The challenge of reducing global poverty and improving the human welfare of millions of poor people could scarcely be more powerful. In 2002 almost 11 million children died before their fifth birthday. Most of these deaths occurred in developing countries, with 4.5 million in Sub-Saharan Africa alone, and many others in South Asia. Maternal mortality is 20 times higher among the poorest quarter of the world’s population than among the richest quarter. In 2002, 3.1 million people died from HIV/AIDS. Life expectancy has fallen by as much as 20 years in those countries with the highest infection rates, and hard-won improvements in child mortality have been reversed. Some 115 million primary-school-age children in developing countries do not go to school; 64 million of them are girls.

The World Bank stands by its commitment to scale up efforts to help countries achieve universal primary education, combat communicable diseases, reduce child mortality, improve maternal health, and protect vulnerable populations from crisis.

EDUCATION

In fiscal 2003 the World Bank provided vigorous support for education to help countries attain the Education for All (EFA) Millennium Development Goals (MDGs), while equipping themselves to compete in dynamic, knowledge-driven global markets. This dual thrust is key to empowering people and fostering economic growth—and, as a result, reducing poverty.

Universal primary completion is increasingly seen as the most attainable of the MDGs, and one that enables progress toward the other 2015 targets. In partnership with developing countries, donors, development institutions, and civil society, the Bank supports the EFA Fast-Track Initiative (FTI). (See box 4.4.) In the last year the FTI has matured significantly with new donor financial and technical support, and many more countries are expected to benefit from the lessons learned.

FTI has raised the profile of education, strengthened government commitment, and focused on outcomes—including primary school completion. It has produced tangible progress in donor harmonization, leading to a more unified policy dialogue, expanded flexible aid for primary education, and donor commitment to cost-effective standards for school construction.

Support at the global level included important analytical work on the role of tertiary education and on new challenges arising from the need for lifelong learning in dynamic, knowledge-driven global markets. A Conference on Lifelong Learning and the Knowledge Economy, held in Stuttgart October 9–10, 2002, explored education and training policies to respond to the knowledge economy. Also contributing to this discussion was Closing the Gap in Education and Technology, a comprehensive study of the role of skills and technology in closing the productivity gap in Latin America and the Caribbean.

At the country level, support for education gathered momentum. At $2.3 billion, lending to the education sector increased for the third consecutive year in fiscal 2003. Support for education components in other sector projects also increased in fiscal 2003 to $577 million, compared with $435 million the previous year.

The Latin America and the Caribbean region accounted for the largest share of lending ($785 million). (See table 6.12.)

Africa received support for education sector reform and basic education ($424 million, all IDA funding), as well as assistance for “development learning centers” to tap into global knowledge on diverse developmental issues to be drawn from in preparing national poverty reduction strategies.

Increased policy and analytical support included both country- and regionwide (East Asia, Africa) policy notes, reports, and dialogue, as well as in-depth analytical contributions in the areas of tertiary education, girls’ education, and service delivery (World Development Report 2003: Making Services Work for Poor People).

Recent data from the Bank’s Operations Evaluation Department (fiscal 2002, partial) showed that 95 percent of education projects had satisfactory outcomes, compared with 83 percent in fiscal 2001 and 74 percent five years earlier.

HEALTH, NUTRITION, AND POPULATION

Communicable diseases, poor maternal and child health, and poor nutrition account for much of the disease burden and many of the deaths among poor people. Each year more than 500,000 women die from pregnancy-related complications. An estimated 140 million children under the age of five are underweight, almost half of them in South Asia. Of almost 11 million deaths in children under five, over half are attributable to preventable and treatable diseases.

During fiscal 2003 the Bank worked with partners and countries to accelerate progress toward the health, nutrition, and population-related MDGs. The improved alignment of the Bank’s work with the MDGs was reflected in total new commitments of $1.6 billion to the health sector in 63 new projects.

Scaling up and expanding coverage of basic services to achieve the MDGs require well-functioning health care systems. The Bank’s health systems agenda this year emphasized institutional and structural reforms, sustainable financing, strengthening governments’ stewardship role (e.g., policymaking, regulation, monitoring and evaluation, and creating demand-side incentives to improve accountability of public providers to patients). New commitments for health system performance amounted to almost $505 million.

Communicable diseases, including HIV/AIDS, continued to be a dominant theme, amounting to over $442 million in new commitments. New lending for population and reproductive and child health reached $407 million. Support for nutrition noted significant gains, accounting for more than $199 million.

Innovative approaches to addressing the MDGs are key. This year the Bank approved projects to support global efforts to eradicate polio in Nigeria and Pakistan. These projects include an IDA “buy-down” mechanism, whereby IDA credits are converted to grants if agreed performance criteria are met. Contributions from Rotary International, the United Nations Foundation, and the Bill and Melinda Gates Foundation are making these projects possible.

Finally, the Bank continued to address the growing epidemic of noncommunicable disease and injury. Throughout the negotiations of the Framework Convention for Tobacco Control, Curbing the Epidemic, a Bank publication on tobacco, was frequently cited as the authoritative summary of the evidence on the economic issues. Work on risk factor surveillance and collaboration with external partners on issues related to water, sanitation and hygiene, indoor air pollution, and road safety continued to grow.

PROTECTING THE MOST VULNERABLE PEOPLE

Lending for social protection and risk management (including natural disaster management) totaled $2.3 billion in fiscal 2003, including $1.1 billion to Latin America and the Caribbean.

Coping measures and social protection, such as risk reduction and mitigation, are essential to protect vulnerable people. In 2003 such mechanisms helped countries create viable old-age income security for poor people, support the unemployed, develop equitable labor markets, eliminate child labor, and provide social safety nets and social funds for vulnerable groups. In addition, the Bank analyzed the effectiveness of social sector interventions and the appropriate mix of national interventions.

In 2003 the Bank took significant steps to integrate social protection within a number of country PRSPs. These activities began with a series of distance learning events (March–April 2002, with 21 countries and 170 participants), five Quality Enhancement Reviews (June 28–July 17, 15 countries), followed by three workshops: in Paris in April 2002 (17 countries and 101 participants); in Addis Ababa in November 2002 (12 countries and 145 participants), and in Paris in July 2002 (100 participants).

The Bank implemented the social protection strategy that was adopted in September 2000. This included undertaking risk and vulnerability assessments and social safety net assessments in Latin America and the Caribbean, South Asia, Europe and Central Asia, and East Asia and the Pacific, including two regional studies that profiled the risks to which poor people are exposed, the instruments they have to manage these risks, and actions to reduce their vulnerability. Guided by two new Bank-wide advisers, the work on children and youth, orphans and other vulnerable children, and disabled people gained new momentum.

In 2003 the Bank is concluding a comprehensive overview of international and national programs and interventions, and qualitative and quantitative data on child labor in Guatemala, Morocco, and the Republic of Yemen. The Bank is also completing a strategy to streamline its work on children and youth. In May the Bank held a second workshop on orphans and vulnerable children. And finally, the Conference on Disability and Development (see box 4.5) brought together Bank staff, bilateral development organizations, and nongovernmental organizations to discuss the role of the Bank in reducing poverty. Regional working groups on disability and development have been formed, and research is under way to further address disability in the Education for All movement, in combating HIV/AIDS, and in data and access issues. The Norwegian Trust Fund for Disability and Development continues to be an important source of support for all activities in this area, including projects in the field.