At a Glance  

·         Weak health systems undermine country efforts to achieve greater progress in maternal, reproductive, child health, nutrition, and other 2015 Millennium Development Goals (MDGs). 

·         In fiscal year 2011 (FY11) the World Bank mobilized $2.96 billion in health, nutrition, and population (HNP) investments. The portfolio is at a historic high of $ 10.8 billion, more than half of which goes to the world’s poorest countries.

·         Bank investments in health contribute to further strengthening health systems; boosting the prevention and treatment of communicable and non-communicable diseases; improving child, maternal, and reproductive health, nutrition, hygiene, and sanitation; and protecting the poor from the impoverishing effects of high and unpredictable out-of-pocket spending.

·         The Bank continues to work with development partners and countries in pursuing approaches to ensure predictability in financing and expanding existing funds for results-based funding. At the 2010 MDG Summit, the Bank committed to increase, by 2015, the scope of its results-based financing programs in health by more than $600 million, focusing on 35 low-income countries, particularly in Sub-Saharan Africa, South Asia, and East Asia, which face particularly difficult challenges in achieving their health-related MDGs. As of June 30, 2011, the Bank has committed more than half the full pledged amount for health, or $314 million, to seven countries.

·         The Bank continues to deepen its engagement with civil society organizations (CSOs), toward the shared goal of helping developing countries achieve the better results called for in the health MDGs. The Bank Civil Society Consultative Group on Health, Nutrition, and Population (CSCG-HNP), is a new mechanism for CSOs to contribute to, influence, and share information, lessons learned, and advice on the development and impact of Bank plans and policies and programs in HNP in low- and middle-income countries.

Improving Health Outcomes through Stronger Health Systems

The Bank’s 2007 Strategy for HNP emphasizes the need to improve health results, particularly for the poorest and most vulnerable. The dramatic increase in the Bank’s HNP investment in recent years continues to support reaching this goal, with a focus on strengthening country health systems to improve health results. The Bank has also positioned itself as a global leader in areas such as reproductive health—with the launch of a new Reproductive Health Action Plan (RHAP) in 2010—and nutrition, as a leader in implementing the Scaling-Up Nutrition (SUN) Framework. The Bank continues to implement the aid effectiveness agenda, particularly for the health sector, as a driving partner of the International Health Partnership (IHP+) and Health Systems Funding Platform (the Platform).

An important pillar of the Bank’s HNP Strategy is increased use of results-based financing (RBF), which holds considerable promise for increasing health service utilization, improving service quality, increasing efficiency, and enhancing equity. 

Technical Assistance for Better HNP Results

The Bank works with country governments and global partners to provide high-quality, relevant, and timely assistance to improve health results, particularly as many of the world’s poorest countries are off-track to reach the health-related MDGs.

·         Halve, between 1990 and 2015, the proportion of people who suffer from hunger

·         Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

·         Reduce by three quarters the maternal mortality ratio

·         Achieve universal access to reproductive health

·         Have halted by 2015 and begun to reverse the spread of HIV/AIDS

·         Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

·         Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

For example, reproductive health is fundamental to better human development results because it affects the productivity of women and their future generations. Yet the least amount of global progress toward achieving the MDGs has been made in improving maternal health. The Bank, in consultation with all partners, has developed the RHAP and is being implementing it in the 57 highest-burden countries to help client countries improve their reproductive health outcomes. Reproductive health is an integral part of the Bank’s results-based financing work. 

The Bank is also scaling up nutrition investments, focusing on the highly vulnerable population of pregnant mothers and children under two years of age, to protect future human capital and in general, to promote greater cross-sectoral linkages between nutrition and such relevant sectors as agriculture, social protection, education, and health. The SUN Framework was launched in spring 2010, now with the support of more than 100 partner organizations as well as more than a dozen countries that have declared themselves “early risers” in their commitment to implementing the framework. The greatest emphasis is appropriately placed on Africa and South Asia.[1] 

In addition to supporting these areas, the Bank has made great strides in improving quality and timely technical support. With the establishment of the Health Systems Global Expert Team, technical experts provide support on a demand-driven basis to many countries. The two health systems strengthening (HSS) hubs in Africa (Dakar and Nairobi) support regional HSS work, predominantly in health financing, governance, pharmaceuticals, human resources, and service delivery. These hubs are particularly notable, as they provide technical assistance for HSS, even in countries where the Bank is not lending in HNP.

Global Partnerships

In line with the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action, the Bank continues to focus more on strengthening country ownership and creating inclusive partnerships, underscoring mutual accountability for results and increased transparency, and identifying concrete actions for all development partners working to improve aid delivery. The Bank is maximizing its analytical and operational work by engaging in a number of strategic partnerships. The Bank continues to deepen its CSO engagement, toward the shared goal of helping developing countries achieve the better results called for in the health MDGs. To this end, the Bank has established the CSCG-HNP, a new mechanism for CSOs to contribute to, influence, and share information, lessons learned, and advice on the development and impact of Bank plans and policies and programs in HNP in low- and middle-income countries. The CSCG held its first meeting in April 2011 and will hold its second face-to-face meeting during the World Bank Annual Meetings in September 2011. The IHP+ , which was launched in late 2007, has played a pivotal role in implementing the principles of aid effectiveness for health. The IHP+ consists of 52 partners (27 developing countries, 25 development partners) and aims to bring partners together at the country level to support the implementation of one national health strategy. Building off the ongoing work of the IHP+ to support national strategies, the Bank is working with the GAVI Alliance, Global Fund, World Health Organization, and others to implement the Health Systems Funding Platform. The Platform provides a framework for participants to finance the country’s health strategy, using a common fiduciary framework and one common monitoring and evaluation platform. Nepal, for example, is using the Platform to further implement the aid effectiveness agenda and bring more donors into a joint fiduciary framework (detailed in a Joint Financing Agreement), to support the national health strategy, which was jointly assessed by all partners using the IHP+ JANS tool.

The Bank’s multi-donor Health Results Innovations Trust Fund (HRITF) supports Results-Based Financing (RBF) approaches in the health sector for achievement of the health-related MDGs. The governments of Norway and the United Kingdom have committed $575 million to the HRITF through 2022. The HRITF  provides support through three funding streams:  (1) to country programs funded by the International Development Association (IDA) for RBF projects (Country Program Support Pilot Grants); (2) for technical dialogue and learning around RBF design and implementation in IDA-eligible countries (Regional RBF Knowledge and Learning Grants); and (3) for RBF program evaluation efforts to learn from successful (and unsuccessful) experiences from around the world and allow for learning in IDA eligible countries (Country RBF Evaluation Grants). 

At the 2010 MDG Summit, the Bank committed to increase, by 2015, the scope of its RBF programs in health by more than $600 million, focusing on 35 low-income countries, particularly in Sub-Saharan Africa, South Asia, and East Asia, which face challenges in achieving their MDGs due to high fertility, poor child and maternal nutrition, and high rates of child and maternal disease.  As of June 30, 2011, the Bank has committed more than half the full pledged amount for health, or $314 million, to seven countries (Benin, Burkina Faso, Burundi, Democratic Republic of Congo, Ethiopia, Laos, and Nigeria).  All seven HRITF-funded projects are IDA projects that focus on improving MDG 1c (nutrition), 4 (child health) and 5 (maternal health).  Each HRITF funding stream has played an integral role in catalyzing the Bank’s policy and lending dialogue to support RBF for health as well as attracted additional resources to the health sector (the $314 million committed includes $233 million of IDA financing linked to an additional $81 million from the HRITF).  Looking ahead, this trend in Bank support for RBF is expected to continue; the HRITF is supporting this effort by providing RBF knowledge and learning grants for 16 of the 35 focus countries. 

For more information, please visit www.worldbank.org/hnp.

Contacts:          Phil Hay, (202) 473-1796, phay@worldbank.org

                        Melanie Mayhew, (202) 458-7891, mmayhew1@worldbank.org 

Updated July 2011