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Topic:Health, Nutrition, & Population
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Comoros CLR Review FY14-19

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This review of the Comoros Completion and Learning Review (CLR) of the World Bank Group (WBG) Country Partnership Strategy (CPS) covers the CPS period, FY14-FY19, and the Performance and Learning Review (PLR) of December 2018. This is the first CPS for Comoros following a series of Interim Strategy Notes (ISNs), the latest of which was prepared in 2010. The WBG programs under the ISNs were Show MoreThis review of the Comoros Completion and Learning Review (CLR) of the World Bank Group (WBG) Country Partnership Strategy (CPS) covers the CPS period, FY14-FY19, and the Performance and Learning Review (PLR) of December 2018. This is the first CPS for Comoros following a series of Interim Strategy Notes (ISNs), the latest of which was prepared in 2010. The WBG programs under the ISNs were limited in scope reflecting the high level of political instability, serious governance issues and related low IDA allocations. The CLR highlighted several lessons about a need to ensure a streamlined project design and flexibility in implementation; value of increased WBG presence on the ground; importance of donor coordination; and a need for greater realism and selectivity in the program. IEG particularly agrees that there is need for greater realism and selectivity in the program, throughout the program, beyond the governance area on which the lesson in the CLR focuses. Being excessively ambitious with respect to institutional targets in a fragile environment increases the risk of program underperformance. IEG adds the following lesson: The decision on a large program expansion at the PLR stage requires a detailed discussion and careful justification in the PLR document because it poses a longer-term implementation risk.

An Evaluation of the World Bank Group’s Support to Municipal Solid Waste Management, 2010–20 (Approach Paper)

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Municipal solid waste (MSW) has emerged as one of the most pressing challenges for urban areas across the world. This evaluation is the Independent Evaluation Group’s (IEG) first major study of the Bank Group’s support for MSWM. It is timely given the rapidly increasing scale of MSW in most MICs and LICs and considering the spectacle of massive open garbage dumps in cities as diverse as Manila, Show MoreMunicipal solid waste (MSW) has emerged as one of the most pressing challenges for urban areas across the world. This evaluation is the Independent Evaluation Group’s (IEG) first major study of the Bank Group’s support for MSWM. It is timely given the rapidly increasing scale of MSW in most MICs and LICs and considering the spectacle of massive open garbage dumps in cities as diverse as Manila, Lagos, and New Delhi. The evaluation will highlight the linkages of MSWM with other sectors and themes such as water supply and sanitation, environment, climate change, health, jobs, and social protection. This can point to how the Bank Group can better support the development of synergistic policy frameworks and regulations for MSWM in client countries. This has implications for developing systematic collaboration between various sectors within the Bank Group and among client government ministries and for leveraging opportunities for climate finance.

Madagascar: Emergency Support to Critical Education, Health, and Nutrition Services Project and Additional Financing (PPAR)

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The World Bank suspended operations in Madagascar in 2009 after a coup d’état and establishment of a de facto government. The unconstitutional regime change caused a prolonged period of political crisis, and together with the 2008 financial crisis, threatened to reverse a decade of sustained gains in social and economic indicators. The dearth of public financing for basic social services and the Show MoreThe World Bank suspended operations in Madagascar in 2009 after a coup d’état and establishment of a de facto government. The unconstitutional regime change caused a prolonged period of political crisis, and together with the 2008 financial crisis, threatened to reverse a decade of sustained gains in social and economic indicators. The dearth of public financing for basic social services and the withdrawal of most donors during the protracted political crisis were especially concerning. The Emergency Support to Critical Education, Health, and Nutrition Services Project was prepared in 2012 after the World Bank’s reengagement in Madagascar and before reentry of other partners. The project’s objective was “to preserve critical education, health, and nutrition service delivery in targeted vulnerable areas.” The project initially focused on five of Madagascar’s poorest and most vulnerable regions, where other donors were not active, and eventually extended nutrition services only to four additional regions (of 22 regions in the country). Ratings for the Emergency Support to Critical Education, Health, and Nutrition Services Project and Additional Financing are as follows: Outcome was highly satisfactory, Bank performance was moderately satisfactory, and Quality of monitoring and evaluation was modest. This assessment offers the following lessons, which focus on the challenges of further strengthening and sustaining a multisectoral approach to nutrition raised in this report: (i) A multisectoral approach, which delivers a range of services that benefit communities, can have a synergistic and impactful effect on the health and nutrition of mothers and children. (ii) The effectiveness and efficiency of Madagascar’s nutrition efforts are contingent on the ONN fully assuming its primary mandate of multisectoral coordination, with the full support and recognition of the public sector, at all levels of government, and in partnership with leaders and stakeholders in the political, administrative, religious, and traditional arenas and in the private sector. (iii) The roles and comparative advantages of the regions and districts in the strategic management and implementation of service delivery, including the support and encouragement of cross-sectoral synergies, will continue to be underexploited as long as the government’s structure is highly centralized. (iv) Successful mobilization of domestic and international resources, planning, programming, and priority setting—including managing the tensions between the goals of expanding nutrition coverage and strengthening existing services—will be difficult to achieve without investments in ONN capacity. Over and above the capacity strengthening needed, improved aid effectiveness and the sustainability of Madagascar’s nutrition efforts also depend on development partners working closely with ONN and the regions and supporting their development plans and priorities, and on an evolution from projects to program support. (v) The World Bank can play a pivotal role in supporting ONN to assume its multisectoral coordination role by advocating to the highest levels of government the importance of prioritizing nutrition as a means of achieving its development objectives and of allocating more budgetary resources to this end, and in supporting the decentralization process to empower regions. (vi) Emergency operations can provide an opportunity for embarking on broader development efforts, as shown by this project, whose interventions transcended recovery efforts. However, the inclusion of such development support without attention to sustainability can undermine gains postproject.

Madagascar: Projet d’Appui d’Urgence aux Services Essentiels d’Éducation, de Santé et de Nutrition et à son financement additionnel (PPAR)

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En 2009, la Banque mondiale a suspendu ses opérations à Madagascar suite à un coup d’état et l’installation d’un gouvernement de facto. Le changement de régime inconstitutionnel provoqua une période de crise politique prolongée qui, ajoutée à la crise financière de 2008, a menacé de renverser une décennie de progrès soutenus des indicateurs sociaux et économiques. Particulièrement inquiétant Show MoreEn 2009, la Banque mondiale a suspendu ses opérations à Madagascar suite à un coup d’état et l’installation d’un gouvernement de facto. Le changement de régime inconstitutionnel provoqua une période de crise politique prolongée qui, ajoutée à la crise financière de 2008, a menacé de renverser une décennie de progrès soutenus des indicateurs sociaux et économiques. Particulièrement inquiétant était le problème du manque de financement public destiné aux services sociaux de base et du retrait des partenaires financiers durant cette crise politique prolongée. Le Projet d’Appui d’Urgence aux Services Essentiels d’Éducation, de Santé et de Nutrition fut préparé en 2012, juste après le réengagement de la Banque mondiale et juste avant le retour des autres partenaires. L’objectif du projet était « … de préserver la fourniture des services essentiels d’éducation, de santé et de nutrition dans les zones vulnérables ciblées. » À l’origine, le projet s’est concentré sur cinq des plus pauvres et plus vulnérables régions de Madagascar, là où les autres partenaires financiers n’étaient pas actifs, pour finalement étendre seulement ses services de nutrition à quatre régions supplémentaires (sur un total de 22 régions du pays). Les évaluations du Projet d’Appui d’Urgence aux Services Essentiels d’Éducation, de Santé et de Nutrition et de financement supplémentaire sont les suivantes: les résultats ont été très satisfaisants, la performance de la Banque a été modérément satisfaisante et la qualité du suivi et de l'évaluation était modeste. De cette évaluation se dégagent les leçons suivantes qui visent à mettre l’accent sur les défis posés pour renforcer davantage et assurer la durabilité d'une approche multisectorielle à la nutrition soulevés dans ce rapport : (i) Une approche multisectorielle fournissant une gamme de services qui bénéficient aux communautés peut avoir un effet synergique et des répercussions importantes sur la santé et la nutrition des mères et des enfants. (ii) L’efficacité et l’efficience des efforts de Madagascar en matière de nutrition dépendent des efforts de l'Office National de Nutrition (ONN) à assumer pleinement son mandat principal de coordination multisectorielle, avec le plein soutien et la reconnaissance du secteur public, à tous les niveaux du gouvernement, et en partenariat avec les dirigeants et les parties prenantes dans les domaines politique, administratif, religieux et traditionnel et dans le secteur privé. (iii) Les rôles et avantages comparatifs des régions et des districts dans la gestion stratégique et la mise en œuvre des fournitures de services, notamment l'encouragement et le soutien aux synergies intersectorielles, continueront d'être sous-exploités tant que la structure du gouvernement restera fortement centralisée. (iv) Une mobilisation réussie des ressources nationales et internationales, la planification, programmation et définition des priorités, notamment en ce qui concerne la gestion des tensions entre les objectifs d'élargissement de la couverture nutritionnelle et ceux de renforcement des services existants, seront difficiles à réaliser en l'absence d’investissements pour développer les capacités de l’ONN. Au-delà de la nécessité de renforcer les capacités, améliorer l’efficacité de l'aide et la durabilité des efforts de Madagascar en matière de nutrition va également dépendre de l’engagement des partenaires au développement à travailler en étroite collaboration avec l'ONN et les régions, de leur appui aux plans et priorités de développement de ceux-ci et de l'évolution du soutien des projets vers une approche programme. (v) La Banque mondiale peut jouer un rôle central, notamment en aidant l'ONN à assumer son rôle de coordination multisectorielle ; en faisant valoir auprès des plus hautes instances du gouvernement l'importance de donner priorité à la nutrition comme moyen d'atteindre les objectifs de développement et d'allouer davantage de ressources budgétaires à cette fin ; et en apportant un appui au processus national de décentralisation pour donner aux régions les moyens de se prendre en charge et d’agir. (vi) Les opérations d’urgence peuvent être l’occasion d’explorer et de lancer des efforts de développement plus larges, comme le montre ce projet dont les interventions ont transcendé les efforts de redressement entrepris. Cependant, l'inclusion d'un tel appui au développement sans une attention accordée à sa durabilité peut, après le projet, compromettre les gains réalisés. English version: Madagascar: Emergency Support to Critical Education, Health, and Nutrition Services Project and Additional Financing (PPAR)

Sierra Leone - Completion and Learning Report : IEG Review

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This is a validation of the Completion and Learning Review (CLR) for the World Bank Group’s (WBG) engagement in Sierra Leone covering the Country Assistance Strategy (CAS, FY10-FY13). For completeness and learning purposes, and while the CAS formally expired in FY13, IEG has elected to examine the period FY14-FY19 as well as no CPF was in place to replace the CAS. Owing to data limitations and in Show MoreThis is a validation of the Completion and Learning Review (CLR) for the World Bank Group’s (WBG) engagement in Sierra Leone covering the Country Assistance Strategy (CAS, FY10-FY13). For completeness and learning purposes, and while the CAS formally expired in FY13, IEG has elected to examine the period FY14-FY19 as well as no CPF was in place to replace the CAS. Owing to data limitations and in line with relevant provisions of the Working Arrangements between the Independent Evaluation Group and WBG, IEG’s review does not rate the CAS’s overall development outcome or the World Bank Group’s performance.

3 lessons from past public health crises for the global response to COVID-19 (coronavirus)

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James Cooper, Sunday Bondo and Patrick Lappaya work together closely to take a sample swab to help determine the death of a women at C.H. Rennie Hospital in Kakata, Margibi County in Liberia on March 10, 2016. Image Credit World Bank
As the public health emergency of the novel coronavirus spreads globally, there is growing interest in how the international community can support countries’ responses to COVID-19 (coronavirus). By analyzing information from recent IEG evaluations of the World Bank Group’s response to public health crises, we identified three lesson areas that shed light on what works and where attention is Show MoreAs the public health emergency of the novel coronavirus spreads globally, there is growing interest in how the international community can support countries’ responses to COVID-19 (coronavirus). By analyzing information from recent IEG evaluations of the World Bank Group’s response to public health crises, we identified three lesson areas that shed light on what works and where attention is needed to deliver both an immediate and a long-term response to the current crisis. MOUNTING A RAPID RESPONSE: Flexible financial response mechanisms are critical for providing timely support and additional funds to address the impacts of a crisis. In 2011, the International Development Association, the World Bank fund for the world’s poorest countries, created a Crisis Response Window (CRW) to deliver timely support to eligible countries faced with severe crises stemming from natural disasters, economic shocks, and public health emergencies. A 2019 evaluation revealed that about half of CRW operations used the additional financing to rapidly scale up operations that were already underway, such as a 2017 allocation to the Republic of Yemen to cope with one of the world’s worst cholera outbreaks amid continuous conflict. In response to the COVID-19 pandemic, the World Bank has established a Fast-Track COVID-19 Facility to address immediate health and economic needs in countries.   Adapting existing operations and reacting quickly to new information can contribute to reducing project design time and to enhancing performance. The World Bank’s Avian Influenza response made use of broad project templates, which listed a wide array of options for governments to tackle the crisis. This contributed to reducing time spent on project design and approval The first phase of the COVID-19 response is organized under a flexible Multiphase Program Approach which will allow for the leveraging of existing operations and ongoing learning about the impacts of the pandemic and adapting the support to countries. Recent experience suggests that partnerships contribute to mitigating risks related to rapid project preparation.  While this can pose challenges to ensuring project quality, evaluations of CRW operations for crises showed that partnering with UN institutions can  mitigate this risk because of the specialized knowledge they bring, and their capacity to implement projects quickly and successfully. COVID-19 operations are being prepared in less than one week, which is unprecedented in the Bank's history. Cooperation and coalition building among countries can strengthen response performance and address longer-term needs. The Bank Group’s response to Ebola was coordinated with a coalition that helped organize the deployment of the necessary knowledge and skills across West African countries to prevent and control the spread of the disease. After Ebola, the Africa Centers for Disease Control and Prevention (CDC) was set up as a regional network to strengthen the continent’s public health institutions and response to disease threats and outbreaks.       Enlarge and download infographic CONTROLLING THE SPREAD: Real-time monitoring of communications and public awareness programs is important to ensure their effectiveness. It cannot be taken for granted that communications campaigns aimed at key segments of the population on hygiene and control are working. Experience from the Avian Influenza suggests that assessing the impact of communications and public awareness programs on behavior is important, to understand what might be needed to achieve the desired changes. The evidence gathered can inform any necessary course corrections in the communications strategies. Mobilization and coordination of civil society and grassroots groups is essential for effective disease monitoring, and case identification in countries. In the case of Avian influenza, weak networks between government and grassroots organizations in some countries meant that important information on cases was not reported for disease monitoring. This lack of timely and trusted access to community level information reduced the effectiveness of investments in the formal disease monitoring and surveillance platforms in some countries. In the case of Ebola, the mobilization of civil society groups was essential to communicate information on the disease and to trace contacts, with cellular phones a key tool. Investments in technology and equipment need to be balanced with capacity building of health workers and knowledge to support laboratory diagnostics. Technical training of health workers and systems for knowledge sharing and communication may be the most important and rapid way to build laboratory capacity and scale-up disease testing. Facility and equipment upgrades have proven to be more complex, expensive, and time consuming than initially projected. IMPLEMENTING A SUSTAINABLE LONG-TERM RESPONSE: Most World Bank operations in response to COVID-19 will go beyond the immediate emergency, creating opportunities for projects that also help countries address long-term risk reduction. Effective logistics will be critical for both the current and future public health crises. If a vaccine or efficacious antivirus for coronavirus becomes available, purchasing it for use by health workers or other vulnerable persons could be valuable, but logistics issues are key. The Avian influenza experience show the importance of logistics management of these supplies to ensure value added use of scarce funds, and access to vulnerable persons. Antiviral drugs have a limited shelf-life and in the case of Avian influenza large stockpiles of purchases drugs went unused even during outbreaks. The WBG and its partners can help strengthen preparedness plans and frameworks in countries with weaker health systems. Preparedness of the health system is the first line of defense. This was a main recommendation of IEG’s evaluation on World Bank Group Support to Health Services. Better staffed health services, protective equipment, laboratory diagnostics, clinical management, surveillance systems, and rapid contact tracing skills can all allow countries to mount more effective responses.   pictured above: James Cooper, Sunday Bondo and Patrick Lappaya work together closely to take a sample swab to help determine the death of a women at C.H. Rennie Hospital in Kakata, Margibi County in Liberia on March 10, 2016. photo credit: World Bank

Myanmar – Completion and Learning Report : IEG Review

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This review of the World Bank Group’s (WBG) Completion and Learning Review (CLR) covers the period of the Country Partnership Framework (CPF), FY15-FY17, and updated in the Performance and Learning Review (PLR) dated June 2, 2017, which extended the CPF period by two years to FY19. This CPF followed the end-2012 Interim Strategy Note (ISN) that resumed WBG operations after a hiatus of about 25 Show MoreThis review of the World Bank Group’s (WBG) Completion and Learning Review (CLR) covers the period of the Country Partnership Framework (CPF), FY15-FY17, and updated in the Performance and Learning Review (PLR) dated June 2, 2017, which extended the CPF period by two years to FY19. This CPF followed the end-2012 Interim Strategy Note (ISN) that resumed WBG operations after a hiatus of about 25 years. To support the Government’s development efforts, the WBG implemented a major expansion of its activities (a seven-fold increase in the Bank’s portfolio), possibly beyond what the country could absorb. Nevertheless, this support contributed to good progress on farming productivity; on access to electricity, telecommunications, health, education, and finance; and on the business climate. IEG agrees with the lessons drawn by the CLR. These are reformulated and summarized as follows: (i) In an environment of constrained implementation capacity, projects with diverse objectives and multiple implementing agencies may become unwieldy and lead to delays in project implementation. (ii) A results framework that excludes the program’s cross-cutting issues will impede assessment of success in addressing these issues. (iii) Use of country systems, support of key reform champions, and joint analytical work are among the factors that build trust with counterparts and stakeholders. (iv) Access to and coordination of trust fund resources will encourage effective implementation and collaboration across development partners. (v) Good and timely data is critical for evidence-based policy dialogue and timely response to country developments. (vi) A “one WBG” approach is critical to leverage WBG instruments toward specific objectives such as access to electricity. Seventh, more careful attention to indicators, including their sources, baselines, targets and time frames will facilitate program monitoring. (vii) A “disconnect’ between written implementation rules and actual practices in Myanmar, e.g., on procurement, may cause implementation delays. IEG adds the following lesson: Joint Implementation Plans (JIPs5) can improve the effectiveness of the “one WBG” approach noted by the CLR lessons. WBG CPFs normally intend collaboration across the Bank, IFC, and MIGA, but more often than not, CPFs do not spell out how such collaboration is to happen. Myanmar’s CPF JIP to improve access to electricity helped ensure that joint work would materialize. IEG rates the CPF development outcome as Moderately Satisfactory and WBG performance as Good.

Not just what, but how: a strong delivery system was key to the success of the Philippines’ nationwide social protection program

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Not just what, but how: a strong delivery system was key to the success of the Philippines’ nationwide social protection program
Effective system identifies beneficiaries and delivers cash transfers in a regular and reliable way.Effective system identifies beneficiaries and delivers cash transfers in a regular and reliable way.

Evaluation of the World Bank’s Support to Improving Child Undernutrition and Its Determinants (Approach Paper)

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Global reports on indicators of child undernutrition show mixed progress in reducing the stunting (impaired growth and development) of children under five, with Africa and South Asia most severely affected. There are many determinants of child undernutrition, which makes the challenge of improving outcomes multidimensional, requiring interventions in areas of health; agriculture; water, Show MoreGlobal reports on indicators of child undernutrition show mixed progress in reducing the stunting (impaired growth and development) of children under five, with Africa and South Asia most severely affected. There are many determinants of child undernutrition, which makes the challenge of improving outcomes multidimensional, requiring interventions in areas of health; agriculture; water, sanitation, and hygiene; social protection; education; and governance, depending on the country context. The objectives of this evaluation are to assess the contribution of the World Bank to improving outcomes related to child undernutrition and its determinants in countries affected by undernutrition, and to provide lessons and recommendations to inform the design of the World Bank’s future multidimensional nutrition support.

The World Bank Group Partnership with the Philippines, 2009–18

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The World Bank Group Partnership with the Philippines, 2009–18 Country Program Evaluation
This Country Program Evaluation (CPE) assesses the development effectiveness of the World Bank Group program in the Philippines between 2009 and 2018.This Country Program Evaluation (CPE) assesses the development effectiveness of the World Bank Group program in the Philippines between 2009 and 2018.