Progress Update – Years 1 & 2

The World Bank’s Reproductive Health Action Plan 2010-2015

July 9, 2012

Summary

• 5-year WB Reproductive Health Action Plan (RHAP) approved by the Bank’s Executive Board in May 2010

• Aims at addressing reproductive health (RH) in 57 high burden countries*

• Focuses on improving RH outcomes through health systems strengthening

• Considerable progress made in Years 1 & 2 on delivering on the RHAP Results Framework

– RH is reflected more prominently in the Bank’s lending and technical assistance;

– We are strengthening our collaboration with global partners on RH

– The Bank is actively engaged with partners in the discussion on global funding fto accelerate progress on MDGs 4 and 5

2* New data on MMR and TFR indicates that 12 countries have progressed out of the high MMR and high TFR category, bringing the number of countries with high MMR and high TFR to 45.

Contents of the Presentation

• Context of the Reproductive Health Action Plan (RHAP)

• Activities and Achievements

• Opportunities and Challenges

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The RHAP Targets Interventions for High Burden Countries and Most Vulnerable Populations

To do this we are focusing on :

• 57 low-income countries with high maternal mortality and high fertility*;

• Meeting the reproductive health needs of young people;

• Improving reproductive health outcomes through health systems strengthening;

• Leveraging partnerships with governments, CSOs, academia, bilateral and multilateral agencies

While the RHAP focus is on low-income countries, we also capture lessons learned

from middle-income countries

4* New data on MMR and TFR indicates that 12 countries have progressed out of the high MMR and high TFR category, bringing the number of countries with high MMR and high TFR to 45.

The RHAP Aims to Address Persisting High Levels of, and Inequities in, Maternal Mortality and Fertility

• 287,000 maternal deaths globally annually

• 85% of these in SSA and South Asia

• Adolescents bear 23% of the disease burden due to pregnancy and childbirth

1.9

2.7

3.3

4.2

5.2

2.8

4.9

6.7

7.4

8

0 5 10

Richest

Fourth

Third

Second

Poorest

Angola 2006/07 Philippines 2008

• Significant intra and inter country inequity

• High unmet need for family planning in SSA (26%)

Fertility Rates By Wealth Quintiles2006/7, 2008 (select countries)

Maternal Mortality Ratios 2010

5Sources: WHO/UNICEF/UNFPA/The World Bank; 2012; Trends in Maternal Mortality: 1990 to 2010; Demographic & Health Surveys for Angola & Philippines (www.measuredhs.com)

Despite Some Progress, the Burden of Maternal Mortality Remains High in Low-Income Countries

• Globally, there were 260 maternal deaths/100,000 live births

• Sub-Saharan Africa had the highest burden of maternal mortality with 640 deaths/100,000 live births

• South Asia had the second highest burden with 280 deaths/100,000 live births

2008

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2010

• Globally, there were 210 maternal deaths/100,000 live births

• Sub-Saharan Africa continued to have the highest burden of maternal mortality with 500 deaths/100,000 live births

• South Asia had the second highest burden with 220 deaths/100,000 live births

The maternal mortality ratio for low-income countries is nearly 30 times that of high- income countries (410 deaths/100,000 live births vs. 14 deaths/100,000 live births)

Sources: WHO/UNICEF/UNFPA/The World Bank; 2012; Trends in Maternal Mortality: 1990 to 2010; WHO/UNICEF/UNFPA/The World Bank; 2010; Trends in Maternal Mortality: 1990 to 2008

• Context of the Reproductive Health Action Plan (RHAP)

• Activities and Achievements

• Opportunities and Challenges

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Contents of the Presentation

RHAP Results are Measured Against Three Components

Analytical and Advisory Work • Analytical and advisory work on RH to inform Country Assistance Strategies; lending and policy dialogue on health in the RHAP focus countries

COMPONENTS DESCRIPTION OF ACTIVITIES

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Improving Portfolio Monitoring on RH

Bank Capacity and Expertise on RH

• Conduct monitoring of Bank’s portfolio on reproductive health

• Establish a baseline for tracking Tier I & II RHAP indicators *

*Tier I indicators: Country development outcomes*Tier II indicators: Country intermediate outcome indicators

• Develop capacity and expertise within the Bank on RH , through recruiting technical specialists where possible and strengthening understanding and expertise of staff working in health sector.

The RHAP is Well On-Track on These Three Components

Conducted Analytical and Advisory Work to Inform Bank Operations

• RH profiles for 51 countries completed and used to inform policy dialogue and lending operations

• Global analysis to understand Success Factors for Achieving MDGs 4 and 5 (with PMNCH) - a mixed methods ongoing study with two phases. Phase I completed (includes literature review, development of a database of 200+ indicators, and 5 detailed country profiles with timeline). Phase II ongoing and includes data analysis, in-depth case studies on the 5 countries, and synthesis paper

• Completed National Health Accounts survey in 36 countries on integrating maternal and child health subaccounts into national health accounts; 7 countries already tracking Reproductive Maternal Neonatal and Child Health expenditures, and 10 to initiate tracking

ACTIVITIES ACHIEVEMENTS in Year 1 &2

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• Country Assistance Strategies or Country Partnership Strategies in 21 high MMR and/or high TFR countries approved and all include discussion on RH

Component 1

… and it is Well On-Track for Delivery in the Regions

• Analytical work on Demographic Dividend in African Countries focusing on policy implications of population growth and economic development initiated

• Case studies on breaking the family planning and nutrition dilemma completed. Advanced policy dialogue on integrating FP and nutrition in community based approaches in Ethiopia, Mali and Rwanda

ACTIVITIES

Africa:

• Analytical work on demand and supply side results based financing programs for reproductive health completed and disseminated

• Delivery strategies for sexual and reproductive health and second chance education and training for youth. Supported policy changes through identifying effective strategies in Papua New Guinea, Solomon Islands, and Vanuatu

East Asia & the Pacific:

• Review of reproductive health content in medical and nursing education curricula completed. Recommendations incorporated into curricula in Tajikistan, Uzbekistan, Moldova, Armenia, Azerbaijan and Kosovo

Eastern Europe & Central Asia:

ACHIEVEMENTS in Year 1 &2

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… and it is Well On-Track for Delivery in the Regions (contd.)

South Asia: • Launch of regional analytical work on Strengthening Commitment

to Sexual and Reproductive Health in South Asia, focusing on documentation of best practices, and identification of health systems bottlenecks

• Review of access barriers to RH services completed. Recommendations on RH and HIV convergence, stigma and harm reduction resulted in the National Plan for Convergence on RH and HIV and recommendations on harm reduction have influenced design of the new National AIDS program in India; policy changes in Maldives

ACTIVITIES

• Analytical work on universal health coverage examining the extent to which maternal health services are provided and maternal health outcomes ongoing

• Review of legal framework of legal rights on teen pregnancy. Framework completed in Nicaragua and Argentina, and nearing completion in El Salvador

Latin America and the Caribbean:

Middle East and North Africa: • Analytical work on Reproductive Health Rights in Egypt recently initiated

ACHIEVEMENTS in Year 1 &2

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ACTIVITIES

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Enhanced Bank Expertise and Capacity on RH

• 18 Bank staff designated as RH champions in their regions and actively coordinating on RH work

• Bank’s revised training course on RH offered in Washington DC in early 2012

• RH training course adapted for South Asia region; regional training held in Sri Lanka in April 2012

Component 2

The RHAP is Well On-Track on These Three Components

ACHIEVEMENTS in Year 1 &2

ACTIVITIES

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Regularized Portfolio Monitoring on RH

• Of the 38 HNP projects approved in the countries with high MMR or high, 47% include reproductive health focus.*

• 2 RH-specific projects in Mali** and Burkina Faso approved

• In addition, projects addressing reproductive health were approved in the following high MMR or high TFR countries:

Bangladesh, DR Congo, Iraq, Lao PDR, Mozambique, Nigeria, Swaziland, Yemen, Central African Republic, Madagascar, Malawi, Nepal, Nigeria, Pakistan, Senegal, Zimbabwe

• Baseline for tracking RH indicators for high MMR/high TFR countries established and available online

(Available at http://corporatescorecard.worlldbank.org; and additional indicators at http://data.worldbank.org

Component 3

The RHAP is Well On-Track on These Three Components

** Due to recent political instability in Mali, all Bank’s operations in the country are suspended.

ACHIEVEMENTS in Year 1 &2

* Of all ongoing HNP projects in countries with high MMR or high TFR, 70% include reproductive health

RH in Bank lending for health

(US$ million) FY10- FY11

FY10 FY110

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

491830

4,383

2,961

RH Only HNP Funding

As a result, World Bank investments in RH are up…

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Bank lending for RH (US$ million)

FY11 approvals

74

370

324

9

31

22

AFR SAR LCREAP MENA ECA

“RH only” in the above figure includes lending for Health Systems Strengthening, child health and nutrition that is oriented to RH outcomes

Source: World Bank Analysis of HNP Portfolio for FY10 and FY11. Update available October 1, 2012.

PROJECT

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World Bank projects on RH are showing promising results

Burundi Health Sector Development Support Project

• The project supports the nation-wide results-based financing (RBF) program. Notable RH achievements in first year include:

An increase facility based births by 25% Increase in prenatal consultations by 20% 35% increase in curative care consultations for pregnant

women; and 27% increase in family planning services obtained through

health facilities

Strengthening Health Activity for Rural Poor Project (Afghanistan)

• The project has been very successful in improving maternal and child health outcomes through better services, including:

Facilities with skilled female health workers increased from 25% to 83% between 2002 and 2007

4-fold increase in outpatient visits between 2004 and 2007

Second HNP and HIV/AIDS Project (Nepal)

• Project has led to significant improvements for maternal health since 2010, including:

36% increase in skilled attendance at birth 43% increase in use of contraception 85% increase in pregnant women attending at least 1 ANC

consultation

ACHIEVEMENTS in Year 1 &2

PROJECT

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World Bank projects on RH are showing promising results (contd.)

Second Women’s Health & Safe Motherhood Project (Philippines)

• The project supports the Government’s efforts in 5 provinces to improve maternal and child health. Between 2005 and 2010 notable achievements include:

Increase in facility based births from 53% in 2009 to 68% 450+ teams trained on Basic Emergency Obstetrics Care

Health Services Improvement Project (Lao PDR)

• The project aims to increase utilization and quality of health services for poor children and women in 8 rural provinces. Between 2005 and 2011 some project achievements include:

45% pregnant women received tetanus vaccinations 35% of women obtaining modern contraception from public

health facilities. 76% of children under age 1 fully immunized

Health Sector Development Project (Djibouti)

• Project has led to significant improvements for maternal health between 2002 and 2011 include:

58% increase in medically assisted deliveries Decrease in HIV/AIDS prevalence among young pregnant

women from 2.9% to 1.4% Decline in child mortality from 103 to 67 deaths/1000 live

births DPT3 vaccination increased by 45%

ACHIEVEMENTS in Year 1 &2

Contents of the Presentation

• Context of the Reproductive Health Action Plan (RHAP)

• Activities and Achievements

• Opportunities and Challenges

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• RH specific indicators in the IDA16 results matrix*

• The UNSG’s Every Woman, Every Child global strategy for women and children’s health (MDGs 4 & 5) synergizes with the RHAP

• The Bank is a key stakeholder and partner with PNMCH in the dialogue on scaling up financing for MDGs 4 and 5

Looking Ahead, There are Opportunities to Continue Scaling Up Support for Reproductive Health

* RH-specific indicators are included in the IDA results matrix, namely Prevalence of HIV/AIDS (% of population aged 15-49), Births attended by skilled health staff (% of total births), Adolescent fertility rate (births per 1,000 women ages 15-19), and Maternal mortality rate (modeled estimate, per 100,000 live births).

Overall: Substantial Achievements to Date, But Key Challenges Remain

• Scaling up the most effective ways to incentivize demand for RH services, including family planning, at country level

• Delivering on the continued need to strengthen country level capacity

• Ensuring full leverage of the Bank’s multi-sectoral advantage to improve RH outcomes, including leveraging RH as a tool for women’s empowerment

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