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Recommendations

The following recommendations for the World Bank and IFC are offered to help improve the implementation of their respective HNP strategies and further the mandate to reduce poverty and promote economic growth in the context of the new aid architecture.

1. Intensify efforts to improve the performance of the World Bank’s support for health, nutrition, and population.

  • Match project design to country capacity and reduce the complexity of support in low-capacity settings, particularly in Africa.
  • Thoroughly and carefully assess the risks of proposed HNP support and strategies for mitigating those risks, particularly the political risks and incentives of stakeholders.
  • Phase health system reforms to maximize the probability of success.
  • Undertake thorough institutional analysis as an input into more realistic project design.
  • Support intensified supervision in the field by the Bank and the borrower to ensure that civil works, equipment, and other outputs have been delivered as specified, are functioning, and are being maintained.

2. Renew the commitment to health, nutrition, and population outcomes among the poor.

World Bank should:IFC should:
  •  
  • Boost population, family planning and other support to reduce high fertility.
  • Incorporate the poverty dimension into project objectives.
  • Increase support to reduce malnutrition among the poor, whether from the HNP sector or other sectors.
  • Monitor health, nutrition, and population outcomes among the poor.
  • Bring the health and nutrition of the poor and the links between high fertility, poor health, and poverty back into poverty assessments.
  • Expand support for innovative approaches and viable business models that demonstrate private sector solutions to improve the health of the poor, including expansion of investments in low-cost generic drugs and technologies that address problems of the poor.
  • Assess the external and internal constraints in achieving broad social impacts in the sector.

 

3. Strengthen the World Bank Group’s ability to help countries to improve the efficiency of health systems.

World Bank should: IFC should: 
  • Better define the efficiency objectives of its support and how efficiency will be improved and monitored.
  • Carefully assess decisions to finance additional freestanding communicable disease programs in countries where other donors are contributing large amounts of earmarked disease funding and additional earmarked funding may contribute to distortions in the health system.
  • Support improved health information systems and more frequent and vigorous evaluation of reforms.
  • Support public-private partnerships through Advisory Services to government and industry and through its investments, and expand investments in health insurance.
  • Improve collaboration and joint sector work with the World Bank, leveraging Bank sector dialogue on health regulatory frameworks to engage new private actors, and more systematically coordinate with the Bank’s policy interventions regarding private sector participation in health.

 

4. Enhance the contribution of support from other sectors to health, nutrition, and population outcomes.

World Bank should: IFC should: 
  • When the benefits are potentially great in relation to the marginal costs, incorporate health objectives into relevant non-health projects for which they are accountable.
  • Improve the complementarity of investment operations in health and other sectors to achieve health, nutrition, and population outcomes, particularly between health and water supply and sanitation.
  • Prioritize sectoral participation in multisectoral HNP projects to reduce complexity.
  • Identify new incentives for Bank staff to work across sectors to improve health, nutrition, and population outcomes.
  • Develop mechanisms to ensure that the implementation and results for small HNP components retrofitted into ongoing projects are properly documented and evaluated.
  • Improve incentives and institutional mechanisms for an integrated approach to health issues across units in IFC dealing with health, including the way that health in IFC is organized.

 

5. Implement the results agenda and improve governance by boosting investment in and incentives for evaluation.

World Bank should:IFC should:
  • Create new incentives for monitoring and evaluation for both the Bank and the borrower linked to the project approval process and the midterm review. This includes requirements for baseline data, evaluation designs for pilot activities in project appraisal documents, and periodic evaluation of main project activities as a management tool.
  • Enhance its results orientation by developing clearly specified baseline indicators and an evaluation framework that adequately measures IFC’s health sector objectives and results.



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