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p. 11 of 27 BACK | NEXT Executive summary Introduction Regional health context The Bank’s involvementin the health sector Trends in Bank lending Performance of health sector lending Relations with bilateral and multilateral organizations Issues and options The Bank’s health policy

Policy for the Health Sector : The Bank’s involvementin the health sector

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Trends in Bank lending

The Bank’s first loan in the health sector was approved in 1978 and through 1998 it has lent $1.2 billion for health and population. In real terms, the Bank’s annual lending, for health and population more than doubled from 1978 to 1997; however, as a proportion of total Bank lending, it has not changed and over the last ten years has averaged 1.5 percent. This is a significantly lower proportion than other multilateral development banks. The difference cannot be accounted for simply by the absence of concessional lending to the PRC and India. In 1996, World Bank lending for health and population to Asia and the Pacific, excluding the PRC and India, accounted for 7.3 percent of total lending, almost four times the proportion of the Bank. There is no obvious upward trend in the proportion of Bank lending for health.

While the Bank has not increased the proportion of its lending devoted to the health sector over the last 20 years, the nature of its lending has changed dramatically. From 1978 to 1991, PHC accounted for only 36 percent. Since the publication in 1991 of the Bank’s paper Health, Population and Development in Asia and the Pacific, PHC has taken up almost 66 percent. Similarly, investments in population activities increased from 2 to almost 20 percent. On the other hand, investments in district and tertiary care hospitals declined from 55 to 4 percent. There has also been a noticeable shift in the type of expenditures the Bank has financed. Financing of

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