknow and Bangalore City; (f) Complete Primary Health Centers consisting of a dispensary, family planning clinic and staff living quarters for health and family planning personnel (according to the Government of India pattern) in all Districts where these buildings do not presently exist; and maternity wings (15-20 beds) in selected PHCs of the four Intensive Districts (Scheme III) in addition to the Government pattern; (g) Subcenters for ANMs (and FWWsin U.P.) according to the Government of India pattern, in all Districts where these buildings have not been constructed; and subcenters for dais, in addition to the Government pattern in the Intensive Districts (Scheme III) of U.P.; and (h) Fourteen ANN Schools - five in Lucknow and Bangalore City and one school attached to every District Hospital vii. Total project costs - consisting of physical facilities and equipment and technical assistance - are estimated to total Rs.113 million (US$15.1 million). - iii- The direct foreign exchange component is about Rs.7.5 million (US$1.00 million). Recurrent expenditures of the project that are additional to the present sanctioned level are e!stimated to total Rs.18.6 million (US$3.6 million) over the first five years. About 59% of project costs and additional recurrent expenditures are for U.P. State and 41% for Mysore State. viii. The Populatiorl project outlined in this report will establish, over a sizable population (20 million) the base for continuing assessment of the program with opportunities for variation and experimentation; thus providing in thie longer term a valuable tool for improvement of the performance of the whole program. INDIA POPULATION PROJECT I. INTRODUCTION 1.01 In the past few years the international community has become increasingly concerned with India's family planning program. The annual growth rate of 2.5% and the addition of 14 million persons each year were matters of serious concern in relation to the efforts at social and economic improvement of the Government of India. 1.02 In November 1969, at the request of members of the Aid India Consortium, the Bank organized a special meeting in Stockholm for representatives
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