Health Sector Programme Bangladesh 2017-2022

The health sector program is based on lessons learned from previous programs and also focuses on  governance and supervision of the sector. The three components that the program focuses on are: i) governance, regulation and supervision of the sector, ii) strengthened health system, and iii) the provision of good quality health services. The progress of the Fourth Sector Program is reviewed and discussed by nine thematic Task Groups. The Swedish support is channeled through a multi donor trust fund administered by the World Bank. The World Bank's program document follows the structure of the government's sector program and forms the basis for the multi donor trust fund, MDTF. The fund, which is structured according to a results-based model, follows up indicators mainly in two geographical areas, Sylhet and Chittagong, where inequality in women's sexual and reproductive health is greatest. The 16 disbursement indicators are in line with Bangladesh's priorities in the fourth sectoral program. The progress of the Fourth Sector Program is reviewed and discussed by nine thematic Task Groups. The added value of Sida's support through the multi donor trust fund through the World Bank 2017-2021 by SEK 190 million, can be briefly said to be that it contributes to: - Aid efficiency and reduces transaction costs - Increased ownership of Bangladesh's government - Coordination and dialogue between donors within the fund and wider in the sector based on the national health agenda - The dialogue in the Ministry of Health's working groups together with the donors - Facilitates WB to have a platform for other programs such as humanitarian interventions and within Nexus, ie the link between development and humanitarian interventions - Increased opportunity to achieve results in vulnerable areas. Examples of results: As of February 01, 2024, the project has disbursed US$506.8 million1 from the IDA, US$128.4 million from the MDTF and US$15 million from the GFF. Sweden disbursed the last funds in the fall of 2020. The progress towards the achievement of the Project Development Objective (PDO) is Satisfactory. Out of the 7 PDO indicators, 6 have achieved the endof project targets and the remaining 1 was reported to be achieved but pending verification from the Implementation Monitoring and Evaluation Division (IMED) of the Ministry of Planning. Out of 98 disbursement linked results (DLRs), 91 DLRs have been reportedly achieved (whether or not verified) during the first 6 years of project implementation. Following is a summary of achieved DLRs throughout the project period: • Fiscal Year (FY) 2017: Of 13 planned DLRs, 12 have been verified as achieved and funds disbursed 1 (DLR 4.2) was reported to be achieved by the MoHFW but the independent verification by IMED noted that the AMS was not effectively implemented. • FY 2018: Of 19 planned DLRs, 16 have been verified as achieved and funds disbursed 2 (DLR 4.2 and 13.4) were verified by IMED to be not achieved and DLR 7.2 for FY18 is not achievable. • FY2019: Of 19 planned DLRs, 18 have been verified as achieved and funds disbursed DLR 6.2 is yet to be reported as achieved. • FY2020: Of 16 planned DLRs, 15 have been verified as achieved and funds disbursed DLR 6.3 cannot be implemented until DLR 6.2 is achieved. • FY2021: Of 16 planned DLRs, 15 have been verified as achieved and funds disbursed. DLR 8.1 was reported to be achieved by the MoHFW but pending IMED verification. •FY22: Of 15 planned DLRs, only 12 DLRs have been verified as achieved and funds disbursed. DLR 8.1 is reported to be achieved but pending IMED verification. The remaining 2 DLRs have been reported as achieved but there is no available balance to be disbursed. Component 4 (HNP services for Rohingya refugees): Progress under this component is rated as satisfactory. All activities under all 4 UN agreements have been completed. Some of the activities under this component have been supported under the WB financed Health and Gender Support Project for Coxs Bazar District. The completion date of the 4th HPNSP has been extended for the second time and the newly established competion date is June 30, 2024. A noncost extension agreement between Sweden and World Bank for the extended completion date was signed by the ambassador of Sweden in Bangladesh on 13th of March 2023. This was to allow sufficient time for the remaining DLRs to be achieved and verified to enable utilization of the undisbursed balance. The likelihood that the objectives will be achieved by the end of the intervention is therefore likely.

The overall objective of the governments Fourth Health, Population, and Nutrition Sector Program is to ensure that all citizens of Bangladesh enjoy health and wellbeing by expanding access to quality and equitable health care in a healthy and safe living environment. The MOHFW considers it as a first, foundational, program toward the achievement of the SDGs by 2030. The strategic objectives of the programme are grouped into three components and eight strategic objectives clustered around 3 components as follows: Component 1: Governance and stewardship of the sector. Strategic objective 1: To strengthen governance and stewardship of the public and private health sectors. Strategic objective 2: To undertake institutional development for improved performance at all levels of the system. Strategic objective 3: To provide sustainable financing for equitable access to health care for the population and accelerated progress towards universal health coverage. Component 2: Stronger health systems Strategic objective 4: To strengthen the Ministry of Health and Family Welfare´s capacity in core health systems (financial management, procurement, infrastructure) Strategic objective 5: Establish a high quality health workforce available to all through public and private health service providers. Strategic objective 6: To strengthen the evidence base for health sector decision-making. Component 3: Quality health services Strategic objective 7: To improve equitable access to and utilization of quality health, nutrition and family planning services. Strategic objective 8: To promote healthy lifestyle choices within a healthy environment. 16 disbursement linked indicators that will be financed by the Sweden, through multidonor trust fund are aligned with the three components described above. DLIs will act as a trigger to achieve the targets set by the strategic objectives which is further operationalsed in the result framework of the fourth SWAP. To achieve the results supported under component 1, activities will be measured against progress in DLI 1 on strengthened system for citizen feed-back and DLI 2 on improved budget planning and allocation. Under component two, progress will be measured against progress in the following indicators: DLI 3. Financial management system is strengthened, DLI 4. Asset management is improved, DLI 5. Procurement process is improved using information technology, DLI 6. Institutional capacity is developed for procurement and supply management, DLI 7. Availability of midwives for maternal care is increased, and DLI 8. Information system is strengthened, including genderdisaggregated data. Indicators that will be used to measure progress under component 3 are: DLI 9. Postpartum family planning services are improved, DLI 10. Utilization of maternal health care services is increased, DLI 11. Emergency obstetric care services are improved, DLI 12. Immunization coverage and equity are enhanced, DLI 13. Maternal nutrition services are expanded, DLI 14. Infant and child nutrition services are expanded, DLI 15. Schoolbased adolescent HNP program is developed and implemented, DLI 16. Emerging challenges are addressed. Sweden concludes the results-based approach will help provide strong incentives to the government to deliver better Health output, process, outcome and impact.