|Population lending, 1970–79
The Bank focused on improving access to family planning services because of concern about the adverse effects of rapid population growth on economic growth and poverty reduction. A handful of nutrition projects was also approved following a 1973 nutrition policy paper, and throughout the decade health components were included in agriculture, population, and education projects as important links between health, poverty, and economic progress were established.
Primary health care, 1980–86
The 1980 Health Sector Policy Paper (World Bank 1980a) formally committed the Bank to direct lending in the health sector with the objective of improving the health of the poor by improving access to low-cost primary health care. The rationale for this policy change was contained in the World Development Report 1980: Poverty and Human Development (World Bank 1980b), which emphasized that investment in human development complements other poverty reduction programs and is economically justifiable. However, over this period systemic constraints were encountered in providing access to efficient and equitable health services.
Health reform, 1987–96
Following the release of Financing Health Services in Developing Countries: An Agenda for Reform in 1987 (Akin, Birdsall, and De Ferranti 1987), the Bank addressed two new objectives: to make health finance more equitable and efficient and to reform health systems to overcome systemic constraints. The message was further refined by the World Development Report 1993: Investing in Health (World Bank 1993c), which highlighted the importance of household decisions in improving health, advocated directing government health spending to a cost-effective package of preventive and basic curative services, and encouraged greater diversity in health finance and service delivery.
Health outcomes and health systems, 1997–2000
The 1997 Health, Nutrition, and Population Sector Strategy Paper (World Bank 1997b) focused on health outcomes of the poor and on protecting people from the impoverishing effects of illness, malnutrition, and high fertility. However, it continued to emphasize support for improved health system performance (in terms of equity, affordability, efficiency, quality, and responsiveness to clients) and securing sustainable health financing.
Global targets and partnerships, 2001–06
The Bank’s objectives, rationale, and strategy remained unchanged, but major external events, the surging AIDS epidemic, and the Bank’s commitments to specific targets and to working in partnerships led to an increase in finance for single-disease or single-intervention programs, often within weak health systems.
System strengthening for results, 2007–present
In the context of changes in the global health architecture, Healthy Development: The World Bank Strategy for Health, Nutrition, and Population Results (World Bank 2007a) emphasizes the need for the Bank to reposition itself, with a greater focus on its comparative advantages, to more effectively support countries to improve health outcomes. It adheres closely to the 1997 strategy’s objectives and means for achieving them, with increased emphasis on governance and demonstrating results.
Source: Fair 2008
Timeline of Health Sector-Related Events in IFC (1997-2007)
Note: WBG = World Bank Group; SME = small and medium enterprises