Health Sector

Health Sector at a Glance

• ADB Policy and Strategy
• ADB Lending to the Health Sector
• ADB Technical Assistance
• Health-related Millennium Development Goals, targets and indicators

ADB is committed to improve health of the poor recognizing that it is a proven mechanism, and necessary input, to reducing the incidence and severity of poverty. The key documents that outline this commitment and specific approaches are:

• The objective of the long-term strategic framework is "to respond to the challenges of poverty and to help achieve [the MDGs] in the Asia and Pacific region."
• ADB's poverty reduction strategy (2000) says "ADB will increase its investments in primary health care. "
• ADB's 'Policy for the Health Sector (1999) states that "The Bank will work to improve the health of the poor… by increasing its lending for the health sector..".
• ADB's stated commitment to assisting DMCs achieve the Millennium Development Goals (MDGs) – three of eight goals are for specific health outcomes and six of the eight goals include health related targets and indicators (see table below).
• The links between health and poverty have been noted by donors in the last several ADF negotiations and in response, ADB has made commitments to increase activity related to achieving MDGs. In particular in the ADF VIII donor's report, donor's endorsed ADB's medium-term operational plans for combating infectious disease and HIV/AIDS.

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Lending Trend. For 27 years, ADB provides assistance to the health sector. But despite its policy pronouncements, its total lending operations to the health sector for both public and private sectors reached only $2.9 billion for the 1978-2004 period. On the average, annual lending to the health sector is 2.5% of the total ADB lending. An upward trend is noticeable during the financial crisis years, where health sector loans increased for Thailand in 1998 and Indonesia in 1999. Another upward trend in 2004 is observed, where a health sector development loan has been approved for the Philippines.

Note: Health sector lending includes 64 public sector loans, 25 multisector projects with health components, and 3 private sector loans on health.

In 2004, four loans related to the health sector, with a total value of $273 million were approved, and three multi-sector (social services) loans with health components amounting to $61.7 million were approved.

Funding Sources. ADF and OCR are the funding sources. The contribution of the funding sources for the 1978-2004 period is as follows:

Regional Lending. Lending to the Southeast Asian region garnered the highest share of 47.7% for 27 years. Lending percentages to the East & Central Asia, Mekong and South Asia regions have slightly increased in the last ten years, while the percentage shares of Pacific and Southeast have slightly dropped.

Subsector Lending. For 1978-2004, the subsector which has the highest lending share is the health systems—this refers to the organization of the health sector and the different aspects of the health system, e.g., primary/secondary/tertiary health care, health management, pharmaceuticals, health MIS, legal/policy/regulatory framework, sector reforms, etc. This is followed by the social protection subsector – which refers to services and programs related to social assistance in kind or cash (e.g., subsidies, workfare programs) to poor and vulnerable individuals/families affected by economic or other shocks.

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TA Trend. ADB provides technical assistance (TA) funding to the health sector—this totaled $105 million for 1978-2004 period. The upward trend of the TA funding started in 1992, but slightly dropped in 1996. It rose in 1998 during the financial crisis year as several social protection/social services projects were approved for Indonesia. Another upward trend in 2003 is observed, as funds were channeled to PRC and to regional activities to address the outbreak of SARS.

*Health Sector includes nutrition, population, early childhood, and social protection. Technical assistance includes regional technical assistance.

TA Type. The distribution of the TA funds by type of TAs is as follows:

In 2004, the TA funds dropped from $13.8 million in 2003 to $7.3 million in 2004, and the approved TA projects were as follows:

• Project Preparation (PPTAs). New funding of $0.8 million was provided for projects in Indonesia on urban nutrition and Viet Nam on HIV/AIDS prevention among youth.
• Advisory Technical Assistance (ADTAs). 10 ADTAs with a value of $3.9 million were approved to support awareness and prevention of HIV/AIDS (KGZ, MON), national food safety strategy (PRC), psycho-social health (SRI), pro-poor health policies (VIE), woman and child health (UZB), and others (BAN, CAM, LAO).
• Inter-regional Technical Assistance. Six regional/inter-regional TAs were approved for a total amount $2.6 million for preventing the trafficking of women and children, ADB response to HIV/AIDS, communicable disease control, social protection system, and additional funds for addressing the outbreak of severe acute respiratory syndrome.

Funding sources. JSF, TASF and other sources (such as PRF, CFWS, ATF, etc) are the funding sources. The contribution of the funding sources for the 1978-2004 period is as follows:

Regional allocation. A review of ADB’s technical assistance to the sector by region over the period 1978-2004 shows that Southeast Asia received 25% of the technical assistance funds, followed by East and Central Asia (15%), Mekong (12%), South Asia (12%) and Pacific (8%). 27% of the funds were for regional technical assistance.

In 2004, East and Central Asia received 25% of the new technical assistance, followed by Mekong (19%), South Asia (16%), and Southeast Asia (6%). There were no new health projects for the Pacific region. 42% of the funds were for regional technical assistance.

Subsector allocation. The pie chart below shows the subsector share of the TA funds for the 1978-2004 period.

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