Transcript The World Bank’s Reproductive Health Action Plan 2010-2015 July 9, 2012 Progress Update – Years 1 & 2

The World Bank’s
Reproductive Health Action Plan
2010-2015
July 9, 2012
Progress Update
– Years 1 & 2
Summary
• 5-year WB Reproductive Health Action
Plan (RHAP) approved by the Bank’s
Executive Board in May 2010
• Aims at addressing reproductive health (RH)
in 57 high burden countries*
• Focuses on improving RH outcomes
through health systems strengthening
• Considerable progress made in Years 1 &
2 on delivering on the RHAP Results
Framework
– RH is reflected more prominently in the
Bank’s lending and technical assistance;
– We are strengthening our collaboration
with global partners on RH
– The Bank is actively engaged with partners
in the discussion on global funding fto
accelerate progress on MDGs 4 and 5
* New data on MMR and TFR indicates that 12 countries have progressed out of the high MMR and high TFR category, bringing
the number of countries with high MMR and high TFR to 45.
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Contents of the Presentation
•
Context of the Reproductive Health
Action Plan (RHAP)
•
Activities and Achievements
•
Opportunities and Challenges
3
The RHAP Targets Interventions for High Burden Countries and
Most Vulnerable Populations
To do this we are focusing on :
• 57 low-income countries with high maternal mortality and high
fertility*;
• Meeting the reproductive health needs of young people;
• Improving reproductive health outcomes through health systems
strengthening;
• Leveraging partnerships with governments, CSOs, academia,
bilateral and multilateral agencies
While the RHAP focus is
on low-income countries, we
also capture lessons learned
from middle-income countries
* New data on MMR and TFR indicates that 12 countries have progressed out of the high MMR and high TFR
category, bringing the number of countries with high MMR and high TFR to 45.
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The RHAP Aims to Address Persisting High Levels of, and Inequities
in, Maternal Mortality and Fertility
Maternal Mortality Ratios
2010
Fertility Rates By Wealth Quintiles
2006/7, 2008 (select countries)
Poorest
8
5.2
Second
4.2
Third
6.7
3.3
Fourth
4.9
2.7
Richest
1.9
0
Angola 2006/07
7.4
2.8
5
10
Philippines 2008
• 287,000 maternal deaths globally
annually
• Significant intra and inter country
inequity
• 85% of these in SSA and South Asia
• High unmet need for family planning
in SSA (26%)
• Adolescents bear 23% of the disease
burden due to pregnancy and
childbirth
Sources: WHO/UNICEF/UNFPA/The World Bank; 2012; Trends in Maternal Mortality: 1990 to 2010; Demographic & Health
Surveys for Angola & Philippines (www.measuredhs.com)
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Despite Some Progress, the Burden of Maternal Mortality Remains
High in Low-Income Countries
2008
2010
• Globally, there were 260 maternal
deaths/100,000 live births
• Globally, there were 210 maternal
deaths/100,000 live births
• Sub-Saharan Africa had the
highest burden of maternal
mortality with 640 deaths/100,000
live births
• Sub-Saharan Africa continued to
have the highest burden of
maternal mortality with 500
deaths/100,000 live births
• South Asia had the second
highest burden with 280
deaths/100,000 live births
• South Asia had the second
highest burden with 220
deaths/100,000 live births
The maternal mortality ratio for low-income countries is nearly 30 times that of highincome countries (410 deaths/100,000 live births vs. 14 deaths/100,000 live births)
Sources: WHO/UNICEF/UNFPA/The World Bank; 2012; Trends in Maternal Mortality: 1990 to 2010; WHO/UNICEF/UNFPA/The World Bank;
2010; Trends in Maternal Mortality: 1990 to 2008
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Contents of the Presentation
•
Context of the Reproductive Health
Action Plan (RHAP)
•
Activities and Achievements
•
Opportunities and Challenges
7
RHAP Results are Measured Against Three Components
COMPONENTS
DESCRIPTION OF ACTIVITIES
Analytical and Advisory Work
• Analytical and advisory work on RH to inform Country Assistance
Strategies; lending and policy dialogue on health in the RHAP
focus countries
Bank Capacity and Expertise on
RH
• Develop capacity and expertise within the Bank on RH ,
through recruiting technical specialists where possible and
strengthening understanding and expertise of staff working in
health sector.
Improving Portfolio Monitoring
on RH
• Conduct monitoring of Bank’s portfolio on reproductive health
• Establish a baseline for tracking Tier I & II RHAP indicators *
*Tier I indicators: Country development outcomes
*Tier II indicators: Country intermediate outcome indicators
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The RHAP is Well On-Track on These Three Components
ACTIVITIES
ACHIEVEMENTS in Year 1 &2
Component 1
Conducted Analytical and
Advisory Work to Inform Bank
Operations
• RH profiles for 51 countries completed and used to inform policy
dialogue and lending operations
• Global analysis to understand Success Factors for Achieving
MDGs 4 and 5 (with PMNCH) - a mixed methods ongoing study
with two phases. Phase I completed (includes literature review,
development of a database of 200+ indicators, and 5 detailed
country profiles with timeline). Phase II ongoing and includes data
analysis, in-depth case studies on the 5 countries, and synthesis
paper
• Completed National Health Accounts survey in 36 countries on
integrating maternal and child health subaccounts into national
health accounts; 7 countries already tracking Reproductive
Maternal Neonatal and Child Health expenditures, and 10 to initiate
tracking
• Country Assistance Strategies or Country Partnership Strategies
in 21 high MMR and/or high TFR countries approved and all
include discussion on RH
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… and it is Well On-Track for Delivery in the Regions
ACTIVITIES
Africa:
ACHIEVEMENTS in Year 1 &2
• Analytical work on Demographic Dividend in African Countries
focusing on policy implications of population growth and
economic development initiated
• Case studies on breaking the family planning and nutrition
dilemma completed. Advanced policy dialogue on integrating
FP and nutrition in community based approaches in Ethiopia,
Mali and Rwanda
East Asia & the Pacific:
• Analytical work on demand and supply side results based
financing programs for reproductive health completed and
disseminated
• Delivery strategies for sexual and reproductive health and
second chance education and training for youth. Supported
policy changes through identifying effective strategies in
Papua New Guinea, Solomon Islands, and Vanuatu
Eastern Europe & Central Asia:
• Review of reproductive health content in medical and nursing
education curricula completed. Recommendations
incorporated into curricula in Tajikistan, Uzbekistan,
Moldova, Armenia, Azerbaijan and Kosovo
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… and it is Well On-Track for Delivery in the Regions (contd.)
ACTIVITIES
South Asia:
ACHIEVEMENTS in Year 1 &2
• Launch of regional analytical work on Strengthening Commitment
to Sexual and Reproductive Health in South Asia, focusing on
documentation of best practices, and identification of health
systems bottlenecks
• Review of access barriers to RH services completed.
Recommendations on RH and HIV convergence, stigma and
harm reduction resulted in the National Plan for Convergence on
RH and HIV and recommendations on harm reduction have
influenced design of the new National AIDS program in India;
policy changes in Maldives
Middle East and North Africa:
• Analytical work on Reproductive Health Rights in Egypt recently
initiated
Latin America and the Caribbean:
• Analytical work on universal health coverage examining the
extent to which maternal health services are provided and
maternal health outcomes ongoing
• Review of legal framework of legal rights on teen pregnancy.
Framework completed in Nicaragua and Argentina, and
nearing completion in El Salvador
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The RHAP is Well On-Track on These Three Components
ACTIVITIES
ACHIEVEMENTS in Year 1 &2
Component 2
Enhanced Bank Expertise
and Capacity on RH
• 18 Bank staff designated as RH champions in their
regions and actively coordinating on RH work
• Bank’s revised training course on RH offered in
Washington DC in early 2012
• RH training course adapted for South Asia region;
regional training held in Sri Lanka in April 2012
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The RHAP is Well On-Track on These Three Components
ACTIVITIES
ACHIEVEMENTS in Year 1 &2
Component 3
Regularized Portfolio
Monitoring on RH
• Of the 38 HNP projects approved in the countries with high
MMR or high, 47% include reproductive health focus.*
• 2 RH-specific projects in Mali** and Burkina Faso
approved
• In addition, projects addressing reproductive health were
approved in the following high MMR or high TFR countries:
 Bangladesh, DR Congo, Iraq, Lao PDR,
Mozambique, Nigeria, Swaziland, Yemen, Central
African Republic, Madagascar, Malawi, Nepal,
Nigeria, Pakistan, Senegal, Zimbabwe
• Baseline for tracking RH indicators for high MMR/high TFR
countries established and available online
(Available at http://corporatescorecard.worlldbank.org; and additional
indicators at http://data.worldbank.org
* Of all ongoing HNP projects in countries with high MMR or high TFR, 70% include reproductive health
** Due to recent political instability in Mali, all Bank’s operations in the country are suspended.
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As a result, World Bank investments in RH are up…
Bank lending for RH (US$ million)
FY11 approvals
RH in Bank lending for health
(US$ million) FY10- FY11
324
5,000
4,383
4,500
9
4,000
31
3,500
2,961
3,000
22
2,500
2,000
74
1,500
830
1,000
500
491
0
FY10
RH Only
FY11
HNP Funding
“RH only” in the above figure includes lending for Health Systems
Strengthening, child health and nutrition that is oriented to RH outcomes
Source: World Bank Analysis of HNP Portfolio for FY10 and FY11. Update
available October 1, 2012.
370
AFR
SAR
LCR
EAP
MENA
ECA
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World Bank projects on RH are showing promising results
PROJECT
Burundi Health Sector
Development Support Project
ACHIEVEMENTS in Year 1 &2
• The project supports the nation-wide results-based financing
(RBF) program. Notable RH achievements in first year include:
 An increase facility based births by 25%
 Increase in prenatal consultations by 20%
 35% increase in curative care consultations for pregnant
women; and
 27% increase in family planning services obtained through
health facilities
Strengthening Health Activity for
Rural Poor Project (Afghanistan)
• The project has been very successful in improving maternal and
child health outcomes through better services, including:
 Facilities with skilled female health workers increased from
25% to 83% between 2002 and 2007
 4-fold increase in outpatient visits between 2004 and 2007
Second HNP and HIV/AIDS Project
(Nepal)
• Project has led to significant improvements for maternal health
since 2010, including:
 36% increase in skilled attendance at birth
 43% increase in use of contraception
 85% increase in pregnant women attending at least 1 ANC
consultation
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World Bank projects on RH are showing promising results (contd.)
PROJECT
Second Women’s Health & Safe
Motherhood Project (Philippines)
ACHIEVEMENTS in Year 1 &2
• The project supports the Government’s efforts in 5 provinces to
improve maternal and child health. Between 2005 and 2010
notable achievements include:
 Increase in facility based births from 53% in 2009 to 68%
 450+ teams trained on Basic Emergency Obstetrics Care
Health Services Improvement
Project (Lao PDR)
• The project aims to increase utilization and quality of health
services for poor children and women in 8 rural provinces.
Between 2005 and 2011 some project achievements include:
 45% pregnant women received tetanus vaccinations
 35% of women obtaining modern contraception from public
health facilities.
 76% of children under age 1 fully immunized
Health Sector Development Project
(Djibouti)
• Project has led to significant improvements for maternal health
between 2002 and 2011 include:
 58% increase in medically assisted deliveries
 Decrease in HIV/AIDS prevalence among young pregnant
women from 2.9% to 1.4%
 Decline in child mortality from 103 to 67 deaths/1000 live
births
 DPT3 vaccination increased by 45%
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Contents of the Presentation
•
Context of the Reproductive Health
Action Plan (RHAP)
•
Activities and Achievements
•
Opportunities and Challenges
17
Looking Ahead, There are Opportunities to Continue Scaling Up
Support for Reproductive Health
• RH specific indicators in the IDA16 results matrix*
• The UNSG’s Every Woman, Every Child global strategy for women
and children’s health (MDGs 4 & 5) synergizes with the RHAP
• The Bank is a key stakeholder and partner with PNMCH in the
dialogue on scaling up financing for MDGs 4 and 5
* RH-specific indicators are included in the IDA results matrix, namely Prevalence of
HIV/AIDS (% of population aged 15-49), Births attended by skilled health staff (% of total
births), Adolescent fertility rate (births per 1,000 women ages 15-19), and Maternal
mortality rate (modeled estimate, per 100,000 live births).
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Overall: Substantial Achievements to Date, But Key Challenges
Remain
• Scaling up the most effective ways to incentivize demand for RH
services, including family planning, at country level
• Delivering on the continued need to strengthen country level
capacity
• Ensuring full leverage of the Bank’s multi-sectoral advantage to
improve RH outcomes, including leveraging RH as a tool for
women’s empowerment
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