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Policy for the Health Sector : The Bank’s health policy
Recommendation
The Board is requested to approve the recommended strategy and policy for the
Bank in the health sector as presented in this chapter and summarized here. (It is
also reflected in the health sector policy matrix in Appendix 5. )
Improving the health of vulnerable groups
The primary objective of the Bank’s assistance to the health sector will be to
help ensure that the citizens of the DMCs have wide access to essential health
services of proven benefit and cost effectiveness (see Appendix 3). The Bank
will increase its lending to the health sector with a continued emphasis on
PHC, including reproductive health and family planning. It will work with its
DMCs to improve the health status of the poor, women, children, and indigenous
peoples. In its policy dialogue, the Bank will encourage DMC governments to increase
PHC budgets and shift away from funding activities that mainly benefit the
wealthy and that have low benefit-cost ratios, such as tertiary care facilities. To ensure that efforts at improving the health of vulnerable groups are
reaching the intended beneficiaries, Bank loans will employ methods to
measure the extent to which the poor, women, children, and indigenous
peoples are receiving essential PHC services. Given the special requirements of women and strong benefits from investing
in their health, the Bank will pay particular attention to their needs in the
design and implementation of projects. Where appropriate, loans specifically
targeted at women’s health will be developed.
Focus on achieving tangible measurable results
To ensure the developmental impact of its investments in the health sector,
the Bank will focus on the achievement of tangible, measurable
results. Thus, the Bank will further strengthen M&E through the selection
of specific indicators, allocation of funds for data collection and analysis, and
development of clear plans for measuring results including the use of
comparison areas and collection of baseline data. The Bank will also support
efforts to build the capacity of DMC governments to carry out monitoring and
impact evaluation, and utilize the information for management purposes. The Bank will prioritize technical interventions for which strong scientific
evidence exists. In the absence of such evidence, the Bank will exercise caution
and facilitate the testing and careful evaluation of promising interventions. The Bank will also ensure the achievement of tangible results by improving
the quality of its loans at entry. One aspect of this will be strengthening of the
technical peer review process for health sector loans. Achieving results will also require more participatory approaches and an in-depth
understanding of beneficiaries. Hence, health sector loans will describe
the participatory methods employed in design and the nature of beneficiary
participation during implementation. Flexibility in project design will be encouraged through the greater use of
process approaches. The Bank will also adopt a realistic approach to local
currency financing to facilitate PHC. Implementation of the Bank’s lending and TA program will reflect the
decentralized nature of the health sector and the importance of systems
software development. Supervision of health sector loans will be strengthened,
and procurement and disbursement procedures will take into account the
special requirements of the health sector.
Support testing of innovations and deployment of effective technologies
To develop the creative approaches that will help meet the challenges the
health sector in the region faces, the Bank will finance pilot tests of innovations
in health care financing, organization, management, and policy development.
Such pilot tests will be undertaken on a scale that can provide definitive results,
utilize a level of investment per beneficiary that is feasible on a countrywide
scale, and employ rigorous evaluation methods, including the use of
comparison groups and collection of before and after data. The Bank will help ensure the rapid deployment of effective new technologies
to its DMCs that will improve the health of vulnerable groups. The Bank will
pay particular attention to assisting the widespread use of new vaccines within
the region.
Encourage DMC governments to take an appropriate and activist role
In the context of the 20/20 commitments made at the World Summit for
Social Development, the Bank will actively encourage the DMCs to increase their
budgetary allocation for health services, particularly PHC. Bank activities aimed at reforming public finances, decreasing subsidies, and
privatizing state-owned enterprises will attempt to divert some of the resultant
savings to the financing of basic human services such as PHC. The Bank will encourage and assist the DMCs to diversify their sources of
financing for the health sector by promoting the use of carefully designed
social health insurance schemes, with the long-term goal of achieving universal
coverage of health insurance. The Bank will address cost recovery on a project-by-project basis taking
into account concerns about both equity and efficiency. The Bank will not
insist on user charges for PHC services, particularly if they discourage the
poor from using PHC facilities. For hospital services, the Bank will encourage
cost recovery in the context of addressing overall health sector financing. Such
user charges will be designed to encourage appropriate use of public hospitals
by the poor, increase the proportion of the public subsidy that is captured by
the poor, and improve the quality of care. The Bank will facilitate public-private partnerships in the provision of health
care to promote improvements in service delivery through increased
efficiency, diversity, and competition. Special emphasis will
be placed on the role of NGOs. The Bank will work with DMC
governments to increase the resources available for purely public goods
such as research, health education, and regulation. The Bank will increase
its support for applied, noncommercial research of particular importance to
the poor, using its loan and TA funds. To assist the DMCs to meet emerging health threats, especially tobacco, HIV/
AIDS, and high blood pressure, the Bank will prioritize research and pilot
testing of activities that are cost effective and that can be implemented through
PHC approaches. In its policy dialogue, and with technical and financial support, the Bank
will encourage DMC governments to adopt a regulatory environment that is
conducive to good health, including decreasing smoking, reducing illegal
drug use, increasing food fortification, reducing pollution, and improving
traffic safety.
Increase efficiency of investments in the health sector
To increase the efficiency of investments in the health sector, the Bank will
use its lending and TA programs to assist the DMCs to improve the technical
and managerial capacity of health sector institutions. Capacity-building
activities will be based on careful institutional analyses. The success of these
activities will be assessed in terms of their ability to improve coverage,
increase the quality of care, and meet the needs of the community. Progress
on these indicators will be measured by management information systems
that are strengthened by household, health facility, and client-satisfaction
surveys, as well as disease surveillance. The Bank will improve its economic and sector work in the health sector.
Staff of the project and programs departments will work closely to ensure
the critical linkages between the health sector and the Bank’s medium-term
strategic objectives, including economic growth, poverty, and improving
the status of women, are properly reflected in the country operational strategy
studies and the country assistance plans. The Bank will strengthen the linkages between the health sector and other
sectors that impinge on good health such as education, environment, and
public finance reform. The Bank will further strengthen its collaboration with partner institutions
operating in the health sector, including the multilateral and bilateral agencies.
The Bank will maintain close cooperation with and utilize the technical expertise
of the United Nations agencies including, UNFPA, UNICEF, and WHO.
Focus on achieving tangible measurable results
Due to the rapidly evolving nature of the health sector, the Bank’s health
policy will be reviewed again in 2004; a midterm review will be undertaken
in 2001. The Bank will adopt the tobacco policy described in this policy. The Bank will widely disseminate the policy paper to DMC governments,
NGOs, and other stakeholders. In addition, Bank staff will be briefed on the
contents of the paper and staff guidelines will be prepared.
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