| Project Detail |
Project Development Objective
PDO Statement
13. The proposed project development objective (PDO) is to increase the utilization of quality health services, and
economic and social inclusion programs, among poor and vulnerable households in select districts in Punjab.
PDO-Level Indicators
• PDO Indicator 1: Percent of pregnant women, among Conditional Cash Transfer (CCT)
13 beneficiaries,
who delivered a child attended by skilled health personnel
• PDO Indicator 2: Percent of children between the ages of 12 and 23 months, among CCT beneficiaries,
fully immunized as per the age specific protocol.
o Percent disaggregated by gender
• PDO Indicator 3: Percent of beneficiaries who reported an overall income increase due to asset support.
o Percent disaggregated by gender.
• PDO Indicator 4: Percent of children who transition from preschool to Grade 1
B. Project Components
14. The financial instrument for this Project will be Investment Project Financing (IPF). Key principles of the
Project are as follows:
• Poverty targeting: For objective targeting based on the household poverty status, the NSER will be used.14
• Geographic targeting of most vulnerable districts: Initially, 11 out of 36 districts in Punjab will be
prioritized. Among the 11 districts, 8 districts are from South Punjab, where poor households are
concentrated.15
The number of districts covered by the Project depends on the scope and cost of planned
activities, as well as available resources.
• Integrated, but selective: Interventions will be integrated (addressing both demand and supply
challenges) in the same set of locations within the same households, multisectoral (health, education, SP)
and selective (complementing existing programs).
• Gender-focused: The Project will: (i) address gender gaps in immunization and school enrollment for early
education; (ii) promote ante-natal care (ANC) and skilled birth attendance; and (iii) address specific
constraints faced by women in income-generating activities and diversification of income sources.
Component 1: Health services quality and utilization (approximately US$115 million equivalent)
15. The component will improve maternal and new-born health, especially among poor and vulnerable
households. This will enable a strong start in a child’s first 1,000 days.
Sub-component 1.1: Quality of health services (approximately US$45 million equivalent)
16. This sub-component will include: a) Strengthening the primary health-care facilities in the provision of good
quality services and their adherence to Minimum Service Delivery Standards (MSDS) by: (i) upgrading of
selected basic health units (BHUs) in selected districts to provide uninterrupted (24/7) services all days of the
week, including provision of essential equipment, medicines and supplies; and (ii) upgrading of selected rural
health centers (RHCs) in the selected districts to provide neonatal intensive care on a pilot basis; (b)
hiring/recruiting and/or training healthcare personnel, including pediatricians, medical officers, lady health
workers (LHWs) and lady health visitors; (c) providing nutrition services through outdoor therapeutic program
(OTP) counters; (d) providing population welfare services in close coordination with the department
responsible for population welfare; and (e) upgrading and scaling-up the electronic medical records system
(EMR) for, and implementing the Environmental and Health Care Waste Management Plan (EHCWMP) in,
health facilities in the selected districts.
17. Facilities rehabilitated under the Project will include measures to facilitate access for persons with different
abilities; have improved resilience to climate shocks such as floods or extremely high temperatures; and
improved energy efficiency with rooftop solar power, where possible. Considering climate risks in targeted
districts, medicines including vaccinations would be strategically stockpiled in selected health facilities,
particularly prior to the annual monsoon season.
Sub-component 1.2: Utilization of health services (approximately US$70 million equivalent)
18. This sub-component will increase the utilization of key health services among poor and vulnerable
households, as identified through the NSER, in the select districts, through: (a) implementing a CCT program
and providing Conditional Cash Grants (CCGs) to eligible pregnant or lactating women and/or parents of
children up to 2 years of age (eligible CCG Beneficiaries); and (b) carrying out outreach, social mobilization and
information dissemination campaigns among health service beneficiaries.
19. CCT co-responsibilities (conditionalities) include: regular health checkups of PLW, skilled birth delivery and
birth registration, growth promotion, immunization of children under two years of age and participation in
counseling and awareness sessions on population welfare, hygiene, feeding and caring practices, children’s
cognitive development, as well as food security and healthy foods for nutrition (See Annex 3 for a detailed
description of co-responsibilities). The Project Operational Manual (POM) contains a section on the CCT
describing operational procedures and implementation arrangements. It was prepared jointly by the PSPA
and the Primary and Secondary Healthcare Department (PSHD). The service delivery process will include
beneficiary outreach through information campaigns, social mobilization and LHWs16. Service delivery will be mainly at primary and secondary healthcare facilities. Upon verification of compliance with co-responsibilities,
transfers will be made digitally to the individuals’ bank accounts.17 Business processes related to the program
will be supported by the service delivery platform described in Component 3. The amount of transfers would
be greater for services critical to child health and nutrition, and for which the take-up has been low. Based on
the number of Benazir Income Support Programme (BISP) beneficiary women; and assumptions regarding the
likelihood of pregnancy, conditionality schedules, and coverage of children up to the age of two, the Project
financing of approximately US$65 million would be used for cash benefits to (up to one million beneficiaries)
beneficiaries, and the remaining US$5 million would be used for social mobilization and empowerment
support by PSPA.
Component 2: Economic and social inclusion (approximately US$65 million equivalent)
20. This component comprises supplementary activities to improve households’ economic and social inclusion.
It will be introduced and are expected to contribute to building early childhood human capital among povertystricken households.
Sub-component 2.1: Economic inclusion (approximately US$35 million equivalent)
21. This sub-component will promote the economic inclusion of poor and vulnerable eligible young parents18
through the provision of technical assistance, goods and training, including and not limited to provide: (a)
labor market readiness (LMR) training; (b) Livelihood Support Grants (LSGs) or the Productive Assets; and (c)
intensive coaching aimed at improving productive behavior to help increase resilience of households of the
eligible young parents.
22. The POM sets out the requirements for participation. Prior to receiving a productive asset, individuals from
target households will participate in the LMR component, which will include training on basic literacy and
numeracy to equip participants with record-keeping skills for managing a livelihood; social and health
awareness; and confidence-building. Market analysis and beneficiary profiling exercises will be conducted
during LMR delivery, to recommend a list of livelihood packages that are viable for the targeted poor,
considering participant skillsets, interest, care burden, resources as well as the environment, particularly
climate risks and the associated need for income diversification. The completion of the LMR package is
expected to pave way for technical skills development (e.g., animal husbandry, entrepreneurship, financial
literacy). Livelihood support, including the transfer of productive assets (e.g. livestock, tools, merchandise,
material on climate-smart agriculture etc.), will then be accompanied by bimonthly coaching services. The
entire series of activities will be directly delivered or informed by community organizations that have local
presence, supervised and monitored by the PSPA. The Project financing would be used to procure community
organizations’ service delivery. |
