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
a focus on results and emphasis on health systems strengthening. IEG notes the underperformance of HIV/AIDS projects during the height of the epidemic in southern Africa during the late 1990s, a period characterized by regional conflict and instability, and the internal displacement of millions of refugees across borders in the Great Lakes Region of the continent. Current projects, focusing on highrisk groups, also constitute a disproportionate number of projects at risk in the current portfolio. In order to redress this situation, a comprehensive approach has been adopted to improve the quality of the Bank’s HIV/AIDS operations, including an umbrella restructuring of the MultiCountry HIV/AIDS Programs (MAPs). Investing in Health Systems—The 2007 strategy underscores the need to focus on health system strengthening to ensure better health outcomes, particularly for the poorest and the most vulnerable. Over the past two years, projects with a primary focus on health systems have increased twofold. In line with the strategy, 67 percent of Bank programs approved since fiscal year 2007 that focused on priority disease areas also include strong components on health system strengthening. An Africa-focused initiative started in 2008 will improve the Bank’s capacity to provide rapid advice and assistance on the ground, particularly in health finance, human resources, governance, supply chain management, and infrastructure planning. Doing More in Population and Reproductive Health—Bank management agrees with IEG that it should do more in this key area. The Progress Report highlights plans for strengthening support for population and reproductive health, using a health systems approach that is critical to improving maternal and child survival rates. Investing in Nutrition Support—We also agree with IEG’s findings that the Bank needs to focus
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more on nutrition. The need for action is even more important today in the context of the ongoing crises in fuel, food, and fertilizers, as well as the escalating effects of the financial crisis. We are therefore investing significant resources in the next few years to ramp up the Bank’s analytical and investment work and leverage resources from other donors. The agenda for scaling up nutrition is being catalyzed with additional budget and external resources, starting in 2009 and continuing for three years. Improving Monitoring and Evaluation (M&E)—As noted in the Strategy Progress Report, this is an important part of strategy implementation, (including the work on retrofitting projects and improving the design of new projects). Routine health monitoring systems (including surveillance, facility reporting, vital registration, census data, resource tracking, and household surveys) may first need to be strengthened to provide the data and indicators that are needed. The Bank is working with partners, such as the World Health Organization, to develop better ways to monitor the health MDGs, including the estimation of trends in child and maternal mortality, for which updates have recently been issued. The International Financial Corporation’s HNP Footprint. IFC has considerably increased its footprint in HNP over the past decade and is prepared to intensify collaboration within the World Bank Group. There is a growing acknowledgement of the role of the private sector in health care in developing countries. The period under review has seen a marked increase in IFC’s activity in health. During this time, many lessons have been learned, specialist knowledge has deepened, and performance has improved by any measure applied. As in other sectors, IFC continues to strive for greater development impact, and we therefore welcome all input that could help us to do better.