Evaluation Shows World Bank Is Failing on Health

Advocates Decry Billions Wasted and 76 Percent Failure Rate in Africa

Washington, DC (May 6, 2009) — The Independent Evaluation Group (IEG) of the World Bank today released a report on the last decade of the Bank’s programming on health, nutrition, and population that shows a vast majority of the Bank’s health programs in Africa are failing to deliver.

“The new IEG report on the World Bank’s health investments should be a cause for alarm – especially the shockingly poor performance in the Africa region,” said Joanne Carter, executive director of RESULTS Educational Fund. “In this time of economic crisis – when millions of people are being pushed into poverty and are having to choose between medicine and food – we cannot afford to waste billions on World Bank programs that are not effective.”

“After succeeding in igniting TB control successes in China and India in the 1990s, the Bank ‘went stupid’ and did not build on and expand success like this in Africa, where the TB crisis and health crises are catastrophic,” said Dr. Bobby John, president of Global Health Advocates in India.

The IEG report evaluates health lending programs totaling $17 billion globally and reported that, even by the Bank’s own standards, a third of all health programs are not achieving “satisfactory outcomes.” In Africa, three-quarters of programs have failed in the last decade. Even projects identified as satisfactory came into question as field visits revealed, for example, that in one project in India, “more than half of the pieces of equipment procured . . . were not delivered or not installed. . . .”

Advocates pointed out that this funding is also largely loans – meaning that impoverished countries already reeling from the impact of the financial crisis are now also accruing debt for World Bank programs that are failing.

Meanwhile, despite this failing grade, donors have pledged billions in new funding to the Bank in recent months, including for a new Vulnerability Fund. Last week, during the World Bank’s spring meetings, it announced a tripling of investments in safety-net programs to $12 billion over two years.

The report has advocates asking why the World Bank is receiving billions for health while the Global Fund to Fight AIDS, TB and Malaria faces a $5 billion resource gap. The Global Fund to Fight AIDS, TB and Malaria last month released its annual “Results Report,” which showed it is surpassing ambitious targets and saving millions of lives. 69 percent of Global Fund-supported programs in Africa have performed at the highest ratings while only 6 percent showed “unacceptable performance,” with funding to these programs halted while they are revamped.

The report shows that approaches championed by the Bank often failed to ensure accountability and results. Sector Wide Approaches (SWAps), increasingly used by the Bank, and efforts at health sector reform, showed some of the worst performance while the one high point in the report showed that 89 percent of infectious disease programs (excluding HIV) were successful.

“The World Bank needs to support health programs that work, are outcome-based, and measure progress in terms of lives saved. Low-income countries should not be going into debt for ineffective World Bank programs,” said Carter.