News / Africa

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

Bank rejects findings, calls report one dimensional.


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.


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

Multimedia Brussels Schools, Metro Reopen Under Heavy Guard

City remains under the highest threat alert level due to what authorities have described as a 'serious and imminent' threat of attack

Video Debt-ridden Refugees Await Onslaught of Lebanese Winter

Aid agencies are attempting to reduce potentially devastating consequences of freezing conditions and snowstorms that killed eight last year, including three Syrian refugees

UN Warns Air Pollution in Asia Pacific Has Rising Cost

Globally some seven million people a year die prematurely due to indoor and outdoor pollution with about 70 per cent of those deaths in region

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

By the Numbers

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
After Paris Attacks, France Steps Up Fight Against ISi
November 24, 2015 3:04 AM
The November 13 Paris attacks have drawn increased attention to Syria, where many of the suspected perpetrators are said to have received training. French President Francois Hollande is working to build a broad international coalition to defeat Islamic State in Syria and in Iraq. Zlatica Hoke reports.

Video After Paris Attacks, France Steps Up Fight Against IS

The November 13 Paris attacks have drawn increased attention to Syria, where many of the suspected perpetrators are said to have received training. French President Francois Hollande is working to build a broad international coalition to defeat Islamic State in Syria and in Iraq. Zlatica Hoke reports.

Video US, Cambodian Navies Pair Up in Gulf of Thailand

The U.S. Navy has deployed one of its newest and most advanced ships to Cambodia to conduct joint training drills in the Gulf of Thailand. Riding hull-to-hull with Cambodian ships, the seamen of the USS Fort Worth are executing joint-training drills that will help build relations in Southeast Asia. David Boyle reports for VOA from Preah Sihanouk province.

Video Americans Sharpen Focus on Terrorism

Washington will be quieter than usual this week due to the Thanksgiving holiday, even as Americans across the nation register heightened concerns over possible terrorist threats. VOA’s Michael Bowman reports new polling data from ABC News and the Washington Post newspaper show an electorate increasingly focused on security issues after the deadly Islamic State attacks in Paris.

Video World Leaders Head to Paris for Climate Deal

Heads of state from nearly 80 countries are heading to Paris (November 30-December 11) to craft a global climate change agreement. The new accord will replace the Kyoto Protocol on Climate Change that expired in 2012.

Video Uncertain Future for Syrian Refugee Resettlement in Illinois

For the trickle of Syrian refugees finding new homes in the Midwest city of Chicago, the call to end resettlement in many U.S. states is adding another dimension to their long journey fleeing war. Organizations working to help them integrate say the backlash since the Paris attacks is both harming and helping their efforts to provide refugees sanctuary. VOA's Kane Farabaugh reports.

Video Creating Physical Virtual Reality With Tiny Drones

As many computer gamers know, virtual reality is a three-dimensional picture, projected inside special googles. It can fool your brain into thinking the computer world is the real world. But If you try to touch it, it’s not there. Now Canadian researchers say it may be possible to create a physical virtual reality using tiny drones. VOA’s George Putic reports.

Video New American Indian Village Takes Visitors Back in Time

There is precious little opportunity to experience what life was like in the United States before its colonization by European settlers. Now, an American Indian village built in a park outside Washington is taking visitors back in time to experience the way of life of America's indigenous people. Carol Pearson narrates this report from VOA's June Soh.

Video Even With Hometown Liberated, Yazidi Refugees Fear Return

While the northern Iraqi town of Sinjar has been liberated from Islamic State forces, it's not clear whether Yazidi residents who fled the militants will now return home. VOA’s Mahmut Bozarslan talked with Yazidis, a religious and ethnic minority, at a Turkish refugee camp in Diyarbakır. Robert Raffaele narrates his report.

Video Nairobi Tailors Make Pope Francis’ Vestments

To ensure the pope is properly attired during his visit, the Kenya Conference of Catholic Bishops asked the Dolly Craft Sewing Project in the Nairobi slum of Kangemi to make the pope's vestments, the garments he will wear during the various ceremonies. Jill Craig reports.

Video Cross-Border Terrorism Puts Europe’s Passport-Free Travel in Doubt

The fallout from the Islamic State terror attacks in Paris has put the future of Europe’s passport-free travel area, known as the "Schengen Zone," in doubt. Several of the perpetrators were known to intelligence agencies, but were not intercepted. Henry Ridgwell reports from London European ministers are to hold an emergency meeting Friday in Brussels to look at ways of improving security.

Video El Niño Brings Unexpected Fish From Mexico to California

Fish in an unexpected spectrum of sizes, shapes and colors are moving north, through El Niño's warm currents from Mexican waters to the Pacific Ocean off California’s coast. El Nino is the periodic warming of the eastern and central Pacific Ocean. As Faiza Elmasry tells us, this phenomenon thrills scientists and gives anglers the chance of a once-in-a-lifetime big catch. Faith Lapidus narrates.

Video Terrorism in Many Forms Continues to Plague Africa

While the world's attention is on Paris in the wake of Friday night's deadly attacks, terrorism from various sides remains a looming threat in many African countries. Nigerian cities have been targeted this week by attacks many believe were staged by the violent Islamist group Boko Haram. In addition, residents in many regions are forced to flee their homes as they are terrorized by armed militias. Zlatica Hoke reports.

Video Study: Underage Marriage Rate Higher for Females in Pakistan

While attitudes about the societal role of females in Pakistan are evolving, research by child advocacy group Plan International suggests that underage marriage of girls remains a particularly big issue in the country. VOA’s Ayesha Tanzeem reports how such marriages leads to further social problems.

VOA Blogs