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World Bank Group Support to Health Services: Achievements and Challenges

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World Bank Group Support to Health Services: Achievements and Challenges

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The presentation summarizes the effectiveness and lessons of the World Bank Group's support for health services in client countries, as outlined in IEG's evaluation.

The presentation summarizes the effectiveness and lessons of the World Bank Group's support for health services in client countries, as outlined in IEG's evaluation.

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World Bank Group Support to Health Services: Achievements and Challenges

  1. 1. The World Bank Group’s Support to Health Services Maria Elena Pinglo, Evaluation Officer February 28, 2019 The Independent Evaluation Group
  2. 2. Today’s presentation 1. Sector Context 2. WBG Support 3. Key Findings 2Independent Evaluation Group 4. Recommendations
  3. 3. 1. Sector Context
  4. 4. At least 400 millionpeople are not receiving essential health services. 6 % of people pushed into extreme poverty because of health spending 4Independent Evaluation Group Health ServicesAre Rapidly Expanding, But Progress Is Uneven 2.5 28.7 Low Income High Income Gap in physicians per 10,000 people
  5. 5. │ WBG Support
  6. 6. Strategies and Initiatives Have Emphasized the Importance of Health Services InAchieving The Twin Goals 2007 Strategy for Health, Nutrition and Population 2014-15 Universal Health Coverage and SDGs 2016 Human Capital Project Increased focus on governance and results focus on comparative advantages to improve health outcomes The World Bank joins the global coalition for Universal Health Coverage SDG 3: Ensure healthy lives and promote wellbeing for all at all ages The goal of the HCP is a world in which all children arrive at school ready to learn, and grow up healthy, skilled, and productive adults. Central role that health services will play in the WBG strategic focus.
  7. 7. The World Bank has invested nearly $23billion in health over the past decade. IFC, 2.7billion 22% 38% 10% 22% 6% 1% 2% 30% 21% 17% 16% 7% 7% 2% 0% 5% 10% 15% 20% 25% 30% 35% 40% Africa Latin America and the Caribbean Europe and Central Asia South Asia East Asia and Pacific Regional Projects Middle East and North Africa 2005 - 2010 2011 - 2016
  8. 8. World Bank support covers a large scope of areas. Health Systems, supply and demand-side interventions Latin America and the Caribbean 0% 10% 20% 30% 40% 50% 60% 70% 80% Health Financing Health Monitoring Info. Systems Stewarship Function INFRA EQUIP MED Financial Incentives to Service Providers CCT Info. Campaigns HealthSystems Supply Demand Leftbar:Closed–Rightbar:Open
  9. 9. WB is broadly aligned with country health needs
  10. 10. 14% 19% 31% 56% 51% 33% 28% 19% 17% 1% 9% 17% 0% 10% 20% 30% 40% 50% 60% LIC LMIC UMIC General Health Maternal & child Communicable Diseases Non-Comunicable diseases Health focus is also consistent with country epidemiological transitions and income levels
  11. 11. IFC is also aligned to health needs Low Health Needs Low Commercial attractiveness High Health Needs Low Commercial attractiveness High Health Needs High Commercial attractiveness Low Health Needs High Commercial attractiveness
  12. 12. │ Key Findings
  13. 13. Global Partnerships Pandemics Public-Private Interactions Focus on three key drivers of UHC 01 02 03 04
  14. 14. 1. The WBG has made progress in improving access but faces challenges in quality and equity Improve Access  better results overtime  incentives approaches perform better Improve Quality  greater emphasis on quality overtime  limited monitoring of all quality dimensions  partial achievement  performance-basedfinancingbetterM&E&greaterachievements Improve Equity  implicit target specific population groups  no explicit objectives for the poor or other disadvantage groups  limited monitoring on distributional impacts
  15. 15. 2. The complexity of the global health landscape shapes the WBG’s role in partnerships programs  25 GPP, 6 MDTF and disbursed 35 billion since 2010.  risk for fragmentation and overlapping mandates and objectives.  Call for greater strategic focus - selectivity and alignment 1990 2015
  16. 16. 3. The WBG performance in pandemic response has improved . Yet progress is needed to mainstream preparedness in client countries health systems. 63 $1.62 Billion 2016 Countries received WBG financial support Avian Influenza and zoonotic diseases Mobilized for Ebola virus outbreak Pandemic Emergency Financing Facility
  17. 17. 4. Limited Public Private interaction  The private sector plays a role in most health systems  Engaging the private sector in UHC remains a challenge.  But the WBG support in this area remains limited.  There have been efforts to foster stronger WB-IFC collaboration (eg, Joint lead and Cascade)  But successful implementation requires adequate resources to attend the needs of client countries and seize stronger opportunities for working together.
  18. 18. │ Recommendations
  19. 19. Improve Strategic Alignment Global Partnership Programs. Integrate Pandemic Preparedness Within Client Countries Health Systems. Strengthen WB and IFC Synergies to Support Public-Private Interactions In Client Countries. Strengthen Quality Measurement and Distributional Effects. 1 2 3 4
  20. 20. Thank you! Visit http://ieg.worldbankgroup.org

Hinweis der Redaktion

  • SLIDE1:Good afternoon to all and thank you for being here. It is a pleasure to present some of the main findings of the Health Services Evaluation, which main purpose was to assess the contributions of the WB and IFC support in Health services to client countries from 2005 to 2016 and recommend measures for achieving greater development results.
     
    When we were doing this Evaluation, we met Victor in Romania. Victor broke his hip in two occasions. First time around he was taken into the hospital in time, had surgery next day and received rehabilitation in the center -6 weeks later he was walking an having a normal life. Two years later he broke the other hip. He was taken right away to the hospital but this time, It took three weeks for the surgery, hospital understaffed, no rehabilitation post surgery offered. He is 100% bed bound. Victors story illustrates the importance of not only having access but to also have sustained quality services and how this matters for peoples livelihoods.
     
  • SLIDE 2: Today, I will divide my presentation in 4 sections. I would like to talk briefly about “sector context”, “WBG Support”, “some of the key findings” and to conclude, “Recommendations”.
     
  • Slide 4: Health Services are Rapidly Expanding But progress is uneven
    At least 400 million people, most of them living in developing countries, are not receiving essential health services
    6 percent of people in low- and middle-income countries are tipped into or pushed deeper into extreme poverty because of health related expenditures.
    low-income countries have 2.5 physicians per 10,000 people compared with almost 29 among high-income countries.


  • So, in light of these challenges what has the WBG response been.

  • Strategies and other initiatives have strengthened the engagement which emphasize the important role of Health Service delivery in achieving the twin goals.
    2007 strategy call to shift focus from inputs to results.
    In 2014, the World Bank joined a global coalition that called for acceleration in universal health coverage
    The 2015 United Nations General Assembly embraced universal health coverage among the targets for Sustainable Development Goal 3
    The recent Bank Group Human Capital Project confirms the central role that health services will continue to play in the Bank Group’s strategic focus.
  • Slide 6: DURING FY05–16,
    The WB delivered $22.8 billion and the IFC $2.7 billion. The World Bank Group’s health services portfolio (including WB ASAs and IFC AS) represents about 4 percent of the overall portfolio.
    Two regions received most of the support LAC and Africa. But Overtime Support to LAC is decreasing and support to Africa is increasing. The World Bank supports health services of about 70 percent of countries in Fragile, Conflict and Violence situations.


  • World Bank support covers a large scope of areas. Health Systems, supply and demand-side interventions

    In Health systems activities support such stewardship functions, health financing and health information management systems. HIMS and HF are the ones that have the largest increase overtime.

    On supply side activities are for example provision of equipment, infrastructure medicine, supporttype of provider. But the largest increase went to financial incentive to health care providers.

    Demand side activities are dominated by Information campaign to health services users and Financial incentives to users with health conditionalities (CCT)
  • WB support is aligned with health needs of client countries.
    At country-level World Bank financing is positively associated with the total burden of disease.

     

  • The health focus is also generally consistent with country epidemiological transitions and income levels. Bank’s support for essential maternal and child services is stronger in low-income countries, where access barriers affects specially the poor.


  • In IFC, we mapped countries following two criteria: business environment and country health needs.
    As expected, we see that IFC investments(denoted by the orange circles) are concentrated in those countries where the enabling environment is good enough for private sector to invest and with high health needs.
    But IFC is active in only about one-third of countries in this quadrant, suggesting potential for IFC investments to expand beyond countries in its current portfolio.
  • LINK to NEXT SLIDE [So with this support, is the bank doing a good job in the sector. I want to leave you with main findings in the following topics.
  • First. Focus on three key drivers of UHC
    Second. Global Partnerships
    Third. Pandemics
    Fourth. Public private interactions
  • ACCESS
    WBG has been successfully focusing on access to health services with better results overtime.
    QUALITY
    But improvements in access aren’t enough to achieve outcomes, Quality Improvements are also needed to achieve sustainable results.
    We have seen that World Bank–financed projects show greater emphasis over time on improving the quality of health services. However, not all the relevant dimensions of quality are monitored, and quality objectives were successfully achieved only half the time.
    Projects adopting performance-based financing interventions stand out with stronger monitoring and evaluation frameworks than the rest of the portfolio and show greater improvements overtime.
    EQUITY
    An important aspect of UHC is to focus on disadvantage populations. We have seen that the majority of World Bank–interventions target identify the specific population groups. However, projects do not have explicit objectives on the poor or other disadvantage groups. This has accountability implications because the specific effect on the disadvantage population in not known.

  • Global health landscape has ben changing overtime.

    The Development assistance for health has increased from $6 billion in 1990 to more than $37 billion in 2015.
    As so the multiplicity of actors (from members of the OECD, philanthropic foundations, and global partnerships and multi-donor trust funds) that increasingly complement traditional single-donor funding.

    Partnership programs are one of the key instruments through which the WBG engages with other development partners at both country and global levels

    The World Bank Group is currently involved in 25 global partnership programs (GPPs) and 6 MDTFs in health. These 25 partnerships have disbursed more than $35 billion for health services since 2010.

    While this is positive as WBG is leveraging resources, which has allowed to broaden the scope of support in health, but at the same time brought challenges of further fragmentation and overlapping mandates and objectives.

    Which require an improvement in the strategic focus (in terms of selectivity and alignment) of the World Bank Group’s participation in global partnership programs.

  • Slide 13: The World Bank Group performance in pandemic response has improved through successive pandemic outbreaks. WBG has learned from past experiences, in particular:
     
    The WB financed 83 operations in 63 countries addressing avian influenza, zoonotic diseases, under the Global Program on Avian Influenza Control and Human Pandemic Preparedness and Response, but it failed to sustain efforts.
     
    The WB was a key member of the global coalition that fought the Ebola virus outbreak in West Africa during 2014-15, mobilizing USD 1.62 billion.

    Building on this experience, the World Bank has put in place a new Pandemic Emergency Financing Facility in 2016, an innovative, fast-disbursing financing mechanism, to prevent the outbreaks from becoming pandemics. This is an encouraging strategy as Quick response to an outbreak is key to control the epidemic, but this evaluation highlights that pandemic preparedness is the best defense and improvement is needed to mainstream preparedness in client countries Health Systems so that support is sustainable and not a one-off responses.

  • The private sector plays a role in most health systems but engaging the private sector in the provision of services to the poor remains a challenge.

    Why because they need adequate incentives, adequate accountability and adequate policies and regulatory framework in place for incentivize the private sector to contribute to UHC.

    But the WBG support in this area remains limited.

    There have been efforts to foster stronger WB-IFC collaboration (eg, Joint lead and Cascade)

    All these efforts have led to an increase the interaction between the IFC and the WB. These are encouraging steps but successful implementation requires adequate resources to attend the needs of client countries
  • And to conclude, the Recommendations called for:
  • Recommendations call for:

    First,
    Improve measurement of the quality of health services and the distributional effects of health services projects.
    (i) Track appropriate indicators of the relevant dimensions of health service quality – structure, process, and outcomes and
    (ii) measure improvements of beneficiaries relative to nonbeneficiaries.

    Second,
    Enhance the strategic alignment and selectivity of World Bank Group engagement in ongoing and future global partnership programs. More specifically, through a strategic review should apply clear selectivity criteria for engagement.

    Third,
    To develop sustainable capacity to Integrate pandemic preparedness and response efforts within client countries health systems. So the bank is well positioned to meet the targets set under IDA18 to support health emergency preparedness, response, and recovery, and ensure that support are sustainable and not one-off responses outside the clients country health system.

    Fourth,
    Strengthen World Bank and IFC synergy to support public-private interactions in client countries.
    For World Bank, work with the IFC to strengthen the planning, regulatory, accountability arrangements and incentives for public- private interactions.
    For IFC, work with the World Bank to crowd-in public financing for privately delivered services.

    So with these recommendations, the WBG can enhance its impact on UHC, help meet its IDA18 commitments, and achieve greater development effectiveness.
  • Thank you! and I will now leave you with Brenda Barbour, who will present our distinguish panel and moderate the discussion.

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