Building Better Health for the Money

The World Bank’s Contribution

Cristian Baeza

Director, Health, Nutrition and Population,

The World Bank

16 October 2010

The World Bank is one of the largest sources of global development aid

• Mission: – Support countries in eradicating poverty and advancing socio-economic development

• How do we work?

– We do so through partnering with member countries and global partners, generating and disseminating knowledge and through providing financial support for development

– More than 198 member countries; work across 19 sectors (Health, Education, Transport, Agriculture, Water & Sanitation; Infrastructure; other)

– On the ground permanent offices and teams in more than 100 countries

• The World Bank Group Financial Support

– IDA provides interest-free loans, grants, and guarantees to 79 low-income countries -- 39 in Africa

– IBRD – loans to middle-income countries– IFC – financing for private sector development

– 50% of IDA goes to Africa – up to 20 % of all ODA– IDA is a Revolving fund: must be replenished every 3 years

In the Health, Nutrition and Population Sector

• Our mission:– To improve the level and distribution (equity) of good health for all, specially the

poor and the vulnerable

– Prevent poverty due to illness,

– Doing so in a way that contributes to overall country global competitiveness and socio-economic development.

• Our contribution to global health efforts– Sharp focus on health, nutrition and population results (real improvements in the

life of people) with emphasis on holistic approach through health system strengthening in all countries

– Currently with active technical and financial support in 140 countries

– Total financial support to health improvement of around US$37 billion since 2000 through multiple sectors

– Directly through the health sector of more than US$12 billion

• Priority focus on MDGs in poorest countries in the world

4

We have much to celebrate in improving health…

* Aggregate IDA countriesSource: World Bank IDA Result website; World Bank Education Sector; WHO Life Tables (from WHO website); Institute for Health Metrics and Evaluation 2009; HNP Team analysis

IDA countries measles immunization*Percent of children covered

IDA countries mortality rate under 5*Deaths per 1,000 children

Life expectancy - EritreaYears at birth

Global maternal mortality1,000 deaths per year

•Significant aggregate health gains

•Higher global awareness = increased health aid

40

50

60

70

80

1990 1995 2000 2005 2010

104124

144

*

***

6561

36

*

***

360

536

**

*

Global health AidBillions, 2007 USD

5

10

15

20

25

1990 1995 2000 2005 2010

5

…yet major challenges remain to reach the MDGs

Recent status reports for selected HNP sub-goalsHNP-related MDGs

▪ Under 5 mortality rate – 88% of 43 low-income countries made insufficient (51%) or no (37%) progress in reducing child mortality rateReduce child

mortality

▪ Maternal mortality rate – reduction of one-third from 1990 – 2008, but still 1,000 women dying each day due to complications from pregnancy and childbirthImprove maternal

health

▪ Access to treatment for HIV and reduction of transmission rates – 4 million people on anti-retroviral treatment, but 250 new cases for every 100 treated

Combat HIV/ AIDS, malaria, and other diseases

▪ Reduce the hunger rate – Progress in reducing hunger eroded by food crisis and out-of-pocket health expenditures continue to impoverish familiesErradicate extreme

poverty and hunger

SOURCE: WB MDG Atlast 2010

6

Distributing bed nets does not guarantee good use*

A strong health systems is essential to meet the MDG challenges

* Residences of fishing villages using bed nets for drying fish and fishing in Lake Victoria (Noburu, 2008)Source: Unforeseen misuses of bed nets in fishing villages along Lake Victoria, Noburu 2008: HNP Team analysis

The international community has learned that a strong health system is needed to help ensure aid effectiveness

7

We know that a functioning health system makes a difference

Source: Healthy development, HNP Strategy 2007; HNP team analysis

The story of Elisabeth and Moussa

• Clinic too far to walk• No transport available - bridge

in disrepair• Clinic closed on weekends;

mother can’t miss work

• Clinic in walking distance, open on weekends

Access to health clinics Presence of health workers Availability of drugs on site

• Qualified health worker not immediately available

• Clinic understaffed to meet demand

• Clinic properly staffed• Queue management practices

triage most urgent cases

• No malaria drugs at the clinic• Only alternative is referral to

hospital, a 2-hour drive

• Drugs immediately provided free of charge, as part of basic health package

Elisabeth

Moussa

Malaria onset

Health status

8

Strengthening health systems requires improving all parts of it, and making them work synergicallyHealth system building blocks Key components

Health services• Provision of services when and where

needed• Cost effective delivery

• Information systems• Leadership capacity• Epidemiological surveillance

Stewardship

• Incentives to steer and influence consumption of health servicesDemand

management

• Human resource training• Pharmaceuticals• Medical devices

Inputs

• Revenue collection• Risk pooling and health insurance• Provider payments and purchasing

Health financing

Governance

• Regulation• Transparency and accountability• Communications

Source: Healthy development, HNP Strategy 2007; World Health Report, 2000, WHO; HNP team analysis

Health system building blocks at play

PATIENTS AND

POPULATION

PUBLIC AND

PRIVATE PROVISION

HEALTH, NUTRITION ANDPOPULATION INTERVENTIONS

FINANCING RESURCEGENERATION

SYSTEMGOVERNANCE

STEWARDSHIP

DEMAND

99

26

28

68

94

293

40

Others***Social

protection &

risk

management

Rural

development

Human

development**

37

Financial &

private sector

development

Total

commitment

Public sector

government

World Bank leverages investments across all sectors for

strong health systems for better health outcomes

Total commitment for approved projects by major theme*

USD Billion, 2000-2010

* Includes IBRD and IDA projects only. Additional USD 1.4 Billion have been committed by IFC for health projects

** HD includes child health, education, health system performance, nutrition and food security, HIV/AIDS, Malaria, Tuberculosis and others

*** Includes Rule of law, Trade and integration, Social development, Environment and natural resources

Source: World Bank Business warehouse; HNP team analysis

Detailed in the following page

10

Including a strong presence and contribution through investments in the Health, Nutrition and Population sector

Transport Others**

1.9

Public

sector

governance

0.4

Education

0.5

1.9

Economic

policy

1.7

Social

protection

2.1

Non-HNP

8.5

HNP

12.2

Health

20.7

* Includes IBRD and IDA projects only. Additional USD 1.4 Billion have been committed by IFC for health projects. Figures represent the

commitment amount allocated to health components in health and non-health sector projects

** Others includes Agriculture and rural development, Poverty reduction, Financial and private sector development, Global information, Water,

Urban development, Energy and mining, Environment and social development

Source: World Bank Business Warehouse; HNP team analysis

Total health commitment for approved projects by WB sector board*

USD Billion, 2000-2010

Amount in health sector

projects

Amount in non-health

sector projects

Our Global Health Contributions in 2010

• Record financing in response to the crisis - $ 4.2 billion in FY10

• Strategic focus on Health systems strengthening, linked to HNP results

• Results-based financing – additional $600+ million to 2015

• Special areas of emphasis – Maternal and Child Health– Scaling Up Nutrition (SUN) Framework– Reproductive Health Action Plan– Help International community to sustain and make even more effective its efforts

on HIV/AIDS, TB, Malaria, NCDs

• Strong commitment for working closely together with global partners at global and country level– IHP+, H-8, H-4, GAVI, Global Fund PNMCH, WHO, Foundations, many other– UNAIDS, Stop TB Partnership, Roll Back Malaria

12

Allowing us to Support country efforts for better health around the world

Senegal – Nutrition

Tanzania – RBF

Nigeria – Malaria

• Malnutrition rate decreased

by 50%

• Doubled practice of

exclusive breastfeeding

• Correct use of bed nets

more than doubled

• Increased health budget

per capita by 30%

• Reduced infant mortality by

33% and under 5 by ~20%

• Expanded use of bed nets

to 52% of pregnant women

• Achieved substantial

increase in households with

bed nets

• Developed new malaria

control strategy

• Pushed behavior changes

among providers

Argentina – Plan

Nacer

Kyrgyz – SWAp

Afghanistan – System

performance

Peru – Health system

Timor Leste – Water

and sanitation

China – TB

• Reached 650 k pregnant

women and 3.5 M kids

• Refurbished 74 health

facilities

• Reduced fragmentation of

vertical programs

• Local plans institutionalized

• Reduced child mortality by

~50%

• Increased immunization

coverage to 95%

• Increased tenfold pre-natal

visits

• Reached 668 million people

• TB-associated deaths

reduced by 770 k

• Prevented 20 million people

from infecting TB

• 100% DOTS coverage

• 77% case detection

• Extended PHC to 85% of

population

• Trained 20 k health workers

• Achieved 98% coverage in

DPT3 vaccination

• 3x women receiving ANT

• Reduced by 94% incidence

of water-borne diseases

• Reached 46,000 households

• Increased hygiene

awareness in 93% of

population

• Reduced to 3% people with

financial barriers to care

• Improved availability of

drugs

• Achieved 74% coverage in

ART to pregnant women

Source: World Bank project specific ICRs (Implementation completion reports); HNP team analysis

1313

…resulting in millions of services provided…

Total

47.6

IDA15

In progress

IDA14

14.0

IDA13

16.6

IDA12

16.7

Access to basic health package

Women receiving antenatal care

Children immunized

Total

2.6

IDA15

In progress

IDA14

1.6

IDA13

0.8

IDA12

0.2

Total

311.0

IDA15

In progress

IDA14

201.1

IDA13

23.5

IDA12

57.2

Children receiving nutrition

supplements

People on Anti retroviral therapy

Bed nets distributed

Total

33.0

IDA15

In progress

IDA14

26.3

IDA13

3.4

IDA12

2.3

Total

98.9

IDA15

In progress

IDA14

54.1

IDA13

13.1

IDA12

2.0

Total

1.9

IDA15

In progress

IDA14

0.0

IDA13

1.6

IDA12

0.3

Aggregate health sector output of closed (ICRs) and active projects (ISRs)

Million, 2000-2010

Significant

impact on

lives saved

between 2000

and 2010

Aggregate non-health

sector project output

Educated girls

Million, 2000-2008

People benefiting from ac-

cess to water and sanitation

Million, 2000-2010

Total

176.8

Education

118.0

Infra-

structure

58.8

Total

12.9

Note: Aggregate output calculated from figures included in project specific ICRs and ISRs. However no standard methodology applied to calculate output figures included in ICRs and ISRs (see annex for

details)

Source: OPCS IDA 12-15 Results; World Bank Water and Sanitation unit; HNP team analysis

1414

…and more than 13 million lives saved!Estimated number of lives saved*, IDA projects

Millions of people, 2000-2010

Total lives

saved

1.6

Bed nets

distributed

0.2

Children

receiving

nutrition

supp

1.0

Children

immunized

3.8

12.4 – 12.9

Road safety

0.01

Water &

sanitation***

0,3 – 0,8

Girls

receiving

education**

1.9

Health

sector

direct

contribution

10.2

Access

to basic

health

package

3.6

People

on ART

Health sector direct

contribution

Non-health sector

contribution

* Estimate likely underestimated as health outputs considered (i.e., input to the estimation model) are only those available as core

sector indicators

** Assumed each girls achieved at least 5 years of education. Impact likely underestimated as data available only up to 2008

*** Range due to different estimate methodologies

Source: WB IDA Core indicators (SAP generated); OPCS IDA 12-15 Results; HNP team analysis

PRELIMINARY

Estimate likely to

increase as

assessment extends

to other sectors