Human development

Human development in:

SP

SSP

KMS

In fiscal 1997 the Bank's strategy for supporting its clients' efforts to develop human capital and social systems focused on: (i) lending and, increasingly, nonlending services to support population, health, nutrition, and education, with a special emphasis this year on support of social programs that protect the most vulnerable people who might otherwise be left out of the growth process; and (ii) efforts to improve the quality of Bank services by working more closely with clients, collaborating with partners, and establishing a human development network to strengthen the Bank's ability to provide quality services. Figure 2-2 gives the breakdown of Bank lending to the social sectors in fiscal 1997.

Human development operations

By the end of fiscal 1997, cumulative Bank lending for human development totaled $41.9 billion, making the Bank the single largest external financier of HD programs in low- to middle-income countries, with active projects in 107 countries and 516 completed projects. In fiscal 1997, disbursements to the sector increased to $3.89 billion, a 45 percent increase over fiscal 1996.

Health, nutrition, and population programs (HNP). The Bank's activities in the HNP sector have grown to a cumulative value of over $12 billion, making the Bank also the single largest external financier of health programs in low- to middle-income countries.

The Bank's HIV/AIDS program has been an important developmental priority in recent years. HIV/AIDS is not simply a health problem, and the Bank's strategy focuses on multisector programs to accomplish the task of sustained prevention and care. These programs focus on HIV/AIDS prevention, treatment, and care at both the country and regional levels. They include projects to provide drugs for sexually transmitted diseases and AIDS-related infections, launch awareness and condom distribution campaigns, and conduct analysis and research on the socioeconomic impact of HIV/AIDS to find cost-effective prevention and care interventions. In fiscal 1997 the Bank extended loans for HIV/AIDS to Argentina, Cambodia, and Sri Lanka.

Designing effective policies to improve the performance of both private and government-run health systems has bedeviled both rich and poor countries over the past decade. In recent years, many countries have turned to sectorwide reforms to improve performance of their health systems and health, nutrition, and population policies. The Bank undertook a strategic shift in its HNP lending in fiscal 1997 to support its clients as they undertook such comprehensive sector reform, with loans totaling $940 million in eleven countries. These efforts were backed by extensive sector work that is providing lessons of experience from many countries.

Client focus has been strengthened through Bank participation in and cosponsorship of major international conferences. The Conference on Innovations in Health Care Financing, organized by the Bank's health group, drew 360 participants from over seventy countries, including more than thirty ministers of health or finance.

Providing the poor with access to family planning and other reproductive health services remains an important priority. The Bank is increasingly helping its clients to more closely link population policies with reproductive health policies, thus integrating them into poverty reduction efforts and the overall development agenda. The Second Maternal and Child Health and Nutrition Project in Argentina and the Reproductive and Child Health Project in India, both approved in fiscal 1997, illustrate this approach (see Summaries of Operations Approved).

Supporting better nutrition is addressed in ongoing Bank projects in a number of ways. Some of the more successful interventions include projects at the community level that emphasize behavioral change, such as in ongoing projects in Tanzania and Zimbabwe; those that target food-marketing programs to enable the poor greater access to food, such as in ongoing projects in Brazil, Colombia, and Honduras; and micronutrient programs, such as in Indonesia's Intensified Iodine Deficiency Control project, approved in fiscal 1997.

Education. In fiscal 1997 the Bank committed $1,017 million for eighteen education loans to fifteen countries. At the end of fiscal 1997, the cumulative value of Bank loans for all levels of education was $23.7 billion. Commitments for education loans temporarily declined from their fiscal 1995 and fiscal 1996 levels of $2,096.8 million and $1,705.7 million, respectively, mainly because of the increased focus on improving the quality and results of the existing portfolio; disbursement and supervision have increased accordingly. In some cases, such as in Brazil, new commitments were delayed as the education portfolio underwent a comprehensive review. The greater focus on portfolio performance through the fiscal year is reflected in a 23 percent increase in disbursements over fiscal 1996.

Attention to girls' education continues to increase among Bank clients. Among other benefits, better-educated women have been shown to have fewer and healthier children and to be in better health themselves and be more likely to educate their children and participate in their communities, through parent-teacher associations, for example. Thus, there is now wide recognition that investing in girls' education is one of the best investments a society can make in its own development.

Social protection (SP). In fiscal 1997 the Bank formed a social protection group, which addresses two priorities: (i) to enhance human capital productivity by improving the operation of labor markets, and (ii) to develop mechanisms and institutions to protect the most vulnerable people, including the elderly, disabled, and women. Social protection activities complement other Bank efforts in the area of social development, and interventions help protect the poor by addressing labor market reform, including unemployment insurance and vocational training, pension reform, and social assistance, including social funds.

Lending for social protection has grown explosively. In fiscal 1997, twenty-three social protection loans were approved, totaling $2.4 billion; twenty-three loans totaling $1.4 billion in fiscal 1996; and ten totaling $0.5 billion in fiscal 1995. By the end of fiscal 1997, cumulative lending for social protection totaled $5.3 billion. More than half of lending for social protection programs in fiscal 1997 was for adjustment loans to Mexico and Russia and a first-time pension adjustment loan to Argentina. Substantial new commitments supported labor market reforms, including support for reviewing labor code revision, employment creation in public schemes, and retraining unemployed or potentially redundant workers, especially in transition economies. Pension reform loans were extended to Argentina, Latvia, Mexico, Peru, and Russia, and social assistance loans to Argentina, Bulgaria, Jamaica, Lithuania, Romania, and Ukraine.

EDI is supporting the demand for knowledge, analytical tools, and lessons from country experience for effective pension reform. The conference on Pension Systems: From Crisis to Reform, held in Washington in November 1996, brought together eighty policymakers from more than thirty countries to discuss pension system design and implementation. Lessons drawn from the conference will be published and disseminated. EDI is also tailoring its activities to meet the specialized needs of different regions; for example, it is working with the government of Mexico to help implement the recently endorsed pension legislation. EDI and the government of Mexico will launch a virtual network of pension specialists in the Latin American region later this year.

Improving the quality of HD operations

In many countries, such as Botswana, Chile, and the Republic of Korea, where economic growth has gone hand in hand with investment in people, significant reductions in poverty have been achieved. In other countries, relatively low economic growth and under investment in people, combined with high population growth, have led to an increase in the number of people who live on a dollar or less a day. When current growth rates are insufficient, sound investment in people is necessary both to reduce human suffering and to lay the foundation for future improvement in living conditions.

Two new instruments are helping to strengthen the Bank's strategic focus and development effectiveness; they are sector strategy papers and knowledge management.

Sector strategy papers (SSP). While the CAS papers are used to elevate policy dialogue and increase development effectiveness in general, they will now be complemented by sector strategy papers (SSP), which provide a cross-cutting global perspective on Bankwide and regional priorities in sector development. The first SSP, on the health, nutrition, and population subsectors, was presented to the Executive Board's Committee on Development Effectiveness in fiscal 1997. Others, on education and social protection, are planned for fiscal 1998 and fiscal 1999, respectively.

Knowledge management. Knowledge management systems (KMS) are of increasing importance in retooling the Bank to better meet its clients' needs. In fiscal 1997 the Bank's education group developed a user-friendly KMS to provide staff with ready access to a variety of information resources, including: (i) "help desks"; (ii) on-line databases of policy papers, best practice papers, electronic forums, terms-of-reference, profiles of staff and consultants, and links to external resources; (iii) a statistical database containing internal Bank data; (iv) a clearinghouse function for data available from other agencies; and (v) a knowledge base on the economic aspects of human development, including good practice of economic analyses in project development. Parts of this system such as the new Early Child Development Web site are available to clients.

Within the KMS, the Education and Health Advisory Services were launched in fiscal 1997 to provide operational staff with customized information, advice on consultants and partners, and direct access to best practices from inside and outside the Bank. The KMS is only available externally on a limited basis at present but will eventually be expanded to provide more access for external users.

KMS is already filling a knowledge gap; for example, when the Nepal Resident Mission needed models of project implementation plans to help its client in the Ministry of Education, the Education Advisory Service provided best-practice examples from similar projects in Burkina Faso, Croatia, Ghana, and Turkey. It also made connections with officials in Turkey and with the Bank's HD office in Hungary to provide the Nepalese government with expert advice quickly on project implementation.

Improving client focus

Participation. A number of innovative programs are focusing on greater client involvement and participation in an effort to increase effectiveness and ownership. The Kenya Early Childhood Development project, for example, approved in fiscal 1997, is training 15,000 preschool teachers and 5,000 community representatives to run and monitor enriched child care programs. Centers will be managed by parent committees trained in organizing, managing, and monitoring early childhood services, with NGOs helping to oversee the communities' management of childcare centers. In Indonesia, two loans to support basic education were provided directly to the provinces of Central Indonesia and Sumatra to ensure local involvement in all phases of the project.

Nonlending services. Greater emphasis has been placed on the importance of economic and sector work (ESW) to raise the quality of the Bank's work in human development. Where possible, ESW is carried out jointly with country representatives. The Vietnam education sector financing study, for example, was prepared by a team co-managed by the government of Vietnam and the World Bank. The study, which places education and training needs within the larger political and macroeconomic framework and gives a comprehensive review of its efficiency, equity, and future direction, resulted in a frank assessment of Vietnam's economy. The government is considering the recommendations, including those to raise teachers' salaries and increase school hours.

A review of China's pension system identified two problems: state-owned enterprises are burdening the system, and the population is rapidly aging. The Bank and the government identified factors contributing to the problems and set out recommendations for solutions.

Sharing lessons of experience among countries is proving useful to policymakers in Central Asia, the World Bank, donor organizations, and other international agencies as they develop cost-effective health reform policies. A survey of health reform in Central Asia produced data on levels and trends in health status, delivery of services, and financing that were used to develop a health reform policy agenda based on the experiences of various countries undergoing similar economic transition.

Partnerships. Partnerships are especially important to increasing the efficiency and effectiveness of human development programs, and increased efforts were made in fiscal 1997 to improve partnerships with other organizations and to share knowledge and experience. The Bank enjoys a close relationship with the International Labour Organization (ILO), and the two institutions benefit from mutual cooperation. Two joint research projects were in progress in fiscal 1997, and in addition to regular informal discussions between staff, a high-level team of ILO officials visited the Bank and reached initial agreement on cooperation in a number of new areas. These include increased collaboration and consultations on harmful child labor practices and labor standards. Delegations from the International Confederation of Free Trade Unions and the World Confederation of Labor also held talks with senior Bank staff to discuss activities for future cooperation. And the Bank continues to work closely with United Nations agencies such as UNESCO, UNDP, and UNICEF, as well as WHO, on health and education programs.

Communications. A vital, but often overlooked component in the complex web of human development is the role of communications. Many of the most cost-effective public health interventions--for example, those aimed at promoting healthier lifestyles, safer reproductive health, and preventing communicable diseases--require behavioral changes that in turn depend heavily on the ability of governments or agencies to communicate effectively with target groups. Contraceptives, vaccines, and micronutrient supplements can only work if people choose to use them. Many other aspects of behavior, including sexual activity, use of harmful drugs, hygiene practices, and views on childrearing have important implications for overall health outcomes. The toolkit for communication for behavioral change was created in fiscal 1997 to provide state-of-the-art advice on best practices in this complex and important process.

Establishing the Human Development Network

Established in fiscal 1997, the Human Development Network was the first network in the Bank's new structure. It brings together all staff working on health, nutrition, population, education, training, and social protection. Headed by the HD council and organized in three sector boards--health, nutrition, and population; education; and social protection--the HD network is responsible for five major activities: strategy; knowledge; staff development; client responsiveness and external partners; and quality assurance.