Improving Effectiveness and Outcomes for the Poor in Health, Nutrition, and Population: An Evaluation of World Bank Group Support Since 1997 (Independent Evaluation Group Studies)

This study evaluates the effectiveness of the World Bank Group s support for health, nutrition, and population (HNP) in developing countries from 1997 to 2008 totaling more than $17 billion and distills lessons for greater impact in the future. It finds that the Bank Group now funds a smaller share of global support for HNP than a decade ago, but its support remains substantial and adds considerable value. About two-thirds of the Bank s HNP support has had satisfactory outcomes, often in difficult environments. But in a number of country settings, particularly in Africa, it has not performed well, in part due to high complexity and weak capacity. Only half of HNP support had a pro-poor focus, while support to reduce high fertility and promote family planning has dwindled. The evaluation highlights the contribution of investments in water supply, sanitation, and hygiene to improving the health of the poor and the lessons from support for sector-wide approaches, communicable disease control, and health reform. Moving forward, the World Bank needs to improve the performance of its HNP support and the Bank and IFC need to take actions to ensure their support reaches the poor and contributes greater social benefits, respectively. 1. Introduction -- Rationale For World Bank Group Investments In Health, Nutrition, And Population -- World Bank Group Strategies In Health, Nutrition, And Population -- Objectives And Scope Of This Evaluation -- Evaluation Design And Methodology -- Organization Of The Report -- 2. Evolution And Performance Of The World Bank's Country Support For Health, -- Nutrition, And Population -- The Health, Nutrition, And Population Portfolio And Its Performance -- Monitoring, Evaluation, And The Results Agenda -- Is Health, Nutrition, And Population Support Reaching The Poor? -- 3. Lessons From Three Approaches To Improve Outcomes -- Communicable Disease Control -- Reforming Health Systems -- Sectorwide Approaches -- 4. The Contribution Of Other Sectors To Health, Nutrition, And Population -- Outcomes -- Intersectoral Approaches In Country Assistance Strategies -- Multisectoral Health, Nutrition, And Population Lending -- Health In The Lending Portfolios Of Other Sectors -- 5. Ifc's Health Strategy And Operations -- Evolution Of Ifc's Approach To Private Investment In Health -- Ifc's Investment Portfolio In Health -- Ifc's Advisory Services In Health -- Ifc's Institutional Arrangements For The Health Sector -- Social Impacts Of Ifc Health Investments -- 6. Conclusions And Recommendations -- Recommendations -- Appendix A. World Bank Group Hnp Timeline -- Appendix B. Definition Of The Samples Used For Portfolio Reviews And World Bank Hnp -- Staff Analysis -- Appendix C. World Bank Hnp Sector Projects Approved In Fiscal Years 1997 -- Appendix D. Ifc Health Investments, Fiscal Years 1997 -- Appendix E. World Bank Support For Population -- Appendix F. World Bank Support For Nutrition -- Appendix G. World Bank Support For Analytic Work On Hnp -- Appendix H. Additional Figures On World Bank Hnp Lending, Analytic Work, And Staffing -- Appendix I. Evaluation Of World Bank Participation In Two Global Hnp Partnerships -- Appendix J. Management Response. At Head Of Title: Ieg World Bank, Ifc, Miga. Includes Bibliograhical References (p. 179-187). Also Available Via The World Wide Web.

Irrigation has made a major contribution to poverty reduction in the past decades, enabling higher yields and better nutrition. Despite these achievements, large-scale irrigation schemes have usually yielded low returns and attracted negative publicity because of their adverse environmental and social impacts. As a result, the Bank has largely switched its support for irrigation away from new construction toward rehabilitation and policy reform. This evaluation supports the need for reform but shows that there are substantial benefits from further investment in infrastructure. This study analyzes these issues through an impact evaluation of one of the last 'old generation' of projects in which the Bank directly supported creation of a new irrigation scheme: India's Second and Third Andhra Pradesh Irrigation Projects (AP II and AP III). Together these projects created a new command area, the Srisailem Right Branch Canal (SRBC), and rehabilitated an existing one that had been constructed with Bank assistance, the Sriramasagar Project.

1. Introduction -- 2. The Projects -- 3. Water User Associations -- 4. Economic Benefits -- 5. Summary And Lessons Learned -- App. A. Sample Selection Of Ieg Irrigation Survey -- App. B. Regression Results -- App. C. Single- And Double-difference Impact Estimates -- App. D. Data Tables -- App. E. The Farm Model, Rate Of Return Analysis, And Distributional Impact -- App. F. Village Profiles -- App. G. Comments From Government Of Andhra Pradesh -- App. H. Impact Evaluation. Prepared By Howard White And Edoardo Masset, With Inputs From Nina Blöndal, Under The Guidance Of Alain Barbu--p. Ix. Includes Bibliographical References (p. 129-130). The Independent Evaluation Group (IEG) of the World Bank has undertaken impact evaluations of the Bank?s support to irrigation in Andhra Pradesh, India (under AP Irrigation II and III), and of the U.K. Department for International Development supported Rural Livelihoods Project (RLP). This is one of a series of IEG impact evaluations (see appendix H). IEG?s program of impact evaluation is in part carried out under a Department for International Development?IEG partnership agreement; hence the focus on RLP. However, survey villages are also covered by the Bank supported DPIP project, so that the