Some World Bank Health Programs Ineffective, Report Says

By Anthony Faiola
Washington Post Staff Writer
Friday, May 1, 2009

One-third of World Bank health, nutrition and population programs from 1997 through 2007 produced unsatisfactory results, with weak monitoring and overly complex projects contributing to the problem, according to the institution's internal watchdog.

The report, released yesterday by the World Bank's Independent Evaluation Group, paints a disturbing portrait of ineffectiveness in areas vital to public health in the developing world. Programs designed to combat HIV-AIDS in Africa, for instance, had only a 25 percent success rate, compared with an 80 percent success rate for World Bank programs overall.

Many projects lacked a procedure to ensure that the poorest and most needy were receiving assistance. Others were poorly implemented. A $26.6 million HIV-response project in Ghana from 2000 to 2005, for example, failed to target populations at risk of contracting the virus.

"A third of the projects did not meet their objectives," Cheryl Gray, IEG director, said. "Over-complexity is a problem, as is the lack of capacity of countries to implement the programs."

Many programs, the report said, were extraordinarily successful, including an anti-malaria campaign in Eritrea that succeeded in reducing deaths by 85 percent.

The report comes as the Bank is attempting to launch millions of dollars worth of emergency programs to aid Mexico with the swine flu outbreak and governments are being asked to give billions of dollars to help institutions such as the World Bank combat the financial crisis.

"The timing of this report is important," said Eswar Prasad, senior fellow at the Brookings Institution and professor of trade policy at Cornell University. "It is a cautionary note about long-held concerns that money to these institutions can generate a lot of waste."

World Bank officials acknowledged flaws in their health programs and said they were preparing to take steps to fix them. They said the Bank is moving to double its staff dealing with malnutrition, and would seek ways to streamline existing programs.

Yet operating under difficult conditions in places such as Africa, officials said, remains challenging.

"I accept much of the report; I accept it as constructive criticism," said Julian Schweitzer, World Bank director of health, nutrition and population. "In hindsight, some of these projects were too complex. But I also want to make a point that health is complicated. It is very hard to develop a good health system."

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