In Washington: Phil Hay (202) 473 1796 cell (202) 409 2909 phay@worldbank.org Magda Garcia (202) 458 5875 Mgarcia3@worldbank.org WASHINGTON, D.C., November 27, 2007—The Norwegian government today announced a new US$ 105 million ‘Health Results Innovation Grant’ for the World Bank to pilot ‘results-based financing’ —innovative and flexible financing that links funding to verifiable better health care for mothers and their infants. In keeping with Millennium Development Goals 4 and 5, this would allow developing countries to reduce the tragic numbers of mothers and babies which die each year from largely preventable causes. The Norwegian fund comes at the same time as the World Bank has just appointed a new Director for Health, Nutrition, and Population (HNP), who will carry out the Bank’s recently developed health strategy to improve health results by strengthening the often perilous state of health systems in low-income countries. Achieving results is the cornerstone of the Bank’s new health, nutrition, and population (HNP) strategy which aims for stronger heath systems to improve the health and well-being of millions of the world’s poorest people, boost economic growth, reduce poverty caused by catastrophic illness, and provide the structural ‘glue’ that combines multiple health-related programs within client countries. “Norway is investing a significant amount of money in the World Bank to help poor countries strengthen their health systems so that mothers can survive their pregnancies and safely deliver babies who live beyond their first weeks of life,” says Norwegian Prime Minister, Jens Stoltenberg. "We look to the Bank to champion greater use of financial incentives to improve care for women and children. We know for example that mothers are more likely to have successful births for their babies if they take place in health facilities where help, advice and equipment is on-hand, rather than at home.” In warmly welcoming the Norwegian fund, the World Bank says that focusing on results gives governments and communities the flexibility and motivation to improve health by fixing problems in the health system that have frustrated achievements to date. ‘Strengthening health systems’ may sound more abstract and less important than fighting specific diseases, but well-organized and sustainable health systems are critical to save lives. For example, 1.8 million women die every year in childbirth. Three-quarters of these deaths could be prevented if women had access to quality obstetric care and other basic services –access that is provided by a health system. Many foreign aid programs rely on countries having well-functioning health systems that can deliver drugs and other essential services to people who need them. But, as the strategy notes, this is often not the case. On the ground, in practical terms, a functioning health system means putting together the right chain of events from financing to governance, to logistics to incentive mechanisms, information, well-trained personnel, basic infrastructure, and supplies). This chain ensures that poor people get the good quality health services they need to save and improve their lives. “Much of the increased health funding available to countries is earmarked to fight priority diseases such as HIV/AIDS, malaria, tuberculosis, and some vaccine-preventable diseases. But it’s vital that governments also have the flexibility to fix the underlying problems in the delivery system and that other priorities such as maternal and child health, nutrition, and family planning are not crowded out,” says Robert B. Zoellick, President of the World Bank Group. Results Framework The Norwegian ‘results-based financing’ grant will support pilots in low-income countries that build on learning from Bank programs already illustrating the value of results-based financing. Two programs in Rwanda are particularly good examples of the impact of linking health financing to verifiable results. One program helps the country’s local municipalities to create incentives for public, private and NGO promotion of basic health messages and outreach services including behaviour change and preventive services that can be delivered at home (e.g., distribution of bed nets, hand-washing, nutrition, use of safe water systems). A recent evaluation found that utilization of bed nets by children less than 5 years of age has increased from 4% in 2004 to more than 70% in 2007. The number of cases of malaria has decreased dramatically and has emptied children’s hospital wards. “Sharing successes like these with other countries is clearly essential to achieving the Millennium Development Goals,” says Joy Phumaphi, the World Bank’s Vice President for Human Development, a former WHO Assistant Director-General for Family and Community Health, and former Health Minister in Botswana. “Along with the rest of the development community, we all have to work that much harder to prevent and treat ill-health which too often is a major cause of poverty, and blunted economic prospects. The clear evidence in developing countries is that weak health systems are a significant roadblock to improving the health of their citizens.” In another program, the government devotes about 15% of its health resources to primary care centres on the basis of performance contracts. This creates incentives for public, private and NGO providers to increase the quantity and quality of basic health care interventions. A 2007 evaluation in target provinces showed a significant increase in immunization coverage up to 95%, almost a doubling in the numbers of people using health services, and a significant jump in the number of assisted deliveries, from 29% in 2000 to 52% in 2006. Good health also brings growth In its new health, nutrition, and population strategy, the Bank envisions its support and advice will also help countries boost their global competitiveness, and good governance. Good health has proven to be not just an outcome of economic growth, but rather a major, inseparable contributor to growth. Advances in public health and medical technology, knowledge of nutrition, population policies, disease control, and the discovery of antibiotics and vaccines are widely viewed as catalysts to major strides in economic development, from the Industrial Revolution in 19th century–Britain to the economic miracles of Japan and East Asia in the 20th Century. Sound health policy has important implications for overall country fiscal policy and country competitiveness. As a result, a country’s economic growth rate is significantly influenced by the health of its general population. “It’s little wonder that illness is often a cause of poverty as well as a catalyst for sudden impoverishment, as families tap into savings or sell what they own to cover the costs of medical care,” Julian Schweitzer, the Bank’s new Director for Health, Nutrition, and Population, and a former Director for Human Development in South Asia, and Country Director for Russia. “As a result, all too often people end up falling below the poverty line. Improving the perilous health of millions of the world’s poorest people is rightly one of the essential priorities of the global development community in this new century.” World Bank contribution to health over previous decade Since the Bank’s last health strategy was approved in 1997, the Bank has lent US $16 billion in HNP for more than 600 projects and programs in more than 100 client countries, making the Bank one of the world’s largest international financing organizations of health, nutrition, and population activities in the last decade.
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