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About Health, Nutrition and Population

The Health sector in the countries of Europe and Central Asia  (ECA) has been undergoing profound changes since the beginning of the transition process in the early 1990s. The transition process in health care has proven difficult, as many countries struggle to build on the strengths of the previous model of financing and service provision while dismantling its weakest elements. The greatest challenge has been to preserve access to care, while embarking on a comprehensive course of reforms usually seeking to improve the sustainability, efficiency and quality of health systems over time. Nutrition and population issues (for example, the issue of ageing populations) are major elements of this equation and play an important part in the World Bank’s work in the Region.

Little girlHealth care systems in place in ECA countries before the transition offered universal access to care with broad coverage and without formal financial barriers. They put a strong emphasis on public health, by providing for example, compulsory childhood immunization. However, significant improvements were needed in the quality and efficiency of care in most of our ECA client countries. For instance, in many cases clinical protocols were outdated or inappropriate to address chronic and non-communicable conditions such as cardiovascular disease or cancer. The abundant human and physical resources developed over fifty years of state-run healthcare could not be retooled to confront the consequences of a rapid epidemiologic transition. The old structure was also fiscally unsustainable, often with too many hospitals, beds, and physicians, and an overemphasis on hospital care relative to more cost-effective primary and outpatient services. As a result, some of the most common health indicators, in decline since the 1980s, continued losing ground relative to international trends in the majority of the former Soviet Union countries (for example,  tuberculosis incidence).

These sectoral challenges were all the more overwhelming given the overall political economy and macroeconomic circumstances. Almost all transition economies suffered significant income declines – as much as 60 percent. Most countries cut real health spending roughly in proportion to revenues. Private expenditures grew, often at the expense of access to high quality care by poor and vulnerable groups. Overall economic decline and years of underinvestment led to shortages of modern medical equipment, pharmaceuticals, and supplies. Infectious diseases such as tuberculosis and malaria re-emerged, while the  HIV/AIDS epidemic gradually became a serious public health threat.


In addition, significant challenges remain in some countries in the region in the area of nutrition. Both malnutrition in childhood, and inadequate diet and nutrition in adulthood, alcohol abuse and tobacco use became major public health challenges, disproportionately affecting male adults. In the future, we expect further challenges to arise as the result of aging trends in some of the ECA countries.


We assist countries in ECA to address these complex challenges by providing lending and advisory services, and advancing knowledge, for the benefit of our client countries and their citizens.


HNPStats - data source for health, nutrition and population indicators 




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