Overview

  • The World Bank Group 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.

    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. In 2015 it was estimated that 400 million people still do not have access to essential health services, according to World Bank Group (WBG) and World Health Organization (WHO) research, and 6% of people in low- and middle-income countries are tipped into or pushed further into extreme poverty because of health spending.

    Health systems in middle income 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 63 percent of deaths globally, with 80 percent 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 universal health coverage. 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 needs to be pursued as part of an integrated plan.

    Each year millions of people are pushed into poverty because of out of pocket health costs. UHC is essential to achieving the WBG’s twin goals of ending extreme poverty and increasing equity, as well as reaching the Sustainable Development Goals (SDGs)

    Last Updated: Jun 19, 2017

  • 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. Over this period, the average annual lending increased significantly from US$1.3 billion to US$2.4 billion.  The Bank currently manages an active HNP portfolio of $11.9 billion.

    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: Jun 19, 2017

  • 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. To help push this agenda and harmonize fragmented RMNCAH approaches, the WBG and partners launched the Global Financing Facility (GFF) in 2015, a multi-stakeholder partnership that supports country-led efforts to improve the health of women, children, and adolescents. The objectives of the GFF, a new financing model, are to achieve measurable and equitable results and close the financing gap for RMNCAH. The annual amount of additional financing required has been estimated at more than $33 billion in 2015. This amount will prevent the deaths of an estimated 24-38 million women, children, and adolescents by 2030.

    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. 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. Investments in early nutrition to reduce malnutrition, especially stunting, can yield permanent and inalienable benefits. The WBG, 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. Relatedly, the WBG’s commitment to investing in the early years (early life nutrition, early learning and stimulation, and nurturing care and protection from stress) is also growing exponentially, in scope, scale, and coverage.

    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: Jun 19, 2017

  • During fiscal years 2014 to 2016, 310.8 million people received essential health, nutrition and population services supported by World Bank operations:

    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.

    While Cambodia has experienced dramatic progress in maternal and child health, the country still has great inequities in health outcomes. To help overcome these, IDA has provided US$30 million to assist with the implementation of the Cambodian government's 2008-2015 health strategic plan. It has led to improved health care services and created a Health Equity Fund, which is now available to 100% of the poor population and helped nearly 8.46 million people get access to basic health, nutrition and reproductive health services by the end of 2015. Also, nationwide, 85% of babies were delivered by trained personnel by the end of 2015, compared to 58% in 2008.

    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. 

    In Uruguay, the WBG helped fund the NCD Prevention Project to support the Uruguayan government’s efforts to re-focus the current health care model towards non-communicable diseases (NCDs) and preventing risk factors. As a result, mortality linked to circulatory system diseases in the population aged 70+ years fell from 75.18% in 2006 to 60.3% in 2014. In addition, the cases diagnosed and under follow-up by primary care teams for the following NCDs increased between 2006 and 2014: from 54.7% to 62.6% for hypertension; from 63.9% to 77.6% for diabetes; and from 13% to 34.3% for obesity and being overweight.

    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.

    Bangladesh has a reasonably good network of health care facilities but it still suffers from a shortage and distribution of qualified health workers. The government has prepared a Health, Nutrition and Population Sector Development Program, which lays out the countrywide health strategy for 2017 to 2021. The World Bank, with financing from IDA, the Global Financing Facility (GFF) and development partners, is supporting the program’s implementation through a Program for Results (PforR) financing instrument. The WBG also financed a portion of Bangladesh’s 2011 to 2016 health program. Results have been encouraging so far. There was a 29% reduction in under-5 child mortality, down to 46 deaths per 1,000 live births in 2014 from 65 deaths in 2007, for example, and a 40% reduction in maternal mortality, down to 194 deaths per 100,000 live births in 2010 from 320 deaths in 2000.

    Last Updated: Jun 19, 2017

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Washington
Anugraha Palan
APalan@worldbank.org