World Bank in India Newsletter - June 2023

World Bank in India

Drones Deliver Medicines to Distant Health Centers in Rural Meghalaya

For a week Eltira Sangma from the West Khasi Hills in Meghalaya, India, noticed she had no energy.

“I was feeling tired all the time and did not feel like cooking for my family or doing any chores at home,” said the mother of an 11-year-old boy.

Worried, Eltira visited the Shallang Primary Health Centre (PHC) 1.5 kilometres away to seek medical advice. After some tests, she was given an iron injection.

Earlier, it would not have been so easy for her to get the injection at the health center near her village of Rongkhugre, tucked away on a distant hillside amidst green foliage and banana plantations. Crucial medicines and injections were often in short supply or too expensive at the far-flung centers.

But ever since a new drone service was introduced by the Government of Meghalaya under the World Bank

financed Meghalaya Health Systems Development Project, essential injections and medicines are brought over once a week by a drone from Jengjal District Hospital over 100 kilometres away.

The medicines are also free of cost. Otherwise, the injection, which needed to be administered three times a week, would have cost Eltira Rs. 280 each time.

Reaching the Unreached

Supplying inexpensive quality healthcare to hard-toreach areas has long been a challenge for Meghalaya. Almost eighty percent of the people living in rural areas find it difficult to access health services, especially during the rainy season between June and September.

“In these circumstances, women’s health often does not become a priority. They avoid visiting healthcare facilities unless it is an emergency,” said Dr Alisha G. Momin, Medical Officer at the Shallang PHC.

The Shallang PHC covers 91 villages in the West Khasi Hills district and receives some 20-30 patients every day; this can go up to around 70 patients on a “market day.” On the day we visited, the PHC received three cases of road traffic accidents, unfortunately, a usual occurrence on the winding hill roads. But thanks to the stock of medicines brought over once a week by drone, there were enough tetanus injections to administer to the injured villagers.

At the same PHC, 53-year-old Merina Sangma was getting treated for hypertension. “Earlier, I would have referred her to the Nongstoin Civil Hospital 80 kilometres away,” explained Dr Momin. “But just last week, the drone dropped off a supply of injectables for hypertension—a surprisingly common disease in these parts—and we can treat Merina here itself.”

The Dadenggre Community Health Centre (CHC) is some 150 kms from Shallang. Dr Dimpy Angel Kmarak, the Medical Officer at the center feels the drone service is a lifesaver.

“The 12-13 villages under this CHC are very hard to reach, and in fact, are unreachable during the rainy season. The drone service has at least ensured that we have adequate supply of medicines to serve pregnant women who are the focus of the Chief Minister’s Safe Motherhood Scheme,”

- Dr Dimpy Angel Kmarak

The drones don’t return empty-handed but take patients’ blood samples for testing. The results are sent in less than 3 hours through WhatsApp, considerably reducing

the turn-around time for patients. “These services have been very helpful in increasing the access and quality of healthcare to villagers in this area,” added Dr Momin.

The bird in the sky

The drone service, started in December 2022, works on a hub and node basis, where the Jengjal SubDivisional Hospital is the hub where the drone station is based. All the medicines and injections are procured here; there is a laboratory to run tests as well. There are currently 12 nodes, including the Shallang PHC and Dadenggre CHC.

The drones fly to these nodes on a weekly basis, taking medicines and injections based on the needs of the different health centres, and bringing back blood samples for testing.

“We started with six PHCs in December 2022 and expanded to 12 within the next two months,” explained an elated Vineeth Pandalai, Operations Manager at Tech Eagle Innovations, the company that is conducting these flights. “Our aim is to bring in another five PHCs by July 2023. Currently, one drone, supervised by a manager and two pilots, serves 12 PHCs and CHCs. Several sub centres around the area are also being served tangentially.”

The drone landing spot at the Shallang PHC is marked by a big red cross on a round concrete landing pad. “The flight takes exactly 46 minutes from Jengjal more than 100 km away and is optimized each time to use less battery and carry more load,” Pandalai explains.

At the Dadenggre CHC, the absence of any open area for a landing pad was a challenge. “The drone ideally needs a concrete surface to land, as it can throw up a lot of dust when landing. So, we are using a nearby basketball court. This is not ideal as every time the drone needs to land, they need to flash a light and blow a siren to clear people from the area.”

Immediate future plans for the drone services include creating a blood bank at the Jengjal Sub-Divisional Hospital and providing matched blood during critical emergencies.

By using drones, Meghalaya is showing how technology can be reimagined to bring quality services to the people.

Since 2021, the Meghalya Health Systems

Strengthening Project with World Bank support of $40 million has been helping the north-eastern state of Meghalaya strengthen its public health system where access to quality health services, remains a challenge, particularly in rural areas.  The project is expanding the design and coverage of the state’s health insurance program; improving the quality of health services through certification; and enabling efficient and improved access to medicines and diagnostics.

The project’s performance-based financing system is aimed at bringing more accountability at all levels. It is benefitting the health sector staff at the primary and secondary levels by strengthening their planning and management capabilities and building their clinical skills. The project is also enabling women to better utilize healthcare services at the community level.

More than 3 million people across all 11 districts of the state are expected to benefit from the project.

Development Dialogue

Women’s mobility must be a key focus in urban policy

Auguste Tano Kouamé | Gerald Paul Ollivier

Historically, cities across the world have been designed to fit the needs of able-bodied men, or a neutral, often male, user. Yet, cities are experienced differently by men and women. Women and girls find their access to employment, education, care services and even leisure is constrained when urban mobility systems and public spaces are not safe and inclusive.

Across Indian cities, studies show that concerns about commuting safely during the late evening hours or beyond a particular radius are among the biggest barriers to girls and women going to school, college and work. For instance, a 2020 study in Bengaluru showed that only 2% of women commuters surveyed made journeys after 9 pm. Barriers to mobility can thus thwart women’s long-term aspirations, eroding their financial independence and agency. The threat of sexual harassment deters women from stepping out.

For instance, a 2017 study in Delhi showed that women were willing to travel for 27 minutes more each day to take a route that was perceived to be safer. It will thus be important to devise strategies to prevent and penalise sexual harassment in public spaces.

Typically, women travel shorter distances at off-peak hours, and make chained trips, frequently changing between transport modes to complete multiple tasks, balancing domestic errands and employment. Systems are, therefore, needed to collect and analyse genderdisaggregated data to understand women’s mobility patterns and design public transport services accordingly.

It was after the Mumbai Railway Vikas Corporation, working with the World Bank, conducted a detailed study of mobility patterns on suburban trains, that it identified women’s safety as a key priority and devised solutions to make platforms, stations, and trains safer for women. These activities sought to do more than just introduce women-only trains — the Ladies Specials — by addressing the fundamental design of the infrastructure to make it more women-friendly.

Hiring more female staff can make travel safer. In Kochi, for instance, 80% of the metro staff are women, working as station managers, train drivers, ticket vendors, and cleaning staff. Similar initiatives can be taken by other bus and rail agencies to enhance safety.

What’s more, since deep-rooted social norms restrict women’s movement outside their homes, local communities need to be brought on board as partners to help shift the norms around women’s mobility. A number of community-based organisations have been working across cities such as Delhi, Gurugram, and Pune to sensitise communities; they also provide gender sensitisation training for frontline public transport workers.

Under the Nirbhaya Fund, the Centre provides valuable resources to states and central ministries to implement solutions for enhancing women’s safety. Since 2015, eight cities (Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad, Ahmedabad and Lucknow) have used these funds to identify hotspots for crime, enhance police capacity for investigating crimes against women and establish one-stop centres for violence survivors.

Moving a step further, the Greater Chennai Corporation established a Gender and Policy Lab, which will support the government of Tamil Nadu in implementing projects under the Nirbhaya Fund to create safer public spaces in the city. An assessment to understand gender differences in mobility was carried out, alongside a safety audit, in Tondiarpet in north Chennai. Installation of CCTV cameras and panic buttons in city buses is also underway, with Chennai’s Metropolitan Transport Corporation establishing a command-and-control centre to monitor incidents of harassment.

Our experience in Chennai and Mumbai, and other cities globally, shows that addressing gender concerns in urban mobility and public spaces requires long-term commitment from multiple stakeholders, with solutions aimed at addressing deep-rooted issues.

Drawing lessons from international best practices and project experiences in India, the World Bank has developed a toolkit for the Indian context, which both government and private agencies can use to make cities safer and more inclusive of women.

The toolkit outlines a four-pillar approach: First, assess the ground situation to understand genderdisaggregated mobility patterns and undertake safety

audits; second, strengthen policies with a focus on fare policies and grievance redressal for sexual harassment; third, build capacity and raise awareness both within government agencies and through partnerships with community-based organisations; and fourth, improve infrastructure and services with a special emphasis on women’s safety and inclusion.

Making cities safer can ensure that women and girls have choices — they can choose to stay longer in the office, go to better educational institutions, and even have a wider array of entrepreneurship opportunities — all of which will help increase female labour force participation and, in turn, boost economic performance in India.

Auguste Tano Kouamé is the World Bank's Country Director for India.

Gerald Paul Ollivier is the Lead Transport Specialist, World Bank.

This Opinion piece first appeared in  Hindustan Times on March 8, 2023.

New Projects

$82 Million for Prevention of Zoonotic, Endemic Diseases in India

The World Bank approved a $82 million loan towards the adoption of global best practices for animal health management to prevent, detect, and respond to endemic zoonotic, transboundary, and emerging infectious diseases. It will strengthen India’s One Health approach, which recognizes that people and animals are connected with their shared environment.

Animal disease outbreaks globally continue to pose risks to public health systems and have enormous economic costs. With India having the largest livestock population in

the world, these risks are particularly high. For example, foot and mouth disease alone costs the country more than $3.3 billion annually.

"The new program will help reduce the risks of animal disease outbreaks by improving disease surveillance and veterinary services in the livestock and wildlife sectors. At least 2.9 million livestock farmers will have increased access to improved animal health services in the participating states of Assam, Karnataka, Maharashtra, Odisha, and Madhya Pradesh."

Auguste Tano Kouame, World Bank’s Country Director for India.

Through state-of-the-art laboratories, the program will also strengthen collaboration and data sharing with the human health sector. It will also enhance food quality and safety in animal products, especially in livestock and wet markets.

The $82 million loan from the International Bank for Reconstruction and Development (IBRD) uses the Program-for-Results (PforR) financing instrument that links disbursement of funds directly to the achievement of specific program results. The loan has a maturity of 11.5 years with a grace period of 4.5 years.

$100 Million to Increase Social Protection and Disaster Resilience in Odisha

The World Bank approved a $100 million loan to help the state of Odisha strengthen its early forecasting systems for improved response to disasters and enhance its social protection coverage for poor and vulnerable households through digital platforms.

The Odisha State Capability and Resilient Growth Program will help reduce losses caused by natural disasters through a multihazard digital warning system and strengthen the state’s data collection efforts for better resilience planning.

The program will also increase social protection coverage through a cash transfer program, with coastal and underserved communities receiving assistance through online delivery platforms (Mo-Sewa Kendras).

The new Program will support the state’s efforts to enhance digital social service delivery systems.

"The Program will help Government of Odisha scale up existing social protection systems to better protect vulnerable households from climate shocks. The proposed engagement complements reform priorities identified by the Government of Odisha while building on the extensive program of technical assistance provided by World Bank to the state over the past decade."

Auguste Tano Kouame, World Bank’s Country Director for India.

The $100 million loan from the International Bank of Reconstruction and Development (IBRD) uses the Program-for-Results (PforR) financing instrument that links disbursement of funds directly to the achievement of specific program results. The Program has a maturity of 12.5 years with a grace period of three years.

$363 Million to Improve Water Supply to 2 million Rural Households in Karnataka

The World Bank has approved a $363 million loan to the southern Indian state of Karnataka to provide clean drinking water supply to 2 million rural households in the state through a piped water connection in their homes.

The Karnataka Sustainable Rural Water Supply Program will support the Government of Karnataka’s ambition to provide functioning tap water connections to every rural household in the state. This will include the construction of the drinking water distribution network and the installation of water meters in rural households.

Will benefit around 10 million people across all 31 districts in the state.

"Gender parity is at the heart of our support to India’s target to get piped water to all rural households. Importantly the Program will enhance the capacity of rural local governments to manage water supply services efficiently which will directly benefit women especially, as they bear the biggest burden of fetching water. They will now have better health and have more time to pursue opportunities for education and formal jobs."

Auguste Tano Kouame, World Bank’s Country Director for India.

The Bank’s Program will support the state government to introduce policies and result-based initiatives that are expected to improve the

overall operational efficiency in the delivery of rural water supply services. Also under the Program.

Around 500 rural water reservoirs in 7 water-stressed districts will be revived to help increase water storage capacity and groundwater recharge .

The $363 million loan from the International Bank of Reconstruction and Development (IBRD), uses the Program-forResults (PforR) financing instrument that links the disbursement of funds directly to the achievement of specific program results. The loan has a maturity of 13.5 years including a grace period of 2 years.

districts

[1] The proposed

are Bengaluru Rural, Bengaluru Urban, Bidar, Chikkaballapura, Kalaburgi, Kolara, and Tumakuru.

$108 Million to Improve Disaster Preparedness for Flood-prone Districts of Assam

The World Bank has approved a $108 million loan to help the northeastern Indian state of Assam improve disaster preparedness and enhance flood forecasting. The project will benefit around 6 million people and is part of a larger $500 million investment program for Assam.

The Assam Integrated River Basin Management Project will help the state reduce vulnerability to floods and river erosion by building green infrastructure in the Beki and Buridehing river basins, protecting around 100,000 people. The Project will also help strengthen the state’s response to disasters through improved flood forecasting and accurate early warning systems, including through mobile alerts. The Project will provide safer evacuation and shelter facilities including access to climate-resilient flood shelters to at least 10,000 people. The project will also help government agencies

The Project will:

• Build green infrastructure in river basins of Beki and Buridehing to reduce flooding and erosion

• Improve flood forecasting & early warning systems.

• Provide flood shelters for at least 10,000 people

to respond faster during crisis with upgraded state and district emergency operational centers.

The Project will support Assam tackle the immediate challenges of floods and erosion while also helping manage its complex river systems. The Brahmaputra River system is the economic lifeline of Assam, and a critical part of the state’s rich natural resources and cultural heritage. But flooding,

"The 2022 floods adversely impacted millions of people in Assam. This project will build on Assam’s disaster risk management approach thus contributing to climateresilient growth while protecting lives and property for the people of Assam."

riverbank erosion, sedimentation and loss of biodiversity have significant economic and environmental impacts on the state, leading to loss of livelihoods for its people.

The $108 million loan from the International Bank of Reconstruction and Development (IBRD) has a maturity of 11.5 years and a grace period of 4 years.

Auguste Tano Kouame, World Bank’s Country Director for India.

$148 Million to Support Water Availability, Increase Food Security for 960,000 People in West Bengal

The World Bank has approved a $148 million loan to support the state of West Bengal harness the availability of surface and ground water.

• Better irrigation practices to benefit 960,000 people.

• 4,000 new and existing minor irrigation schemes will serve around 80,000 hectares.

The West Bengal Accelerated Development of Minor Irrigation

Project – Phase II will support the state’s Department of Water Resources Investigation and Development and water-user associations (WUAs) to plan and operate new irrigation structures such as check dams, smallscale storage structures, creek rehabilitation, tube wells, and pump dug wells. The irrigation practices will allow for crop diversification to help yield high-value crops including the production of 17,000 tons of oilseed and at least 10,000 tons of fish each year.

During Phase I, the Project created 2,277 WUAs and reached 125,000 beneficiaries.

"The World Bank is supporting green investments in farmerled irrigation around the world to help them adapt better to climate change challenges. The proposed engagement builds on the success of Phase I to provide climate-smart agriculture technologies and expand market linkages to over 240,000 small and marginal farmer households."

Auguste Tano Kouame, World Bank’s Country Director for India.

The $148 million loan from the International Bank for Reconstruction and Development (IBRD) has a maturity of 11.5 years with a grace period of four years.

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World Bank in India

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