It takes lots of things for a baby to be born healthy and thrive. It takes her mother being able to plan her family and access affordable prenatal care, eat nutritious foods and take vitamins, receive lifesaving vaccines and medicine, and deliver her baby at an equipped health facility by a trained health worker. It also takes education to train the health worker, roads and trucks to get her mother and the medical supplies to the clinic, and clean water and electricity for a safe delivery. It takes all of these things, working in a system—a health system—the network of people, information, resources, and policies all working together for better health outcomes. Strong health systems can make the difference between a mother who dies in childbirth at home and one who delivers safely in a clinic, a polio vaccine sitting in a vial and one protecting a child, or a family that falls into poverty due to catastrophic illness and one that has coverage to afford the care they need.
During the past decade, there has been a more than doubling of global health aid and huge advancements in lifesaving health technologies and medicines. Yet significant obstacles remain—from poor infrastructure and weak logistics to inadequate policies or lack of sustainable financing or health insurance coverage—preventing these lifesaving resources from reaching the poor people in developing countries who need them most. Investing in better health systems is the key to achieving better health for all. Since 2000, the Bank has provided $24 billion—in health-sector-specific and multisectoral programs—to reach the Millennium Development Goals and help people in developing countries create healthy futures.
Strategy
Strengthening health systems is at the center of the World Bank’s global strategy for health, nutrition, and population. We don’t focus on one disease or condition; we look at health as a whole: what is preventing people from being healthy, how we can change this, and what impact it will have on development.
The Bank provides financing, state-of-the-art analysis, and policy advice to help countries expand equitable access to quality, affordable health care; protect people from falling into poverty or worsening poverty due to illness; and achieve universal access to health care in a fiscally sustainable way. We finance investments in all sectors that impact people’s health – including education, infrastructure, water and sanitation, and transportation, to name just a few.
One of the key approaches to implement our Healthy Development strategy is results-based financing (RBF). RBF is an innovative financing strategy to expand the quality and reach of health care services in the poorest countries by linking financing to results. RBF focuses on paying for outputs and outcomes—for example, increasing the percentage of women receiving antenatal care or having a trained health worker deliver their baby – rather than for simply inputs or processes (e.g. training, salaries, and medicines).
Reflecting the Bank’s commitment to the Millennium Development Goals, three areas of special focus for our health strategy are expanding access to reproductive health; scaling up support for early childhood nutrition; and the prevention of HIV/AIDS and other communicable diseases.
Increasing effectiveness of global health aid is a key aim of the strategy. We are a proud partner in the International Health Partnership (IHP+) and are scaling up our civil society engagement in health, nutrition, and population.
Results
Through the International Development Association (IDA) the Bank’s Fund for the Poorest, the Bank has helped save lives and improve the health of millions in developing countries. Some examples of IDA results from 2000-2011:
Provided more than 68 million people with basic packages of health, nutrition, or population services;
Immunized 343 million children;
Provided 124 million children with vitamin A supplements;
Provided 55 million pregnant women with antenatal care;
Delivered antiretroviral therapies to 1.5 million adults and children with HIV;
Purchased and/or distributed 813 million condoms for the prevention of HIV, sexually transmitted diseases, and unwanted pregnancies;
Purchased and/or distributed almost 35 million mosquito nets to prevent malaria;
Constructed, renovated, and/or equipped 26,000 health facilities to improve access to health services; and
Trained 2.2 million health personnel to improve the quality of health services delivery.
Here are some examples where the Bank has made a difference in the countries and regions where we work:
In the China Tuberculosis (TB) Control project, the case detection rate for new smear-positive TB cases increased from 23% in 2002 to 77% in 2010 (target: 70%) and the cure rate for smear-positive TB cases increased from 80% in 2002 to 93% in 2010 (target: 85%).
In Senegal, the Bank supports an innovative, multi-sector health program that operates at the community level in collaboration with local governments, district health authorities, and civil society organizations. National malnutrition rates have dropped to 17% from 22%, bringing Senegal within reach of achieving the Millennium Development Goal to halve the rate of malnutrition.
In Rwanda, Bank support has led to an increase in health insurance enrollment from 7% to more than 70% of the population; a 50% increase in utilization of health services by poor children; a 63% increase in the use of insecticide-treated mosquito nets; a doubling of use of family planning services; a 62% decrease in malaria incidence; and a 30% decrease in child mortality.
Results-based financing for health programs is showing great promise: In Afghanistan, the government reduced the deaths of infants and children under five by 22% and 26%, respectively, in three years. In Argentina, nearly 1.5 million previously uninsured pregnant women and children now have basic health insurance and secure access to services, and infant mortality has fallen 20% since 2002.
The Bank-supported Abidjan-Lagos Corridor HIV initiative, which covers the largest transport corridor in Africa, led to a 30% increase in knowledge of how to prevent HIV, underpinned by a 20-fold increase in condom distribution, and major declines in risky behavior.
With Bank support, India designed its national HIV/AIDS response to focus on high-risk groups, eventually culminating in a decline in HIV new infections by nearly 50%.
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