Fifth population project
 Report No: ; Type: Report/Evaluation Memorandum ; Country: India; Region: South Asia; Sector: Targeted Health; Major Sector: Health Nutrition &
                                                      Population; ProjectID: P009887


       The India Fifth Population project, supported by Credit 1931-IN, for US$57 million equivalent,
was approved on June 21, 1988. The credit was closed on March 31, 1996, three months behind schedule.
An undisbursed balance of US$5.17 million equivalent was canceled on August 26, 1996. The South Asia
Regional Office prepared the Implementation Completion Report (ICR), to which the borrower’s
comments and report are appended.

          This project is the fifth in a series of nine population projects and the first to support urban health
programs. The project’s objectives were to (i) expand family welfare services with an emphasis on
maternal and child health (MCH), birth spacing, and increased use of temporary contraceptives; (ii)
improve the quality of family welfare services; (iii) strengthen the capacity of Greater Bombay, Madras,
and the Chingleput District of Tamil Nadu to implement urban family welfare programs; and (iv) increase
the participation of private voluntary organizations (PVO) and private medical practitioners (PMP). The
project included four components to: (i) construct, furnish, equip, and staff Health Posts (HP); (ii) provide
staff training; (iii) reorganize Health and Family Welfare Bureaus; and (iv) assist PVOs to operate HPs
and train PMPs in health and family welfare. Because of savings resulting from depreciation of the Rupee,
the project was restructured in 1990 to include additional areas around Bombay and in Tamil Nadu, which
increased its population coverage by 25 percent.

        While there was a year’s delay in initiating project implementation, this time was made up and
nearly all the targets specified for the first three components were achieved. Service delivery and
demographic targets were substantially met, service quality improved, and training and management
improvements were carried out as planned. Involvement of PVOs and PMPs fell short of expectations, and
a number of studies were completed too late to be of use by the project.

         The project introduced a revised service delivery paradigm (more emphasis on reproductive
health, meeting individual needs, and temporary contraceptive methods for birth spacing). This paradigm
plus the addition of outreach activities demonstrated a method of providing services to urban slum
populations which is being copied and built upon in other projects. The project also demonstrated that a
client-focused MCH approach can work in India. A third lesson learned is that expecting the private sector
to assist the government sector in a largely subordinate role can lead to disappointing results.

         The ICR rates project outcome as satisfactory based on the successful achievement of key
objectives, sustainability as likely, institutional development as substantial, and Bank performance as
satisfactory. OED agrees with these ratings.

         The ICR is satisfactory and benefited from the borrower’s inputs. No audit is planned.