Across the world, poor people face high mortality rates, malnutrition, and limited access to reproductive and other basic health services. At the same time, millions fall into poverty every year as a result of illness. Health conditions are particularly dire in Africa, where no country is on track to meet the child mortality MDG. Recent years have seen massive increases in international aid for health, with much of it targeted to specific diseases, such as HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome), tuberculosis, and malaria. However, relatively few resources have been provided to support health systems, and few institutions are in a position to bring donors, single-cause funds, and other sources together to help countries improve health outcomes. This is an area to which the World Bank is strongly committed and in which it has a comparative advantage. The Bank’s updated strategy in health, nutrition, and population (HNP), discussed by the Board in April 2007, draws on the Bank’s long experience in health financing, health systems, and cross-sectoral investments. Under the new strategy, lending in HNP will be even more closely tied to results than it has been in the past. The Bank will work across sectors and engage with a diverse group of actors to strengthen health systems and interventions, a necessary step for achieving improved treatment and prevention of any single disease. The Bank will also work to prevent poverty resulting from illness and to improve governance, accountability, and transparency in the health sector. Lending for HNP, including health financing, reached $1.83 billion in fiscal 2007. Health systems performance was a dominant theme in fiscal 2007, representing $739 million in new lending. Support to population and reproductive health programs totaled $303 million, and support to the treatment and prevention of HIV/AIDS reached $300 million. The Bank has long supported health-related projects in countries such as Argentina, Ghana, Mozambique, and Tanzania, where a wide range of lending approaches has been used over time. Bank assistance has also had a positive effect in postconflict countries. For example, in Afghanistan and Timor-Leste, armed conflict resulted in huge losses in health personnel, infrastructure, and management capacity. Consequently, the countries turned to civil society organizations to provide basic health services. As conflict died down, both governments developed new strategies to integrate public and nonstate health service providers using robust monitoring and contracting approaches. Bank financing for HNP and other sectors, as well as support for public financing reforms, helped the governments implement these strategies. In Afghanistan, the immediate result has been a fourfold increase in the use of health services in target provinces. In Timor-Leste, the average use of health services increased from one annual visit per person to at least two-and-a-half visits. Measles immunizations rose from 26 percent to 73 percent of children, and skilled attendance at birth increased from 26 percent to 41 percent. Most of the analytic work and technical assistance the Bank provided in fiscal 2007 concentrated on health systems issues. Two reports, Health Financing Revisited and Beyond Survival, summarize global lessons in health financing and provide policy recommendations based on the specific economic, political, and institutional conditions countries face. Education The World Bank is the world’s largest source of external investment support for improving education in middle- and low-income countries, having transferred about $40 billion in loans and credits for education since it started lending to the sector in 1963. This represents nearly 7 percent of total lending over that 44-year period. As with health, the Bank has a unique ability to consult with national governments, United Nations (UN) agencies, bilateral agencies, donors, civil society organizations, and other stakeholders to support developing countries in their efforts to provide education to all their citizens as a means to empower them and to boost economic growth. Education lending in fiscal 2007 reached $2 billion. The Bank provided about $1.6 billion in IDA funding, an all-time high. Aid to Africa—which had declined steadily over the past five years to a low of $339 million in fiscal 2006—reached $707 million, nearly all from IDA, in fiscal 2007. The Bank approved 28 education projects in fiscal 2007. These included $280 million for vocational and technical education in India; nearly $250 million for two projects in Nigeria aimed at increasing access and learning in primary schools and at improving the quality of higher education; $150 million for postconflict support for education in the Democratic Republic of Congo; and $80 million for decentralizing education in Kenya. Because education’s role in broadly shared growth is complex and pervasive, 79 investment projects or development policy operations approved in fiscal 2007 contain funding to support education. For this same reason, the Bank’s approach to education has often involved addressing problems outside education that hinder development of the sector. Reducing or eliminating school fees, addressing HIV/AIDS in schools, and devolving decision making and funding to schools and parents are examples of reform priorities that require a cross-cutting approach. Seven low-income countries—Benin, Cambodia, Mali, Mauritania, Mongolia, Mozambique, and Sierra Leone—received a total of $265 million in grant support under the Education for All Fast-Track Initiative (FTI) in fiscal 2007. The FTI is a global partnership between donor and developing countries that helps to provide increased, better coordinated, and more effective aid to countries with sound education plans. These grants were made under the FTI Catalytic Fund, a multidonor trust fund managed by the Bank that provides transitional financial assistance to countries whose education sector plans have been endorsed under the FTI process but that have difficulty mobilizing sufficient external funding. Thirty-one countries are now endorsed by the FTI. Fiscal 2007 saw other encouraging results. Worldwide, the number of primary-school-age children out of school has fallen from about 100 million in 2000 to an estimated 77 million
in 2006, and the ratio of girls to boys in primary schools is rising rapidly in many countries. The greatest increases in enrollments have occurred in South Asia. Bangladesh has raised gross primary enrollment rates to almost 100 percent and has already met the MDG on gender parity in school enrollment. These hopeful signs suggest that globalization can work in support of shared growth in the countries that continue to invest in education. In addition to investment support, the Bank continues to produce sector analyses and cross-cutting analytical reports that raise local awareness and increase global knowledge. More than 30 education sector papers or strategy documents were prepared in fiscal 2007, and numerous Poverty Reduction Strategy Papers addressed education. Feedback from governmental counterparts and nongovernmental actors indicates that the Bank’s policy advice and global knowledge base are at least as important as its financial support. A redoubling of efforts will be required in education in fiscal 2008 and beyond. Only 25 of 81 IDA-eligible countries have achieved or are on track to achieve universal completion of primary school by 2015 (the second MDG). Bank support for reaching this goal, including support through the interagency FTI, has mostly emphasized increased access, according to an Independent Evaluation Group (IEG) analysis from fiscal 2007. Although the Bank was widely successful in increasing enrollment and access, problems with student dropout and learning outcomes remained. IEG recommended that future Bank support increase the emphasis on learning outcomes and on improved system management and governance and that the Bank work with FTI partners to reorient the initiative. Since that evaluation, all new primary education projects have been reviewed for attention to learning outcomes; programs of analysis, training, and policy dialogue have been organized around the theme of learning outcomes and assessment; and the Bank has engaged its FTI partners in building learning outcomes into the initiative. Measuring learning results and benchmarking them against local and international standards will help link countries to the global economy.
(See www.worldbank.org/education.) Gender Equality The Bank has a strong comparative advantage in the promotion of gender equality. The Bank’s analytical capacity puts it in a good position to make the business case for gender equality and to document how increased gender equality can accelerate shared growth. Operationally, the wide sectoral scope of the Bank’s lending means that it is able to take advantage of many entry points—ranging from health and education to financial markets and infrastructure—to promote gender equality. During fiscal 2007, the Bank adopted an action plan to empower women economically. The plan, Gender Equality as Smart Economics, launched operations in all developing regions. These operations included new activities targeting agriculture, private sector development, financial services, and infrastructure to help increase the productivity and earnings of women producers. In Tanzania, where women have very poor access to financial services, the plan has established a line of commercial credit for women through a local bank. The program
is providing training to women to increase their “bankability,” and it is supporting regulatory reforms to give women better access to credit. This project and others under the gender action plan can facilitate women’s transition to good-quality employment; can increase the number of women starting agribusinesses and engaging in high-value agriculture; and can boost women’s access to essential infrastructure services, particularly transport, water, and energy. The Multi-Country AIDS Project for Africa has focused particular attention on addressing gender dynamics in its response to the pandemic. In Chad, IDA funds a project to reduce the transmission and socioeconomic impact of HIV/AIDS by supporting education and income-generating activities for women. In Rwanda, IDA has financed access to antiretroviral care for 5,000 poor rural people, most of them women. In Africa generally, IDA has financed services to prevent mother-to-child HIV transmission for more than 1.5 million women and has helped distribute 1.3 billion male and 4 million female condoms. The focus of the Bank’s Global Monitoring Report 2007 was on gender equality and on the progress of member countries in meeting the related official MDGs. The report identified gaps and developed a set of complementary indicators to strengthen gender-equality monitoring. Financial support from the governments of Canada, Denmark, Germany, Norway, Sweden, and the United Kingdom continues to encourage innovation in the mainstreaming
of gender issues in the Bank’s work. (See www.worldbank.org/genderequality.)
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