Health Overview

Overview

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Context
Strategy
Focus Areas
Results

The World Bank Group (WBG) is committed to helping governments achieve universal health coverage (UHC) by 2030, which has the potential to transform the health and well-being of individuals and societies. The vision of UHC is that all people can obtain the quality health services they need without suffering financial hardship. UHC also allows countries to make the most of their strongest asset: human capital. Health is a foundational investment in human capital and in economic growth--without good health, children cannot go to school and learn, and adults cannot work and be productive contributors to their households and economies.
Globally, there has been significant progress towards UHC. Most parts of the world have seen an expansion in the access to health services and coverage of key interventions over the last two decades. There have also been notable improvements in financial protection. Yet, the challenges remain immense.
In many countries there are still large coverage gaps, in particular for poor and marginalized communities. Half the world's population cannot access needed health services, while 100 million people are pushed into extreme poverty each year because of health expenses, shows WBG/World Health Organization (WHO) research from 2017. In addition, 800 million people spend at least 10 percent or more of their household budget on healthcare expenses, often forcing them to choose between their health and other needed expenses for their family. Even if health services are available, countries at all incomes levels often struggle to ensure quality in health services.
Health expenses are an important reason families around the world are pushed into poverty. UHC is thus fundamental to achieving the WBG’s twin goals of ending extreme poverty and increasing equity and the overarching Sustainable Development Goal of ending poverty. As long as millions are impoverished each year because of health expenses, neither goal can be reached.
Health systems in many countries are also confronting the challenges of aging populations and a growing burden of lifestyle diseases. The burden of non-communicable diseases (NCDs), such as cancer, cardiovascular disease, diabetes and mental health, is growing. NCDs are now the cause of 70 percent of deaths globally, with the majority of these deaths occurring in low- and middle-income countries. At the same time, despite advances in reducing the burden of communicable disease, rates still remain high in many parts of the world for malnutrition, unmet need for sexual and reproductive health services, and maternal mortality.
Achieving universal health security, which protects all people from threats to their health, is an essential component of providing UHC. Universal health security means protecting everybody, not just because that is the equitable thing to do, but because with infectious diseases, true health security can only be achieved if everyone is protected. It both depends on and complements broader efforts to strengthen health systems and make them more resilient, so it needs to be pursued as part of an integrated plan.

Last Updated: Oct 04, 2018
The World Bank Group (WBG) works to help nations build healthier, more equitable societies and to improve fiscal performance and country competitiveness. To support countries in reaching the goal of UHC by 2030, the Bank provides financing, state-of-the-art analysis, and policy advice to improve service delivery and expand access to quality, affordable health care. During the period from fiscal year 2000 to 2016, the World Bank invested US$35 billion in the Health, Nutrition and Population (HNP) thematic areas. The Bank currently manages an active HNP portfolio of US$14.5 billion in net commitments, and over US$1 billion in trust funds.
The WBG has focused its health sector investments and research in areas that are especially vital to helping countries achieve UHC by 2030, working closely with donors, development partners, governments, and the private sector. Some of these focus areas include ending preventable maternal and child mortality; reducing stunting and improved nutrition for infants and children; strengthening health systems and health financing; ensuring pandemic preparedness and response; promoting sexual and reproductive health and rights; and the prevention and treatment of communicable diseases.

Last Updated: Oct 04, 2018
Ensuring that every woman and child has access to health care is fundamental to ending poverty, building robust economies, and achieving UHC. However, there’s still much to be done for the reproductive, maternal, newborn, child and adolescent health (RMNCAH) agenda. Many countries continue to be burdened by high rates of maternal mortality and high fertility, which are closely linked to high infant mortality and gender inequality. The Global Financing Facility (GFF), a multi-stakeholder partnership hosted by the World Bank, is helping countries tackle the greatest health and nutrition issues affecting women, children and adolescents. The GFF supports governments to bring together partners around a country-led plan, prioritizing high-impact but underinvested areas of health. The GFF Trust Fund acts as a catalyst for financing, with countries using modest GFF Trust Fund grants to significantly increase their domestic resources alongside the World Bank’s IDA and IBRD financing, aligned external financing, and private sector resources. Each relatively small external investment is multiplied by countries’ own commitments—generating a large return on investment, ultimately saving and improving lives.
Pandemics pose a serious threat not only to universal health security and achieving UHC, but also to economic security. While outbreaks are inevitable, strong health systems can allow countries to better detect and respond to diseases and prevent an outbreak from becoming a pandemic. Despite progress made since the recent Zika and Ebola crises, a report by the International Working Group on Financing Preparedness, established by the World Bank, finds that most countries are still not adequately prepared for a pandemic. IDA 18 mandates specific commitment from the WBG to strengthen pandemic preparedness in at least 25 countries. The World Bank supported by donors and WHO have also developed the Pandemic Emergency Financing Facility (PEF), a quick-disbursing financing mechanism that provides a surge of funds to enable a rapid and effective response to a disease outbreak. News of an Ebola outbreak in the Democratic Republic of Congo in May 2018 triggered the WBG’s Pandemic Emergency Financing Facility’s first cash window disbursement of $12 million to combat the onset of the disease. With strong government leadership and partner collaboration, this funding enabled a swift and robust response. Investing in strengthening health systems and preparedness for pandemics and other infectious disease outbreaks is also one of the best ways to contain antimicrobial resistance (AMR), when antibiotics and other antimicrobial drugs no longer treat infections.
Nutrition interventions are consistently identified as one of the most cost-effective development actions. But in 2016, 155 million children were stunted (low height-for-age), which indicates not only a failure to achieve one’s own genetic potential for height but is also a predictor of many other developmental constraints, including cognitive deficits and future economic opportunities. The World Bank has led the effort to estimate the cost and cost-effectiveness of nutrition interventions to support advocacy and increase investment in nutrition at the global and country levels. At the global level, the World Bank, in partnership with R4D, 1000 Days, the Bill and Melinda Gates Foundation, and the Children’s Investment Fund Foundation published An Investment Framework for Nutrition which provides a roadmap, including estimates of resources required and possible financing scenarios to achieve the global nutrition targets set out by the World Health Assembly and enshrined in the Sustainable Development Goals. This has been followed up with the development of a tool (Optima Nutrition) that helps countries maximize the efficiency of nutrition investments, so promised results can be achieved.
While the incidence of infectious diseases has declined globally, they continue to have major health and economic costs. Caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi, infectious diseases, also known as communicable diseases, can be spread directly or indirectly from one person to another. Stopping the spread of infectious diseases globally is not only beneficial for a country’s economy and its population’s health, but it is also essential for countries to achieve UHC. Reaching this goal requires prevention of and access to quality treatment for infectious diseases, including malaria, TB and HIV, as well as adequate sanitation.
Smoking is a leading cause of preventable disease and death – it causes more deaths each year than HIV/AIDS, malaria, and tuberculosis combined. The total economic cost of smoking exceeds US$ 1.4 trillion per year, equivalent to 1.8% of the world’s annual gross domestic product. In response, the WBG’s Global Tobacco Control Program assists countries in fostering and implementing tobacco tax reforms to achieve public health goals by reducing tobacco affordability and consumption, and for mobilizing domestic resources to expand the fiscal space to fund priority programs and investments that benefit the entire population, and controlling illicit trade on tobacco by strengthening customs systems.
Mental health disorders also impose an enormous disease burden on societies across the world. Depression alone affects 350 million people globally and is the leading cause of disability worldwide. Worsened by low levels of investment and treatment coverage, mental disorders also have serious economic consequences.

Last Updated: Oct 04, 2018
During fiscal years 2011 to 2017, 602 million people received essential health services through the World Bank’s IDA funds:
The crisis in Yemen has taken a heavy toll on the country's children. While most WBG operations halted at the start of the conflict, a partnership with WHO/UNICEF has allowed for the continuation of the Health and Population Project by channeling IDA funding through these UN agencies. This funding in 2016 provided critical support for the delivery of essential health services, such as national polio campaigns, maternal and child health, and nutrition services. This contributed to the vaccination of 5 million Yemeni children under 5 and 150,000 beneficiaries being treated for malnutrition, deworming, and maternal and child illnesses.
With a stagnant economy for the last 30 years, Madagascar has become one of the poorest countries in the world. In response, in 2015 US$40 million in IDA funding helped establish and expand two safety net programs, providing more than 80,000 poor households with regular cash transfers while promoting nutrition, early childhood development, school attendance of children, and productive activities of families. Initial reports show children’s primary school attendance rates improved to 97% and there’s an expected increase in food consumption and food diversity, especially for young children.
In East Africa, IDA funding backed the East Africa Public Health Laboratory Networking project, which has helped public health officials successfully mount joint efforts to control the spread of communicable diseases and expand access to quality diagnostic services for vulnerable groups in cross border areas, serving over 4 million beneficiaries (of which 60% are women) through a network of 32 upgraded laboratories in Burundi, Kenya, Rwanda, Tanzania, and Uganda.
In Guatemala, a WBG pilot training program for indigenous midwives (comadronas) has worked to strengthen their capacity to identify women with high-risk pregnancies and to refer them to hospitals. Almost 70% of the midwives have completed the training and all have received safe birthing kits. While the program is still being monitored, there are early signs of progress, with some midwives referring patients to the National Hospital.
Malnutrition was highly prevalent in Senegal at the start of the millennium when stunting affected as many as 30% of children under age 5. In response, the Government of Senegal, with support from IDA, shifted its approach on nutrition to a community-based holistic strategy. It has worked with local governments, public service providers, and nongovernmental organizations to deliver to communities and households nutrition services, such as health education, breastfeeding promotion, essential micronutrient supplementation, conditional cash transfers, and more. The stunting prevalence in Senegal is now 19%, making it one of the lowest of sub-Saharan Africa.
As part of its efforts to strengthen health systems following the devastation caused by Ebola, the WBG and its partners launched the Regional Disease Surveillance Systems Enhancement (REDISSE) Program in Guinea, Senegal and Sierra Leone, and in a second wave added Guinea Bissau, Liberia, Nigeria, and Togo. The initiative is an interdependent series of projects working to strengthen national, regional, and cross-sectoral capacity for integrated disease surveillance and response in the region. This follows up on the WBG’s efforts to assist Guinea, Liberia and Sierra Leone in responding to the Ebola crisis, for which IDA financed such things as essential supplies and drugs, personal protective equipment and infection prevention control materials, health worker training, and hazard pay.

Last Updated: Oct 04, 2018