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.TRANSCRIPT
How can donor support for health, nutrition and population be more nutrition, and population be more effective and reach the poor?
Findings from an Evaluation of World Bank Group Support Since 1997
Global development financing for health, nutrition, and population more than doubled since 2000and population more than doubled since 2000
16
18Private non-profits 16.7
12
14
llars
Other multilaterals
IDA
Development banks
8
10
ons
of U
S do
l
UN agencies
Bilateral agencies
6.4 6.8
8.1
4
6
Bill
io 6.4
0
2
1997-99 2000 2002 2006
Source: World Bank, Global Monitoring Report 2008, and Michaud (personal communication)
Health conditions continue to improve in all regions, but inequities across and within countries remainbut inequities across and within countries remain
102
112 111
105
120
102
89
3
79
89
80
100
rths
595955
494444
6773
60
80
er 1
,000
live
birt Sub-Saharan Africa
South Asia
Middle East and North Africa
Eastern Europe & Central Asia44
36
44 4237
32
29
22
43
3530
3439
4340
Dea
ths
pe Eastern Europe & Central Asia
East Asia and Pacific
Latin America and Caribbean
Source: UNICEF 2006, 2009
2226
0
20
1990 1995 2000 2004 2007 ,1990 1995 2000 2004 2007
Lending by the Bank’s HNP sector has been sustained, but an increasing share is by other sectorsbut an increasing share is by other sectors
2500
2000
lion) HNP sector Other sectors Trend, HNP and
other sectors
1500
nts
(US$
mil
500
1000
Com
mitm
e
0
19701972197419761978198019821984198619881990199219941996199820002002200420062008
Source: World Bank data
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2
Fiscal Year of Approval
IFC lending to the private sector for health is on the rise, but the sector is still smallthe rise, but the sector is still small
350 14
250
300
US$ m
illion
)
10
12
ber)
Net CommitmentsProjects
100
150
200
mm
itmen
ts (U
4
6
8
Proj
ects
(num
0
50
100
Net c
om
0
2
4 P
0
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Fiscal year
0
Source: IFC data
M j fi di Major findings on country support
►►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environmentsenvironments
Malaria incidence was reduced in Eritrea
140 45 ITNs + bednetsreimpregnated
100
120
ns 30
35
40
100
,000
) m
m)
reimpregnated(10,000)Breeding sitesfilled andtreated (1 000)
60
80
nter
vent
ion
15
20
25
e ra
te (p
erai
nfal
l (10
m treated (1,000)Number ofhouses sprayed(1,000)
20
40
In
5
10
15
Inci
denc R
a
Incidence rate
A l01998 1999 2000 2001 2002 2003 2004 2005 2006
0 Average annualrainfall
Source: IEG Project Performance Assessment Report, Eritrea Health and HAMSeT Projects
Excess inpatient bed capacity declined in Kyrgyz RepublicKyrgyz Republic
90
100
70
80
90
popu
latio
n
40
50
60
l bed
s pe
r 10,
000
20
30
40
Hos
pita
10
1996 1997 1998 1999 2000 2001 2002 2003 2004
K yrgyz R epublic Batken J alal‐AbadIssyk‐Kul Naryn OshTalas C hui B ishkek
Source: IEG Project Performance Assessment,Kyrgyz Republic Health Reform I & II Projects
M j fi di Major findings on country support
►►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environmentsenvironments
►Analytic work supported better outcomes
M j fi di Major findings on country support
►►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environmentsenvironments
►Analytic work supported better outcomes
►I i h lth t i t►Increasing health components in some sectors
M j fi di Major findings on country support
►►Two-thirds of Bank HNP projects had satisfactory outcomes, often in difficult environmentsenvironments
►Analytic work supported better outcomes
►I i h lth t i th t►Increasing health components in other sectors
►Performance of IFC hospital investments improved lessons learnedimproved, lessons learned
Sh i ff iShortcomings on effectiveness
►One third of Bank HNP support has not►One third of Bank HNP support has not performed well, especially in Africa
Performance of HNP projects stagnated while in other sectors outcomes continued to improveother sectors outcomes continued to improve
100
63 6772
79
70
8090
oder
ately
er
6470 68
40
50
60
ojec
ts ra
ted m
oac
tory
or h
ighe
3620
3040
Perc
ent o
f pro
satis
fa
Other SectorsHNP Sector
(n=14)
0
10
1987-91 1992-96 1997-2001 2002-06Fiscal year project closed
Sh i ff iShortcomings on effectiveness
►One third of Bank HNP support has not►One third of Bank HNP support has not performed well, especially in Africa
► Weak incentives to deliver health results in► Weak incentives to deliver health results in other sectors (water supply, transport)
Incentives for health outcomes of water supply and sanitation are weak and have declinedand sanitation are weak and have declined
92
8590
100
FY97-01 (n=62)
FY02-06 (n=55)
5560
70
80
proj
ects
FY02-06 (n=55)
55
44
40
50
60
cent
of W
SS p
15
5510
20
30Perc
552
0Environmental
improvements withplausible health
b fit
Health benefitscited as rationale
Explicit healthobjective
Health objectivetargeted to the poor
benefits
Sh i ff iShortcomings on effectiveness
►One third of Bank HNP support not performing►One third of Bank HNP support not performing well, especially in Africa
► Weak incentives to deliver health results in► Weak incentives to deliver health results in other sectors (water supply, transport)
► Lack of monitoring and evaluationg
If the evaluation design was not spelled out at the start the evaluation was unlikely to occurthe start, the evaluation was unlikely to occur
Completed HNP projects with pilot and impact evaluations approved in FY97 06
32
30
35
evaluations, approved in FY97-06
20
25
proj
ects
710
15
Nmbe
r of
p
7
4
0
5
Projects with a pilot or impactevaluation
Had a detailed evaluation designin the PAD
Conducted the evaluation
Sh i ff iShortcomings on effectiveness
►One third of Bank HNP support not performing►One third of Bank HNP support not performing well, especially in Africa, no signs of improvement
► Weak incentives to deliver health results in► Weak incentives to deliver health results in other sectors (water supply, transport)
►Lack of monitoring and evaluationg
► Fragmented organization of IFC health activities
W k f h Weak focus on the poor
►► Only half of HNP support had pro-poor focus, very few could show that poor benefited more
In most regions, government health spending is not pro-poorspending is not pro poor
35di
ture
20
25
30
men
t exp
en
10
15
nt o
f gov
ernm
0
5
Latin South Asia East Asia Europe & Sub-
Perc
en
America &Caribbean
& Pacif icp
CentralAsia
SaharanAf rica
Poorest quintile Richest quintile
W k f h Weak focus on the poor
►► Only half of HNP support had pro-poor focus, very few could show that poor benefited more
► D i d li i dd i f il► Dramatic decline in support addressing family planning, high fertility, and malnutrition
W k f h Weak focus on the poor
►► Only half of HNP support had pro-poor focus, very few could show that poor benefited more
► D i d li i dd i f il► Dramatic decline in support addressing family planning, high fertility, and malnutrition
►D li i t t t f HNP i t►Decline in treatment of HNP in poverty assessments
The share of poverty assessments with a focus on HNP declinedon HNP declined
100
8080
FY00-03 (n=50)
58
40
60
Perc
ent
FY04-07 (n=72)
28
1220
40
712
7
0Health Nutrition PopulationHealth Nutrition Population
W k f h Weak focus on the poor
► O l h lf f HNP h d f► Only half of HNP support had pro-poor focus, very few could show that poor benefited more► Dramatic decline in support addressing family► Dramatic decline in support addressing family planning, high fertility, and malnutrition►Decline in treatment of HNP in poverty p yassessments►IFC hospital investments primarily benefit
iddl d imiddle- and upper-income groups
1. How can HNP support be more 1. How can HNP support be more effective?
T b ff iTo be more effective,
►►Manage complexity, improve quality• Match complexity to capacity – sequence, prioritize, and phase reformsand phase reforms
• Ex ante risk analysis, especially political risks
• Ex ante institutional assessments
• Better definition of objectives
• Analytic work in support of design
T b ff iTo be more effective,
►►Manage complexity, improve quality
►Increase the impact of other sectors on HNP outcomes
• Incentives for demonstrating health impacts
• Links between water supply & sanitation & HNP• Links between water supply & sanitation & HNP
• Evaluation and monitoring of retro-fitted activities
T b ff iTo be more effective,
►M l i i li►Manage complexity, improve quality►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
2. How can HNP support better ensure 2. How can HNP support better ensure that the poor benefit?
T h h b fiTo ensure that the poor benefit…
►►Target support to the poor and monitor outcomes
T h h b fiTo ensure that the poor benefit…
►►Target support to the poor and monitor outcomes
►I d hi h f ili d►Increase support to reduce high fertility; expand support to reduce malnutrition
T h h b fiTo ensure that the poor benefit…
►T h d►Target support to the poor and monitor outcomes
►Increase support to reduce high►Increase support to reduce high fertility; expand support to reduce malnutrition
►Expand IFC support for private investments with greater social benefits
• Low-cost generic drugsg g
• Technologies that address problems of the poor
• Health insurance trainingHealth insurance, training
►Manage complexity, improve quality
To be more effective…
►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 malnutritionexpand support to reduce malnutrition►Expand IFC support for private investments with greater social benefits