News / Africa

Report says World Bank and Donor Health Investments May be Falling Short of Mark

Bank rejects findings, calls report one dimensional.

Multimedia

Audio
Joe DeCapua

A new report says despite investing billions of dollars in health care, the World Bank and other development agencies have fallen short of their goals.

The report – Aid Without Impact – was released Wednesday by partnership of groups called ACTION or Advocacy to Control Tuberculosis Internationally.  The report examines – what are called – sector-wide approaches (SWAps) to health programs in sub-Saharan Africa.

Paul Jensen, ACTION’s global research coordinator, says the main criticism is that the World Bank and other development partners have invested billions of dollars over more than a decade in a sector wide approach to health care “that by and large isn’t improving people’s health.”

He says, “When you go back to the mid 90s, when this approach was conceived, it was really conceived as a way to improve results on the ground.  This was meant as a way to improve the way that aid was delivered for health….  And over the course of a decade… we find that it’s really not associated…with improvements in health outcomes looking specifically at sub-Saharan Africa.”

What’s gone wrong?

A sector wide approach, for example, may call for donors to pool their money to support a single policy or program, often with local governments taking the lead.

“It’s meant to improve or build or strengthen a health care system systemically.  And it’s meant to finance the delivery of a wide range of interventions.  It’s really meant to align the donors and a country around one program of work, like a national health plan,” says Jensen.

ACTION report evaluates World Bank and donor sector-wide approach to health programs
ACTION report evaluates World Bank and donor sector-wide approach to health programs

He says overall the idea behind it is sound.  But he adds, “There’s nothing wrong in terms of the concept.  It looks great on paper.  But when we reviewed the literature and when we analyzed the program ocuments…and talked to people who are knowledgeable, we find that the way that they’re implemented is not associated with improvements with health outcomes.”

The report says implementation of the sector wide approach places a lot of emphasis on coordination.  “And what’s lost,” says Jensen, “is that fact that SWAps are a means to an end.  And what they’re doing is confusing process with substance…and really confusing means with ends.”

The ACTION report blames part of the problem on a failure to set priorities.

“One of the main criticisms that we have is that there’s actually been very little resources going to robust external evaluations of these SWAps to make sure that they’re working,” he says.

Recommendations

The World Bank is asking donors this year to continue or increase funding for many sector-wide programs.

“The funding that comes from governments needs to be hinged to demands for improvements in performance in the way that the Bank does business in health in sub-Saharan Africa,” he says.

However, he says other donors need to do the same “because SWAp is inherently a multi-donor animal….  We want these programs to be independently evaluated at least every two years.”

He also calls for the “management structure within these institutions to be contingent on improvements in performance, in the sense that incentives are provided for management to do better.”

The report states: The findings of a World Bank Independent Evaluation Group (IEG) evaluation of SWAps in the health sector were consis­tent with this review’s findings, identifying major flaws in the approach the Bank and its development partners are taking to SWAps. These flaws included, among others:

• A general lack of attention to results

• Insufficient attention to ensuring that SWAps are technically sound

• A general failure to monitor country expendi­tures to be sure they focus on the highest-priori­ty investments

• Very weak monitoring and evaluation of the health programs that SWAps are supporting

The report adds that one of the key areas where the sector wide approach has not achieved the desired results is in TB control.

World Bank rejects findings

The World Bank striongly disagrees with the ACTION report findings.  Phil Hay, an adviser to the World Bank's Human Development Network spoke to VOA to dispute the report. Click below to listen.

Also, in a statement, the World Bank says, "The World Bank agrees that tuberculosis is a very serious health problem but considers this new report by the group Action as unfortunately a one-dimensional report that confuses the way that SWAps operate on the ground in Africa."

It says, "TB is a major health problem in the lives of people in Africa and elsewhere. SWAps, however, are large health programs that involve many different donors pooling their money and technical help in the one basket to achieve overall health outcomes.

"Large number of different partners are involved in Africa SWAps. In most cases, the Bank provides a relatively small share of the financing—usually less than 20 percent—with many other donors contributing. With so many donors and partners involved, it is clear that the World Bank cannot be singled out when it comes to discussions on health Swaps in Africa."

The majority of World Bank Africa health operations, it says, do not involve SWAps, adding Africa has 50 ongoing health operations, "of which less than 10 percent support SWAps."

The Bank says, "Our country clients in Africa and other regions continue to look to the Bank for its financing and strategic guidance and leadership, especially during the recent food and fuel emergencies and the continuing economic crisis."

It estimates by the end of the current fiscal year, the Bank will have provided over $4 billion for better health, nutrition, and population over the last twelve months.

You May Like

Photogallery Oxfam: Ebola Could Be 'Disaster of Our Generation'

Meanwhile, Fidel Castro, the former leader of Cuba, says the Caribbean island nation will 'gladly cooperate' with the US in the fight against Ebola in West Africa More

Multimedia Kobani Fighting Sends 400,000 Refugees to Turkey

Refugees receive help from Turkish authorities and individuals, but say much more is needed More

India’s Ruling Nationalist Party Makes Gains in Regional Elections

Bharatiya Janata Party’s huge margin over its rivals puts it on course to form governments in the northern Haryana and western Maharashtra states More

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Exclusive: American Joins Kurds' Anti-IS Fighti
X
Zana Omer
October 18, 2014 6:37 PM
The United States and other Western nations have expressed alarm about their citizens joining Islamic State forces in Syria and Iraq. In a rare counterpoint to the phenomenon, an American has taken up arms with the militants' Syrian Kurdish opponents. Elizabeth Arrott has more in this exclusive profile by VOA Kurdish reporter Zana Omer in Ras al Ayn, Syria.
Video

Video Exclusive: American Joins Kurds' Anti-IS Fight

The United States and other Western nations have expressed alarm about their citizens joining Islamic State forces in Syria and Iraq. In a rare counterpoint to the phenomenon, an American has taken up arms with the militants' Syrian Kurdish opponents. Elizabeth Arrott has more in this exclusive profile by VOA Kurdish reporter Zana Omer in Ras al Ayn, Syria.
Video

Video South Korea Confronts Violence Within Military Ranks

Every able-bodied South Korean male between 18 and 35 must serve for 21 to 36 months in the country’s armed forces, depending upon the specific branch. For many, service is a rite of passage to manhood. But there are growing concerns that bullying and violence come along with the tradition. Reporter Jason Strother has more from Seoul.
Video

Video Comanche People Maintain Pride in Their Heritage

The Comanche (Indian nation) once were called the “Lords of the Plains,” with an empire that included half the land area of current day Texas, large parts of Oklahoma, New Mexico, Kansas and Colorado.The fierceness and battle prowess of these warriors on horseback delayed the settlement of most of West Texas for four decades. VOA’s Greg Flakus reports from Lawton, Oklahoma, that while their warrior days are over, the 15,000 members of the Comanche Nation remain a proud people.
Video

Video Turkey Campus Attacks Raise Islamic Radicalization Fears

Concerns are growing in Turkey of Islamic radicalization at some universities, after clashes between supporters of the jihadist group Islamic State (IS) or ISIS, and those opposed to the extremists. Pro-jihadist literature is on sale openly on the streets of Istanbul. Critics accuse the government of turning a blind eye to radicalism at home, while Kurds accuse the president of supporting IS - a charge strongly denied. Henry Ridgwell reports from London.
Video

Video Syrian Defector Leaks Shocking Photos of Torture Victims

Shocking photographs purporting to show Syrian torture victims are on display at the U.S. Holocaust Memorial Museum in Washington. The museum says the graphic images are among thousands of photographs recently smuggled out of Syria by a military policeman-turned-defector. As VOA reporter Julie Taboh reports, the museum says the photos provide further evidence of atrocities committed by the government of Syrian President Bashar al-Assad against its own people.
Video

Video Drought-Stricken California Considers Upgrading Water System

A three-year drought in California is causing a water shortage that is being felt on farms and cities throughout the state. As VOA's Mike O’Sullivan reports, water experts, consumers and farmers say California needs to make changes to cope with an uncertain future.
Video

Video TechShop Puts High-tech Dreams Within Reach

Square, a business app and card reader, makes it possible to do credit card transactions through cell phones. But what made Square possible? VOA’s Adrianna Zhang and Enming Liu have the answer.
Video

Video Church for Atheists Goes Global

Atheists, by definition, do not believe in God. So they should have no need of a church. But two years ago, a pair of British stand-up comedians decided to create one. Sanderson Jones and Pippa Evans told the BBC they envisioned “something like church but without God". Their “Sunday Assembly” movement has grown from a single congregation in London to dozens of churches around the world. Reporter Mike Osborne visited with the members of a Sunday Assembly that now meets regularly in Nashville.
Video

Video Robot Locates Unexploded Underwater Mines

Many educators believe that hands-on experience is the best way to learn. Proving that the method works is a project developed by a group of students at the Stevens Institute of Technology, in Hoboken, New Jersey. They rose up to a challenge posted by the U.S. Department of Defense and successfully designed and built an underwater robot for locating submerged unexploded ordnance. VOA’s George Putic reports.
Video

Video Liberia's JFK Hospital Reopens After Temporary Ebola Exposure

JFK Hospital is Liberia’s largest and one of its oldest medical facilities. The hospital had to close temporarily following the deaths of two leading doctors from Ebola. It is now getting back on its feet, with the maternity ward being the first section to reopen. Benno Muchler has more for VOA News from Monrovia.
Video

Video Hong Kong Protests Expose Generation Gap

Most of the tens of thousands of protesters in Hong Kong are students seeking democracy. Idealistic youths say while the older generation worries about the present, they are fighting for the territory's future. VOA's Daniel Schearf reports from Hong Kong.
Video

Video Liberians Living in US Struggle From Afar as Ebola Ravages Homeland

More than 8,000 Liberians live in New York City, more than in any other city outside of Liberia itself. As VOA’s Bernard Shusman reports, with the Ebola virus ravaging their homeland, there is no peace of mind for these New Yorkers.
Video

Video Kurds See War-Ravaged Kobani As Political, Emotional Heartland

Intense fighting is continuing between Islamic State militants -- also known as ISIS or ISIL -- and Kurdish forces around the Syrian town of Kobani, on the Turkish border. The U.S. said it carried out at least nine airstrikes against Islamic State positions Friday. Meanwhile the U.N. has warned that hundreds of civilians would be massacred if the town falls to the militants. Henry Ridgwell looks at the strategic significance of the city.

All About America

AppleAndroid