Improving Effectiveness and Outcomes for the Poor in Health, Nutrition, and Population

Abstract

The Bank Group now funds a smaller share of global support for health, nutrition, and population (HNP) 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 International Finance Corporation (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 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. 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.