According to the Bank’s website, Jharkhand State in eastern India is the 15th largest state by area, and the 14th largest by population. As per the census of India in 2011, the total population of Jharkhand was 33 million, (2.72% of India's population). The 2025 census population projections estimate that the population has grown to 41.5 million. This shows a projected population increase of over 25%. The state's gross domestic product (GDP) is estimated to have increased by 7.5% (at constant prices) in fiscal year (FY) 2024 over the previous year (compared to India's 9.5%) and is expected to grow at the rate of 10% in (FY) 2026. Poverty in Jharkhand dropped from 42.10% in (FY) 2016 to 28.21% in (FY) 2020, however state's nominal per capita income is half of the national per capita income, signifying a large proportion of the population continue to be poor.

Inadequate access to quality public tertiary care. The state of Jharkhand was formed after Bihar was bifurcated into two (Bihar and Jharkhand) in 2000, with Bihar getting most of the existing health infrastructure. However, the primary health centers (PHCs) have increased faster in Jharkhand as compared to the rest of India between 2019 and 2021 with the percentage change being 67% in Jharkhand and only 52% for rest of India. Nonetheless, the percentage change in government hospitals providing secondary and tertiary care during the same period has lagged considerably, with Jharkhand showing only a 2.83% increase compared to an impressive 48.28% in India overall (footnote 6). Furthermore, quality of tertiary health care infrastructure requires significant upgrade. Many public medical colleges and tertiary care hospitals were designed decades ago and face critical infrastructure obsolescence. Outdated layouts hinder patient-centric workflows, while aging equipment limits the ability to deliver high-quality, specialized care. These facilities often fail to meet modern building codes, clinical standards, and safe and all-weather access, undermining efficiency and safety. Further, the number of available beds as per India Public Health Standards (IPHS) norms is very low. This lack of access to free and quality tertiary health care in the public sector impacts service delivery in the state and can be a significant contributor to high catastrophic health expenditure. In 2017-18, out-of-pocket expenditure (OOPE) for Jharkhand was considerably higher at 68% of the Total Health Expenditure (THE), compared to an all-India average of 48.8% (footnote 6). Further, unless access to quality tertiary care is ensured, strengthening the primary and secondary sector alone will not have the desired health outcomes. It will create a weak and lopsided referral chain structure that will keep operating sub optimally even when health insurance schemes funded by the central and state governments strive to provide cashless health care services to the poor population for critical cases. Thus, there is an urgent need to modernize and enhance tertiary care facilities to meet current and future demands and cater to changing disease patterns. Improved facilities would also have potential to provide neighboring countries with more accessible and reliable healthcare and are expected to attract regional patient inflow, demonstrating a strategic approach to regional health care integration.

Environment: B
Involuntary Resettlement: C
Indigenous Peoples: C

The financing amount is $317,730,000, which will be financed on a loan basis by ADB’s ordinary capital resources.

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