The World Bank Group is addressing key drivers of universal health coverage although with different levels of emphasis across the key drivers. The most frequent objectives sought by World Bank Group–financed projects are the improvement of access, quality, or health systems. Objectives related to health outcomes and equity are less frequently pursued.
Improve access. The World Bank has made substantial contributions to improving access to health services. It is an objective in 54 percent of World Bank–financed projects approved during the evaluation period, and it has been achieved in 70 percent of the 259 evaluated projects. IFC also contributed to improved access to health services. It is an objective in 88 percent of the investment projects, and it has been achieved in 73 percent of its evaluated projects. However, due to the limitation of the monitoring frameworks of IFC projects, it is not possible to determine if they contributed to expanding coverage or to improving availability and use among those who were already covered.
Improve quality. Quality improvement is an objective in 27 percent of World Bank-financed projects. Over time, World Bank–financed projects show, greater emphasis on improving the quality of health services (from 18 percent among closed to 44 percent among open projects) but only partial success. Only 46 percent of quality improvement objectives in evaluated projects have been rated positively (moderately satisfactory and above). IFC projects frequently included quality improvement objectives, but with a declining trend (from 27 percent among closed to 19 percent among open projects). Moreover, IFC quality improvement objectives and indicators focus on a narrow aspect of quality (structure).
Strengthen health systems. The second most common project objective, it is included in about 37 percent of World Bank–financed projects. However, the presence of this type of objective has been decreasing over time, even if health systems strengthening activities are identified in about 90 percent of projects. Additionally, about 55 percent of the health systems strengthening objectives have been rated positively.
Improve equity. Few World Bank–supported projects have objectives that explicitly aim at improving equity. However, there seems to be an implicit equity focus in many projects. In fact, the majority (64 percent) of World Bank–financed projects target specific disadvantaged population groups (often the poor). IFC also strives to invest in clients with a strong focus on corporate social responsibility. However, the distributional impact of World Bank and IFC projects is not known.
Improve health outcomes. Explicit objectives toward health improvement are present in 29 percent of World Bank–financed projects, but with a reduced frequency over time (from 35 percent among closed to 16 percent among open projects) and in only 1 percent of IFC projects. About half of the World Bank–financed projects reached the desired health improvement objectives.
Read more in Chapter 4: The Drivers of Universal Health Coverage