How can donor support for health,
nutrition,
nutrition and population be more
effective and reach the poor?
   Findings fr...
Global development financing for health, nutrition,
and population more than doubled since 2000
                          ...
Health conditions continue to improve in all regions,
but inequities across and within countries remain
                  ...
Lending by the Bank’s HNP sector has been sustained,
but an increasing share is by other sectors

                        ...
N e t c o m m it m e n t s ( U S $ m illio n )




                                        0
                             ...
Major fi di
M j findings on country support

►Two-thirds of Bank HNP projects had
satisfactory outcomes, often in difficul...
Malaria incidence was reduced in Eritrea

       140                                                                      ...
Excess inpatient bed capacity declined in
                               Kyrgyz Republic
                                 ...
Major fi di
M j findings on country support

►Two-thirds of Bank HNP projects had
satisfactory outcomes, often in difficul...
Major fi di
M j findings on country support

►Two-thirds of Bank HNP projects had
satisfactory outcomes, often in difficul...
Major fi di
M j findings on country support

►Two-thirds of Bank HNP projects had
satisfactory outcomes, often in difficul...
Shortcomings on effectiveness
Sh      i        ff i
►One third of Bank HNP support has not
performed well, especially in A...
Performance of HNP projects stagnated while in
       other sectors outcomes continued to improve

                       ...
Shortcomings on effectiveness
Sh      i        ff i
►One third of Bank HNP support has not
performed well, especially in A...
Incentives for health outcomes of water supply
and sanitation are weak and have declined
                              100...
Shortcomings on effectiveness
Sh      i        ff i
►One third of Bank HNP support not performing
well, especially in Afri...
If the evaluation design was not spelled out at
the start, the evaluation was unlikely to occur
     start
               ...
Shortcomings on effectiveness
Sh      i        ff i
►One third of Bank HNP support not performing
well, especially in Afri...
Weak focus on the poor
W kf           h

► Only half of HNP support had pro-poor focus,
very few could show that poor bene...
In most regions, government health
spending is not pro-poor
                pro poor
                   ment expenditure  ...
Weak focus on the poor
W kf           h

► Only half of HNP support had pro-poor focus,
very few could show that poor bene...
Weak focus on the poor
W kf           h

► Only half of HNP support had pro-poor focus,
very few could show that poor bene...
The share of poverty assessments with a focus
on HNP declined
             100



                   80
             80

 ...
Weak focus on the poor
W kf           h
► O l half of HNP support had pro-poor f
   Only h lf f                 h d       ...
1. How can HNP support be more
effective?
To be
T b more effective,
          ff i

►Manage complexity, improve quality
  • Match complexity to capacity – sequence,...
To be
T b more effective,
          ff i

►Manage complexity, improve quality
►Increase the impact of other sectors on HNP...
To be
T b more effective,
          ff i
►Manage complexity, i
►M              l i improve quality
                       ...
2. How can HNP support better ensure
that the poor benefit?
To
T ensure that the poor b
          h h          benefit…
                           fi

►Target support to the poor and...
To
T ensure that the poor b
          h h          benefit…
                           fi

►Target support to the poor and...
To
T ensure that the poor b
          h h          benefit…
                           fi
►Target support to the poor and
...
To be more effective…
►Manage complexity, improve quality
►Increase the impact of other sectors on HNP outcomes
►Improve t...
How can donor support for health,nutrition, and population be more effective and reach the poor?
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How can donor support for health,nutrition, and population be more effective and reach the poor?

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This presentation highlights the findings and recommendations of IEG's evaluation of the World Bank Group’s support for health, nutrition and population.

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How can donor support for health,nutrition, and population be more effective and reach the poor?

  1. 1. How can donor support for health, nutrition, nutrition and population be more effective and reach the poor? Findings from an Evaluation of World Bank Group Support Since 1997
  2. 2. Global development financing for health, nutrition, and population more than doubled since 2000 18 Private non-profits 16.7 16 Other multilaterals 14 IDA B illio n s o f U S d o lla rs 12 Development banks l UN agencies 10 Bilateral agencies 8.1 8 6.4 6.8 o 6 4 2 0 1997-99 2000 2002 2006 Source: World Bank, Global Monitoring Report 2008, and Michaud (personal communication)
  3. 3. Health conditions continue to improve in all regions, but inequities across and within countries remain 120 112 111 105 102 100 89 89 rths 79 80 Deaths pe 1,000 live birt 73 3 Sub-Saharan Africa 67 South Asia 59 59 60 55 Middle East and North Africa 49 er 44 44 Eastern Europe & Central Asia 42 43 37 36 East Asia and Pacific 40 43 32 39 Latin America and Caribbean 35 34 29 30 26 22 20 0 Source: UNICEF 1990 1995 2000 2004 2007 2006, 2009 ,
  4. 4. Lending by the Bank’s HNP sector has been sustained, but an increasing share is by other sectors 2500 2000 C o m m itm e n ts (U S $ m illio n ) Trend, HNP and HNP sector Other sectors other sectors 1500 1000 500 0 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06 08 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 Fiscal Year of Approval Source: World Bank data
  5. 5. N e t c o m m it m e n t s ( U S $ m illio n ) 0 50 100 150 200 250 300 350 1970 1971 1972 1973 1974 1975 1976 1977 Projects 1978 1979 1980 Net Commitments 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 Fiscal year 1991 1992 1993 1994 the rise, but the sector is still small 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 IFC lending to the private sector for health is on Source: IFC data 2006 2007 2008 0 2 4 6 8 10 12 14 P ro je c t s ( n u m b e r)
  6. 6. Major fi di M j findings on country support ►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environments
  7. 7. Malaria incidence was reduced in Eritrea 140 45 ITNs + bednets reimpregnated 40 (10,000) Incidenc e rate (per 100,000) 120 35 Breeding sites 100 filled and R ainfall (10m m ) 30 ns ntervention treated (1,000) (1 000) m 80 25 Number of 60 20 houses sprayed (1,000) In 15 a 40 Incidence rate 10 20 5 0 0 Average annual A l rainfall 1998 1999 2000 2001 2002 2003 2004 2005 2006 Source: IEG Project Performance Assessment Report, Eritrea Health and HAMSeT Projects
  8. 8. Excess inpatient bed capacity declined in Kyrgyz Republic 100 90 80 Hospital beds per 10,000 population 70 60 50 40 30 20 10 1996 1997 1998 1999 2000 2001 2002 2003 2004 K yrgyz R epublic B atken J alal‐Abad Is s yk‐K ul Naryn Osh T alas C hui B is hkek Source: IEG Project Performance Assessment, Kyrgyz Republic Health Reform I & II Projects
  9. 9. Major fi di M j findings on country support ►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environments ►Analytic work supported better outcomes
  10. 10. Major fi di M j findings on country support ►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environments ►Analytic work supported better outcomes ►Increasing h lth components in some sectors ►I i health t i t
  11. 11. Major fi di M j findings on country support ►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environments ►Analytic work supported better outcomes ►Increasing h lth components in other sectors ►I i health t i th t ►Performance of IFC hospital investments improved, improved lessons learned
  12. 12. Shortcomings on effectiveness Sh i ff i ►One third of Bank HNP support has not performed well, especially in Africa
  13. 13. Performance of HNP projects stagnated while in other sectors outcomes continued to improve 100 90 79 oderately 80 72 67 70 63 er ojects rated mo actory or highe 60 70 68 64 50 40 Percent of pro satisfa 30 36 (n=14) Other Sectors 20 HNP Sector 10 0 1987-91 1992-96 1997-2001 2002-06 Fiscal year project closed
  14. 14. Shortcomings on effectiveness Sh i ff i ►One third of Bank HNP support has not performed well, especially in Africa ► Weak incentives to deliver health results in other sectors (water supply, transport)
  15. 15. Incentives for health outcomes of water supply and sanitation are weak and have declined 100 92 FY97-01 (n=62) 90 85 FY02-06 (n=55) 80 cent of WSS projects 70 60 55 p 50 44 40 Perc 30 20 15 10 5 5 2 0 Environmental Health benefits Explicit health Health objective improvements with cited as rationale objective targeted to the poor plausible health benefits b fit
  16. 16. Shortcomings on effectiveness Sh i ff i ►One third of Bank HNP support not performing well, especially in Africa ► Weak incentives to deliver health results in other sectors (water supply, transport) ► Lack of monitoring and evaluation g
  17. 17. If the evaluation design was not spelled out at the start, the evaluation was unlikely to occur start Completed HNP projects with pilot and impact evaluations, evaluations approved in FY97 06 FY97-06 35 32 30 25 Nmber of projects 20 p 15 10 7 5 4 0 Projects with a pilot or impact Had a detailed evaluation design Conducted the evaluation evaluation in the PAD
  18. 18. Shortcomings on effectiveness Sh i ff i ►One third of Bank HNP support not performing well, especially in Africa, no signs of improvement ► Weak incentives to deliver health results in other sectors (water supply, transport) ►Lack of monitoring and evaluation g ► Fragmented organization of IFC health activities
  19. 19. Weak focus on the poor W kf h ► Only half of HNP support had pro-poor focus, very few could show that poor benefited more
  20. 20. In most regions, government health spending is not pro-poor pro poor ment expenditure 35 30 25 Percen of governm 20 15 10 nt 5 0 Latin South A sia East A sia Europe & p Sub- A merica & & Pacif ic Central Saharan Caribbean A sia A f rica Poorest quintile Richest quintile
  21. 21. Weak focus on the poor W kf h ► Only half of HNP support had pro-poor focus, very few could show that poor benefited more ►D Dramatic d li i support addressing f il i decline in dd i family planning, high fertility, and malnutrition
  22. 22. Weak focus on the poor W kf h ► Only half of HNP support had pro-poor focus, very few could show that poor benefited more ►D Dramatic d li i support addressing f il i decline in dd i family planning, high fertility, and malnutrition ►Decline in treatment of HNP in poverty ►D li i t t t f i t assessments
  23. 23. The share of poverty assessments with a focus on HNP declined 100 80 80 FY00-03 (n=50) 58 FY04-07 (n=72) 60 Percent 40 28 20 12 7 7 0 Health Nutrition Population
  24. 24. Weak focus on the poor W kf h ► O l half of HNP support had pro-poor f Only h lf f h d focus, very few could show that poor benefited more ► Dramatic decline in support addressing family planning, high fertility, and malnutrition ►Decline in treatment of HNP in poverty p y assessments ►IFC hospital investments primarily benefit middle- and upper-income groups iddl d i
  25. 25. 1. How can HNP support be more effective?
  26. 26. To be T b more effective, ff i ►Manage complexity, improve quality • Match complexity to capacity – sequence, prioritize, and phase reforms • Ex ante risk analysis, especially political risks • Ex ante institutional assessments • Better definition of objectives • Analytic work in support of design
  27. 27. To be T b more effective, ff i ►Manage complexity, improve quality ►Increase the impact of other sectors on HNP outcomes • Incentives for demonstrating health impacts • Links between water supply & sanitation & HNP • Evaluation and monitoring of retro-fitted activities
  28. 28. To be T b more effective, ff i ►Manage complexity, i ►M l i improve quality li ►Increase the impact of other sectors on HNP outcomes ►Improve the results focus and better governance through evaluation • Incentives for monitoring and evaluation • Baseline data requirements • Evaluation design for all pilots • Periodic evaluation of components • IFC health sector evaluation framework
  29. 29. 2. How can HNP support better ensure that the poor benefit?
  30. 30. To T ensure that the poor b h h benefit… fi ►Target support to the poor and monitor outcomes
  31. 31. To T ensure that the poor b h h benefit… fi ►Target support to the poor and monitor outcomes ►Increase support to reduce hi h f ili expand ►I d high fertility; d support to reduce malnutrition
  32. 32. To T ensure that the poor b h h benefit… fi ►Target support to the poor and ►T h d monitor outcomes ►Increase support to reduce high fertility; expand support to reduce malnutrition ►Expand IFC support for private investments with greater social benefits • Low-cost generic drugs g g • Technologies that address problems of the poor • Health insurance, training insurance
  33. 33. To be more effective… ►Manage complexity, improve quality ►Increase the impact of other sectors on HNP outcomes ►Improve the results focus and better governance through evaluation To ensure that the poor benefit… ►Target support to the poor and monitor outcomes ►Increase support to reduce high fertility; expand support to reduce malnutrition ►Expand IFC support for private investments with greater social benefits

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