Remarks by Beth Hogan, USAID India Deputy Mission Director At the Launch of the Health Vouchers Scheme, Haridwar, Uttarakhand

May 20, 2007

Honorable Health Minister Dr. Ramesh Chander Pokhriyal Nishank, Principal Secretary Mr. Bijender Pal, Secretary Mrs. Manisha Panwar, distinguished guests, good afternoon.

I am honored to be here today to participate in the state’s launch of this pilot voucher scheme that will benefit women and families in two blocks of Haridwar. You are among just a few states in India who are trying such schemes. I congratulate you on your vision and willingness to try a new initiative that promises to bring health benefits to poor and disadvantaged families in Uttarakhand. This program will help provide access to high quality services for ante-natal care, deliveries, family planning and post-natal care, free of cost to those who need it most.

USAID’s commitment to Uttarakhand remains strong. We have been involved with the state family planning and reproductive health programs since 2002. We supported development of the first health and population policy and the first state Project Implementation Plan, a critical document that is used to request budget support for health programs from the central government. We also have helped to craft district health action plans for all 13 districts in the state.

One of our biggest investments in Uttarakhand is in the Innovations in Family Planning Services Project, which works to pilot innovative models for public private partnership in the areas of reproductive and child health. As you can imagine, breaking new ground can be difficult and challenging, yet extremely rewarding. I commend Uttarakhand and the state leadership for their work on health reforms and the clear commitment that they have shown to scale up scale up successful interventions across the state.

In Uttarakhand, USAID is working with the government on not only the voucher scheme but also on several other public private partnerships and new initiatives. In one of the difficult-to-reach hilly districts, USAID and the government of Uttarakhand are looking at the feasibility of partnering on a “contracting out” project. This will improve health services in this district through an innovative partnership between the government and NGOs.

In three districts in the mountainous, rural areas of Uttarakhand, we are working with the state to pilot the “Asha-plus” scheme. This program is examining the advantages of an ASHA who receives enhanced training and support through NGOs as well as an expanded range of services for which she is reimbursed. We hope to learn about how to implement the ASHA- plus scheme in this state so that it is replicable in the rest of the country.

Recognizing that access to health services is a challenge in Uttarakhand, USAID and the state government are supporting the operation of a mobile van in Ram Nagar block of district Nainital. The van will provide health services, including family planning, general outpatient care and diagnostic facilities such as x-ray and blood tests.

And lastly, USAID and the government will be working together on the development of two media campaigns. One will focus on childhood immunizations and the other on increasing the number of pregnant women who deliver in an institution under the care of a skilled provider.

While there is still much to be done to improve public health in the state, I want to applaud the state government for some of the good news that is coming out of the state. Recent data from the Third National Family Health Survey tells us that the health situation in Uttarakhand has shown an improvement in the last few years.

The state is demonstrating progress especially in the area of reproductive health and family planning. The NFHS data shows that 75% of women receive at least one ante-natal care visit and 59% of women are using some form of contraception. The number of children per family is at 2.6 meaning that people are thinking more about planning their families. I think that this is in part due to the government’s willingness to think creatively about how to address health issues in the state, to “think out of the box” when it comes to addressing health issues.

In Haridwar, however, health status in the district is among the worst in the state. The percentage of births taking place in a facility is 31% in the district and only 22 percent in rural areas, the percentage of children fully vaccinated is 23.6% and the percentage of women receiving full antenatal care is only 7.9%.

A tough situation calls for innovative solutions, like the one for which we are gathered today. I congratulate all of you that have come together in this partnership, ASHAs, NGOs, private providers, and government, to work on this initiative. I have big hopes that together we will make a positive difference for women, children and families in Haridwar.

Thank you.