Improving Effectiveness and Outcomes for the Poor in Health, Nutrition, and Population : An Evaluation of World Bank Group Support since 1997
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Washington, DC: World Bank
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This evaluation aims to inform the
implementation of the most recent the World Bank and
International Finance Corporation (IFC) health, nutrition,
and population (HNP) strategies to enhance the effectiveness
of future support. It covers the period since fiscal year
1997 and is based on desk reviews of the portfolio,
background studies, and field visits. The evaluation of the
HNP support of the World Bank focuses on the effectiveness
of policy dialogue, analytic work, and lending at the
country level, while that of IFC focuses on the performance
of health investments and advisory services before and after
its 2002 health strategy. The themes it covers are drawn
from the two strategies and the approaches adopted by
international donors in the past decade. Independent
Evaluation Group (IEG) has previously evaluated several
aspects of the Bank's HNP support. IFC's support
for the health sector has never been fully evaluated. Many
lessons have been learned over the past decade about the
successes and pitfalls of support for health reform: First,
the failure to assess fully the political economy of reform
and to prepare a proactive plan to address it can
considerably diminish prospects for success. Political
risks, the interests of key stakeholders, and the risk of
complexity- issues the evaluation case studies found to be
critical are often neglected in risk analysis in project
appraisal documents for health reform projects. Second,
reforms based on careful prior analytic work hold a greater
chance of success, but analytic work does not ensure
success. Third, the sequencing of reforms can improve
political feasibility, reduce complexity, ensure that
adequate capacity is in place, and facilitate learning. When
implementation is flagging, the Bank can help preserve
reform momentum with complementary programmatic lending
through the Ministry of Finance, as it did in Peru and the
Kyrgyz Republic. Finally, monitoring and evaluation are
critical in health reform projects-to demonstrate the impact
of pilot reforms to garner political support, but also
because many reforms cannot work without a well-functioning
management information system.
Palabras clave
ACCESS TO FAMILY PLANNING, ACCOUNTABILITY, AGED, AGING, AIDS RELIEF, ALLOCATION OF RESOURCES, BANKS, CAPACITY BUILDING, CARE FOR CHILDREN, CHILD HEALTH, CHILD MORTALITY, CHILD SURVIVAL, CHILDREN PER WOMAN, CITIES, CIVIL SOCIETY ORGANIZATIONS, CLIMATE CHANGE, COMMUNICABLE DISEASE CONTROL, COMMUNICABLE DISEASES, CONTRACEPTIVE USE, COST-EFFECTIVENESS, DECENTRALIZATION, DEMOGRAPHIC CHANGE, DEMOGRAPHIC TRANSITION, DEVELOPING COUNTRIES, DEVELOPMENT ASSISTANCE, DEVELOPMENT OBJECTIVES, DEVELOPMENT POLICY, DISCUSSION OF POPULATION, DISSEMINATION, DOCTORS, EARLY CHILDHOOD, ECONOMIC GROWTH, EMERGENCY PLAN, EMERGING MARKETS, EPIDEMIC, EPIDEMIOLOGY, EXERCISES, EXTERNALITIES, FAMILY PLANNING, FERTILITY RATE, FINANCE MINISTRIES, FINANCIAL CRISES, FINANCIAL PROTECTION, GENERIC DRUGS, GLOBAL DEVELOPMENT, GLOBAL REPRODUCTIVE HEALTH, GOOD GOVERNANCE, GOVERNMENT CAPACITY, GOVERNMENT LEADERSHIP, HEALTH CARE, HEALTH CARE PROVISION, HEALTH CONDITIONS, HEALTH EXPENDITURES, HEALTH FINANCE, HEALTH FINANCING, HEALTH FUNDING, HEALTH IMPACT, HEALTH IMPACTS, HEALTH INFORMATION, HEALTH INFORMATION SYSTEMS, HEALTH INSURANCE, HEALTH INSURERS, HEALTH INTERVENTIONS, HEALTH INVESTMENTS, HEALTH NEEDS, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH PROBLEMS, HEALTH PROGRAMS, HEALTH PROJECTS, HEALTH PROVIDERS, HEALTH REFORM, HEALTH REFORMS, HEALTH RESULTS, HEALTH SECTOR, HEALTH SERVICES, HEALTH STATUS, HEALTH STRATEGY, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH SYSTEM REFORM, HEALTH SYSTEM STRENGTHENING, HEALTH SYSTEMS, HEALTH SYSTEMS STRENGTHENING, HEALTH-SECTOR, HEALTHY DEVELOPMENT, HIGH FERTILITY, HIV, HIV/AIDS, HOSPITAL, HOSPITALS, HOUSEHOLD SURVEYS, HUMAN DEVELOPMENT, HUMAN IMMUNODEFICIENCY VIRUS, HUMAN REPRODUCTION, HUMAN RESOURCES, HYGIENE, ILL HEALTH, ILLNESS, IMMUNODEFICIENCY, IMPACT EVALUATIONS, INCIDENCE OF POVERTY, INCOME, INCOME GROUPS, INFANT, INFANT MORTALITY, INFANT MORTALITY RATES, INFANT NUTRITION, INFANTS, INFECTIOUS DISEASES, INFORMATION SYSTEM, INSTITUTIONAL CAPACITY, INSTITUTIONAL DEVELOPMENT, INSTITUTIONAL MECHANISMS, INSURANCE SCHEMES, INTERNATIONAL COMMUNITY, INTERNATIONAL CONSENSUS, INTERNATIONAL COOPERATION, INTERVENTION, INVENTORY, LABOR MARKETS, LEGAL STATUS, LIFE INSURANCE, LOCAL CAPACITY, LONG-TERM CARE, LOW-INCOME COUNTRIES, MALARIA, MALARIA CONTROL, MALARIA INCIDENCE, MANAGEMENT INFORMATION SYSTEMS, MANDATES, MARGINAL COSTS, MATERNAL CARE, MATERNAL MORTALITY, MEDICAL EDUCATION, MILLENNIUM DEVELOPMENT GOAL, MILLENNIUM DEVELOPMENT GOALS, MINISTRIES OF FINANCE, MINISTRIES OF HEALTH, MINISTRY OF HEALTH, MORBIDITY, MORTALITY, NATIONAL HEALTH, NATIONAL HEALTH EXPENDITURES, NATIONAL LEVEL, NATIONAL STRATEGY, NUTRITION, NUTRITIONAL STATUS, PEACE, PILOT PROJECTS, POLICY DIALOGUE, POLICY MAKERS, POLIO, POLITICAL SUPPORT, POOR HEALTH, POOR PEOPLE, POPULATION GROUPS, POPULATION SECTOR, PORTFOLIO ANALYSIS, POVERTY REDUCTION, PREPAYMENT SCHEMES, PRIVATE HEALTH INSURANCE, PRIVATE HOSPITALS, PRIVATE SECTOR, PRIVATE SECTORS, PROBABILITY, PROFITABILITY, PROGRESS, PUBLIC EXPENDITURE, PUBLIC HEALTH, PUBLIC HEALTH SPENDING, PUBLIC INSURANCE, PUBLIC INSURANCE SCHEMES, PUBLIC SECTOR, QUALITY ASSURANCE, QUALITY OF SERVICES, REFUGEES, REGULATORY FRAMEWORKS, REORGANIZATION, REPRODUCTIVE HEALTH, REPRODUCTIVE HEALTH PROGRAMS, RISK GROUPS, RURAL AREAS, RURAL DEVELOPMENT, SAFE WATER, SAFETY NET, SANITATION, SCREENING, SELF-ASSESSMENT, SERVICE DELIVERY, SEXUALLY TRANSMITTED DISEASES, SOCIAL IMPACT, SOCIAL SAFETY NETS, SOCIAL SECURITY, STRATEGIC PRIORITIES, SUBSIDIARY, SUSTAINABLE ACCESS, TECHNICAL ASSISTANCE, TRANSACTION COSTS, TRANSPORT, TRUST FUNDS, TUBERCULOSIS, UNDER-FIVE MORTALITY, UNIVERSAL ACCESS, USE OF HEALTH SERVICES, VITAL STATISTICS, WATER SUPPLY, WOMAN, WORLD HEALTH ORGANIZATION