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# Specific Proposals for Immediate Action

_53._ First, Country tXpartments should be sure that country strategies include attention to population issues wherever demographic pressures are a problem. It would be useful for Country and Technical Departments to work together to see what additional things should be built into work programs to strengthen analyses, dialogue, or lending. (An assessment of the treatment of these issues in recent Country Strategy Papers and ESW would be helpful in this regard.) Such analysis would include assessing the impact of population change on other development parameters and examining the policy options for bringing demographic factors into balance with development objectives -- in other words, treating population as a macroeconomic variable. In most cases, it would mean examining the impact of high fertility and rapid population growth on the development aspirations of the member country and examining the potential demographic impact of alternative programs in such areas as agriculture (e.g., land inheritance systems), health (e.g., maternal and infant mortality), and education (e.g., female primary education). But in other cases, population movement, or mortality, or age structure may prove to be of greatest significance. The point is that population dynamics -- changing demographic variables -- are extremely important in planning for economic development, whether one is looking at Haiti's high fertility, or Uganda's rapidly rising mortality because of AIDS (which is having increasingly important demographic consequences in many countries), or Hungary's aging population, or rapid urbanization in Cote d'lvoire. Obviously, where such analysis has already been competently done by others (e.g., the countries themselves, USAID, UNFPA), it need not be duplicated by Bank staff.

54. Where such analysis demonstrates that population growth represents an important obstacle to the achievement of other development objectives, where high fertility is shown to have deleterious effects on large numbers of households, and where governments are deemed to be doing too little in response, population action plans could be prepared.

_55._ Second, Regions could take steps to further encourage, assist, and monitor regional performance. Unless this is done, it is unlikely that the recommendation for strengthened analytical work and strategy formulation will fare any better now than it did following the 1976 Freedman and Berelson report (see references), which made essentially the same point. To this end, each Region could consider establishing a senior population position. These senior regional population staff would contribute substantially to an increase in the level and quality of population work. (This seems less necessary for Africa which already has, de facto, such a position and a very active program.) 56. Third, population training for country and lead economists would be useful to carry out thie increased and improved analytic work. A Bank-wide training program for both economists and managers began in the spring of 1991 and merits strong continuing support.

57. Fourth, we need to begin to think more consistently about population objectives. As is pointed out above, for years the effectiveness of many of the Bank's population projects has been difficult to assess because their objectives have not been made explicit. Rather than being preoccupied with the volume of lending or the number of projects in the population field, or the proportion of each **PHN** project th%at is actually for population, the Bank needs to focus on impact. Do these projects, whatever one calls them, contribute to increased availability of services, increased prevalence of contrac._ptive use, and, ultimately, reduced fertility, maternal and infant mortality and morbidity? Appropriate PHN projects should be carefully reviewed to be sure that they have explicit population objectives, consistent with those of the country itself. It is not easy to attribute fertility decline, or even increased contraceptive prevalence, to a single project, but if the project represents a substantial element of a country's population program (as Bank projects usually do), it is not unreasonable to infer that a substantial share of any observed change is attributable to the