Conclusions and Recommendations
T
he global aid architecture in health has changed over the past decade with the adoption of international goals and a major expansion of the levels and sources of development assistance, particularly for lowincome countries. The World Bank Group’s support for health, nutrition, and population has been sustained over the decade, but it is now a smaller share of global HNP assistance. The mandate of the World Bank Group is to promote poverty reduction and economic growth in developing countries. Poor health is both a cause and consequence of poverty and an impediment to economic growth. This evaluation has pointed to some important accomplishments of the World Bank’s HNP support to countries, often in difficult settings, and its contribution in helping build government capacity to manage the sector. The latter is important for improving aid effectiveness more generally, given the increasing reliance of the international community on government systems. The evaluation has also found improving performance in IFC’s health portfolio and important lessons learned in this small but expanding sector. The fieldwork for this evaluation also points to areas where the World Bank and IFC continue to add value (box 6.1). The results are a reminder that the value added by the World Bank Group is not measured solely by the magnitude of its support, and that its actual comparative advantage or that of any other development partner depends not only on its institutional assets, but also on the country context, health needs, and the activities of others. Looking forward, the developments in the international aid architecture for health
over the past decade and the increased levels of assistance from other sources present both opportunities and challenges for the World Bank Group. In the context of the Paris Declaration on Aid Effectiveness, the Bank has an opportunity to leverage its experience to help governments strengthen their capacity to manage effectively their own resources as well as the new donor funding being channeled through government. While the Bank’s resources are now a smaller share of global development assistance for health, the Bank nevertheless continues to bring key institutional assets to the table: longterm, sustained engagement in the sector; experience in many countries with similar issues; a history of support for building country capacity for implementing social sector investments; sustained large-scale financing; strong links to the Ministry of Finance, which can be critically important both in leveraging reforms and in improving the dialogue between the ministries of health and finance; and a country approach in which HNP support is part of a portfolio of activities in many sectors, some of them with potential complementary contributions to health outcomes. These are assets that the Bank can continue to bring to bear on making health systems work better and to ensure that health benefits reach the poor. 95