How many of these four recommendations have been taken into consideration during the development of the World Bank health grant to Myanmar?

Jamie

++++++++++++++++++

World Bank Group Support to Health Financing
World Bank

The way countries finance health care influences how well a health system performs and achieves its expected outcomes, including how equitable and efficient it is. Countries decide how to mobilize revenues from different sources for financing health care, how to pool revenues in public and private insurance and in a national health system with automatic coverage (risk pooling), and how to purchase care from health care providers.

The World Bank has implemented health financing activities in 68 countries during FY03–12. Health financing interventions are found in about 40 percent of the Bank’s Health, Nutrition, and Population portfolio. Most projects include interventions on revenue collection from public sources. Almost half of the projects support public health insurance and automatic coverage. More recently, results-based financing (RBF) operations became more prominent. The International Finance Corporation (IFC) delivered a small program in health financing.

This is the first evaluation by the Independent Evaluation Group of the World Bank Group’s support to countries trying to address health financing issues. While much remains to be learned about the health benefits, equity in service use and finance, and the financial protection value of health financing reforms supported by the Bank Group, this evaluation has been able to draw the following four major conclusions:

- First, there have been some notable successes of Bank support to health financing. Bank support was more successful when the Health and Public Sector teams drew on a variety of skills across sectors and where government commitment to reforms was strong.

- Second, Bank support has helped raise or protect public revenues for health. Equity in pooling increased where the Bank assisted governments in subsidizing compulsory contributions to various health insurance for low-income groups. However, increased pooling did not always lead to pro-poor spending, improved equity in service use, or greater financial protection. Support to reduce user payments was limited.

- Third, the Bank has increased its focus on activity- or results-based payments supported by RBF projects. Little attention was paid to the impact on costs and broader effects on the public sector.

- Fourth, an integrated approach that links health financing with public sector reforms is likely to be more effective than single-issue interventions because it builds the institutions that are needed for sustainability. This includes equitable revenue instruments, taking into account the overall public finance situation, moving toward compulsory pooling in insurance and national health systems, focusing on strategic purchasing, and giving attention to adverse effects in a broader public sector context. The linking of health financing to public finance requires strong collaboration across the Bank Group to facilitate the dialogue at all government levels.

The evaluation makes five main recommendations: support government commitment and build technical and information capacity; address health financing as a cross-cutting issue at the country level; focus on health financing as a core comparative advantage; integrate all health financing functions; and strengthen monitoring and evaluation in Bank and IFC projects.

http://ieg.worldbank.org/evaluations/wbg-support-health-financing