Publication: How are Health Services, Financing and Status Evaluated? An Analysis of Implementation Completion Reports of World Bank Assistance in Health
Date
2006-11
ISSN
Published
2006-11
Author(s)
Subramanian, Savitha
Peters, David
Willis, Jeffrey
Abstract
This paper reports on an analysis of how
World Bank assistance at the country level has influenced
health services, health financing, and status on
peoples' health. The Implementation Completion Reports
used to evaluate all 118 projects involving health services
completed between fiscal years 2003-2005 were systematically
analyzed to determine how they measured changes in health
services, health financing, and health status outcomes. The
results showed that few Bank-assisted projects in the health
sector evaluated changes in health services, health
financing, or health status, with nearly all those measuring
change demonstrating improvements. In multivariate models
including the type of project organization (e.g. disease
program, sector wide approach), project inputs, key project
activities, and contextual factors including per capita
income level, geographic region, and Country Policy and
Institutional Assessment ratings, there was a statistically
significant association between use of a sector-wide
approach (SWAp) and measurement of improvements in health
services and improvements in health status. Projects that
used contracting mechanisms were also more likely to show an
improvement in health services. No other type of
organization of project support, project input or project
activity was statistically associated with measurement of
improvements in health services in the multivariate
analysis. The results from this analysis show that the three
strategic priorities outlined in the 1997 HNP Strategy-- (i)
to improve health, nutrition, and population outcomes of the
poor; (ii) to enhance the performance of health care
systems; and to (iii) secure sustainable health care
financing, were not well measured in the evaluation
frameworks of Bank assistance in health. With the
development of the new HNP Strategy, the World Bank should
encourage policy makers to demand more rigorous monitoring
and evaluation of health sector investments with Bank funds.
Citation
“Subramanian, Savitha; Peters, David; Willis, Jeffrey. 2006. How are Health Services, Financing and Status Evaluated? An Analysis of Implementation Completion Reports of World Bank Assistance in Health. HNP discussion paper series;. © World Bank, Washington, DC. http://openknowledge.worldbank.org/entities/publication/5e4c1156-58fc-50fc-9932-79c560374223 License: CC BY 3.0 IGO.”