18 combined PHN projects support the provision and management of family planning services -- joint costs incurred in training, building management and information systems, supplying equipment and drugs, constructing and rehabilitating clinics, and so on -- features not fully accounted for in the estimates for population lending given here. In addition, social development projects in Cameroon, Chad and The Gambia include population components,. The assistance given by the Bank has, moreover, been greatly magnifled by increasing coordination with other donors at many levels of aid -- from cooperation in the design of assistance to a region, to division of labor in support to country programs, to cofinancing of projects.

42. The encouraging news for the population sector in FY90 lies more in the number and geographical range of the projects than in the amount of lending alone, though this too was up, and more projects showed substantial support to population than was evident last year. The stimulus to population activitics given by cofinancing, particularly in social development projects, has also been .ery encouraging. This overview of the population sector has concentrated on themes that have run through the FY90 program - increased donor coordination, increased use of NMOs, and increasing integration of population into country development strategies. As stated earlier in this section, the full and rigorous treatment of population as a macroeconomic issue remains a challenge for the Bank. Another emerging issue is that of meeting the increased demand for contraceptive supply. The growing numbers of governments providing family planning services, and the growing number of women of reproductive age, taken together with USAID's warning that it cannot continue to underwrite contraceptive supply indefinitely, implies increased demand for Bank resources in this area. In fact, the larger question, vithin which the commodity issue lies, is that of the almost inevitable demand for increasing Bank support, given the stagnant level of funding from other sources.

# HEALTH

43. Sector work and PHRHN research make clear that the following factors, among others, present a formidable challenge to Bank staff responsible for health sector development work in the Bank in the 1990s:

- (a) Demand for health projects is great and growing, stimulated by the high priority placed on human resources development objectives by national govemments and the World Bank;

- (b) Weak institutional capacity severely constrains the potential of govemments to translate policy into appropriate programs and to effectively manage their financing and implementation.

- (c) The epidemiological and demographic profiles of countries are evolving (albeit at various stages of evolution, depending on the country/region) towards a disease burden, whose composition is shifting away from infectious and parasitic diseases and undernutrition, whose main victims are children, to non-communicable disease (e.g. cardiovascular disease and cancer), which largely affect adult populations. The emergence of AIDS has also significantly affected national and regional epidemiological profiles and priorities. Thus the choice of target populations, as well as of priority interventions for Bank investments, is not an easy one.

- (d) Constrained resources for the health sector render priority-setting crucial, and call for efforts to maximize sector efficiency and to mobilize additional resources for