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World Bank: Norway provides US $105 million for poor countries

2 December 2007 at 08:52 | 772 views

The Norwegian government recently announced a
new US$ 105 million ‘Health Results Innovation Grant’ for the World Bank to
pilot ‘results-based financing’ -innovative and flexible financing that links
funding to verifiable better health care for mothers and their infants.

In keeping with Millennium Development Goals 4 and 5, this would allow developing
countries to reduce the tragic numbers of mothers and babies which die each
year from largely preventable causes.

The Norwegian fund comes at the same time as the World Bank has just appointed
a new Director for Health, Nutrition, and Population (HNP), who will carry out
the Bank’s recently developed health strategy to improve health results by
strengthening the often perilous state of health systems in low-income
countries. Achieving results is the cornerstone of the Bank’s new health,
nutrition, and population (HNP) strategy which aims for stronger heath systems
to improve the health and well-being of millions of the world’s poorest
people, boost economic growth, reduce poverty caused by catastrophic illness,
and provide the structural ‘glue’ that combines multiple health-related
programs within client countries.

“Norway is investing a significant amount of money in the World Bank to help
poor countries strengthen their health systems so that mothers can survive
their pregnancies and safely deliver babies who live beyond their first weeks
of life,” says Norwegian Prime Minister, Jens Stoltenberg. "We look to the
Bank to champion greater use of financial incentives to improve care for women
and children. We know for example that mothers are more likely to have
successful births for their babies if they take place in health facilities
where help, advice and equipment is on-hand, rather than at home.”

In warmly welcoming the Norwegian fund, the World Bank says that focusing on
results gives governments and communities the flexibility and motivation to
improve health by fixing problems in the health system that have frustrated
achievements to date. ‘Strengthening health systems’ may sound more abstract
and less important than fighting specific diseases, but well-organized and
sustainable health systems are critical to save lives. For example, 1.8
million women die every year in childbirth. Three-quarters of these deaths
could be prevented if women had access to quality obstetric care and other
basic services -access that is provided by a health system.

Many foreign aid programs rely on countries having well-functioning health
systems that can deliver drugs and other essential services to people who need
them. But, as the strategy notes, this is often not the case. On the ground,
in practical terms, a functioning health system means putting together the
right chain of events from financing to governance, to logistics to incentive
mechanisms, information, well-trained personnel, basic infrastructure, and
supplies). This chain ensures that poor people get the good quality health
services they need to save and improve their lives.

“Much of the increased health funding available to countries is earmarked to
fight priority diseases such as HIV/AIDS, malaria, tuberculosis, and some
vaccine-preventable diseases. But it’s vital that governments also have the
flexibility to fix the underlying problems in the delivery system and that
other priorities such as maternal and child health, nutrition, and family
planning are not crowded out,” says Robert B. Zoellick, President of the World
Bank Group.

Results Framework

The Norwegian ‘results-based financing’ grant will support pilots in low-
income countries that build on learning from Bank programs already
illustrating the value of results-based financing. Two programs in Rwanda are
particularly good examples of the impact of linking health financing to
verifiable results.

One program helps the country’s local municipalities to create incentives for
public, private and NGO promotion of basic health messages and outreach
services including behaviour change and preventive services that can be
delivered at home (e.g., distribution of bed nets, hand-washing, nutrition,
use of safe water systems). A recent evaluation found that utilization of bed
nets by children less than 5 years of age has increased from 4% in 2004 to
more than 70% in 2007. The number of cases of malaria has decreased
dramatically and has emptied children’s hospital wards.

“Sharing successes like these with other countries is clearly essential to
achieving the Millennium Development Goals,” says Joy Phumaphi, the World
Bank’s Vice President for Human Development, a former WHO Assistant Director-
General for Family and Community Health, and former Health Minister in
Botswana. “Along with the rest of the development community, we all have to
work that much harder to prevent and treat ill-health which too often is a
major cause of poverty, and blunted economic prospects. The clear evidence in
developing countries is that weak health systems are a significant roadblock
to improving the health of their citizens.”

In another program, the government devotes about 15% of its health resources
to primary care centres on the basis of performance contracts. This creates
incentives for public, private and NGO providers to increase the quantity and
quality of basic health care interventions. A 2007 evaluation in target
provinces showed a significant increase in immunization coverage up to 95%,
almost a doubling in the numbers of people using health services, and a
significant jump in the number of assisted deliveries, from 29% in 2000 to 52%
in 2006.

Good health also brings growth

In its new health, nutrition, and population strategy, the Bank envisions its
support and advice will also help countries boost their global
competitiveness, and good governance. Good health has proven to be not just an
outcome of economic growth, but rather a major, inseparable contributor to

Advances in public health and medical technology, knowledge of nutrition,
population policies, disease control, and the discovery of antibiotics and
vaccines are widely viewed as catalysts to major strides in economic
development, from the Industrial Revolution in 19th century-Britain to the
economic miracles of Japan and East Asia in the 20th Century. Sound health
policy has important implications for overall country fiscal policy and
country competitiveness. As a result, a country’s economic growth rate is
significantly influenced by the health of its general population.

“It’s little wonder that illness is often a cause of poverty as well as a
catalyst for sudden impoverishment, as families tap into savings or sell what
they own to cover the costs of medical care,” Julian Schweitzer, the Bank’s
new Director for Health, Nutrition, and Population, and a former Director for
Human Development in South Asia, and Country Director for Russia. “As a
result, all too often people end up falling below the poverty line. Improving
the perilous health of millions of the world’s poorest people is rightly one
of the essential priorities of the global development community in this new

World Bank contribution to health over previous decade

Since the Bank’s last health strategy was approved in 1997, the Bank has lent
US $16 billion in HNP for more than 600 projects and programs in more than 100
client countries, making the Bank one of the world’s largest international
financing organizations of health, nutrition, and population activities in the
last decade.

Photos: The World Bank’s Joy Phumaphi and Norwegian Prime Minister Jens Stoltenberg.