At a Glance Weak health systems undermine country efforts to achieve greater progress in maternal and child health and nutrition.
In FY 2009 the World Bank mobilized more than US$ 3 billion in health investment, channeled mostly through projects to strengthen health systems.
US$626 million helped improve child health.
Last month, the Bank received US$ 420 million to expand its health-results-based financing and buy-down programs from the United Kingdom and Norway.
The Bank provided rapid assistance to countries on the front lines of the A/H1N1 influenza epidemic
Overview In poor countries, non-communicable diseases (NCDs) and injuries are now the leading cause of illness and death. In less developed countries, and among the poor in middle-income and wealthy countries, NCDs affect and kill mostly adults during their productive years. As a result, developing countries now face a “dual burden of disease” that requires expanded action to address. Sustained gains in preventing and controlling these diseases, as well as other major killers such as HIV/AIDS, malaria, and tuberculosis, can be achieved through health systems that deliver effective interventions and work with multiple sectors in addition to health. The importance of strengthening the capacity of health systems to detect and treat the spread of diseases is dramatically illustrated both by emerging new communicable diseases such as A/H1N1 Influenza and multidrug-resistant tuberculosis, as well as by the rapid increase of chronic respiratory diseases and lung and liver cancers. Besides contributing to illness, suffering, and premature death, diseases can add to the stress on the global economy. Highly infectious acute CDs such as A/H1N1 influenza disrupt commerce and trade in the short term. On the other hand, NCDs can have an extended insidious impact on productivity, particularly among the poor. Chronic illness drains family income over the long-term—it can cause children to stay home from school for prolonged periods; prevent caretakers from working outside the home; and can cause premature death for working family members. Key Issues Despite substantial gains in traditional communicable diseases, the overall heath burden and premature preventable global deaths will increase in the coming decade. Thanks to intense national and international efforts, deaths from CDs, maternal and perinatal conditions are projected to decline by 3 percent during the next 10 years. However, the incidence of ill-health and premature deaths from NCDs and injuries are expected to rise by 17 percent (substantially faster than population growth). The link of ill health to poverty is well understood and documented, as is the impact of a sick population on productivity and GDP. By some estimates, Russia may lose as much as 5 percent of its GDP in 2015 because of NCDs. Specific efforts to improve country capacity to achieve health outcomes, regardless of their primary cause, must be integrated into the country’s overall health program and be aligned with efforts in other sectors that influence health. Safe water and sanitation are central to many CDs, and as many as 80 percent of the tools for reducing the wide exposure to NCDs are regulated and enforced outside the health sector. Primary examples include trade (tobacco imports and smuggling), agricultural subsidies of glucose-producing crops, school boards (which can regulate diet and exercise in schools), ministries of finance (taxation of harmful products such as alcohol), regulations of environmental emission levels through though international treaties, and so forth. The health sector can play multiple roles in leveraging those of other sectors, including coordination, education, research, standard-setting, and advocacy. Bank Activities Apart from its disease-specific projects in the areas of HIV/AIDS, TB, and malaria, the Bank is the main international investor in health systems development and is actively engaged in reducing road deaths through its road infrastructure projects, several of which contain road safety components. To reflect the desire of the international community to track resources, the Bank has introduced tracking codes that enable it to determine the share system strengthening projects that will benefit specific diseases and/or interventions. The Bank continues to work closely with governments and partners to achieve better health results through strengthening of the financial and delivery systems that enable governments to control and prevent all types of diseases.
In FY09, the Bank’s overall direct investment in the health sector directly was more than $US 3 billion.
About US$593 million of this focused mostly on communicable diseases.
More than US$626 million was allocated to child health interventions.
The Bank continues to work on Avian Influenza and A/H1N1 influenza by working with partner agencies to provide technical and financial help to countries such as Argentina, Mexico, and other countries in Latin America and Asia.
Donor Activities / Partnerships The Bank plays a leadership role in several key areas of several CD partnerships, including the RBM and STOP TB Partnerships. It also sponsors UNAIDS and has an observer role on the boards of the Global Fund and GAVI. Further details can be found in the respective disease-focused briefs. Moreover, the Bank has joined the newly convened Non-Communicable Diseases Network lead by the World Health Organization (WHO), and it is an active partner of the IHP+ initiative, and the high-level Forum for Innovative Health Financing. Stronger Health Systems Are Essential Weak health systems are undermining the ability of countries to achieve and sustain health results. Progress toward maternal and child health and nutrition outcomes is particularly slow because these “neglected” Millennium Development Goals (MDGs) are dependent on well-functioning health systems. There is a growing realization that countries cannot deliver basic health services through isolated interventions or through fragmented or earmarked health systems funding alone. The 2007 World Bank Strategy for HNP Results emphasizes strengthening of country health systems and improving the Bank’s focus on results in the sector. It calls for efforts to achieve HNP results for the poor in terms of health improvements and financial protection and, as a means to those ends, strengthening health systems (HSS). Several complementary developments in the international arena have impacted the sector since the Strategy’s adoption in 2007. In recognition of the urgent need to improve coordination of development assistance in health, the International Health Partnership (IHP+) was launched in September 2007. The Bank is working with partners to provide strategic leadership in advancing HSS for improved HNP results, in line with the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action. The IHP+ seeks to strengthen national health systems and to achieve better health results by mobilizing donor countries and other development partners around a single country-led national health strategy. IHP+ partners recognize that this approach requires substantial changes in the way donors and development actors have traditionally done business, with simplified aid architecture, stronger civil society involvement and a greater focus on mutual accountability that will reach far beyond the IHP+ partner countries. Development partners requested that the Bank, with WHO, coordinate the work of the partnership. In 2008, the Taskforce on Innovative International Financing for Health Systems (Taskforce) was launched with the objective of identifying and promoting innovative financing mechanisms to bridge the financing gaps that are compromising attainment of the health-related MDGs. The Taskforce highlighted the need to raise an additional US$10 billion per year to spend on health in low-income countries. To make better use of new and existing funds, low-income countries could focus on strengthening health systems as part of a national health strategy to improve governance and finance the scaling up of services required to reach the health MDGs. In its report, the Taskforce presented innovative financing options that countries and other stakeholders can choose to support to help fill health systems financing gaps. In line with the recommendations of the Taskforce, a common health systems platform is being established between the Global Fund, GAVI Alliance, and the Bank. The intent is to coordinate, mobilize, streamline, and channel the flow of existing and new international resources to support national health strategies. The three agencies have made important progress on this recommendation and have sought input from the global health community throughout the process. An inter-agency working group has established a number of principles for the Joint HSS work and has made suggestions on how the three agencies may be able to harmonize their work in this area. Key principles for joint HSS work include a country-led and country-focused process in keeping with IHP+ principles. HNP is undertaking this work as part of our commitment to “improve strategic engagement, and reach agreement with global partners on collaborative division of labor for the benefit of client countries,” as laid out in the 2007 HNP strategy. A new Health Systems for the Health MDGs program was launched in late 2008 to fund and implement coherent country-led health sector programs in Africa, beginning with the 14 IHP+ countries. The program is increasing on-the-ground technical assistance and coordination of partners to better support national strategies. The establishment of two regional HSS hubs in Africa (in Dakar and Nairobi) will improve the Bank’s ability to rapidly assist and advise HNP operations on the ground, particularly in the areas of health finance and risk pooling mechanisms, human resources for health, governance, supply chain management, as well as infrastructure planning. For more on the World Bank’s work in health, nutrition, and population, please click here. Media Contact: Phil Hay, (202) 473-1796, phay@worldbank.org Updated September 2009 |
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