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Special Evaluation Study on ADB Policy for the Health Sector
Completed: 2005

This study evaluated the Asian Development Bank's (ADB) 1999 policy for the health sector. It reviewed 209 ADB documents, consisting of health and non-health loans, technical assistance (TA), and grants funded through the Japan Fund for Poverty Reduction (JFPR), health documents from the pre-Policy and post-Policy periods, and country strategies and programs. Seven countries were selected for in-depth review: Bangladesh, People's Republic of China, Indonesia, Mongolia, Papua New Guinea, Philippines, and Vietnam.

The Policy and loan portfolio were assessed against the Policy's five strategic considerations in support of

• primary health care for the vulnerable groups;
• strengthening monitoring and evaluation, emphasizing effective interventions, and improving project quality at entry and during implementation,
• innovations and pilot testing of new approaches to health care financing, organization, and management, and the deployment of new technologies;
• encouraging DMC governments to conduct health sector reforms; and
• increasing sector efficiency by improving managerial capacity and collaboration with partner institutions.

  Summary of Findings

The basic principles of the Policy for the Health Sector remain relevant and ADB's adherence to and implementation of the Policy are satisfactory. Among the positive trends were

• the large increase in the number of loans using specific health-outcome indicators;
• the inclusion of cost benefit and/or economic sustainability analysis in all projects approved since 2001;
• the inclusion of economic rate of return calculations in most of these projects; and
• the attention to supporting governance through health sector reforms and institutional capacity building.

  Recommendations

The report supports ADB's plan to update the Policy and make it an integrated Health, Nutrition, and Population strategy (the Strategy).

The Strategy should

• Cover health, nutrition, and population (HNP) and other related social sectors;
• Identify innovative loan and grant products that will facilitate greater ADB involvement in the HNP sector;
• Cover governance and corruption;
• Allow ADB to finance health infrastructure and equipment, particularly in a decentralized system where health infrastructure and equipment are lacking;
• Place more emphasis in developing partnerships with other donors, the private sector, and civil society; and
• Analyze the staffing implications associated with different options considered so that the Board and Management understand the trade-offs between strategic options and resource considerations.