20 on the FY90 sector report on Women's Reproductive Health in Brazil, and also the Bolivia Integrated Health Development Project, India Population VII and Nutrition 11, to name only a few);

- (c) investments to improve hospital management and efficiency and strengthen urban services (Lesotho Population, Health and 1.utrition IIL Yemen Health 11);

- (d) significant Investment in drug supplies (Nigeria Essential Drugs);

- (e) emphasis on institution building (e.g., Haiti Population and Health, Nigeria Essential Drugs, India Population VII, and Morocco Health);

- (f) important resource allocation and mobilization initiatives (e.g., Tanzania Health and Nutrition, Haiti Population and Health, and Morocco Health); and

- (g) coordination with NOOs (e.g., Lesotho Population, Health and Nutrition II).

47. Research and policy work undertaken in PHRHN during FY90, as descnbed in Chapter IV, also contributes to the exploration and resolution of salient health issues outlined above.

# NUTRMON

48. Bank support of nutrition activities, both including and in addition to PHN operations, has expanded significantly. Lending in FY90 totaled approximately $150 million for four operations in which nutrition was the principal focus (India ibmil Nadu Nutrition II, bnzania Health and Nutrition, Colombia Community Child Care and Nutrition, Jamaica Social Sector Development). This compares to $50 million and two operations during the ten year period FY80 to FY89. In addition to these four significant operations, seven of the other nine PHN and four of the other five Social Sector projects, approved in FY90, support nutrition components. Other FY90 approved Bank operations which provide for nutrition activities include: three agriculture sector adjustment operations (Mala-wi SAC, Mali Agriculture SECAL, Mauritania Agriculture SECAL); three education operations (MaIdagascar Education Sector Reinforcement, Bangladesh General Education, Pakistan Sind Pr;maqy Education Development); and five structural adjustment operations (Sao Tbme & Principe SAC III, Senegal SAL IV, Sri Lanka Economic Restructuring Credit, Algeria Economic Reform Loan, Thnidad & Tobago SAL 1). The pipeline for future ope,rations is strong, as well. Nutrition lending is expected to approach $200 million for three major projects in FY91, and exceed $500 million for at least six major projects in FY92. When counting nutrition components in projects in other sectors and the nutrition portion of adjustment projects, lending for nutrition for the period FY90-92 is expected to exceed $1 billion.

49. India continues to account for the largest volume of free-standing nutrition lending. Tamil Nadu Nutrition II will extend the successful Tamil Nadu pioneer project from the original 9,000 villages to all of that State's 20,000 villages. A new project tied to India's Integrated Child Development Services (ICDS) program (approved in September, 1990, $106 million) will extend Bank nutrition assistance to two new states, Orissa and Andra Pradesh. Also in the region are free-standing nutrition projects (or projects in which nutrition will be a main theme) in various stages of preparation, for Bangladesh, Indonesia, the Philippines, Sri Lanka and, again, India.

_50._ LAC has the most broad-based nutrition program of the Bank's four regions. Most significant in FY90 are the innovative Colombia Chi.d Care and Nutrition project and the