World Bank HNP Program Evaluation

Locations of Fieldwork Involved in this Study

The World Bank Group’s support for health, nutrition, and population (HNP) has been sustained since 1997—totaling $17 billion in country-level support by the World Bank and $873 million in private health and pharmaceutical investments by the International Finance Corporation (IFC) through mid-2008. This report evaluates the efficacy of the Bank Group’s direct support for HNP to developing countries since 1997 and draws lessons to help improve the effectiveness of this support.

The evaluation reviewed findings and lessons for three prominent approaches to raising HNP outcomes over the past decade — communicable disease control, health reform, and sector wide approaches (SWAps). These approaches have been supported by the Bank as well as the international community and are not mutually exclusive.

• Support for communicable disease control can improve the pro-poor focus of health systems, but excessive earmarking of foreign aid for communicable diseases can distort allocations and reduce capacity in the rest of the health system.
• Health reforms promise to improve efficiency and governance, but they are politically contentious, often complex, and relatively risky.
• SWAps have contributed to greater government leadership, capacity, coordination, and harmonization within the health sector, but not necessarily to improved efficiency or better health results.
• The contribution of other sectors to HNP outcomes has been largely undocumented; the benefits of intersectoral coordination and multi­sectoral approaches need to be balanced with their costs in terms of increased complexity.