T H E C O N T R I B UT I O N O F OT H E R S E C TO RS TO H E A LT H , N UT R IT I O N , A N D P O P U L AT I O N OUT C O M E S
Water supply and sanitation 2% Social insurance or protection Population or 2% safe motherhood 2% Health 7%
Early childhood development 2% Other communicable diseases 2%
Social sector expenditure/reform/ restructuring 8% Nutrition 10%
HIV/AIDS 63%
Source: IEG portfolio review. Note: N = 84.
More than a third of the HNP-managed projects approved between fiscal 1997 and 2006 (38 percent) were managed or implemented by more than one ministry or agency in the borrowing country. Nearly two-thirds of multisectoral projects were HIV/AIDS projects; the remaining third included projects in nutrition, health (multisectoral components), water supply and sanitation, early childhood development and multisectoral social sector lending, (figure 4.2). Compared with the rest of the HNP portfolio, multisectoral projects were more likely to have objectives to improve health or nutrition status or to change behavior. They were less likely to have objectives of improving the access to or quality of health care, reforming or decentralizing the health system, or to have poverty-targeted objectives.
cent of all HNP projects) than in middle- More than a third of HNPincome countries (35 percent). Re- managed projects were gionally, more than half of projects in managed or implemented Africa, a third in East Asia and Latin by more than one America, and a quarter in South Asia ministry or agency. are multisectoral (figure 4.4). Multisectoral HIV/AIDS projects comprised 45 percent of all HNP projects approved in Africa, while about a third of all projects approved in East Asia were non-AIDS multisectoral projects. The main rationale for involving several sectors in managing or implementing these projects is their complementarity in producing health outcomes. The choice of sectors is based on the perceived or demonstrated comparative advantages in relation to the outcome in question. Early child development, for example, may involve both learning opportunities and proper health and nutrition. Nutrition objectives may require inputs from health, agriculture, or even industry (in the case of salt iodization). There are many examples of collaboration between the education and health ministries to promote health education in the schools. In projects featuring social sector expenditure reform, health Figure 4.3: Multisectoral HIV/AIDS Lending Accounts for All of the Increase in Multisectoral HNP Lending 100 14
90
14
11
80 70 Percent
Figure 4.2: Two-Thirds of Multisectoral HNP Projects Involve HIV/AIDS
35
60 50 40
75
30
51
20
The share of HNP multisectoral projects doubled in 10 years, from a quarter to nearly half of all projects. This increase is attributable to a growing number of multisectoral HIV/AIDS projects. The share of non-HIV multisectoral projects has remained constant, at 14 percent, while the share of multisectoral HIV projects tripled, from 11 to 35 percent (figure 4.3). Multisectoral projects are more common in low-income countries (45 per-
10 0 1997–2001 (n = 99)
2002–06 (n = 121)
Fiscal year of approval Other multisectoral HNP Other HNP
Multisectoral HIV-AIDS
Source: IEG portfolio review.
59