World Bank: Evaluation of Health, Nutrition and Population program

The Independent Evaluation Group released an assessment of World Bank Group support for health, nutrition and population on 30 April 2009. To download the full report, visit the World Bank website.

Findings

    * The Bank Group now funds a smaller share of global support for health, nutrition, and population than it did a decade ago, but its support remains significant -$17 billion in country-level project financing, in addition to policy advice, analytic work, and engagement in global partnerships by the World Bank and $873 million in private health and pharmaceutical investments by IFC from 1997 to mid-2008. The Bank Group continues to play an important role and add value in HNP.
    * About two-thirds of the Bank's HNP projects show satisfactory outcomes. Performance can be substantially improved by reducing project complexity, strengthening risk assessment and mitigation, conducting more up-front institutional analysis, and incorporating more evaluation to promote evidence-based decisions. The performance of IFC health investments, mainly hospitals, has improved markedly, but IFC has had limited success at diversifying its health portfolio.
    * The accountability of Bank Group investments for demonstrating results for the poor has been weak. The Bank's investments often have a pro-poor focus, but their objectives need to address the poor explicitly and outcomes among the poor need to be monitored. Importantly, the Bank needs to increase support to reduce high fertility and malnutrition among the poor and ensure discussion of HNP in poverty assessments. IFC-financed hospitals mainly benefit the non-poor; IFC needs to support more activities that both make business sense and yield broader benefits for the poor.
    * The Bank Group has an important role in helping countries to improve the efficiency of health systems. The Bank needs to better define efficiency objectives, track efficiency outcomes, and support better information and vigorous evaluation of reforms. IFC needs to enhance support to public-private partnerships and improve collaboration and joint sector work with the Bank.
    * The potential for improving HNP outcomes through actions by non-health sectors is great, but incentives to deliver them are weak. Adding HNP objectives to Bank projects in other sectors, such as water supply and sanitation, raises the incentive to deliver health benefits. Strengthening the complementarity of investments in HNP and other sectors can also improve outcomes. In IFC, incentives, institutional mechanisms, and an integrated approach to health are needed to improve coordination across units.

Recommendations

For the Bank Group to achieve its objectives of improving health sector performance and HNP outcomes among the poor, it needs to act in five areas:

   1. Intensify efforts to improve the performance of the World Bank portfolio.
   2. Renew the commitment to delivering results for the poor, including greater attention to reducing high fertility and malnutrition.
   3. Build its own capacity to help countries to make health systems more efficient.
   4. Enhance the contribution of other sectors to HNP outcomes.
   5. Boost evaluation to implement the results agenda and improve governance.