Overview

The global movement toward universal health coverage (UHC) provides an umbrella under which the World Bank Group (WBG) works with governments and development partners to ensure all people receive quality, affordable care without suffering financial hardship. UHC aims to achieve better health and development outcomes in line with the Sustainable Development Goals (SDGs). SDG 3 includes a target to “achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.”

Our work to help countries achieve UHC is closely linked to our work to end preventable maternal and child mortality by 2030; reduce stunting and improve nutrition for infants and children; strengthen health systems; and prevent and treat communicable diseases.

During the period from 2000 to 2016, the World Bank invested US$35 billion in the Health, Nutrition and Population (HNP) sector. Over this period, the average annual lending doubled from US$1.3 billion to US$2.6 billion.  The Bank currently manages an active HNP portfolio of $11.5 billion.

Last Updated: Sep 20, 2016

The WBG’s Health, Nutrition and Population Global Practice provides financing, state-of-the-art analysis, and policy advice to help countries expand access to quality, affordable health care. It also prioritizes protecting people from falling into poverty or becoming poorer due to illness; and promoting investments in all sectors that form the foundation of healthy societies.

Universal health coverage: In promoting universal health coverage (UHC), the WBG supports developing countries’ efforts to provide quality, affordable health care to everyone, regardless of their ability to pay, reducing financial risks associated with ill health, and increasing equity. The path to UHC is specific to each country. Whatever the path, the WBG aims to help countries build healthier, more equitable societies, as well as to improve fiscal performance and country competitiveness.

In August 2016, the Bank Group and the World Health Organization (WHO), together with the government of Japan, Japan International Cooperation Agency, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the African Development Bank launched UHC in Africa: A Framework for Action, which provides a big-picture view of UHC in the region and identifies key areas that will be critical to achieving better health outcomes, such as financing, service delivery, targeting vulnerable populations, mobilizing critical sectors and political leadership.

The WBG and World Health Organization (WHO) released a first of its kind report—Tracking Universal Health Coverage -- to measure health service coverage and financial protection to assess countries’ progress towards universal health coverage. Following that, the WBG released Going Universal, a study that looks at how 24 developing countries have embarked on the journey to UHC, with a focus on expanding coverage to the poor.

Global Financing Facility: The Global Financing Facility (GFF) is a multi-stakeholder partnership that supports country-led efforts to improve the health of women, children and adolescents by:

  • acting as an innovative financing pathfinder to accelerate the efforts to reach the 2030 goals for women, children’s and adolescents’ health;  
  • financing high impact, evidence- and rights- based interventions to achieve measurable and equitable results;
  • building inclusive, resilient systems and increasing domestic financing over time to sustain the gains and ensure that all women, children and adolescents have access to essential health care, contributing to universal health coverage; and
  • filling the financing gap by mobilizing additional resources from public and private sources, both domestic and international, and making more efficient use of existing resources.

It is underpinned by International Health Partnership (IHP+) principles and serves to harmonize fragmented RMNCAH approaches, using existing structures and processes.

The GFF supports country leadership by drawing on the comparative advantages of the broad set of stakeholders involved in the RMNCAH response, including the financing of the World Bank Group, Gavi, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and bilateral donors; the technical expertise and normative mandates of UN agencies; the reach and community-connectedness of non-governmental and faith-based organizations; and the capacity and speed of the private sector. The GFF was officially launched by the UN Secretary General and the World Bank President at the Third International Conference on Financing for Development in July 2015. GFF is currently working in DRC, Ethiopia, Kenya, Tanzania, Bangladesh, Cameroon, India, Liberia, Mozambique, Nigeria, Senegal and Uganda.

Results-based financing for health: One of the key approaches to implementation is Results-Based Financing (RBF), an innovative approach to expand the quality and reach of health care services in the poorest countries by linking financing to results. RBF focuses on paying for outputs and outcomes—for example, increasing the percentage of women receiving antenatal care or having a trained health worker deliver their baby—rather than for simply inputs or processes.

Pandemics:  Pandemics pose a serious threat not only to global health security, but also to economic security and to our ability to end extreme poverty and achieve the SDGs. While outbreaks are inevitable, pandemics, if addressed early, are for the most part preventable. Ebola wiped out many of the recent development gains in Guinea, Liberia and Sierra Leone, which were among the fastest growing economies in the world prior to the crisis. The WBG estimated losses on the gross domestic product for the three countries last year were $2.2 billion. The World Bank Group’s response to the Ebola crisis is focused on stopping the spread of infections, improving public health systems throughout West Africa, and assisting governments in achieving universal health coverage. 

With the lessons of Ebola in mind, the World Bank Group, the World Health Organization and partners developed the Pandemic Emergency Financing Facility (PEF). The PEF will be a quick-disbursing financing mechanism that will provide a surge of funds aimed at effective response. It is an innovative financing model, using a combination of public and private funds, to cover low-frequency, high-severity outbreaks. The PEF launched in May at the G7 Ministers of Finance Meeting in Sendai. Japan, which holds the G7 Presidency, committed the first $50 million in funding toward the new initiative. Following receipt of financing commitments by development partners, the PEF is expected to be up and running in early 2017.

Drug resistant infections: Antimicrobial resistance (AMR) means that antibiotics and other antimicrobial drugs no longer treat infections the way they are supposed to. This phenomenon of drug-resistant infections is on the increase globally and is observed both in humans and animals. New research by the World Bank finds that in a worst-case AMR scenario low income countries could lose over 5 percent of their GDP. AMR is also projected to cause 28 million people, mostly in developing countries to fall into poverty by 2050. Investing in strengthening preparedness for pandemics and other infectious disease outbreaks, and improving public and veterinary health systems overall, are the best way to contain AMR, if it is made an integral part of these systems.

The World Bank Group, together with partners, will focus on developing more AMR-specific interventions like antimicrobial stewardship and reducing overuse, infection prevention and control, and the appropriate use of antibiotics in animal husbandry.

NutritionThe prevalence of stunting (an indicator of chronic undernutrition) has declined globally. However, 159 million children are stunted in their growth (low height for age), and have limited potential to contribute to their country’s growth. In sub-Saharan Africa, stunting reduction has flat lined, and there are now 12.5 million more stunted children in the region than there were in 1990. The WBG is focused on reducing child undernutrition and stunting worldwide, through innovative partnerships such as the Power of Nutrition.  Our investments in nutrition and food security more than tripled between 2011-12 and 2013-14, rising from $260 million to $750 million.

At the global level, the World Bank Group, in partnership with R4D, 1000 Days, the Bill and Melinda Gates Foundation, and the Children’s Investment Fund Foundation, released an investment framework on the resources needed to reach the global nutrition targets, such as an additional nutrition investment of $2.2 billion/year over 10 years that would save 2.2 million lives and reduce the number of stunted children by 50 million. .

Increasing effectiveness of global health aid is also a key aim. The Bank Group is a proud partner in the International Health Partnership and the H6 and is scaling up civil society engagement in health.

Last Updated: Sep 20, 2016

Through the International Development Association (IDA), the Bank Group has helped save lives and improve the health of millions in developing countries. From FY13-FY15, IDA:

  • Immunized 142.8 million children;
  • Provided 28.9 million pregnant women with antenatal care during a visit to a health provider;
  • Provided basic nutrition services to 177.3 million pregnant/lactating women, adolescent girls and/or children under 5;
  • Ensured nearly 12 million births were attended by skilled health personnel; and
  • Ensured 2.6 million people received tuberculosis treatment in accordance with the World Health Organization-recommended directly observed treatment short course (DOTS).

Here are some examples where IDA has made a difference in individual countries and regions:

To assist Guinea, Liberia and Sierra Leone in responding to the Ebola crisis, IDA has financed essential supplies and drugs, personal protective equipment and infection prevention control materials, health worker training, hazard pay and death benefits to Ebola health workers and volunteers, contact tracing, vehicles, data management equipment, and door-to-door public health education outreach.

In response to a crippling humanitarian crisis in the Horn of Africa resulting from a severe drought and the corresponding outpouring of Somali refugees, IDA supported food security and health in the world’s two largest refugee camps, Dabaab in Kenya and Dollo Ado in Ethiopia. IDA contributed US$30 million from2011 to 2013, to support the United Nations High Commissioner for Refugees’ (UNHCR) delivery of emergency services, benefitting more than 1.6 million individuals. Nearly 86,000 children with severe acute malnutrition were treated, far exceeding the target of 5,275, and more than 174,000 pregnant and lactating women received food supplements, exceeding the target of 23,475.  

IDA is the first and last external financier of a remarkable AIDS response in India. IDA financed the third national AIDS control project (2007-2012) which has seen new infections decline by 60% nationally, and by 90% in the oldest epidemic state of Tamil Nadu, based on prevention of mother-to-child transmission.  Thanks to targeted prevention interventions, an estimated 3 million HIV infections will have been averted by the end of 2015.

Senegal River Basin water resources improvement program -- which focuses on fisheries, irrigation, and health in Guinea, Mali, Mauritania, and Senegal – has led to a number of improvements in local health outcomes, particularly related to malaria and neglected tropical diseases. The distribution of 3.1 million insecticide treated mosquito nets to cover about 5.6 million people resulted in a dramatic increase in net use, from 28% in 2009 to 46%in 2012, in an area largely populated by poor farmers and their families.

In Ethiopia, funding from the Bank’s Rapid Social Response Program has helped the country expand nutrition data collection and analysis and build capacity to respond quickly to worsening nutrition situations and economic shocks. In addition, the Bank supports the July 2015 Seqota Declaration, which reaffirms Ethiopia’s commitment to invest further to improve nutrition for health and sustainable development.

In Peru, 31% of 0-5 year olds suffered from chronic malnutrition in 2000. By 2007, despite high economic growth and hundreds of millions of dollars spent on nutrition programs, the stunting rate stood at 28.5%. But with strong government commitment, in addition to World Bank and partner efforts in advocacy, operations and non-lending technical assistance, stunting fell by half to 14 % in only 7 years. Nearly half a million children age 0-5 escaped chronic malnutrition and are off to a brighter start in their lives. This ranks among the most successful achievements in improving child nutrition in the world.

In Vietnam, the IDA-financed Mekong Regional Health Support project (2006-2012) increased coverage of health care through both demand side and supply side interventions, both of which were critical for improving health outcomes among the poor.  The proportion of patients satisfied with overall treatment and the condition of facilities/equipment increased from 52% in 2008 to 82.7% in 2011. The inpatient mortality rate from newborn respiratory distress decreased from 36% in 2008 to 3.7% in 2011. A total of 2.4 million people were enrolled in the insurance program by project closing.

In Burundia national-level, performance-based financing program is improving maternal and child health through financial incentives to facilities to deliver more key services, with additional incentives for a quality scoring. From 2010 to 2014, results were as follows: births at health facilities increased by 25%, prenatal consultations increased 20.4 %, children fully vaccinated increased by 10.2%, curative care consultations for pregnant women increased by 34.5%, and family planning obtained via health facilities increased by 26.9%.

Other Bank Group health, nutrition and population results include:

  • In Argentina, improved health services and accessibility for poor pregnant women and children led to a decrease in low birth weight and in-hospital deaths of babies in the first 28 days of life for program beneficiaries.
  • In Armenia, the Bank Group contributed to the implementation of the government’s health reform program through the expansion of access to quality primary health care, which led to a tremendous increase—from 17% in 2004 to 85% in 2010—in the population served by qualified family medicine practices. Overall satisfaction with the quality of and access to primary health care services rose from 87.6% to 95%.
  • In Brazil, the Bank Group helped strengthen the health surveillance system and expanded access to and improved the effectiveness of health, water, and sanitation services for especially vulnerable groups, including indigenous peoples. As a result, 74% of the indigenous population was immunized by 2010 and malaria-related deaths declined by 60% from 2003 to 2007.
  • In the China TB Control Project, the case detection rate for new smear-positive TB cases increased from 23% in 2002 to 77% in 2010 (target: 70%) and the cure rate for smear-positive TB cases increased from 80% in 2002 to 93% in 2010 (target: 85%).
  • In Nepal, the Bank Group supported the national health sector program in expanding access to and increasing the use of essential health services, especially to underserved populations. As a result, contraceptive prevalence increased from 35% in 2001 to 51.7% in 2010 with a concomitant decrease in total fertility rate from 4.1 to 2.9 births per woman. Skilled attendance at birth also increased from 8% to 35%, and the percentage of children immunized against measles/DPT3 increased from 62% in 2001 to 83% in 2009 for the lowest income quintile.
  • In Rwanda, Bank Group support has led to an increase in health insurance enrollment from 7% to more than 70% of the population; a 50% increase in utilization of health services by poor children; a 63% increase in the use of insecticide-treated mosquito nets; a doubling of use of family planning services; a 62% decrease in malaria incidence; and a 30% decrease in child mortality.
  • In Senegal, the Bank Group supports an innovative nutrition health program that operates at the community level in collaboration with local governments, district health authorities, and civil society organizations. National underweight malnutrition rates dropped from 22% in 2005 to 17% in 2012, bringing Senegal—among very few countries globally—within reach of achieving the MDG to halve the rate of malnutrition.

Last Updated: Sep 20, 2016



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