I M P ROV I N G E F F E C T I V E N E S S A N D OUT C O M E S F O R T H E P OO R I N H E A LT H , N UT R IT I O N , A N D P O P U L AT I O N
8. Bangladesh Health and Population, India Women and Child Development, Afghanistan Health Sector Emergency, Burkina Faso Health Sector Support and AIDS. 9. See, in particular, chapter 4 for a discussion of the health effects of water supply and sanitation interventions in Nepal. 10. The Bank’s performance was rated satisfactory for 57 percent of the closed projects, and the borrower’s performance only slightly better (64 percent). 11. World Bank 2004b. Note, however, that these figures are based on a comparison of a baseline total goiter rate among both schoolchildren and pregnant women and a follow-up measurement of schoolchildren only. This is an example of the very weak M&E in most of the nutrition portfolio. A 2001 study by IEG compared the performance of this project with two other iodine deficiency projects that promoted production, distribution, and consumption of iodized salt in China and Madagascar (Goh 2001). The study pointed to the extreme difficulty of getting results in Indonesia because of the large number of small salt producers that are difficult to regulate (70 percent of salt production comes from small salt farmers). In contrast, salt production and distribution is centrally controlled in China, while about six large producers in Madagascar produce 80 percent of the salt. That study found four key factors affecting the success of projects promoting iodized salt to combat iodine-deficiency disorders (IDD): (a) information and behavior change communication concerning IDD to raise the demand for iodized salt; (b) easy access; (c) industry compliance, through persuasion and alignment of incentives with the self-interests of the salt industry and consumers; and (d) quality control, since consumers cannot tell the extent of iodization. 12. In the Sri Lanka Health Services Development Project, low birthweight declined marginally, and an evaluation of one year of work by the nongovernmental organizations showed minimal impact; other indicators like the consumption of iodized salt were not measured. The Mauritania Nutrition, Food Security and Social Mobilization Project—a Learning and Innovation Loan that was supposed to test two different approaches to improved nutrition—did not do so; malnutrition was reduced 16 percent in two urban areas (though the data being compared are from a lean month and a normal season, so this may be exaggerated) and increased in rural areas by 6–8 percent; anemia among 176
pregnant women and consumption of iodized sale were not measured. (Mauritania also experienced a major drought and locust infestation during project implementation.) The Bangladesh National Nutrition Program did not collect baseline data until two years before the project closed, and found that some of the targets that had been set were already achieved at baseline; project monitoring data suggest a decline in severe proteinenergy malnutrition (PEM) from 24 to 16 percent from 2004 to 2006, and moderate PEM from 30 to 25 percent. There was substantial evidence of increased knowledge and change in some behaviors, however. Finally, there was no discernable improvement in malnutrition indicators in Andhra Pradesh, India, during the Economic Restructuring Project. (Source: Implementation Completion Reports.)
Appendix G 1. ESW is an activity that “(a) involves analytic effort; (b) is undertaken with the intent of influencing an external client’s policies and/or programs; and (c) represents the views of the Bank (that is, not attributed to individual authors).” (IEG 2008h, p. 1) 2. Of this amount, $27.7 million was from the Bank budget and $15.1 million was financed from trust funds. Fiscal 2000 is the starting point for this review, because before that date ESW was not systematically tracked in the Bank’s internal information systems. 3. The Reaching the Poor with HNP Services Project was partly financed by the Bank’s research support budget, partly as knowledge management through the World Bank Institute and the HNP anchor, in addition to the Bill and Melinda Gates Foundation and the governments of Netherlands and Sweden. The only part of the exercise captured as official ESW were a few dissemination activities. 4. This total excludes obvious duplicates (for example, when a research working paper was also published as a book chapter). See the discussion in appendix H. One reason for the difference is that ESW for fiscal 1997–99 is not in the official database. However, because of the elapsed time, analytic work from those years was also more difficult to locate, despite an exhaustive search conducted by IEG. 5. The distribution of HNP ESW is slightly more skewed toward regional ESW and less to the country level, compared to the distribution for all sectors combined (country-level, 78 percent; regional, 17 percent; global, 5 percent) (IEG 2008h).