The World Bank and other development partners have been involved in the implementation of nutrition programs for over 30 years. While a number of these programs have become successful and sustainable ...large-scale operations, many others have been hindered by political and administrative obstacles. The disparate results of these nutrition programs suggest that generating technically sound knowledge about nutrition and providing it to policymakers is not enough to ensure good results. It is also crucial to understand the political context, and the constraints and motivations of politicians, public officials, and other relevant players to initiate, implement, and sustain sound policies. In May 2007 the World Bank held an international workshop on these issues to help increase the impact of nutrition programs and policies at the country level. This paper summarizes the results of that workshop. Drawing from the political economy literature, it presents two frameworks for understanding how to undertake action to put nutrition on the agenda and move it forward, as well as insights on how and why political factors derail reforms and how to keep that from happening. These frameworks are accompanied by a discussion of the politics of nutrition policies, including typical obstacles to policy development and implementation, and possible solutions. To complement the political economy approach, the paper also draws on the insights that management and organizational fields offer regarding change promotion. Experiences from Senegal, Madagascar, Ghana, Tanzania, Benin, and India are discussed, sketching out the history of nutrition policies and the factors that promoted change, main obstacles and challenges. The paper closes with an attempt to encapsulate all elements presented in a single analytical framework, and provides plans of action for specific countries as prepared by some of the participants.
This part of the public sector pay reform policy note represents a summary of main messages and findings of the report. The report also provides the summary of simulations for various policy ...scenarios; it is not imperative that quantitative parameters of policy actions (for example, base pay levels, etc.) should be exactly the same as in the policy note, actual numbers may change depending on available fiscal space by the time when final decision is taken vis-a-vis pay increase. Summary of recommendations is provided in annex two; by the time when the report was ready for publication, the Government already took actions to address immediate objectives of the pay reform agenda in public sector; it issued a decree to increase pay levels for civil servants, education and health sector workers as well as other social sector workers. In general, the decree was consistent with overall immediate objectives of pay reform in public service. Public sector wage reform is a key aspect of the reform agenda in Tajikistan. The strong erosion of real wages, as a consequence of the civil war and the collapse of the economy in the 1990s, and very limited employment opportunities in the country combined with increasing opportunities for labor migration, as a consequence of growing economies in Kazakhstan and Russia, have led to a large outflow of qualified personnel in the public service. At the same time, these sectors are crucial to the achievement of Millennium Development Goals (MDGs) and for ensuring sustainable growth. The public sector continued to provide a quarter of employment (25 percent) over the last seven years. Job creation in the economy was very marginal. It is very likely that the public sector will continue be one of the major employers in the local labor market in medium term. The policy note focuses on civil service, education, health, social protection, science, culture, and sport, sectors with a very uneven reform background and different starting points. The policy note attaches special emphasis on state of play in these sectors and explores options that could encompass policy decisions of the authorities in a three- to five-year timeframe.
There is an emerging consensus in Papua New Guinea (PNG) -- both at the governmental level and among civil society more generally -- that human development outcomes are far less than satisfactory and ...that service provision in many parts of the country is collapsing despite the significant level of both government and development partner financing of the human development sectors. In response, the government and the Joint Donors -- the Australian Agency for International Development (AusAid), the Asian Development Bank (ADB), and the World Bank -- embarked on a Human Development Review to suggest options for improving human development outcomes and government expenditure efficiency. In this review of strategy options for health, HIV/AIDS, and education, it is argued that human development sectors are at an important crossroad with a large unfinished agenda and a range of critical challenges.
Poverty in Guatemala is part of the World Bank Country Study series. These reports are published with the approval of the subject government to communicate the results of the Bank’s work on the ...economic and related conditions of member countries to governments and to the development community.This report is part of a collaborative multi-year program of analytical work and technical assistance (the Guatemala Poverty Assessment Program, or “GUAPA” program). This poverty assessment report conducts an in-depth, multi-dimensional analysis of poverty building on the framework of the World Bank’s World Development Report (WDR) for 2000/2001 using both quantitative and qualitative data. This study also examines the impact of government policies and spending on the poor. Finally, it uses the empirical findings to identify options and priorities for poverty reduction in the future. Policy options are outlined not only in general, but for the specific themes and sectors covered. This report is also expected to contribute to the definition of the country assistance strategy (CAS) and lending operations of the World Bank and other donors, so as to make these interventions more effective in the future. This type of study is conducted by the World Bank in its client countries on a regular basis with the objective of assessing the poverty situation of the country in question.
The authors report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what ...determines their performance, and how the government can improve it. They find current performance leaves room for improvement in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector, or by simply encouraging providers-public and private-to compete with one another for individual patients. In contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid-shifting away from fee-for-service and the distorted price schedule toward prospective payments. Active purchasing by insurers could further improve outcomes.
The World Bank commissioned a capacity assessment study of the Ministry of Health (MOH) that was undertaken in March 2006. The terms of reference covered the following areas: Identify the existing ...analytical work being done by other donors in the health field and summarize their terms of reference and main conclusions; assess the MOH capacity to implement health policies and strategies adopted by the government; assess the MOH capacity to implement projects financed by the Bank, the Global fund, EU and others focusing the analysis on the MOH capacity for policy formulation, mobilization of funds, and program implementation; assess the capacity at central, provincial and municipal level in (i) program management, (ii) service delivery, including the number and distribution of staff; analyze the decision making process and the incentives for decision making including how much the system is centralized or decentralized; analyze the existing stock of health professionals including the MOH and military, identifying key constraints and gaps in capacity, government plans to increase capacity; existing training institutions and their capacity to produce new professionals and follow-up training; propose options for short term and long-term interventions including training managers, training of doctors and nurses, recruitment, on-job-training, review of curricula and other; make cost estimates of short term capacity building interventions that could be financed by the Bank and other donors; and identify future work that may be needed to undertake deeper or follow-up analysis.
Throughout the 20th century, the debate on women's rights and their role in Afghan society has been closely interlinked with the national destiny. Women not only carry the burden of symbolizing the ...honor of the family, but often are seen as embodying the national honor as well. Gender has thus been one of the most politicized issues in Afghanistan over the past 100 years, and attempts at reform have been denounced by opponents as un-Islamic and a challenge to the sanctity of the faith and family. During the years of turmoil, concerns about women's security led to the imposition of ever-stricter interpretations of socially acceptable female behavior, supported by the most conservative reading of the holy scriptures. Despite the rhetoric, women suffered from very serious human rights violations throughout the conflict. With the overthrow of the Taliban regime in 2001, Afghanistan embarked upon a new beginning, recognizing anew the contribution of the female half of its society. This Country Gender Assessment report identifies critical areas in which gender-responsive actions are likely to enhance growth, poverty reduction and human well-being. The extent of gender discrimination in Afghanistan is pervasive, and the present report focuses on a few key sectors deemed particularly important for both short- and long-term interventions. Gender gaps are widespread in health, education, access to and control over resources, economic opportunities and power and political voice, and while women and girls bear the direct cost of these inequalities, the negative effects are felt throughout society. This report makes the case that improvements in women's situation are essential for the reconstruction of the country - and that sizable investments in this regard will yield large benefits.
Forestry contributes 7-10 percent of Lao Gross Domestic Product (GDP) and 15-20 percent of non-agricultural GDP. In rural areas forest exploitation is one of the few available economic activities, ...and non-timber products provide more than half of family income. The sector contributes 34 percent of total export value, and even more of net foreign exchange. Forestry royalties as a share of government revenues have decreased from 20 percent in the mid-1990s to 6 percent of tax revenues and 5 percent of all revenues last year. Collection rates are low, around 50 percent, and royalty revenues have been declining since mid-1990s. Over the last five years, Treasury has realized only about one-third of the estimated market value of the timber harvested. Current wood industries' capacity exceeds long-term sustainable AAC, and despite heavy investment, their performance has not met expectations. There is no evidence that wood production has had a positive impact on rural poverty; rather it has had a negative one by destroying the environment on which the poor depend. This report concludes that fundamental problems in the forest policy framework can, and must be corrected for forestry to make its full contribution to national development. This Review focuses on proposing a narrow and select set of priority policy and implementation initiatives: improving production forest management and utilization, community participation in forest management, and controlling illegal logging. With interlinked and mutually reinforcing efforts in these areas, the production forestry sub-sector could be put on a sustainable path, greatly enhancing prospects or success in biodiversity conservation, watershed management and upland rural development. The blend of policy institutional and investment action needed, and priority for implementation is indicated in the attached summary Forest Policy Matrix and Proposed Action Plan.
This report is an attempt to assess the validity of poverty reduction strategies as an effective tool to manage poverty brought about by disability, by reviewing the disability policy content of ...poverty reduction strategy papers. In doing so, the report focuses on whether the specific poverty dimensions of disabled persons are acknowledged and the critical interventions for improving the economic and social integration of disabled persons are included in poverty reduction strategy papers. There is a wide consensus that disabled persons, being disproportionately poor, are among the population groups that should benefit from the poverty reduction programs of poverty reduction strategy papers. The issue, however, is whether they are de facto excluded from benefiting from current poverty reduction strategies. Poverty reduction strategy papers do not meet the needs of disabled persons because they are based on a limited social protection policy that conveys a wrong impression about the abilities and aspirations of the majority of disabled persons. Furthermore, they do not reflect the basic principles of the modern approach to disability adopted by the United Nations. Progress across regions and in developing the various components of the disability strategy has remained uneven. Partly for historical and institutional reasons related to the importance of pensions and transfers for the government budget, disability issues have received more attention among Eastern European countries. They have received the least attention in the Africa region.
Pharmaceuticals have a major impact on health, on government and household spending, and on health systems. Despite the fundamental role of pharmaceuticals, there remains a profound gap between the ...benefit which pharmaceuticals have to offer and the reality that for millions of people -- particularly poor and disadvantaged people -- medicines are unavailable, unaffordable, unsafe or improperly used. This World Bank Pharmaceuticals Discussion Paper provides a pragmatic analysis of some of the causes for this gap and strategic directions to help close this gap. The strategic directions outlined in this Pharmaceuticals Discussion Paper complement and reinforce the objectives outlined in the WHO Medicines Strategy: 2000-2003 (World Health Organization, Geneva, 2000, WHO/EDM/2000.1). The WHO strategy describes specific objectives, expected outcomes, and progress indicators in the areas of drug policy, access to essential drugs, quality and safety, and rational use of medicines. Both the World Bank and the WHO initiatives rest on a fundamental commitment to work with governments, on governmental organizations, the private sector, professional bodies, and other key actors to help strengthen the pharmaceutical sector and its ability to contribute to improved health outcomes.. The current burden of disease falling on the two billion people living on less than one dollar per day undermines both individual well-being and collective economic development. Much of this burden of disease can be reduced by securing the availability, affordability, and rational use of essential drugs of assured quality. Yet this aim can not be achieved by governments alone, by individual multilateral organizations working alone, or by any other individual organization. It can only be achieved when committed governments and local organizations are supported by clear, consistency, and mutually compatible approaches by agencies such as the World Bank, WHO, UNICEF, others in the UN family, bilateral donors, and the broader development community. This discussion paper provides an important contribution to this process.
