The World Bank: Policies and Investments for Reproductive Health Sadia A Chowdhury Coordinator, Reproductive and Child Health, The World Bank Bangkok, Dec 9, 2010
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Maternal Mortality Ratio (MMR): Burden remains high in South Asia 1,000 900 MMR (per 100,000 live births) 800 700 600 500 400 300 200 100 1990 2005 0 East Asia & Pacific Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub-Saharan Africa Source: Maternal Mortality in 2005, Estimates developed by WHO, UNICEF, UNFPA and The World Bank.
Highest Total Fertility Rate (births per woman) 6 5 4 TFR 3 2 1 0 East Asia & Pacific Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub- Saharan Africa Note: 35 countries have TFR >5 (31 in AFR, 4 in EAP, SAR and MNA) Source: WDI 2006.
Contraceptive Prevalence Rate 100 Percent of women ages 15-49 80 60 40 20 0 East Asia & Pacific Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub- Saharan Africa Source: WDI 2006.
But In-Country Variations Can Be Significant Percentage institutional deliveries (%) 0 20 40 60 80 100 Institutional deliveries vs fertility rates across districts in India, 2007-08 Kerala Tamil Nadu Rajasthan Uttar Pradesh Chattisgarh 0 20 40 60 Percent of births of parity 3 or higher (%) Source: DLHS-III Country Wealth quintile Lowest Second Middle Fourth Highest Total Bangladesh 2007 3.2 3.1 2.7 2.5 2.2 2.7 Colombia 2005 4.1 2.8 2.4 1.8 1.4 2.4 India 2006 3.9 3.2 2.6 2.2 1.8 2.7 Namibia 2007 5.1 4.3 4.1 2.8 2.4 3.6 Philippines 2003 5.9 4.6 3.5 2.8 2.0 3.5 6
Technical solutions to improve Reproductive Health are well-known, but not well implemented and coverage remains inequitable due to lack of Political Commitment and Weak Health Systems 12/9/2010 7
Stronger Health Systems: More Health for the Money, More Money for Health Financing Infrastructure & supplies Governance Personnel RESULTS Insurance Information Payments/ incentives Logistics
How to address Health Systems and Demand Challenges? Enhancing the ability of couples to plan families through improved access to modern contraceptives Less than half the demand for family planning is being met. Poor planning and logistics often cause shortage stock-out of Contraceptives. Ensuring that all women receive skilled care during pregnancy, child birth and after delivery as complications are not predictable A third of pregnant women do not receive care from skilled birth attendants during childbirth. Poor access to facilities and shortage of trained health workers remains a challenge, especially in Africa. Addressing financial and cultural barriers to enhance demand for RH services Use of services by the poorest households remain low. 12/9/201 0 9
Sustained political commitment and leadership are vital At the national and local levels, the quality of overall governance directly affects the health systems functioning and the accountability of providers and program managers to the clients and results. Countries where Government effectiveness is higher tend to have better reproductive health outcomes consistently than countries with poor governance At the global level, despite growing global consensus on solutions, political commitment and supportive actions has remained weak This is reflected in the ODA flows - we are not spending what we should and where we should. 12/9/2010 10
The World Bank s Commitment to Reproductive Health The Bank gave its first health sector loan to Jamaica for family planning (US$ 2m) in 1970. Since 1994, the Bank has committed US$ 24 billion in health and US$ 2.5 billion for Pop/RH The Bank s policy on population and reproductive health has evolved over time responding to its client country needs and global consensus. The 2007 HNP strategy re-affirms Bank s commitment to ICPD 1994, and places high emphasis on delivering comprehensive package of services through health systems In 2010 Reproductive Health Action Plan focuses on improving RH outcomes particularly for the poor and vulnerable with strong focus on health systems strengthening 12/9/2010 11
Pop/RH Pipeline FY09 and 10 *IBRD/IDA/Grant Commit Amt in Millions $33.3 $28.4 $63.7 $35.3 $40.0 AFR EAP SAR ECA MNA LCR $131.2 12/9/2010
The World Bank s Reproductive Health Action Plan 2010-20152015 Reproductive health is fundamental to better human development. Investing in Women s Health not only improves the mother s health and that of her family but also contributes economic growth and build secure nations. 12/9/2010 13
WB Reproductive Health Action Plan Develop more effective and efficient national health systems Support increased use of reproductive health services, focusing on assisted deliveries and family planning Tie financing to performance in maternal health programs Protect poor women from ill health and unaffordable costs and treatment Motivate young people to delay pregnancy and achieve higher levels of education 12/9/2010 14
WB RHAP s Focus High Burden Countries with high Maternal Mortality (MMR>220) and Fertility (TFR of 3 and above) Health Systems Strengthening to ensure availability of quality contraceptives, skilled birth attendants and Emergency Obstetric Care Reaching the Poor through conditional cash transfers/vouchers and CSO/Private partnerships Engaging the Youth through cross sectoral efforts (education and youth empowerment) and making facilities and providers responsive Promoting Partnerships for country led-health systems strengthening to deliver and finance quality reproductive health services (IHP+; H4+; PMNCH; RHSC; GAVI/GFATM/WHO/WB HSP ) 12/9/2010
East Asia & Pacific Laos Health Service Improvement Project: improve quality and utilization of health services, and strengthen the provision and delivery of a minimum package of health services including reproductive health services. Laos Community Nutrition Project aims to improve coverage of essential maternal and child health services and improve mother and child caring practices among pregnant and lactating women and children less than two years old. Cambodia: Second Health Sector Support Program - reduce maternal, infant, and child morbidity and mortality through the provision of increased reproductive and health services. Philippines: Second Woman s Health and safe motherhood supports the Government's continuing efforts to promote the health of women and their children. Three key components of Women's Health services will receive special focus under the project -- (i) family planning, (ii) RTI/STD/HIV/AIDS prevention, and (iii) emergency obstetrical care. Timor Leste: Health Sector Strategic Plan Support Project- to improve the quality and coverage of preventive and curative health services, particularly for women and children, in order to accelerate progress toward the health MDGs.
East Asia & Pacific PNG: Assessment of Family Planning Services identification of level of constraints faced by men, women and communities seeking to access family planning services, as well as by providers of family planning services; Pacific Islands: Identifying Delivery Strategies for Sexual and Reproductive Health for Youth in the PNG, Solomon Islands and Vanuatu analyzing supply-side and demand-side barriers to access and delivery, to create better evidence and information for policy regarding improvement of health among youth; Indonesia: policy note assessing the impact of Jamkesmas, the Government s financed health insurance for the poor, on skilled birth attendance in Indonesia; Indonesia Maternal Health Assessment: a rapid review of the current policies and programs in maternal health, to advise the development of Indonesia s Medium-Term Development Plan 2010-2014;
. 12/9/2010 South Asia Analytical Report Sparing Lives, Better Reproductive Health for Poor Women in South Asia. Five focus countries Bangladesh, India, Nepal, Pakistan, and Sri Lanka India Second Reproductive and Child Health Project Bangladesh HNP assists the GOB in implementation of its Strategic Investment Plan 2003-2010. Reproductive health one of the priories in the health sector program under preparation. Pakistan, Afghanistan, Nepal and in several Indian States, the Bank has provided operational support for systems strengthening with an emphasis on reproductive health and MCH services. Sri Lanka - Health Sector Development Project (USD 65 million) provides support to reduce the inter district variation for MCH services and related health outcomes.
with H4+ Afghanistan : A joint action plan including launch of a maternal mortality survey report in March 2011, & provincial MNCH planning and programming: H4 missions also planned in Bhutan, Nepal and Bangladesh, to inform national strategic planning PNG Family Planning Assessment a H4+ collaboration
A SAR Reproductive Health team has been formed with a focal person in each country team. The priorities are: Regional knowledge sharing & capacity building-- documenting and sharing best practices south-tosouth Monitoring progress towards MDG 4 and 5 with a focus on a core set of indicators Making partnerships work for our clients, e.g. maximizing the benefits of H4 missions and other global partnerships
Moving Forward With only 5 years left for 2015, there is urgent need to scale-up efforts to improve reproductive health outcomes as many countries in Sub Saharan Africa are not on track to achieve the MDG 5 Its not only that we need more money, we also need to do much better with the resources available While improving health systems is necessary, it is also important to address social and economic barriers outside the health systems limiting access to essential health services for women 12/9/2010 21
Thank You