USAID/India health of the urban poor : mid-term evaluation report

Despite compelling need, urban health has not been a priority issue and receives less attention than rural health care. In response to the Government of India's proposed National Urban Health Mission (NUHM), USAID's Health of the Urban Poor (HUP) project in 2009 was designed to work at state, municipal, and community levels to develop innovative policies and program strategies to better meet the health needs of the urban poor. This mid-term HUP evaluation was designed to provide an assessment of the project's progress in addressing five key components (i.e., technical assistance (TA), public private partnerships, convergence, demonstration models, and management and governance) after one year of project implementation. The evaluation addresses the extent to which HUP is developing and implementing innovative urban health interventions and models that can be considered for replication and scale up, in India and possibly other countries as well. The evaluation's goal is to provide useful guidance on how well the project has been rolled-out, what appears to be working or not working, and how HUP might be best deployed to ensure positive results during the remainder of the project. The evaluation was conducted over a period of four weeks during June and July 2012. The evaluators found that the HUP project has several accomplishments and achievements, despite encountering many challenges which include: on-going delay in the launch of the NUHM and thus, no clear incentive for states to address urban health issues; a 10-month delay in HUP project approval by GOI, resulting in a very short period (six to 12 months) for implementation of project activities to date; and uncertainty about the remaining time period (one or two years) until project completion. Another fundamental challenge is the nature of the project design, which includes a broad range of activities to be provided through a TA approach in eight states and five municipalities representing diverse environments. Also, the project's performance indicators make it difficult to assess achievements in many areas. However, in a relatively short period, the HUP project has helped to delineate national- and state-level policies on urban health, in addition to broadening the participation of relevant stakeholders in the development of NUHM policies, program priorities, and operational strategies (e.g., national- and state-level ministries and departments). (Excerpt, modified)