PHN **1992** Sector **Review** 13 age and children under the age of five. Considerable emphasis is thus given to maternal and child health services. A fundamental objective of these interventions is to improve the quality, efficiency, and equity of basic services. Quality issues are primarily addressed through interventions to: upgrade physical facilities, upgrade the technical and outreach skills of personnel, ensure the availability and affordability of essential drugs and adequate recurrent financing, and involve communities in the design and management of sector activity. (See Chapter IV for a fuller discussion of quality issues).

2.44 As a complement to interventions at the service level, FY92-approved health operations provide considerable support to building national capacity for policy formulation and sector management and to the field testing and eventual country-wide application of policy reforms, which aim for increased sector efficiency and equity. T-hese objectives are largely realized through financing and institutional reforms such as: the mobilization of additional resources through cost recovery and increasing health's share of the public budget; reallocation of the public budget for health in favor of basic services for the poor and underserved; more financial autonomy for hospitals and increased private sector activity thus liberating public funds for basic services for the poor; decentralization; and increased involvement of NGOs and communities in health sector activity. Section E of Chapter III provides a more detailed analysis of project support in this regard.

2.45 Notable features of this year's portfolio reveal two emerging trends in health sector lending: increasing attention to urban primary health care and to the hospital sector. In support of urban health services, the Kenya Health Rehabilitation project will support the development and initial implementation of a strategic plan for health services in the Nairobi areas; the Mauritania Health and Population project will strengthen basic health services in three regions including Nouakchott; and the India Family Welfare project will improve the supply and management of family welfare services for poor urban populations.

2.46 Assistance to the hospital sector will be provided through a number of health operations. The Chile Technical Assistance and Hospital Rehabilitation project will initiate improvement in the quality of hospital services in Santiago through the support of subprojects to rehabilitate hospitals to be designed and implemented by hospital staff and local health authorities. The Equatorial Guinea Health Improvement project will support key reforms in the management of two national hospitals, in Malabo and Bata, including progressive management and financial autonomy, the selective application of the fee-for-service policy, and the strengthening of accounting and administrative controls. Under the Kenya Health Rehabilitation project, the Kenyatta National Hospital will be rehabilitated and its organization and management strengthened.

2.47 Health operations also targeted a number of priority diseases. This year the Bank's second ever freestanding AIDS project was approved for India (the first being for Zaire in FY89). AIDS is also addressed through projects in Romania (safer blood products and AIDS testing), China (surveillance of STDs and AIDS), Kenya (HIV/AIDS-related supplies for hospital workers to avoid inadvertent transmission), and Rwanda (targeting of emergency assistance to AIDS-afflicted families and orphans). In addition, the Equatorial Guinea project will help establish a sexually transmitted diseases (STD) program in the Ministry of Health. Malaria is a primary target of both the Equatorial Guinea and Sao Tome and Principe projects. Schistomiaisis is the sole target of a project in Egypt and one of two targets in the China project, the other being tuberculosis.

# 3. _Nutrition_

2.48 Nutrition lending in the Bank continues to grow. While the number of PHN projects with nutrition components decreased between FY91 and FY92 from 22 to 10 (reflecting the overall drop in the total number of PHN projects in FY92), the estimated allocation of total project resources for nutrition in the three-year period