Even in those projects targeted specifically at women, like safe motherhood programs, projects fail to focus adequately on programs to ensure safe delivery, particularly the management of obstetric complications. Finally, maternal health issues fail to be incorporated into the Country Assistance Strategies that guide Bank dialogue and lending operations, especially in Africa. A key indicator of successful health sector is the development of the institutional infrastructure for the delivery of health services. In part, this is because the Bank is unable to learn from what it does. The Bank therefore has not used its lending portfolio to systematically collect evidence on what works, what does not, and why.
Effective reform is an intricate process of consensus building by all stakeholders.
Internal and external reviews all point to problems in the Bank s incentives and organizational culture. For example, the Bank remains more effective at insuring the hardware construction of civil works and procuring equipment than at delivering the software components necessary for effective provision of quality health services. The Bank s own assessments reveal that only 4 of 224 completed HNP projects reviewed by the OED had documented evidence of beneficiary decision-making power in project design. That same review notes that the Bank continues to conflate participation with charging consumers for services. But unless the Bank can address the serious problems to its operations on the ground, more money is not the solution.