Health

All people aspire to receive quality, affordable health care. Universal health coverage (UHC) is about people having access to the health care they need without suffering financial hardship. UHC aims to achieve better health and development outcomes, help prevent people from falling into poverty due to illness, and give people the opportunity to lead healthier, more productive lives. 

Recently, the global UHC movement has gained momentum, with the World Health Assembly and the United Nations General Assembly calling on countries to “urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and quality healthcare services.” UHC is a continuation of the Millennium Development Goals (MDGs) and offers flexibility for countries to determine what will help them reach their health goals.

In line with its global strategy for health, nutrition, and population, the World Bank Group provides financing, state-of-the-art analysis, and policy advice to help countries expand access to quality, affordable health care; protects people from falling into poverty or worsening poverty due to illness; and promotes investments in all sectors that form the foundation of healthy societies. 

The path to UHC is specific to each country. Whatever the path, the Bank Group’s aim is to help countries build healthier, more equitable societies, as well as to improve their fiscal performance and country competitiveness—toward the goals of ending extreme poverty by 2030 and boosting shared prosperity. On December 6, 2013, Bank Group President Jim Yong Kim announced that the Bank Group and the World Health Organization (WHO) would release a joint framework for monitoring progress toward UHC with two targets: 

• For financial protection, by 2020, the Bank Group and WHO propose to reduce by half the number of people who are impoverished due to out-of-pocket health care expenses. By 2030, no one should fall into poverty because of out-of-pocket health care expenses. Achieving this target will require moving from 100 million people impoverished every year at present, to 50 million by 2020, and then to zero by 2030.
• For service delivery, the Bank Group and WHO propose to double the proportion of poor people in developing countries who have access to basic health services, such as vaccination for children or having a skilled attendant available at childbirth, from 40% today to 80 % by 2030. In addition, by 2030, 80% of the poor will have access to other essential health services such as treatment for high blood pressure, diabetes, mental health, and injuries.

One of the key approaches to implement the Bank Group’s health strategy is results-based financing (RBF), an innovative strategy 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. In September 2013, President Kim announced that the Bank Group would invest $700 million by 2015 to improve women and children’s health. The funding is enabling scale-up of successful reproductive, maternal, and child health projects, which also include malaria, tuberculosis (TB), and other disease-prevention activities.                                                                                                                                      

Reflecting the Bank Group’s commitment to the MDGs, three areas of special focus are expanding access to family planning and reproductive health, preventing HIV/AIDS and other communicable diseases, and scaling up support for early childhood nutrition. In June 2013, the Bank Group projected that it would nearly triple direct financing for maternal and early childhood nutrition programs in 2013-14 to $600 million, up from $230 million in 2011-12.

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 H4+ and is scaling up civil society engagement in health.

Through the International Development Association (IDA), the Bank Group has helped save lives and improve the health of millions in developing countries. During the past decade (2003-2013), IDA has:

• Provided more than 117 million people with access to basic packages of health, nutrition, or reproductive health services
• Trained more than 2.6 million health personnel
• Constructed, renovated, and/or equipped more than 10,000 health facilities
• Immunized nearly 600 million children
• Provided more than 194 million pregnant women with antenatal care during a visit to a health care provider
• Ensured that more than 29 million births were attended by skilled health personnel
• Ensured that more than 210 million pregnant/lactating women, adolescent girls, and/or children under age five were reached by basic nutrition services
• Purchased and/or distributed more than 149 million long-lasting, insecticide-treated malaria bed nets
• Purchased and/or distributed more than 386 million condoms
• Provided more than 7.6 million people with TB treatment according to WHO DOTS recommendations
• Ensured that more than 1.3 million adults and children received antiretroviral combination therapy

 Here are some examples where the Bank Group has made a difference in the countries and regions:

• 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 Burundi, over just one year, births at health facilities rose by 25%, prenatal consultations went up by 20%, and the number of children fully vaccinated increased by 10%.
• 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 India, the national AIDS program with support from the Bank Group prevented an estimated 3.5 million of India’s expected 5.5 million HIV infections.
• 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.
• In Vietnam, as of 2013, 68% of the population was covered by fully subsidized health insurance. Though nationwide coverage for the “near-poor” (those living within 130% of the poverty threshold) is estimated at 30%, with Bank Group support, coverage for this group in the central north region reached 64% as of 2013.