• Hospital services at secondary level play a vital and complimentary role to the tertiary and primary health care systems and together form a comprehensive district based health care system.
  
  
• It was noticed that in the state of Punjab, District Hospitals, Sub-Divisional Hospitals and Community Health Centers were having critical gaps in buildings, equipment, manpower, and skills and were unable to provide required basic health care services.
  
  
  
  
• With an objective to improve efficiency and quality of the health care provided at first referral level hospitals, the State Govt. took an initiative to prepare a proposal for seeking aid from the World Bank.
  
  
• On the request of the State Govt., the Bank team visited the State in March-95 to review preparation and pre-appraisal of the proposal for the