**Poiy; Research, and Exernal AHar**

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**Population, Health, and Nuirition**

# **WPS 707**

This paper -a product of **the** Population, Health, and Nutrition Division, Population and Human Resources Department-is part of a largereffort in PRE to increase awareness of the lessons learned from the Bank's operational work. Copies are available free from the World Bank, 1818 H Street NW, Washington, DC 20433. Please contact Otilia Nado-a, room S6-065, extension 31091 (69 pages, with tables).

World Bank lending in the populatior., health, and nutrition (PHN) sectors increased significantly in fiscal 1990. Over the past five ycars, PHN lending has grown rapidly both in the number of projects and in the amounts ot loans and credits. T- future lending portfolio indicates continued growth. Bank support of nutrition activities, both within the PHN sectors and as components of projects outside the PHN sectors, has expanded significantly.

The content and focus of PHN lending and sector work during fiscal 1990 respond to the needs of borrowing countries and to the Bank's emphasis on human resources development and poverty, and reflects the pertinent issues that PHN sector development work poses today. PHN work now focuses much more on the policy level than it did in the past. Health financing issues continue to be rigorously addressed as a priority. The use of local consultants and the participation of beneficiaries in Bank work is on the rise. Increased attention has been focused on NGOs in recognition of the important role they play in the PHN sectors. Social sector development operations, a new feature of PHN lending, have presented challenges to the Bank because of the streamlining and coordinating of roles and responsibilities in the Bank and at the national level that they require. Efforts to raise cofinancing and coordinate aid are being intensified because of the acute shortages of resources for the sectors in many borrower countries.

The Bank still faces important challenges in its effort to improve the effectiveness of its interventions in the PHN sectors. First and most important, the Bank has not yet comprehensively addressed all facets of the population issue, which encompass full and rigorous consideration by country operations and senior management staff, as well as effective and efflicient delivery of family plaining services. Second, while most PHN staff appreciate the importance of addressing management and institutional development issues, the quality and depth of PHN interventions in this rcgard vary.

The review suggests a number of recommendations for further improving the Bank's performance in the PHN sectors. On the technical side, the Bank should (1) continue to focus and improve its interventions at the policy level; (2) address management and institutional development issues more rigorously and comprehensively through project, sector, and research work; (3) squarely address and encompass the role of the private sector and N0Os **in** ihe design and delivery of PHN interventions; and (4) continue efforts to address and resolve PHN financing issues, given its comparative advantage in this regard.

Internally the Bank should (1) address the need to expand staff io accommodate continued growth likely in Bank work in the PHN sectors and (2) encourage greater use of experts from developing countries and the participation of beneficiaries in Bank work.

Because a population strategy paper is at an advanced stage of preparation, this review withholds suggestions for improving the effectiveness of the Bank's work in the population sector.

**The** PRE Working Paper Series disseniinates thc findings of work under way in the Bank's Plolicy, Rcsearch, and External AffairsComplex. Anobjectiveoftheseries is to get these findings out quickly, even ifpresentations are Iess than fully 1x)lished. The findings, interpretations, and conclusions in these papers do not necessarily represent official Bank policy.

Produced by the PRE Dissemination Centcr