World Bank Admits Most Health Aid Fails

The World Bank has made little progress in improving the health of poor people in spite of a $10bn (£6.75bn) increase in spending, its in-house monitoring body said last night.

Announcing a review of the Bank's health department from 1997 to 2008, the Independent Evaluation Group said that despite increasing spending from $6.7bn in 1997 to $16bn in 2006, progress had been poor.

The watchdog said the performance in Africa was "particularly weak", with only 27% of projects considered satisfactory.

It added that monitoring of health programs "remains weak" and "evaluation is almost non-existent". The lack of proper monitoring and evaluation had led to "irrelevant objectives, inappropriate project designs, unrealistic targets, and an inability to measure the effectiveness of interventions."

The IEG is a standalone unit that reports to the Bank's directors on "what works and what does not". The lead author of the report to the Bank's health, nutrition and population (HNP) department, Martha Ainsworth, said: "Overly complicated project designs and weak government capacity contributed to low outcomes."

However, two-thirds of global projects had been satisfactory, the group said.

The Bank has increased the number of professional HNP staff by a quarter since 2000 in an attempt to improve the health of the world's poorest people. Of every 1,000 children in sub-Saharan Africa, 146 die before their fifth birthday, while life expectancy at birth is just 51.

Reducing child and maternal mortality is one of the main Millennium Development Goals - the 2015 anti-poverty targets agreed by the United Nations nine years ago.

In its report, the evaluation group found only half of HNP support was focused on the poorest people, and that much of the World Bank's spending ended up helping the richest 20% of people.

"The evidence that HNP investments are reaching the poor is thin," Ainsworth said. "In most countries people in the wealthiest quintiles [20%] benefit the most from public health spending, so we can't assume that simply spending more on health will be pro-poor."

A spokesman for the HNP department said the Bank launched a new health strategy two years ago, which had not been included in the report. He added that the "under-performing projects were emergency operations for HIV and Aids in sub-Saharan Africa at the height of the epidemic, with widespread civil instability in the region, food shortages, internal displacement and millions of refugees."

Development groups said the report was an indictment of the Bank's record, and said Britain should divert its health funding from the Bank to the Global Fund, a partnership of the public and private sectors, and civil society.