Transcript Julian Schweitzer Health Nutrition Population Human Development Network World Bank

Julian Schweitzer
Health Nutrition Population
Human Development Network
World Bank
The World Bank's New Health
Strategy
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Updates the World Bank’s
contribution to improving health
outcomes, including the MDGs
Aims at bolstering client country
efforts to improve health
conditions for the poor and the
vulnerable
Aims to support/advise countries
to achieve HNP results in a way
that contributes to their overall
fiscal sustainability, economic
growth, global competitiveness,
and good governance
Introduction: Why Now?

Dramatic changes in DAH since the turn of the century
 Client-countries have changed their expectations significantly
and expect the Bank to serve as the “glue” that holds global
initiatives together at the country level
Development assistance for health from
bilaterals in 2005
Development assistance for health, by source
2000 and 2005, US$ billion
5,000
15
Private non-profit
4,500
1,500
1,000
500
country
United
Sweden
Portugal
New
Luxembourg
Italy
0
Greece
year
2,000
France
2005
2,500
Denmark
2000
3,000
Belgium
0
Bilateral
agencies
3,500
Australia
5
10
US$ (millions)
US$ billions
4,000
Other
multilaterals
Development
banks
UN agencies
Opportunities and Challenges
Challenges
Emerging
new risks for global
pandemics
Malnutrition affecting the
poorest people received
relatively little attention
MDG 4 & 5 are not on track in
many countries (population,
reproductive and child health)
Public policy actions limited in
many developing countries
Inadequate attention to
measuring and monitoring
Results.
Opportunities

Global attention to health
policy has increased
dramatically, with private
foundations and other new
partners
 While single-intervention
approaches have proliferated,
renewed attention to health
systems is being embraced by
global partners
 Rapid technological
development in
pharmaceuticals and devices
offer potential low cost
solutions
Opportunities and Challenges
 Aid

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effectiveness could be Improved:
Often not aligned with government priorities
Can be unpredictable, short-term and volatile
May be poorly harmonized, increasing transaction
costs for clients
 The
emerging Global Initiatives offer
opportunities to address these issues
The New HNP Strategy Focuses on
Four Results…
1.
Improve level and distribution of key HNP outcomes health
outcomes (e.g. MDGs 1b, 4, 5, and 6), outputs and system
performance at country and global levels
2.
Prevent poverty due to illness (Improve Financial
Protection)
3.
Improve financial sustainability in the HNP sector and its
contribution to sound macroeconomic and fiscal policy and
to country competitiveness
4.
Improve governance, accountability, and transparency in the
HNP sector
Result #1. Improve the Level and Distribution of
Key HNP Outcomes, Particularly for the Poor and
Vulnerable
Trends in infant mortality rate by
World Bank region, 1980 – 2004
Use of Basic MCH Services by Lowest
and Highest Economic Quintiles, 50+
Countries
120
EAP
100
ECA
LAC
80
MNA
60
SAR
40
AFR
20
100
90
80
70
60
50
40
30
20
10
0
% of population group covered
infant mortality rate per 1,000 live births
140
Antenatal care
Full immunization
Lowest economic quintile
0
1980
1990
year
Attended delivery
Highest economic quintile
2004
Source: World Development Indicators 2002 and 2006.
Source: Gwatkin, Wagstaff, Yazbeck. 2005. DHS Data 1990 – 2001.
Result #2. Prevent Poverty Due to Illness
(Improve Financial Protection)
People are falling into poverty due to illness
12
Previsional HH Income as a Multiple of
the Poverty Line
12
10
10
8
8
6
6
4
4
2
0
2
-2
-4
Previsional Households Ranked in Ascending Order of Income
Poverty Line
Pre-OOP Income
0
Argentina
Chile
Ecuador Honduras
Post-OOP Income
Percentage of people
Average provisional household monthly per capita income
pre- and post-out-of-pocket health spending,
Honduras 1998-1999
Source: Fiedler 2004 for Beyond Survival 2006.
Percentage of people below
the poverty line in
select Latin American countries, 2004
Source: Baeza and Packard. 2006.
Result #3. Improve Countries’ Financial Sustainability in the
HNP Sector and its Contribution to Sound Macroeconomic
and Fiscal Policy and Country Competitiveness
external resources for health as
% of total health expenditures
Financial sustainability in key, as countries face extreme volatility in external resources for health
50
45
40
35
30
25
20
15
10
5
0
1999
Laos
Lesotho
Niger
Zambia
2000
2001
year
Source: World Development Indicators. 2006.
2002
2003
Result #4. Improve Governance, Accountability, and
Transparency in the Health Sector
Uganda (2003)
Tajikistan (1999)
Slovakia (2000)
Russia (2002)
Romania (2000)
Poland (2002)
Kosovo (2000)
Kazakhstan (2001)
Kazakhstan (1999)
Ghana (2000)
China (n.d.)
Bulgaria (2001)
Bangladesh (2002)
Armenia (2001)
Albania (2001)
0
10
20
30
40
50
60
70
80
90
100
Percentage
Outpatient
Hospital
Proportion of patients making informal payments by type of service, selected countries, 1998Source: Lewis. 2006.
2002
Strategic Directions
1.
Renew Bank focus on HNP results
2.
Increase Bank contributions to client-country efforts to
strengthen health systems for HNP results
3.
Ensure synergy between health system strengthening
and priority programs and interventions, particularly in
Low Income Countries
4.
Strengthen Bank capacity to advise client countries on
multisectoral approaches to HNP results
5.
Increase selectivity, improve strategic engagement, and
reach agreement with global partners on collaborative
division of labor for the benefit of client countries
In Conclusion…
The Strategy seeks to provide…
 Better synergy between health systems strengthening
and support to priority programs –including the
“neglected MDGs” (nutrition, population and child
health);
 Effective tools for client countries and global partners
to implement sustainable health policies and reduce
poverty at scale at country level;
 Collaborative division of labor with global partners;
and
 Better linkages to macroeconomic policies to reduce
poverty in the world
Moving Forward
Health Directions
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Key Initiatives
Implement results-based HNP

Strategy
Strengthen health systems and service
delivery
Ensure priority disease programs are
sustainable and aligned with health
system efforts
Improve policies and tools for global
public goods and innovative financing
Rapid, flexible response to fast
changing global health architecture
Focus on neglected MDGs
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Malnutrition (MDG1b)
Child mortality (MDG 4)
Maternal mortality (MDG 5)
International Health
Partnership and related
initiatives (IHP+)
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Catalytic Initiative
Deliver Now for
Women and Children
Health Results
Innovation Grant
Providing for Health
Initiative
Thank You