Health System Capacities in Developing Countries and Global Health Initiatives On Communicable Diseases

This background paper is an outgrowth of the IEG ’s evaluation of Bank supported global programs and was commissioned by the International Task Force on Global Public Goods. It represents the views of the authors and not those of IEG or of the International Taskforce on Global Public Goods. The paper focuses on communicable diseases, analyzing: The effectiveness of international health programs in building the capacity of national health systems to prevent communicable diseases, and The coherence across international health programs, given the importance of avoiding wasteful duplication and exploiting economies of scale and scope, especially in view of the limited resources at the disposal of developing countries. The paper assesses seven international health programs addressing communicable diseases: three programs with major financing—the Special Program for Tropical Disease Research (TDR); the Global Alliance for Vaccines and Immunization (GAVI); and the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM)—and four programs mainly for advocacy, broadly defined including international networking, planning for disease control, technical guidelines, training, promotion of best practices, monitoring and evaluation —the Global Forum for Health Research, UNAIDS, Stop TB, and Roll Back Malaria. Its recommendations include Develop an effective mechanism for greater coherence and coordination at both the strategic and the country operational level, especially among the three core organizations—WHO, the World Bank, and GFATM—but also other related partners and funders. Increase the core funding of WHO (as opposed to funding from extra-budgetary sources that are ad hoc and of questionable sustainability), so that WHO can properly serve as an anchor institution and satisfy the growing technical assistance needs of developing countries. The World Bank needs to become more proactive in building country-level health system capacities and coordinating the activities of bilateral donors in this field. The Global Fund needs to continue evolving towards becoming a true funding agency. Improve the balance between disease-specific and sectorwide programs, between treatment and prevention, and among the roles of public, private, and community organizations. Sharpen the focus of some programs and consolidate others. Establish programs aimed at overcoming shortages of skilled and motivated professionals for the health system as a whole. Substantially enhance monitoring and evaluation, research, and data gathering capacity at both the global and the country level.

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The Independent Evaluation Group (IEG) is an independent unit within the World Bank; it reports directly to the Bank's Board of Executive Directors. The goals of IEG 's evaluations are to draw lessons from Bank experience, and to provide an objective basis for assessing the results of the Bank's work.