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Main Evaluation Questions
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The main task of the evaluation is to assess the development effectiveness of the World Bank's support for HNP outcomes over the past decade — in terms of its relevance, efficacy and efficiency. What have been the objectives of this support? Has the support been relevant, addressing borrowers' priorities and the Bank's strategies? How effectively has the support contributed to achieving its objectives? Have the programs and policies supported been efficient in design and cost-effective in implementation?
Beyond these fundamental portfolio-wide issues, the evaluation addresses four questions linked to the priorities of the former and current World Bank HNP strategies:
1. How effective has the Bank's support been in improving HNP outcomes among the poor? To what extent have Bank projects and analytic work explicitly addressed HNP outcomes in general, and specifically among the poor? How have projects gone about targeting the poor? To what extent have the Bank's country strategies taken into account the potential contribution of sectors beyond HNP to improve outcomes? What strategies or approaches have been used in different settings? Have they succeeded in improving the access of the poor to HNP services? Have they improved HNP outcomes on average or among the poor?
2. What lessons have been learned about the efficacy, advantages, and disadvantages of various approaches in different settings? Examples of these approaches include the following: - Programs to "strengthen" or "reform" the health system, including decentralization, health insurance, regulatory frameworks and contracting with the private sector, and health finance reform
- Sectorwide approaches designed to improve ownership, reduce transaction costs, and improve the allocation of resources
- Control of communicable diseases that disproportionately affect the poor
- Approaches relying on intersectoral contributions or collaboration.
3. What have the revealed "strengths," "value added," and "comparative advantages" or "contributions" of World Bank support for HNP been in developing countries over the past decade, and how is that changing? What has the contributed Bank's HNP support — in terms of policy dialogue, analytic work, and lending — relative to the counterfactual of no Bank support? How do the views of government and other partners differ in this regard? How significant has the Bank's finance of HNP been in relation to overall finance of the sector? How effectively has the Bank used its support to leverage policy reform? How, if at all, has this picture changed over the past decade, given (a) the surge in development aid for health, most of it in grant form, and the emergence of new actors; and (b) the new emphasis on working through country-level partnerships?
4. In light of the focus of the new HNP strategy on results, to what extent has the Bank's HNP support monitored results and used evaluation to improve the evidence base for decision making? What share of Bank projects have been designed in the absence of baseline information on outputs, financing, or outcomes that are an objective of the project? How frequently are relevant outputs and outcomes tracked over time, in a manner that allows an analysis of trends? Are pilot projects being evaluated before they are generalized? Is evaluation being used as a management tool? What are the main constraints to better M&E for HNP support? In projects with good M&E where decisions are guided by evidence, what incentives or capacity-building activities were associated with this result, for the Bank and/or the borrower? |
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