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Topic:Health, Nutrition, & Population
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Four things countries can do to support Universal Health Coverage: Insights from a recent evaluation

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Four things countries can do to support Universal Health Coverage
How governments and institutions like the World Bank can do more to support progress towards Universal Health Coverage.How governments and institutions like the World Bank can do more to support progress towards Universal Health Coverage.

World Bank Group Support to Health Services: Achievements and Challenges

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World Bank Group Support to Health Services: Achievements and Challenges
This evaluation assesses the roles and contributions of the World Bank Group in supporting health services in client countries and provides lessons and recommendations for achieving greater development effectiveness going forward.This evaluation assesses the roles and contributions of the World Bank Group in supporting health services in client countries and provides lessons and recommendations for achieving greater development effectiveness going forward.

Liberia CLR Review FY13-17

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Liberia is a low-income country with a GNI per capita (Atlas method) of 380 US dollars in 2017. After a period of conflict and instability, Liberia's Gross Domestic Product (GDP) grew at an average annual rate of 6.2 percent during 2003-2013. The ebola virus disease (EVD) crisis of 2014-2016 and a drop in global commodity prices resulted in slower average annual GDP growth of 2.1 percent with per Show MoreLiberia is a low-income country with a GNI per capita (Atlas method) of 380 US dollars in 2017. After a period of conflict and instability, Liberia's Gross Domestic Product (GDP) grew at an average annual rate of 6.2 percent during 2003-2013. The ebola virus disease (EVD) crisis of 2014-2016 and a drop in global commodity prices resulted in slower average annual GDP growth of 2.1 percent with per capita annual GDP growth at -0.4 percent during 2013-2017. As a post conflict country aiming to achieve sustained broad-based growth, Liberia faces several development challenges: large infrastructure gaps, poor education and health indicators, a large youth cohort, lack of economic diversification, and weak public institutions. The World Bank Group's country partnership strategy had three pillars: (i) economic transformation; (ii) human development; and (iii) governance and public sector institutions. In addition, the CPS had two cross-cutting themes of capacity development and gender equality. The CPS focus areas and objectives were well aligned with the government's agenda for transformation with a strong focus on infrastructure. The CLR provided a succinct assessment of the achievement of program objectives. It identified the increases in IDA lending attributable to the EVD outbreak. The CLR review agrees with the CLR lessons: (i) ensure government's strong commitment to the CPF program through close alignment with the country's development plans; (ii) adapt and apply a sound post-conflict and fragile country lens in the design of CPF programs for post conflict countries; (iii) keep an eye on medium-term goals even in the face of a crisis such as EVD; (iv) being selective about cross-cutting themes and including outcomes associated with these themes helps maintain the Government's and Country Team's focus on them throughout implementation. IEG provides the following additional lessons: (i) flexibility of the CPS program enabled the WBG to respond to the EVD crisis in a timely manner; and (ii) trust fund activities need to have a well-articulated strategic focus and explicit selectivity filters to ensure that they contribute to the achievement of CPS objectives.

An Independent Evaluation of the World Bank Group’s Support to Mexico (2008–17)

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An Independent Evaluation of the World Bank Group’s Support to Mexico
This evaluation assesses the development effectiveness of the World Bank Group’s country program in Mexico between 2008 and 2017.This evaluation assesses the development effectiveness of the World Bank Group’s country program in Mexico between 2008 and 2017.

Kyrgyz Republic CLR Review FY14-17

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The Kyrgyz Republic is a lower middle-income country with a GNI per capita of $1,100 in 2016. It is a country with a land-locked and mountainous geography, and rich in mineral and water resources. GDP growth averaged 3.7 percent during the CPS period (2014-17), somewhat below the average during the previous four years (4.0 percent). Gold production and worker remittances have been significant Show MoreThe Kyrgyz Republic is a lower middle-income country with a GNI per capita of $1,100 in 2016. It is a country with a land-locked and mountainous geography, and rich in mineral and water resources. GDP growth averaged 3.7 percent during the CPS period (2014-17), somewhat below the average during the previous four years (4.0 percent). Gold production and worker remittances have been significant drivers of growth, but are subject to volatility and do not lend themselves to sustained growth. Growth helped reduce poverty rates, from the recent peak of 38.0 percent in 2012 to 25.4 percent in 2015. Nevertheless, the country’s Human Development Index improved slightly from 0.656 in 2013 (ranked 125nd among 187 countries) to 0.664 in 2015 (ranked 120th among 188 countries). Inequality (the GINI Index) declined from 28.8 in 2013 to 26.8 in 2016, Policy effectiveness has been undermined by high levels of corruption and frequent changes in Government. Kyrgyz’s rank in Transparency International’s Corruption Perception Index deteriorated from 123rd of 167 in 2015 to 135th of 167 in 2017. During the CPS period, there were five different prime ministers. The World Bank Group’s (WBG) CPS had three pillars (or focus areas): (i) public administration and public service delivery, (ii) business environment and investment climate, and (iii) natural resources and physical infrastructure. The CPS was aligned with the Government’s National Sustainable Development Strategy (NSDS), 2013-2017, specifically with NSDS objectives on public administration, judiciary, social services, financial and private sector development, agribusiness, exports, environmental protection/resource management, energy, transport, and urban development. These objectives were part of the NSDS broad focus on governance, state building, and economic development. WBG’s support was also aligned with a number of specific government programs (e.g., the Governance and Anti-Corruption Plan adopted in 2012).

Romania CLR Review FY14-18

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This review of the World Bank Group’s Completion and Learning Report (CLR) covers the Country Partnership Strategy (CPS) and the Performance and Learning Review (PLR) dated November 3, 2016. The original CPS period (FY14-17) was at the PLR stage extended by one year to cover FY14-18. The CLR and this review cover this extended period. Romania is an upper middle-income country with a GNI per Show MoreThis review of the World Bank Group’s Completion and Learning Report (CLR) covers the Country Partnership Strategy (CPS) and the Performance and Learning Review (PLR) dated November 3, 2016. The original CPS period (FY14-17) was at the PLR stage extended by one year to cover FY14-18. The CLR and this review cover this extended period. Romania is an upper middle-income country with a GNI per capita of $9,480 in 2016 and a population of 19.7 million. Romania’s per capita GDP had grown rapidly up to 2009, reducing poverty, but the global financial crisis of 2008 triggered a severe recession. The IMF Article IV report (May 2017) notes that Romania strengthened its economy considerably after the global financial crisis. Romania registered an average annual GDP growth of 3.9 percent during the review period (2014-2016). Public debt and fiscal and current account imbalances are moderate compared to many emerging markets, but significant challenges remain and the momentum of progress in policies has waned. Income convergence with the EU has slowed and poverty is among the highest in the EU. Romania has a Human Development Index (HDI) of .802 in 2015, placing the country in the very high human development category and ranking 50 (of 188) in HDI in 2015. Its Gini coefficient is 28.3 in 2016 (from around 35 in 2010) and its poverty headcount ratio based on the national poverty line is 25.4 percent (average 2014-2016).

Bulgaria: Social Inclusion Project (PPAR)

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Bulgaria is a middle-income country that joined the European Union (EU) in 2007. After setbacks in social well-being and economic growth precipitated by the 2008 global economic crisis, Bulgaria has recently made progress in improving economic performance and reducing poverty. However, it faces the formidable challenge of addressing persistent pockets of poverty and social exclusion. Poverty in Show MoreBulgaria is a middle-income country that joined the European Union (EU) in 2007. After setbacks in social well-being and economic growth precipitated by the 2008 global economic crisis, Bulgaria has recently made progress in improving economic performance and reducing poverty. However, it faces the formidable challenge of addressing persistent pockets of poverty and social exclusion. Poverty in Bulgaria is linked with low levels of education, high unemployment, rural residence, belonging to an ethnic minority, female gender, and old age. Social exclusion is both a cause of poverty and a consequence. Fighting poverty and social exclusion is a priority of Bulgaria, and education a key component of its national policies. The objective of the Social Inclusion Project (SIP) is “to promote social inclusion through increasing the school readiness of children below the age of seven, targeting low income and marginalized families, including children with a disability and other special needs” (World Bank 2008a). The objective did not change during the life of the project. Ratings for the Social Inclusion Project are as follows: Outcome is moderately satisfactory, risk to development outcome is moderate, Bank and Borrower performance are both moderately satisfactory. The following lessons, offered to this end, are relevant to both the World Bank and the government: (i) Official databases are important, but may need to be complemented with mapping of target communities and households and their needs, priorities, motivations, and dynamics, undertaken by those with intimate knowledge of the community and with community development expertise. (ii) Mobile services and mediators face challenges in reaching target populations, especially when mediators are few relative to their target populations and have heavy workloads, and they do not always share the language, culture, and living conditions of those populations. (iii) Low appreciation of evidence for learning, program refinement, and policymaking can undermine the effectiveness of programs and policies, especially where piloting is intended. The development of M&E capacities could provide MLSP with a critical management tool for ensuring continuous learning and accountability for ECD results and increase its potential for resource mobilization and future replication. (iii) Experience under the SIP reveals the scope and opportunity to clarify roles and responsibilities to optimize comparative advantages and synergies of the many actors involved both horizontally (across partners at each level of the system) and vertically (up and down the various levels of decentralized government). (iv) Investments in ECD and social inclusion activities targeted to low-income and marginalized children ages 0–7 years and their parents are necessary, but they are insufficient to ensure the children’s success and inclusion in primary school and beyond.

Serbia: Consolidated Collection and Pension Administration Reform Project and Delivery of Improved Local Services (PPAR)

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Following the dissolution of the former Yugoslavia and a series of regional wars, the Federation of the Republics of Serbia and Montenegro rejoined the World Bank in 2001. Serbia experienced solid growth during 2000–2008, followed by a series of severe recessions combined with rapidly rising unemployment and growing public debt over 2008–2014. To improve its growth prospects Serbia embarked on Show MoreFollowing the dissolution of the former Yugoslavia and a series of regional wars, the Federation of the Republics of Serbia and Montenegro rejoined the World Bank in 2001. Serbia experienced solid growth during 2000–2008, followed by a series of severe recessions combined with rapidly rising unemployment and growing public debt over 2008–2014. To improve its growth prospects Serbia embarked on several structural reforms between 2014 and 2017. Growth fundamentals and prospects are now sound, and the underlying growth trend is vibrant. Serbia is at a late stage of demographic transition, characterized by a total fertility rate well below the population replacement rate, and an aging and shrinking population. Demographic and population changes have clear implications for the delivery of health, education, and social assistance services, and for the sustainability of the pension system. In the meantime, Roma, having a much higher total fertility rate, are going to represent a growing percentage of the total Serbian population and the future workforce. This PPAR covers two projects. The first, Consolidated Collection and Pension Administration Reform Project (PARP) and was put in place to (i) develop the framework for the consolidation of collection of all social contributions and, if feasible, personal income taxes; and to (ii) improve the effectiveness and efficiency of the pension system through modernizing and streamlining the institutional capacity in the pension system; improved pension system administration; developing the capacity for policy identification and analysis; monitoring; and increased public understanding of the pension system. The second, Delivery of Improved Local Services Project (DILS) aimed to improve the local delivery of health, education, and social assistance services. Ratings for the PARP project are as follows: Outcome is moderately satisfactory, Risk to development outcome is moderate, Bank and Borrower performance are both moderately satisfactory. Ratings for the DILS project are as follows: Outcome is moderately satisfactory, Risk to development outcome is moderate, and Bank and Borrower performance are both moderately satisfactory. Eight lessons that could help improve future World Bank operations are identified. The first lesson arises from both projects, followed by three lessons from PARP and four lessons from the DILS project. (i) Clarity around the overall vision and data architecture is needed for successful MIS investments. (ii) A stakeholder analysis can be a useful tool to identify potential supporters and resistance when reforms involve several actors. (iii) The tax administration can be usefully included in the administrative reform process. (iv) Rationalizing the social insurance system takes time. (v) Multisector projects have the advantage of providing bridge financing that allows continuity and deepening of reforms policy, but this design feature may negatively affect other project ratings. (vi) Activities carried out by entities with a clear institutional status can be better sustained than those implemented by ad-hoc bodies. (vii) The employment of contractual staff (consultants) in the project implementation unit does not build sustainable capacity in the ministries. (viii) Projects that aim at strengthening locally delivered services should ensure alignment between local functions, capacities, and financing to succeed.

Gambia CLR Review FY13-16

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This review of the World Bank Group's (WBG) Completion and Learning Review (CLR) covers the Second Joint Partnership Strategy (JPS-2), FY13-FY16, for the Gambia. The JPS-2 was a joint strategy of the WBG and the African Development Bank (AfDB).The Gambia is a small, fragile and landlocked country with a GNI per capita income of USD 430 in 2016.The JPS-2 had eight objectives organized around two Show MoreThis review of the World Bank Group's (WBG) Completion and Learning Review (CLR) covers the Second Joint Partnership Strategy (JPS-2), FY13-FY16, for the Gambia. The JPS-2 was a joint strategy of the WBG and the African Development Bank (AfDB).The Gambia is a small, fragile and landlocked country with a GNI per capita income of USD 430 in 2016.The JPS-2 had eight objectives organized around two pillars or focus areas: (i) enhancing productive capacity and competitiveness; (ii) strengthening the institutional capacity for economic governance and public service delivery. The JPS-2 was aligned with the government's medium term development plan as articulated in its Program for Accelerated Growth and Employment (PAGE) 2012-2016 and the government's long-term plan contained in Vision 2020.The JPS-2 focus areas and objectives were aligned with government's Medium Term Development Plan (PAGE), and its long-term strategy, Vision 2020. The joint strategy and clear division of labor with AfDB provided the foundation for WBG's selectivity. The WBG's program was generally selective in terms of focus areas, objectives and interventions. IEG concurs with some of the key lessons which are summarized as follows: (i) strong donor collaboration is critical but could also have high transactions costs; (ii) country capacity is an important consideration in data collection and quality, and in developing a results framework; and (iii) formal mid-course corrections through the PLR process is even more important in a difficult country circumstances. IEG adds the following lessons: i) Small and fragile countries could benefit from participation in regional integration operations by leveraging limited IDA financing and maximizing development impact. In the case of the Gambia, its participation in regional operations brought benefits to the country in terms of improved technology adoption in agriculture and increased connectivity. ii) To the extent possible, it is important that WBG interventions are aligned to the CPS objectives and their contributions reflected in the results framework. In the case of the Gambia, there were IFC interventions in several areas that were not reflected in the results framework.

Burkina Faso CLR Review FY13-16

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Burkina Faso is a low-income country with a GNI per capita of $620 in 2016. During 2013-2016, annual GDP growth averaged 5.0 percent, but annual GDP per capita growth was only 1.9 percent due to high population growth. Economic growth was built on a narrow base, mainly agriculture and mining, and has failed to produce a sufficient number of jobs to absorb the rapidly growing work force, 80 Show MoreBurkina Faso is a low-income country with a GNI per capita of $620 in 2016. During 2013-2016, annual GDP growth averaged 5.0 percent, but annual GDP per capita growth was only 1.9 percent due to high population growth. Economic growth was built on a narrow base, mainly agriculture and mining, and has failed to produce a sufficient number of jobs to absorb the rapidly growing work force, 80 percent of which are in agriculture. While the poverty rate declined from 50 percent to 40 percent between 2003 and 2014, the absolute number of people living in poverty, of which 90 percent live in rural areas, remained roughly the same between the two periods – lack of access by the poor to social services and basic infrastructure has been a major constraint. The level of vulnerability of households is high, with two-thirds suffering from shocks each year, mainly from natural hazards. Burkina Faso ranked 185 out of 188 countries in 2015 in the Human Development Index.