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Policy for the Health Sector : The Bank’s involvementin the health sector
Relations with bilateral and multilateral organizationsWHO is the lead technical agency in the health sector worldwide and aims to help achieve universal attainment of the highest possible level of health. In support of this goal, WHO has four main tasks: (i) to provide worldwide guidance in the field of health; (ii) to set global standards for health; (iii) to cooperate with governments in strengthening national health programs; and (iv) to develop and transfer appropriate health technology, information, and standards. WHO maintains very close relations with the ministries of health in the DMCs, and hence plays an important role in policymaking, standard setting, regulation, aid coordination, and capacity building. Generally its country programs do not include large-scale investment projects and its assistance is usually technical in nature. The United Nations Children’s Fund (UNICEF) focuses on the protection of children’s rights, helps meet their basic needs and expands their opportunities to reach their full potential. UNICEF places emphasis on the most disadvantaged children and the countries in greatest need. Its country programs promote the equal rights of women and girls, and support their full participation in the political, social, and economic development of their communities. The United Nations Population Fund (UNFPA) extends assistance to developing countries, countries with economies in transition, and other countries at their request to help them address reproductive health and population issues; and raises awareness of these issues in all countries. UNFPA’s four goals are to (i) help ensure universal access to reproductive health, including family planning and sexual health, for all couples and individuals; (ii) support population and development strategies that enable capacity building in population programming; (iii) promote awareness of population and development issues; and (iv) advocate for the mobilization of the resources and political will necessary to accomplish these goals. The World Bank is the largest external financier of health, population, and nutrition (HPN) projects and its assistance to the sector dates back to 1970. Initial assistance aimed at expanding access and providing essential supplies, but evolved to place more emphasis on institutional strengthening and reform of health systems. The World Bank’s HPN strategy, issued in 1997, emphasizes the need to work with many partners in the sector to ensure mobilization of sufficient financing for the sector as well as sharing of the lessons learned. To date, it has financed about 250 HPN projects for a total of $13.5 billion. In its health sector operations, the Bank recognizes the importance of close cooperation with partner institutions. Collaboration with WHO, UNFPA, UNICEF, World Bank, and other multilateral and bilateral institutions has been extensive. Almost all projects have involved detailed consultation and coordination with other development partners active in the health sector of the country concerned. In addition, WHO and other agencies have participated in loan fact-finding and appraisal missions. The Bank has relied heavily on the technical expertise that WHO pro-vides and maintains close high level and technical relationships with WHO region-ally and by country. Similarly close relationships have been maintained with the World Bank, UNICEF, UNFPA, and bilateral organizations, through both formal and informal channels. Formal cofinancing with bilateral or multilateral organizations has taken place in 34 percent of health sector loans; levels of cofinancing were substantially higher in the last six years compared with previous years. Cofinancing has been obtained from a wide variety of sources, including Australia, European Union, Germany, Nordic Development Fund, Sweden, United Kingdom, UNFPA, United Nations Development Programme, World Bank, and WHO. Even in situations where formal cofinancing has not occurred, the Bank and other development institutions have found mechanisms to coordinate their activities. There have been four loans in which joint project implementation units were financed with the World Bank to reduce administrative costs to the governments involved. Regional TA and sector work have been undertaken with UNICEF, World Bank, and other partner institutions. The Bank’s comparative advantage lies in the financial, economic, and technical expertise it brings to the health sector, as well as the relatively large-scale and long-term financing it can provide. This combination of expertise and financing allows it to work closely with technical agencies, such as WHO and organizations like UNICEF and UNFPA, that play a key role in advocacy. The Bank enjoys an advantage in addressing broad issues of health care systems development, which often require more substantial investments than can be provided by other bilateral or multilateral partners. Similarly, innovations in health care financing, management, and organization require testing on a scale that other development partners cannot generally provide. The Bank can also help finance the expansion of successful programmatic interventions that have been developed by other agencies. For example, in Lao PDR, UNICEF helped the Government develop a community-based approach to malaria control that was then expanded with Bank financing. Another comparative advantage of the Bank is its ability to bring together other key players, including ministries of finance and planning, to work with health care planners and policymakers. Based on the considerable experience gained since it began lending to the sector in 1978, the Bank can apply the lessons learned from previous projects to assist policymakers in health sector reform. The Bank has indepth knowledge of the Asian and Pacific region and has established excellent relationships with DMC governments. This translates into an ability to engage in meaningful and amicable policy dialogue with senior government officials.
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