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
Table 1.1: Objectives and Strategic Directions of Healthy Development, the 2007 World Bank HNP Strategy Objectives • Improve the level and distribution of key HNP outcomes (for example, MDGs), outputs, and system performance at the country and global levels in order to improve living conditions, particularly for the poor and vulnerable.
Strategic directions • Renew Bank focus on HNP results. • Increase Bank contribution to client country efforts to strengthen and realize well-organized and sustainable health systems for HNP results.
• Prevent poverty due to illness (by improving financial protection).
• Ensure synergy between health-system strengthening and priority disease interventions, particularly in lowincome countries.
• Improve financial sustainability in the HNP sector and its contribution to sound macroeconomic and fiscal policy and to country competitiveness.
• Strengthen Bank capacity to advise client countries on an intersectoral approach to HNP results.
• Improve governance, accountability, and transparency in the health sector.
• Increase selectivity, improve strategic engagement, and reach agreement with global partners on collaborative division of labor for the benefit of client countries.
Source: World Bank 2007a, p. 7.
cost; strengthen locally adapted institutions to manage the long-term response; and invest heavily in M&E capacity and incentives as the basis for evidence-based decision making.
Objectives and Scope of this Evaluation This report evaluates the efficacy, specifically the HNP outcomes, of World Bank Group countrylevel support for HNP over the past decade and draws lessons from that experience. The objectives of the evaluation of the World Bank are to assess the effectiveness of the Bank’s support in improving HNP outcomes at the country level since 1997, particularly among the poor, and to identify lessons from that experience that can be employed to improve the efficacy of the Bank’s support in the next decade. Support to countries includes policy dialogue, analytic work, and lending. The evaluation focuses on assessing the effectiveness of support under the supervision of the HNP sector, as well as support with likely health benefits supervised by the water supply and sanitation and the transport sectors.10 The evaluation of the Bank addresses four main questions: • What have been the objectives, effectiveness, and main outcomes of the World Bank’s country-level HNP support over the past decade and what accounts for this performance? How 8
effective has the Bank’s support been in helping countries improve HNP outcomes, on average and among the poor? To what extent has the Bank improved its M&E performance and used evaluation to improve the evidence base for decision making in HNP? These findings are intended to contribute to more effective implementation of the 2007 HNP strategy’s objective of improving HNP outcomes among the poor and of its results focus. • What lessons have been learned about the efficacy, advantages, and disadvantages of three approaches to improving HNP outcomes in different settings: control of communicable diseases that disproportionately affect the poor; programs to “strengthen” or “reform” the health system; and sectorwide approaches designed to improve ownership, reduce transaction costs, and improve the allocation of resources? These three approaches, which are not mutually exclusive, are closely related to the HNP strategy’s objectives of health system strengthening and are relevant to the balance between investments in communicable diseases and health systems. • What has been the contribution of activities in other, complementary sectors to improving HNP outcomes? In particular, to what extent have Country Assistance Strategies been used as a vehicle to coordinate the activities of other sectors to maximize the impact on HNP outcomes? Have projects in non-HNP sectors