Year 1

Implementation & Progress

The World Bank’s

Reproductive Health Action Plan

2010-2015

Human Development NetworkJuly 19, 2011

Summary

• Reproductive Health Action Plan

developed at the request of the Bank’s

Executive Board May 2010

• Aims at addressing RH is 57 high

burden countries

• Focuses on improving RH outcomes

through health systems strengthening

• Considerable progress made in Year 1

on delivering on the RHAP Results

Framework

– SRH is reflected more prominently

in the Bank’s lending and technical

assistance; and

– Our relationship with global partners

on SRH is more robust.

2

Contents of the Presentation

• Context of the Reproductive Health

Action Plan (RHAP)

• Year 1 Activities and Achievements

• Opportunities and Challenges

3

The RHAP Targets Interventions for High Burden Countries and Most

Vulnerable Populations

To do this we are focusing on :

• 57 LICs with high maternal mortality and high fertility;

• Especially, meeting the reproductive health needs of the youth;

• Improving RH outcomes through health systems strengthening;

• Leveraging partnerships with governments, CSOs, Academia,

Bilaterals and Multilaterals

Whilst the focus is the LICS we

capture lessons learnt from the

experiences in MICs

4

The RHAP Aims to Address Persisting High Levels of, and Inequities

in Maternal Mortality and Fertility

• 358,000 maternal deaths globally

annually

• 87% of these in SSA & SAR

• 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 Quintiles

2006/7, 2008 (select countries)

Maternal Mortality Ratios

2008

5

• Context of the Reproductive Health

Action Plan (RHAP)

• Year 1 Activities and Achievements

• Opportunities and Challenges

6

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

7

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 indicators *

*Tier I indicators: Country development outcomes

Tier II indicators: Country intermediate outcome indicators

Note: A comprehensive list of RHAP implementation results in Year

1 is presented in the Annex (slides 16 – 20)

• 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 47 countries completed and disseminated.

• 5 country case studies on success factors for progress on MDGs

4 and 5 will be completed by October 2011

• Completed 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

8

• CASs in 7 high MMR/high TFR countries approved and all

include discussion on RH

• Regional report on RH disseminated in SAR; initiated in AFR,

EAP, and ECA

Component 1

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

South Asia:

• Review of access barriers to RH services. 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

ACHIEVEMENTS in Year 1

• Case studies on breaking the family planning and nutrition

dilemma. Advanced policy dialogue on integrating FP and

nutrition in community based approaches in Ethiopia, Mali and

Rwanda; , with interest from Malawi

ACTIVITIES

Africa:

• 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:

Eastern Europe & Central Asia:

• Review of reproductive health content in medical and

nursing education curricula. Recommendations being

incorporated into curricula in Tajikistan, Uzbekistan,

Moldova, Armenia, Azerbaijan and Kosovo

• Review of legal framework of legal rights on teen pregnancy .

Framework is being developed for Central AmericaLatin America and the Caribbean

ACTIVITIES ACHIEVEMENTS in Year 1

10

Enhanced Bank Expertise

and Capacity on RH • 18 Bank staff designated as RH champions in their

regions and 4 staff with RH expertise hired

• Bank’s training course on RH revised based on RHAP;

first training under revised curriculum in Budapest in

May 2011

• Training for statisticians on measurement of maternal

mortality conducted in collaboration with H4+ partners*

in Nairobi

Component 2

*H4+: UNAIDS, UNFPA, UNICEF, WHO and World Bank

The RHAP is Well On-Track on These Three Components

ACTIVITIES ACHIEVEMENTS in Year 1

11

Regularized Portfolio

Monitoring on RH• Health projects approved in FY11 with RH components

in DR Congo, Mozambique, Nigeria, Swaziland,

Bangladesh, Pakistan, Iraq, Yemen, as well as

Argentina and Brazil

• 2 RH-specific projects in Mali and Burkina Faso under

preparation

• Baseline for tracking RH indicators for high MMR/high

TFR countries and available online established

Component 3

The RHAP is Well On-Track on These Three Components

Share of RH in Bank lending for health

(US$ million) FY10- FY11

491830

4,383

2,961

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

FY10 FY11

RH Only HNP Funding

As a result, investments in RH are up…

12

Bank lending for RH (US$ million)

FY11 approvals

74

370

324

9

31

22

AFR SAR LCR EAP MENA ECA

RH only includes lending for HSS, child health, nutrition, oriented to RH

outcomes

Source: Pop/RH Team Analysis of HNP Portfolio for FY10 and FY11

Contents of the Presentation

• Context of the Reproductive Health

Action Plan (RHAP)

• Year 1 Activities and Achievements

• Opportunities and Challenges

13

RHAP has created a tide of opportunity for the Bank to engage with the

world on the RH agenda

14

• RHAP has energized a dialogue and provided concrete space for

engagement with civil society (CSO Consultative Group)

• RH is well-positioned in the IDA16 results matrix

• The UNSG’s Global strategy for Women and Children (MDGs 4 and 5)

synergizes with the RHAP

• The WDR 2012 provides a platform to showcase RH as a key priority

Looking Ahead, There are Opportunities to Continue Scaling Up

Reproductive Health

Overall There Have Been Substantial Achievements, But There are

Challenges Moving Forward…

• Scaling up the most effective ways to incentivize much needed

demand for RH, 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

15