About ADB

Supporting Human Development

ADB's main human development objective is to reduce poverty by improving the health, living standards, and livelihood of people in its DMCs. This is done by strengthening institutions; building capacity; reforming policy; and providing loans and technical assistance in education, health and nutrition, water supply and sanitation, and urban sectors.

No country or region has done well in reducing poverty without first providing widespread basic education and health services. Education helps to empower the poor, to enhance their income-earning potential, and to improve the quality of their lives. Without basic education-without basic skills and knowledge-the poor lack the tools essential for breaking the poverty cycle. People with basic education are more productive and more likely to earn higher incomes. Where attention has been paid to educating women, multiple benefits have been obtained: educated women have lower fertility rates and their children have lower infant mortality rates; and educated mothers are more likely to use health services and to send their children to school.

Children from poor families are less likely to attend or to complete school and, as adults, these children will be less likely to improve their quality of life or that of their own children. The poor child-who was malnourished as an infant-may have diminished learning ability, may suffer from chronic disease, and therefore may be unable to benefit fully from schooling. A child from a poor family is less likely to receive appropriate stimulation and encouragement at home and may find the transition from home to school more difficult. Early childhood development programs ensure adequate nutrition and health care, help compensate for disadvantaged home environments, and lay the foundation for better performance at school.

ADB and education: Work continued in 1999 on preparing an updated education sector policy paper to assess ADB's evolving role in education, with particular attention to education's role in reducing poverty. Of all types of education, primary education is clearly the most important for poverty reduction. But even when this is available and successfully completed by the poor, their transition to higher education and training is limited. Strategies for education and poverty reduction must identify ways to ensure equity of access to education beyond the basic levels. As poor adults are likely to have had no access to education in their childhood or to have dropped out of school early, investing in adult and community education programs (designed to teach basic literacy and numeracy, transfer essential knowledge in health and nutrition, and provide entrepreneurial and income-enhancement skills) is warranted. Enrollment of the poor in both higher education and skills development programs must be encouraged. However, entry qualifications often require completion of lower levels of education that are often not completed by the poor. Because books and supplies are expensive, the cost of such programs is usually beyond the means of the poor, even when tuition is provided free. The opportunity cost of attending post-basic education training in terms of income foregone is higher for the poor, whose immediate income is needed by the family. ADB-assisted programs in higher education and skills development support programs to enhance equity of access to higher levels of education and training for the poor through the provision of vouchers and scholarships, and develop alternative means of delivering and assessing skills training and higher education. Policy dialogue with governments and capacity building are needed to put in place pro-poor policies and pro-poor resource allocation mechanisms.

ADB and health: ADB's updated health sector policy, adopted in February 1999, reemphasizes primary health care, including reproductive health, family planning, and selected nutrition interventions, as the best strategy to provide universal access to essential health services. ADB's overall objective in the health subsector is to assist DMC governments in ensuring that their citizens have broad access to basic preventive, promotive, and curative services. ADB focuses on

1. improving the health status of the poor, women, infants, children, and indigenous peoples;
2. promoting health sector reforms;
3. enhancing the efficiency of health subsector investments through institutional strengthening and capacity building;
4. achieving tangible, measurable results; and
5. testing innovative approaches and supporting effective and affordable new technologies.

The Asian financial crisis highlighted the need for governments to actively pursue health subsector reform and implement effective and cost-efficient strategies. Reforms in health subsector financing aim to mobilize more resources for health and to make better use of available resources, particularly government subsidies. ADB projects support reforms that further decentralize health service delivery, encourage partnerships with the private sector to improve efficiency and coverage, and focus on protecting vulnerable groups, especially the poor, women, children, and indigenous peoples.

Decentralization allows greater participation of beneficiaries in identifying issues and developing solutions, and requires closer collaboration between ministries of health and local governments. Many countries are developing public-private partnerships in health services delivery and ADB is actively promoting private sector participation. Besides mobilizing new financial resources, private sector involvement in the health subsector helps improve management and cost efficiency of services delivery and allows governments to better target subsidies to vulnerable groups because the private sector takes charge of part of the population. In several DMCs, health services are being contracted to nonprofit NGOs; in others, services are contracted whereby, for example, public sector personnel work in collaboration with the private sector to acquire expertise in management and training.

ADB and water supply and sanitation: Providing safe and reliable drinking water and appropriate sanitation facilities is an important aspect of ADB's strategy to reduce poverty. ADB aims to provide investments in equitable, cost-effective, and sustainable water supply and sanitation projects for the conservation and sustainable development of water resources. Water supply and sanitation projects are aimed at providing a balanced package of development benefits, including supporting human and economic development, reducing poverty, improving gender equity, and protecting the environment. Participation of and consultation with affected communities and NGOs in project planning, design, and implementation are emphasized to ensure commitment by stakeholders and action that is socially acceptable and that reflects the communities' changing needs. To sustain project benefits, ADB encourages private sector involvement in management and maintenance activities. Institutional and agency capacity building is also supported to improve the efficiency of delivery, operation and maintenance, financial management, and cost recovery, for long-term sustainability.

ADB and urban development and housing: Reducing the impact of poverty caused by rapid urbanization is a major challenge facing DMCs. A return to economic growth following the Asian financial crisis, social development, and the creation of better living conditions in urban areas-all these depend on improving the quality, quantity, and efficiency of basic infrastructure and essential municipal services. The willingness and ability of the population to pay for services and the extent of private sector investment in urban infrastructure are vital factors that will determine the future level of services provided in most DMCs.

ADB's main objectives in urban development and housing are

1. reducing urban poverty;
2. lifting living standards in urban areas;
3. enhancing the quality of life, including promoting human development and improving the status of women; and
4. achieving sustainable urban development by protecting the environment.

ADB supports urban development projects that promote good governance through decentralization of authority, responsibilities, and resources from central to local government units, improved urban management, community participation, and partnerships with the private sector. Support is provided to improve urban management through institutional strengthening and capacity building. ADB also encourages mobilizing financial resources by promoting fiscal autonomy, direct cost recovery, and market-based pricing of services. Emphasis is placed on reducing urban poverty by strengthening gender equity, improving access to microcredit, and developing partnerships between all levels of government and the community. Urban development includes projects on integrated urban development, water supply and sanitation, solid waste management, urban transport, and urban housing.

Supporting Education

ADB lending for education in 1999 was in education rehabilitation, secondary education, skills development, teacher training, and higher education.

In Bangladesh, the $60 million Secondary Education Sector Improvement Project will lay the foundation for a comprehensive and systematic reform of secondary education, including policy and institutional reforms and capacity building. In Papua New Guinea, a $20 million Employment-Oriented Skills Development Project will improve income-earning opportunities for the unemployed and underemployed by providing short-term technical and entrepreneurial training. An $18.8 million Skills Development Project in Sri Lanka will restructure and reorient the vocational training system to ensure the quality and relevance of programs to match the demands of industry. The $20 million Social Sector Rehabilitation Project in Tajikistan will rehabilitate school facilities and replace textbooks destroyed by civil conflict and provide teacher training. The $59.3 million Higher Education Development Project in Thailand will strengthen the role of higher education in developing domestic capacity to carry out research and development activities in collaboration with industry. A $25 million Teacher Training Project in Viet Nam will upgrade the preservice teacher training system for lower secondary education.

ADB technical assistance will prepare education projects in several countries. In Bhutan, the emphasis is on basic skills development; in Nepal and Uzbekistan, the focus is on basic education development; and in Samoa, the project will address the sectoral and institutional needs of primary and secondary education.

Secondary education projects are being prepared in Sri Lanka and Uzbekistan. A second education quality improvement project focusing on teacher education reform is being prepared in the Lao People’s Democratic Republic. In Mongolia, a second education development project is being prepared that will build on comprehensive ADB support that began in 1997. Capacity was improved through technical assistance for education and training institutions in Sri Lanka, Uzbekistan, and Viet Nam. In Cambodia, a secondary education investment plan is being developed; and in the Federated States of Micronesia, social indicators will be updated and key policy and management issues in education and health identified. In Mongolia, the Government was supported in preparing an education sector strategy for 2000–2005.

Supporting Primary Health Care

Ensuring that the poor have access to good quality, essential health care was the primary objective of health subsector interventions in Indonesia, Marshall Islands, Pakistan, and Tajikistan.

In Indonesia, the $300 million Health and Nutrition Sector Development Program focused on ensuring continued availability of basic health, nutrition, and family planning services to those most at risk: pregnant women, new mothers, infants, and young children. Emphasis was placed on strengthening service delivery through health centers and community health posts. The Program supports broad health subsector reforms to mobilize additional resources and improve efficiency, sustainability, and transparency through decentralization. Government budget allocations are provided directly to health centers in proportion to the number of poor and vulnerable groups covered by each health center. In the Marshall Islands, health care services will be improved for one fourth of the national population through implementation of the $9.3 million Ebeye Health and Infrastructure project. In Pakistan, a $47 million loan for the Women's Health project will expand health and nutrition programs serving poor rural women and children, develop "woman-friendly" health care systems, and improve district health management to sustain women's health care. In Tajikistan, the $20 million Social Sector Rehabilitation project will refurbish hospitals and health centers, provide essential equipment and supplies to restore health services disrupted by civil conflict, and strengthen the targeting of services to the most vulnerable.

Through regional technical assistance, ADB has initiated studies on major health problems affecting Asia and the Pacific. A systematic review of safe motherhood strategies in collaboration with the United Nations Children's Fund will identify successful strategies to reduce maternal morbidity and mortality and assist governments in adapting effective strategies to local circumstances. Mechanisms will be identified to ensure long-term availability of financial resources to maintain and extend vaccination programs. Effective strategies to prevent human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among the significant migrant populations of the Greater Mekong Subregion require collaboration and coordination of several national programs. ADB is also involved in developing strategies to reduce child malnutrition. Regional technical assistance has assisted eight countries in developing national nutrition investment programs to reduce malnutrition within a 10-year investment framework.

Supporting Water Supply and Sanitation

In 1999, a $300 million loan was approved for the People's Republic of China (PRC) to reduce pollution and restore the water quality in Shanghai's Suzhou Creek and its tributaries. The Project will improve the environment, water resource management, living conditions, and public health standards in the urban areas adjacent to the creek. In Cambodia, a $20 million loan was approved to support the Government's objectives of human development and poverty reduction by rehabilitating the water supply system in six towns and providing sewage collection and treatment systems. A $20 million loan was also approved in the Lao People's Democratic Republic to decentralize the water supply subsector by establishing a regulatory framework for the Government to invest in water supply and sanitation systems in small towns and Vientiane's periurban areas.

Also in 1999, PRC, Papua New Guinea, and Viet Nam were recipients of project preparatory technical assistance in the water supply and sanitation subsector. In the PRC, assistance was approved for Heilongjiang to provide safe drinking water and to manage water resources in the cities of Harbin and Mudanjiang, and in Tianjin for wastewater treatment and water resource management. Papua New Guinea received assistance to formulate a strategy for improving social indicators by providing adequate water supplies and sanitation arrangements in provincial towns and to improve governance in the water supply sector. In Viet Nam, assistance was approved to help the Government prepare water supply and sanitation projects in provincial towns suitable for external financing. Technical assistance was approved for the Fiji Islands to improve the efficiency of water supply and sewerage services.

Supporting Urban Development

ADB approved three loans totaling $200 million in 1999 to assist the Government of India in developing urban and environmental infrastructure, meeting basic human needs, and improving the quality of life of urban residents by providing long-term funds to reform-oriented municipal bodies, private sector project sponsors, and microfinance institutions. An integrated urban development project loan of $175 million is helping Karnataka, India meet basic human needs by developing urban services, building capacity, and supporting community participation at the state and local levels. In Indonesia, two ADB loans of $320 million are supporting the Government's decentralization efforts, reducing poverty, and building the capacity of village and district entities to prepare them for their new responsibilities. In the Maldives, equitable development is being pursued under an $8 million loan project through a regional effort in institutional, infrastructure, and environmental improvement. Tuvalu is being provided a $4 million loan to support the Government's agenda to develop the outer islands, including decentralization and regional development, sustainable development finance, private sector participation, and capacity-building assistance. In Viet Nam, ADB is supporting the Government's urban development priorities through a $70 million loan to develop urban infrastructure to sustain economic growth, improve living conditions, reduce poverty, and enhance the overall environment in Ho Chi Minh City.

Technical assistance in the urban sector was approved for Bangladesh, Cambodia, People's Republic of China, Fiji Islands, India, Indonesia, Lao People's Democratic Republic (Lao PDR), Federated States of Micronesia, Nepal, Papua New Guinea, Philippines, Solomon Islands, Sri Lanka, Tuvalu, and Vanuatu. Advisory technical assistance was directed at building capacity and strengthening institutions, promoting good urban governance, developing policy for reducing poverty, and formulating sustainable urban strategies and policies. In addition, project preparatory technical assistance was approved for housing finance in India, urban infrastructure improvement in Lao PDR, urban environmental improvement in Nepal, governance and private sector reform in Papua New Guinea, community development in the Philippines, and population policies and services in Solomon Islands. Regional technical assistance was approved for preparing the Cities Data Book for Asia and the Pacific.

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