metadata: authors: 0: author: Gittinger, J. Price
1: author: Bradford, Carol
docna: 0: docna: World Bank project-financed research on
            population, health, and nutrition
docty: Policy Research Working Paper
subtopic: Health Care Services Industry,Nutrition,Educational Sciences,Cholera,Malaria,Communicable Diseases,Leprosy
teratopic: Poverty Reduction
abstracts: cdata!: This report on World Bank
            project-financed research on population, health and
            nutrition (PHN) is based on a review of 109 staff appraisal
            reports for projects financed in fiscal years 1980-91 and on
            selected interviews with task managers. The report looks at
            only the simplest dimensions of project-financed research
            and examines research outcomes of only a few projects. Among
            conclusions tentatively reached: (1) more than 90 percent of
            PHN projects from fiscal years 1980-91 financed research.
            (2) Bank experience with project-financed research in the
            PHN sector has been extremely variable: quite successful in
            some countries and almost a total failure in others. Even
            so, some striking successes justify continued efforts to
            incorporate research into projects and to encourage use of
            that research to improve both national PHN policy and
            follow-on Bank financed projects. (3) Personalities make a
            difference, both among borrowers and within the Bank. Often
            successes are associated with a particular person within the
            government or the Bank who has taken a continuing personal
            interest in encouraging research. (4) Supervision is crucial
            to good results. Supervision must be frequent enough to keep
            the research component on time and of good quality. For
            quality research to be completed, it is important that those
            responsible for supervision attach a high priority to
            research even if it is not a large part of the project in
            terms of budget. (5) Research that leads to a project
            outcome - such as research needed to justify release of
            funds or for a follow-on project - is more likely to be
            undertaken and completed than is research with a more
            general objective. (6) In countries where the institutional
            capability exists, using a national institution to review
            research proposals and to administer research grants can be
            quite effective. Experience indicates that some sort of
            peer-group review produces better research. (7) There is
            probably room for more best-practices workshops where PHN
            staff can exchange experiences about successful design and
            supervision of project-financed research components. But
            usually it will be necessary to retain experienced
            consultants to help design substantial research components.
            (8) More systematic collection and dissemination of
            project-financed research is justified, given the
            considerable amounts of money and effort devoted to it.
repnme: repnme: World Bank project-financed research on
            population, health, and nutrition
display_title: World Bank project-financed research
            on population, health, and nutrition
listing_relative_url: /research/1992/11/699509/world-bank-project-financed-research-population-health-nutrition
topicv3: Nutrition m1326779 644,Malaria m1327042 1420,Education m1327048 470,Population, Aging and Health m1327736 640,Health m1504661 3480
publishtoextweb_dt: 2010-07-01T00:00:00Z
historic_topic: Poverty Reduction
origu: Pop & Human Resources Department
no_of_pages: 22
model_extractions: <!-- Start of picture text --> r_ Policy R orh<br>Poualn, Health, and Nutrition<br>WPS 1046<br><!-- End of picture text --> Thispaper-aproductofthe Health and Nutrition Divis -n, Populationand Human Resources Department - is part of a larger effort in the department to dissemLa&te Bank-funded population, health, and nutrition research. Copies of the paper are available free from the World Bank, 1818 **H** Street NW, Washington, DC 20433. Please contact Otilia Nadora, room **S6-065,** extension 31091 (November 1992, 16 pages).

This report on World Bank project-financed research on population, health, and nutrition (PuN) iL based on a review of 109 staff appraisal reports for projects finarnced in fiscal 1980-91 and on selected interviews with task managers. The **report** looks at only the simplest dimensions of project-financed research and examines research outcomes of only a few projects. Among conclusions tentatively reached:

* More than 90 percent of PHN projects from fiscal 1980-91 financed research.

* Bank experience with project-financed research in the PHN sector has been extremely variable: quite successful in some countries and almost a total failure in others. Even so, some striking successes justify continued efforts to incorporate research into projects and to encourage use of that research to improve both national PHN policy and follow-on Bank-financed projects.

* Personalities make a difference, both among borrowers and within the Bank. Often successes are associated with a particular person within the govemment or the Bank who has taken a continuing personal interest in encouraging research.

* Supervision is crucial to good results. Supervision must be frequent enough to keep the

research component on time and of good quality. For quality research to be completed, it is important that those responsible for supervision attach a high priority to research even if it is not a large part of the project in terms of budget.

* Research that leads to a project outcomesuch as research needed to justify release of - funds or for a follow-on project is more likely to be undertaken and completed than is research with a more general objective.

I in countries where the institutional capability exists, using a national institution to review research proposals and to administer research grants can be quite effective. Experience indicates that some sort of peer-group review oroduces better research.

* There is probably room for more bestpractices workshops where PHN staff can exchange experiences about successful design and supervision of project-financed research components. But usually it will be necessary to retain experienced consultants to help design substantial research components.

* More systematic collection and dissemination of project-financed research is justified, given the considerable amounts of money and effort devoted to it.

The Policy Research Working Paper Series disseminates the **fmdings** of work under way im the Bank. Anobjective of the series is to get these findings out quickly, even if presentations are less than fully polished. The findings, interpretations, and conclusions in these papers do not necessarily represent official Bank policy.

Produced by **the** Policy Research Dissemination Center
# World Bank Project-Financed Research on Population, Health, and Nutrition

by J. Price Gittinger and Carol Bradford
# Table of Contents

|Proportion of Projects wlth Research<br>.........|....................<br>1|
|---|---|
|Categories of Research Financed .............................|1|
|Total Value of Project-Financed Research..................|...........<br>.<br>4|
|Project-Financed Reseach EBperlence .............................|4|
|Conmnon Theme and Condusions .............................|10|
|Other Sector Project-Flnanced Rescarh ..........................|11|
|Annex Projects Reviewed ...........................|13|
# World Bank Project-Financed Research on Population, Health, and Nutrition

This note reports on World Bank project-financed research on population, health, and nutrition (PHN). It is based on a review of 109 staff appraisal reports (SARs) for projects fLianced in fiscal years 1980 through 1991 and selected interviews with task managers. The projects reviewed include 47 in the Africa region; 13 in the East Asia and Pacific region; 15 in the South Asia region; 14 in the Middle East and North Africa region; and 19 in the Latin America and Caribbean region. In tbis note, Tu,rkey is tabulated in the Middle East and North Africa region. There were no operations in the Europe and Central Asia region during the period reviewed. (A list of the projects reviewed is given in the Annex.) The projects represent essentially all Bank financing in the PHN sector during the period under review.

The World Bank encourages PHN research tostrengthen Word Bnkenow gebase uPoN resech<sup>to</sup> to strengthen the kcnowledge base upon _Which_ **to** design cost-effective investments in population, health, and nutrition; to strengthen the analytical capacity of borrowing governments to undertake policy-related PHN research; and to evaluate program and project performance as a basis for improving future design.

four of the five regions covered, the proportion of projects which included a research component was over 90 percent; in MENA 80 percent of the projects included a research component.

## Categories of Research Financed

For every project reviewed, the research proposed in the SAR was dassified by one of six categories or else was noted as uncategorized (see box). Projects were reviewed and tabulated Bankwide and on a regional basis (Table 1).

The categories were medical, demographic/ epidemiological, human resources (including studies relating to personnel practices), managerial (including operational research), financial,<sup>and</sup> research needed to prepare information,<sup>education,</sup> and communication (IEC) programs.

This note is an initial, exploratory survey. It looks only at the simplest dimensions of projectfinanced research and examines research outcomes of only a few projects. Hence, the conclusions reached must be considered tentative and subject to , revision in the light of fuller investigation.

### Proportion of Projects with Research

Virtually every project in the PHN sector during the period reviewed contained some provision for research (Figure 1). Bank-wide and in <!-- Start of picture text --> tooprt .oo ....... ,..-------.--<br>9_<br>so . .. .. 0 .. .<br>0 ... .... ... ....<br>40 _ --- .... .. _ .. _ . ._<br>20 .... ... ... ...<br>A _ "t o A<br>& r"i54 W-<br><!-- End of picture text --> Figure 1. Proportion of projects with research components by region and Bank-wide.
Project-Financed FHN Research 2 -

## _Frequency of Categories_

# Research Categories

Research proposed in the 109 SARs reviewed for this note was categorized in one of six categories or else noted as uncategorized. Research was taken to mean special studies of some sort, either as part of project impleir :tation or for a broader purpose.

_MEDICAL._ Includes biological research, clinical studies, medical trials, etc.

_DEMOGRAPHICGTPIDEMIOLOGICAL._ Covers surveys, censusts, studies done with large groups to determine the effect of a program, etc. Includes epidemiology.

**_HUMAN_** _RESOURCES._ Res earch carried out to determine numbers of personnel needed or to assess the skills of individuals providing care or other services. Includes assessments of additional training needed or how existing skills might be improved.

_MANAGERLi._ Studies assessing administrative issues, including operational research and means to increase program efficiency. Includes stand-alon **e** valuations of projects or programs. However, it was assumed that every project would have a management information system, so MIS intended primarily as a management tool during project implementation was not included.

_FINANCIAL._ Research on program costs or means of financing health care or nutrition interventions. Includes studies on cost-recovery and health insurance.

_INFORMATlON, EDUCAI7ON,_ **_AND_** _COMMUNICATION (IEC)._ Research on information needed for IEC programs, but not preparation of the materials themselves.

Bank-wide, the most common research component was a managerial study or operational research. Seventy-two percent of all projects reviewed included one or another kind of managerial research. The next most common categories of research were demographic/epidemiological included in 48 percent of all projects and financial studies included in 47 percent of all projects reviewed. Research turning on human resources issues, including training of personnel, was included in 30 percent of the projects. Studies needed to prepare IEC materials were included in 16 percent of the projects reviewed. (Preparation of the IEC materials themselves was not counted as research.) In some 13 percent of the projects there was a medical research component.

## _Regional Differences_

While there are regional differences in the frequency in which categories are included in projects, they are not striking and p:obably are not significant. In every region except MENA, managerial studies were the most frequent category encountered. Demographic/epidemiological or financial research were the second and third most common. It is interesting to note that financial studies in the Africa region frequently revolved around cost recovery, a topic which was of great concern to health admniistrators and governments during the decade of the 1980s. On the other hand, studies of medical insurance were concentrated in Asia. Research for EEC materials and programs ranged from 7 percent in MENA to 40 percent in South Asia. The reason for the variation is not clear, and it may be insignificant; it proved difficul **t** o separate out the research needed to prepare **IEC** materials from the work of preparing the materials themselves. While no project in MENA included medical research, more than one in five LAC projects did so.
Project-Financed PHN Research Table 1. Projects with Research Components by Region and Category, FY'80-FY'91 (Percent) -

|Research<br>Category|Africa|East<br>Asia and<br>Pacific|South<br>Asia|MENA'|LAC|Bank-<br>wide|
|---|---|---|---|---|---|---|
|Medical<br>Demographic/|13|15|13|0|21|13|
|Epidemiolog-<br>ical|43|54|47|60|47|48|
|Human|||||||
|Resources|28|31|47|20|32|30|
|Managerial|74|54|93|53|74|72|
|Financial|_55_|38|27|40|53|47|
|IEC|17|8|40|7|_5_|16|

# a. Includes Turkey.

# _Other 7ypes of Research_

# _Research for Follow-On Projects_

The range of research proposed in the SARs Bank-wide, 21 percent of the SARs included reviewed was extremely broad, even within the some explicit provision for research intended to tabulated categories. In population projects, it was facilitate preparation of a follow-on project common to find provision for family planning (Figure 2). The proportion in Africa was 28 knowledge, attitude, and practice (KAP) research. percent, in East Asia and Pacific 23 percent, in Population projects also included research on South Asia 20 percent, in MENA 7 percent, and materna mortality and on contraceptive use (classified as demographic/epidemiological research). Research into drug prescription practices, distribution, or formulation figured in several projects. 100Pat ...... Structural adjustment loans with PHN activities often included research to look at the social dimens ...... .. sions of adjustment. Nutrition projects, not surprisingly, generally included nutrition-related o ... research, especially the extent of malnutrition (classified as demographic/epidemiological re. ................... ....... search). The importance of malaria in the Amau zon basin led to inclusion of entomological re20 ........_.............. **te.** search in the Brazil Amazon Basin Malaria Control Project. **O MA. At** t MC Book-l Bank-wide, 21 percent of the SARs included some explicit provision for research intended to facilitate preparation of a follow-on project percent, in East Asia and Pacific 23 percent, in South Asia 20 percent, in MENA 7 percent, and Figure 2. Proportion of projects with follow-on project research components by region and Bank-wide.
Project-Financed PHN Research

- 4 -

with research intended to support follow-on proincluded would contribute to the preparation of a made provision for strengthenin **g** support preparation of follow-on projects.

# Total Value of Project-Financed Research

The sources of data for this note do not permit more than a very rough approximation of the total amount of Bank and IDA funds used for project-financed research. The SARs often do not include explicitly the amount envisioned for research; instead research is often included with other items such as training or the management information system. SARs, of course, are statements of intent; whether the funds envisioned were actually expended is not known on the basis of the documentation used in this study. Even the Project Completion Reports often do not report the or contentious component of the project. Frequently when information about the amoun **t** o be spent on research is included in an SAR, it is not clear to what extent loan funds will finance the research or if it will be financed entirely from the government contribution to the project.

However, while keeping these limitations in mind, a gross approximation of the amount of of the cases where it is possible to identify the one and two percent of the total project costs. mation. Total SAR proposed lending for the research is between one and two percent of this, would make the Bank, after the World Health million annually. However, according to the WHO Office of Research Promotion and Development, in 1988 only 3 percent of this was for areas which might include policy research, or on the order of $2 million. Since Bank projectfinanced research is dominantly in the areas of demography/epidemiology, management, or finance, project-financed research is probably the leading source of external finance for these kinds of research.

# Project-Financed Research Experience

Eight country experiences are presented to provide insight into the effectiveness of projectfinanced research. They were selected to give a regions, and both successful and unsuccessful efforts to promote research.

# _Bangladesh_

The Bank-led Bangladesh Population and Health Consortium, grouping 13 financiers including IDA and the Government plus three executing Project approved in fiscal year 1991. The Fourth Fourth Five-Year Plan which extends from 1990 Plan. The Consortium is probably the longest-
_-5_ Project-Financed PHN Research successful example of donor coordination and<sup>co-</sup> financing in the history of Bank operations.

Preparation of the Fourth Population and Health Project was marked by an extensive series of workshops where the issues and priorities were debated. There was, for example, a three-day high level seminar for senior officials from the Bangladesh Planning Commission, Ministry of Health and Family Welfare, and Ministry of Finance. Another three-day seminar permitted field-level staff to articulate their views about issues and priorities. Representatives of donor agencies met in a workshop to coordinate their views about issues and priorities. Finally, yet another three-day workshop brought together donors and government officials to agree on the broad-brush outline of the major approaches and priorities for the five-year implementation period of the Fourth Project. There was a three-day workshop in May 1990 in conjunction with the World Health Assembly where donor representatives and senior government officials discussed the directions and activities to be included in the Government of Bangladesh's Five-Year<sup>Plan.</sup> This process of extensive consultation was greatly facilitated by the availability of a set of 24 extensive studies on various aspects of the population and health sector that had been included in the Third Population and Family Health Project approved in fiscal year 1986. Preparation of the Third Project was not nearly so consultative in nature as was the Fourth Project, and it was recognized at the time that in many areas information needed for jointly planning and setting priorities was incomplete or unavailable. During implementation of the Third Project, the 24 studies were carried out either directly by the External Evaluation Unit of the Planning Commission Oater the Population Development and Evaluation Unit) or on contracts supervised by the Unit. These studies were critical background documents for the various workshops through which the approaches and priorities of the Fourth Population and Health Project were agreed upon.

# _Brazil: Malaria Control_

Project-financed research in Brazil has had a substantial impact in changing malaria control 'irograms, has provided a substantial input to a follow-on project, and has influenced thinking about malaria control strategies world-wide.

When preparation began for the Northwest Region Integrated Development Program Project financed in fiscal year 1982, there was limited interest among Government agencies in including provision for research in the project. However, the division chief concerned had visited research institutes in Brazil and was convinced more operational research conducted by these institutions could improve the effectiveness of the anti-malaria campaigns implemented by SUCAM, the semiautonomous organization responsible for planning and implementing control programs for all the endemic diseases in Brazil. At Bank urging, a research component was included in the project; US$2.8 million of the $37.7 was allocated for "research and evaluation." As the project was implemented, SUCAM, using predominantly project funds, commissioned research at local institutions. The results of this research made it possible to adapt and adjust the SUCAM anti-malarial campaigns to be more specific to particular areas and, thus, more effective.

By 1987, a sizeable body of research on malaria had been financed by project funds. SUCAM, using project funds, sponsored a "Malaria Days" conference in Brazil, which proved to be highly successful. For three days, researchers from all over the country presented the results of their research. The collected papers were later published in a volume which presents one of the more comprehensive views of malaria control operations ever undertaken.

The "Malaria Days" conference was also one of the first steps in the preparation of the followon Amazon Basin Malaria Control Project,<sup>a</sup>
Project-Financed PHN Research

-6 -

US$198 million project for which the Bank lent however, the Ministry of Health expressed appreUS$150 million. For the follow-on project, 10 hension about assuming the loan commitmnent withoperational research studies were commissioned out having direct administrative responsibility. A with project preparation facility funds. compromise was worked out by which the Ministry would enter into a "consultative" relationship The Amazon Basin Malaria Control Project with IPEA, but would itself be responsible for the also contains funds for research to be administered contracting and administration of the proposed as grants to research institutions. Changes in the studies. It was decided to make a separate US$2 organization of research institutes in Brazil have million loan for the project. slowed implementation of the grant program, but recently progress has been made in funding reFrom the start implementation was slow. search proposals. From Board approval in June 1984 to loan signing recently progress has been made in funding reFrom the start implementation was slow. search proposals. From Board approval in June 1984 to loan signing took approximately six months, and it was another The research financed by the Northwest year before effectiveness in January 1986. Six Region Integrated Development Program Project months before the project was originally scheduled had repercussions far beyond Brazil. The emerg- to close, 41 percent of the loan funds had been ing pattern of malaria control strategies based on committed to 20 studies, but actual disbursements the research substantially influenced thinking in the totalled only US$270,000. The project was international malaria community. Previous efforts extended an additional two years, and closed on to 'eradicate' malaria were being recognized as December 31, 1989 with the cancellation of unrealistic. There was a growing appreciation that US$279,000. At closing, the Bank had received it would be necessary to shift to malaria control, only one completed study. and that different strategies would be needed. The success of the Brazilian project in using opEarly in 1989, a new administrator was put erational research to shape effective local proin charge of science and technology in the Minisgrams made it a model closely observed by the try. He felt that policy research was important international community. and that the loan funds should be utilized to Early in 1989, a new administrator was put in charge of science and technology in the Ministry. He felt that policy research was important and that the loan funds should be utilized to support the research. As a result, 64 research projects were identified under the project. As of this writing, reports for 23 studies have been received by the Bank, but many research projects

# _Brazil: Healdt Policy Studies_

The National Health Policy Studies Project have simply been left uncompleted. in Brazil, a stand-alone part of the Second Health Project approved in fiscal year 1984, is one of the Many implementation problems can be few Bank projects in any sector aimed exclusively attributed to thg fact that the Ministry is<sup>not a</sup> at funding policy research. It also illustrates the research institution, nor had it any experience with importance of carefil project design and close research administration. Although IPEA did have supervision. (This discussion draws extensively such experience, the respective roles and responsifrom a draft Project Completion Report on the bilities of the two institutions were not well deproject.) fined, and coordination problems persisted Many implementation problems can be<sup>not a</sup> research institution, nor had it any experience with research administration. Although IPEA did have bilities of the two institutions were not well defined, and coordination problems persisted throughou **t** he project. The compromise design assigned the role of evaluating study proposals to a coordinatin **g** roup, CIPLAN, within the Minission-making.

The project was appraised jointly with the assigned the role of evaluating study proposals to Sao Paulo Basic Health Project approved at the a coordinatin **g** roup, CIPLAN, within the Minissame time in fiscal year 1984. As originally try, which further complicated and delayed decidiscussed, the project was to be administered by sion-making. the Government Planning Institute (IPEA) or another research institution. During negotiations,
-7 -

Project-Financed PHN Research The project was also adversely affected by the early research contracts were not indexed and there were long delays in disbursement by the Ministry, many researchers abandoned their projects for lack of funds.

In retrospect, Bank handling of the project have been more careful in institutional design of the project, and more forceful in persuading the Once it was agreed that the Ministry of Health was to be the administering body, the Bank should have discussed more often, and in greater detail, have been more consistent in its supervision and ing backgrounds, and supervision missions were often charged with other activities so that they were unable to devote sufficien **t** ime to the project.

Health policy studies were important for Brazil at the time the project was formulated, and continue **to** be so at present. As a result, with the lessons of this project in mind, discussions are research component in a forthcoming loan.

# _Cidna_

experience with project-financed research.

Project. One component was to support three research institutions, the National Center for Preventive Medicine, the Research Center for Institute of Chinese Materia Medica.

The National Center for Preventive Medicine none of which was particularly distinguished. Now reorganized as the Academy for Preventive Medicine so that it can award doctoral degrees, it has become quite successful in the eyes of the Bank staff responsible for the project. It has developed one of the best reporting systems on causes of has completed more than 300 scholarly studies in such areas as operational research on the Chinese effective treatment regimes.

The Research Center for Health Planning Initially, the Center did not sufficiently appreciate sis. Revitalized under a new head, and renamed the Center for Health Statistics and Information, it now has an effective data collection system and is well positioned to do effective operational research.

A very interesting outcome of the Bank credit was the broad range of research which has been undertaken with project funds not envisioned appreciation of the SDR against the dollar which resulted in substantial sums becoming available for additional research. One research activity being financed is a community-based project in Tianjin which has instituted the world's largest chronic cholesterol levels, smoking behavior, and heart attack and stroke management. The Communicabecome a full partner, along with the Finnish Ministry of Public Health and the Academy for Preventive Medicine. The study thus combines rising rates of stroke and heart disease, the industrialized country with the highest incidence of
Project-Financed PHN Research

- 8 -

stroke and heart disease (Finland), and<sup>an industri-</sup> alized country which has succeeded in<sup>reduciz.g</sup> stroke and heart disease (the United States).

Another successful health research effort established with the additional project<sup>funds is</sup> being carried out in Beijing in cooperation with Oxford University. The study Is<sup>tracing the</sup> effects of different regimes of treating stroke<sup>on</sup> mortality and recovery time.

Yet another study made possible with the additional project funds is the world's<sup>largest study</sup> linking health practices and cause of death.<sup>More</sup> than 500,000 people have been identified and<sup>will</sup> be. monitored over a twenty-year period.<sup>Of key</sup> interest will be the information the study yields about the link between smoking and mortality, since nearly all the existk g studies of smoking<sup>and</sup> mortality have been carried out in industrialized countries and may have limited applicability<sup>in a</sup> developing country.

Finally, the project has financed part of an ongoing study of adult-onset diabetes with cooperation from researchers in the United Kingdom, Finland, France, Italy, and the United States.

Other Chinese projects have also resulted in successfil project-financed research. The<sup>Rural</sup> Health and Preventive Medicine Project<sup>(Second</sup> China Health Project) approved in fiscal year<sup>1986</sup> financed research into alternative insurance schemes which has influenced Chinese rural<sup>health</sup> policy. The Integrated Regional Health<sup>Develop-</sup> ment Project approved in fiscal year 1989<sup>has</sup> funded research to determine if school-based programs influence smoking behavior among<sup>par-</sup> ents. Cartoon books about the health risks<sup>associ-</sup> ated with smoking were the basis for an<sup>experi-</sup> mental curriculum. The result of the program<sup>was</sup> an immediate sharp drop in smoking among<sup>the</sup> parents of the children taking part in the program.

Project-financed research will continue<sup>to</sup> influence Chinese health policy. For example,<sup>a</sup> fiscal year 1992 Bank loan focuses on schistosomiasis and tuberculosis control. The TB<sup>treatment</sup> regime to be extended on a wide scale<sup>is one</sup> developed with project-financed research<sup>from the</sup> fiscal year 1984 Rural Health and Medical<sup>Educa-</sup> tion Project.

# _India-Tami Nadu_

The Tamil Nadu Integrated Nutrition Project in India was an innovative and hi'ghly successful project. It showed that large-scale, communitylevel interventions in the social sectors<sup>can work.</sup> (rhe credit became effective in August 1980<sup>and</sup> closed at the end of March 1989. This<sup>section</sup> draws heavily on the Project Completion<sup>Report</sup> for the project.) The project as designed included provision for a baseline survey and formal mid-term<sup>and</sup> final evaluations. Partly because the mid-term evaluation findings were not ready until 1986,<sup>they</sup> were not acted upon by project management<sup>until</sup> work began on the design of the Second Tamil Nadu Nutrition Project approved in fiscal<sup>year</sup> 1990. However, the results of both the mid-term and final evaluations did have a significant impact on the design of the second project.

The Project Management Unit (PMU) had<sup>at</sup> its disposal funds to commission small, stand-alone research projects and some 40 to 60 such<sup>studies</sup> were authorized. Most were judged by Bank<sup>staff</sup> to be of poor quality and had only a limited<sup>impact</sup> on the redesign of the project. In retrospect,<sup>the</sup> fact that the PMU had great freedom in<sup>commis-</sup> sioning research and so could act rapidly and<sup>with</sup> great flexibigity also contributed to poor<sup>research</sup> design and limited usefulness. It indicates<sup>that a</sup> more formal research committee with qualified members which could review proposals for<sup>rele-</sup> vance and methodological soundness would<sup>have</sup> been a better mechanism. The fact that the<sup>stand-</sup> alone research component was not a very significant part of the total project may have meant<sup>that</sup> Bank staff could not devote sufficient supervision
Project-Financed PHN Research

- 9 -

time to improve the quality of the stand-alone policy and medical research. The project provides research projects. for a US$4 million Population Research Fund to for a US$4 million Population Research Fund to finance research into a range of topics, including the socio-cultural and economic supports for largeand economic supports for large Nigerian Institute for Social and Economic Research through a Technical Committee which includes representatives of the major user groups. The project also supports extension to other states of research work at the University College Hospithe first World Health Organization collaborating fiscal year 1991, and which became effective in March 1992, has provision to support studies. studies were already underway to support anticipated requests for grants from the Fund.

It should be noted that a distinguished group the socio-cultural and economic supports for largeand economic supports for large of evaluation studies have been published about families and the determinants of fertility and this project. They showed large drops in undernu- contraceptive use in Nigeria. An interesting trition and mortality among children. However, feature is that the Fund is administered by the these studies were not funded by the project. Nigerian Institute for Social and Economic Re-

# _Mgerla_

Nigeria is another country where Bank tal of the University of Ibadan. The hospital was experience with project-financed research has been the first World Health Organization collaborating quite successful. In part this is due to the avail- research center for human reproduction in Africa. ability of able Nigerian researchers and senior The Health System Fund Project, also approved in officials interested to foster research and to use the fiscal year 1991, and which became effective in results in policy formulation and to prepare new March 1992, has provision to support studies. projects. In part, it is due to a continuing interest Even before the project became effective, some in research among the Bank staff responsible. studies were already underway to support anticiThe first PHN lending operation of the 1980s in Nigeria was the Sokoto Health Project approved in fiscal year 1985. The project includ- _Philippines_ ed US$1.4 million earmarked for studies. The money was used to prepare follow-on projects and The Philippine Health Development Project for major health care financing studies in Sokoto, approved in fiscal year 1989 includes a significant Ogun, and Oyo states. The survey work in Ogun policy research component. A contract for was used extensively by Bank staff to prepare a US$1.2 million for 36 studies was signed between major sub-sector report, _Federal Republic of Nge-_ the Department of Health (DOH) and the Philip- _ria-Health Care Cost, Fnancing and Utilization,_ pine Institute for Development Studies (PIDS) in which appeared in October 1991. The results of mid-1991, and work is proceeding. the research and the sub-sector report are being used as a basis for the First Referral Hospital The project builds upon the successful Project and a nutrition project now under prepara- implementation of a grant made in 1988 to PIDSof a grant made in 1988 to PIDS tion.

used as a basis for the First Referral Hospital The project builds upon the successful Project and a nutrition project now under prepara- implementation of a grant made in 1988 to PIDSof a grant made in 1988 to PIDS tion. by the International Health Policy Program (IHPP), a program to encourage health policy A second lending operation in Nigeria, the research supported by the Pew Charitable Trusts Imo Health and Population Project approved in and the Carnegie Corporation of New York, in fiscal year 1989, included funds to establish a cooperation with the World Bank and the World Population Studies Center at Imo State University. Health Organization. That grant resulted in six The Center has been established, a director apsubstantial studies, mostly by younge **r** esearchers pointed, and a research program is being prepared. not previously working on health policy, which have been widely disseminated and carefully The National Population Project, approved reviewed by the DOH. in fiscal year 1991, is intended to support both
Project-Financed PHN Research

- 10-

For the Bank-financed research, the DOH, in cooperation with the University of the Philippines School of Economics and PIDS, developed terms of reference for baseline studies to be system. From this emerged the specific studies to be supervised by PIDS. A Project Steering Committee chaired by a DOH under-secretary has been established. The topics chosen for the research studies include beneficiary and provider profile and behavior, financial resource base and institutions, the health care financing environment, and planning models for the health care financing system. In addition, Bank-financed research would collect, generate, and disseminate data pertinent to the health care financing system and the health system in general. A secondary data inventory and primary data collection are part of the project activities. The primary data collection is aimed at gathering baseline data which are not collected by government or private statistical agencies. The data base is expected to be maintained after completion of the project by the DOH with USAID assistance. Monitoring and consultation activities are built into the project implementation and several local and national level workshops are planned following a pattern developed under the earlier IHPP program.

# _Zaire_

Finally, the experience in Zaire demonstrates once again that the Bank can be of only limited effectiveness in situations where the overall political and ecenomic environment is adverse. The Social Sector Project and the National AIDS Control Program Assistance Project, both approved in fiscal year 1991, contained between them provision for some US$1.5 million for research. Yet conditions have been such that as of this date virtually no research has been undertaken.

# Common Themes and Conclusions

The information on which this note is based can only support preliminary conclusions about research. There are, however, which can be made:

- Bank experience with project-financed research in the PHN sector has been extremely variable, quite successful in some countries and almost a total failure in others. Even so, some striking successes can be noted, as the country experiences outlined here have demonstrated. These successes certainly justify continued efforts to incorporate research into projects and to encourage use of that research both to improve overall national PHN policy and follow-on Bank-financed projects.

- Personalities make a difference, both among borrowers and within the Bank. Quite often when there has been a successful experience, a particular person within the government or within the Bank has taken a personal and continuing interest in encouraging research.

- **0** Supervision is crucial to good results. Supervision must be frequent enough to keep the research component on time and of good quality. It is important if good quality research is to be completed that those responsible for supervision attach a high priority to research even if it is not a large part of the project in money terms.

- **0** Research that leads to a project outcome -such as that needed to justify release of funds or for a follow-on project-is more likely to be undertaken and completed than is research with a more general objective.
-11 -

Project-Financed PHN Research

- In countries where the institutional capability exists, using a national institution to ister research grants c;un be quite effective. Experience indicates some sort of research.

- There probably is room for more "best practices" workshops where PHN staff sary to retain experienced consultants to assist with the design of substantial research components.

- More systematic collection and dissemination of project-financed research is of money and effort which is devoted to it.

# Other Sector Project-Financed Research

Two other recent studies of World Bank project-financed research have been published, one each in the education and agriculture sectors.

# _Education_

The education study is _World Bank Lending for Education Research, 1982-89_ by Marlaine E. between fiscal year 1982 and fiscal year 1989. Of these, 116 included research components. The authors found that 2.2 percent of the loans and credits of these 116 projects was allocated **to** research, an outcome not much different from the however, that research as a percentage of total loan commitment declined sharply from 1982 to 1989, an outcome not demonstrated by this study for the PHN sector. Of the 436 planned studies were completed and of these only 84 were available through Regional Information Centers. not yield anything close to such a precise estimate of the number of studies included in projects, but the general impression from talking to task managers is that in the PHN sector, too, many planned critical of the fact that only 5.6 percent of the completed studies "had anything to do with assessing educational outcomes." The authors recommended that more attention be paid to the design and implementation of conclusion which many would probably feel valid for PHN projects. To facilitate this, they recommend that the Bank develop a program to train operational staff to design studios with appropriate methodologies and which would develop domestic research capacity. In the PHN sector, it would appear more appropriate to assure access to suitable consulting services for the design of research components rather than to undertake a training program substantial enough to teach operational staff how to design research components. They recommended free-standing educational research projects in larger countries. Except for the Brazil Health Policy Studies Project that was part of the Second Health Project, no PHN project reviewed substantial measure of support for free-standing PHN research projects. Finally, the authors recommend much more attention be paid to dissemination of research reports within the Bank and within the borrowing country, and that project studies completed under a project, both suggestions which would be applicable to the PHN sector.
- 12 -

Project-Financed PHN Research

# _Agriculture_

agricultural research systems; (2) an examination on a regional basis for the lack of effectiveness of The other major recently published study of research components; (3) evaluation of the effecproject-financed research is _Lending by the World_ tiveness of policy-based lending in the develop- _Bank for Agricultural Research-A Review of the_ ment of agricultural research; (4) training for Bank _Years 1981 through 1987_ by Anthony J. Pritchard. staff to increase skills in supervision and appraisal of research projects; (5) expansion of the timeThe extent of Bank lending to support frame of agricultural research projects; (6) analysis research in agriculture is much greater than it is in of the relationship between component size and the the PHN sector. From 1981 through 1987, the success of research programs; (7) development of Bank lent for 21 free-standing research projects Bank policy regarding support of biotechnology and 209 agricultural and rural development proresearch for developing countries; (8) reassessment jects with research components. The total cost of of the Bank's influence on research programs at the agricultural research elements in Bank-financed the international agricultural research centers to agricultural projects was $2.1 billion-25 to _50_ ensure efficient use of resources; (9) developing a times the amount of project-financed research in methodology to determine costs and benefits of PHN projects. Additional support for agricultural agricultural research projects and components; research was provided through 12 education pro(10) an evaluation of the contributions of consuljects, 16 policy-based loans, and grants to the tant experts in agricultural research projects; and Consultative Group for International Research and (11) a review of the concepts and procedures for other international institutions. extension-research linkages.

Because of differences in the history of To increase the chances of success in agriagricultura **l** ending and PHN lending within the cultural research projects and components, Bank and because free-standing research projects Pritchard suggested increased attention to: (1) are more common in the agriculture sector, agriadministrative and procedural problems during culture staff have a tendency to be much more project start-up; (2) adaptive and applied research directly involved in the establishment of research needs for the complete farming system; (3) develinstitutions and programs and in supervising oping national agricultural research plans; (4) research activities. supporting regional research initiatives; (5) allocating project funds for contract and collaborative Pritchard found that free-standing research research; (6) defining staffing needs, identifying projects were generally successful 'in institution- requirements for support staff, and providing building and in financing productive research adequate training and education opportunities; (7) programs." However, "problems in implementing developing public awareness programs to broaden research components in agricultural and rural public support for agricultural research; (8) prodevelopment projects were sometime **s** evere and viding incentives for research workers to assure the limited success of these components is a cause retention of high calibre staff; and (9) exploring for concern." alternative means of providing operating funds for research.

Pritchard had a number of recommendations, many of which would be inappropriate if applied in the PHN sector given the different emphasis and scale, but some of which would sound familiar to PHN staff. He recommended: (1) continued emphasis on development of strong national

# J. Price Gittinger Carol Bradford
Project-Financed PHN Research

-13 -

# Annex. Projects Reviewed

|Region/<br>Country|Project|Fiscal<br>Year|Total<br>Amount<br>of Project<br>(USS million)|Amount<br>of Loan/<br>Credit<br>(US$ million)|
|---|---|---|---|---|
|AFRICA|||||
|Benin|Health Services Development|1989|32.0|8.6|
|Botswana|Family Health|1984|26.6|11.0|
|Burkina Faso|Health Services Development|1985|28.0|26.6|
|Burundi|<br>Population and Health|1988|18.7|14.0|
|Cameroon|<br>Social Dimensions of Adjustment|1990|85.7|21.5|
|Chad|<br>Social Development Action|1990|26.9|13.4|
|Comoros|Health and Population|1984|3.1|2.8|
|C6te d'Ivoire|Health and Demographic|1986|29.7|22.2|
|Ethiopia|<br>Family Health|1988|43.9|33.0|
|Gambia|<br>National Health Development|1987|20.8|_5.6_|
|Gambia|Women in Development|1990|15.1|7.0|
|Ghana<br>|Health and Education Rehabilitation|1986|16.0|15.0|
|Ghana|Second Health and Population|1991|34.3|27.0|
|Guinea|<br>Health Services Development|1988|22.5|19.7|
|Guinea-Bissau|<br>Population, Health and Nutrition|1987|4.4|4.2|
|Kenya|Integratd Rural Health and Family||||
||Planning|1982|61.0|23.0|
|Kenya|Third Population|1988|28.3|12.2|
|<br>Kenya|<br>Fourth Population|1990|41.3|35.0|
|<br>Lesotho|<br>Health and Population|1985|7.4|3.5|
|Lesotho|Second Popation, Health and Nutri-||||
||tion|1990|22.1|12.1|
|Madagascar|Health Sector Improvement|1991|42.5|31.0|
|<br>Malawi|<br>Health|1983|8.7|6.8|
|Malawi|Second Family Health|1987|24.9|11.0|
|Malawi|Population, Healdth and Nutrition Sec-||||
||tor Credit|1991|74.3|_55.5_|
|Mali|Health Development|1984|17.6|16.7|
|Mali|<br>Second Health, Population and Rural||||
||<br>Water Supply|1991|61.4|26.6|
|Mozambique|Health and Nutrition|1989|42.5|27.0|
|Niger|Health|1986|29.3|27.8|
|Nigeria|Sokoto Health|1985|53.0|34.0|
|<br>Nigeria|Imo Health and Population|1989|36.8|27.6|
|<br>Nigeria|<br>Essential Drugs|1990|85.1|68.1|
|<br>Nigeria|<br>Health System Fund|1991|94.5|70.0|
|<br>Nigeria|<br>National Population|1991|93.6|78.5|
|Rwanda|Family Health|1986|14.5|10.8|
|Rwanda|First Population|1991|26.1|19.6|
- 14 -

Project-Financed PHN Research

|Region/<br>Country|Project|Fiscal<br>Year|Total<br>Amount<br>of Project<br>(US$ million)|Amount<br>of Loan/<br>Credit<br>(USS million)|
|---|---|---|---|---|
|Senegal<br>|Rural Health<br>|1983<br>|16.7<br>|_15.0_<br>|
|Senegal|Human Resources Davelopment|1991|37.8|35.0<br>|
|Sierra Leone<br>|Health and Popuation Sector Support<br>|1986<br>|_5.7_<br>|5.3<br>|
|Tanzania<br>|Health and Nutrition<br>|1990|70.0|47.6|
|Togo|Population and Health Sector Adjust-||||
||<br>ment|1991|52.7|14.2|
|Uganda|First Health|1988|_65.5_|42.5|
|Uganda<br>|Social Costs of Adjustment<br>|1990|37.0|28.0|
|Zaire|National AIDS Control Program||||
||Assistance|1989|21.9|8.1|
|Zaire<br>|Social Sector<br>|1991<br>|37.0|30.4<br>|
|Zambia|Social Recovery|1991||20.0|
|Zimbabwe|Family Health|1987|52.6|10.0|
|Zimbabwe|Second Family Health|1991|116.9|25.0|
|EAST ASIA AN<br>|D PACIFIC<br>||||
|China<br>|Rural Health and Medical Education<br>|1984|322.8|85.0|
|China|Rural Health and Preventive Medi-||||
||cine<br>|1986|177.4|80.0|
|China|Integrated Regional Health Develop-||||
||ment|1989|113.0|52.0|
|Indonesia|Third Populadon|1980|72.6|35.0|
|Indonesia|Provincial Health|1983|54.4|27.0|
|Indonesia|Fourth Population|1985|94.4|46.0|
|Indonesia|Second Health (Manpower Develop-||||
||ment)|198S|65.9|39.0|
|Indonesia|Second Nutrition and Community||||
||Health|1986|_57.5_|33.4|
|Indonesia|Third Health|1989|103.5|43.5|
|Indonesia|Fifth Populadon|1991|148.4|104.0|
|Korea|Population|1980|93.4|30.0|
|Korea<br>|Health Technology<br>|1991<br>|81.2<br>|60.0|
|Philippines|Health Development|1989|108.4|70.1|
|SOUTH ASIA|||||
|Bangladesh|Third Populaton and Family Health||||
|||1986|213.8|78.0|
|Bangladesh|Fourth Population and Health|1991|601.4|180.0|
|<br>India|<br>Second Population|1980|96.0|46.0|
|lidia|Tamil Nadu Nutrition|1980|66.4|32.0|
|Ildia|Third Population|1984|123.5|70.0|
|India<br>|Fourth Population<br>|1986|89.9|51.0|
|India|Fifth (Bombay and Madras) Popula-||||
||<br>tion|1988|182.0|57.0|
Project-Financed PHN Research

- 15 -

|Region/<br>Country|Project|Fiscal<br>Year|Total<br>Amount<br>of Project<br>(US$ million)|Amount<br>of Loan/<br>Credit<br>(US$ million)|
|---|---|---|---|---|
|India|Sixth (National Family Welfare<br>||||
||Training and Systems Development)<br>||||
||Population<br>|1989<br>|182.0<br>|124.6<br>|
|India<br>Idi|Seventh Population<br>|1990<br>|141.5<br>|86.7<br>|
|na<br>|Second Tamil Nadu Nutrtion<br> <br>|1990|139.1|95.8|
|India|Integrated Child Development<br>Servic-<br>||||
||es<br>|1991<br>|157.5<br>|106.0<br>|
|Pakistan<br>|Population<br>|1983<br>|28.2<br>|18.0<br>|
|Pakistan<br>|Family Health<br>|1991<br>|62.9<br>|45.0|
|Sri Lanka<br>|Health and Family Planning<br>|1988<br>|21.4<br>|17.5<br>|
|Sri Lrank|Poverty Alleviation|1991|85.0|57.5|
|MIDDLE EAST A<br>|ND NORTH AFRICA<br>||||
|Algeria<br>|Pilot Public Health<br>|1991<br>|26.7|16.0|
|Egypt<br>|Social Fund<br>|1991<br>|572.0<br>|140.0<br>|
|Jordan<br>|Primay Health Care<br>|1985<br>|30.5<br>|13.5<br>|
|Morocco<br>|Health Development<br>|1985<br>|47.6|28.4|
|Morocco<br>|Health Sector Investment<br>|1990<br>|171.3<br>|104.0|
|Oman<br>|Health<br>|1987<br>|30.6|13.3|
|Tunisia<br>|Health and Population<br>|1981<br>||12.5|
|Tunisia<br>|Poplation and Family Health<br>|1991<br>|63.2<br>|26.0<br>|
|Tunisia<br>|Hospital Resctudring and Supply<br>|1991<br>|49.5<br>|30.0|
|Turkey<br>|Health|1989|146.7|75.0|
|Yemen Arab Re-<br>|||||
|public<br>|Health<br>|1983<br>|15.9<br>|10.5|
|Yemen PDR<br>|Health Development<br>|1983<br>|10.4<br>|7.6|
|Yemen PDR<br>|Second Health Development<br>|1989<br>|7.6<br>|4.5|
|Yemen<br>|Health Sector Development<br>|1990<br>|19.1<br>|15.0|
|Yemen|Emergency Recovery|1991|59.5|33.0|
|LATIN AMERIC<br>|A AND CARIBBEAN<br>||||
|Bolivia<br>|Integrated Health Development<br>|1990<br>|38.6<br>|20.0<br>|
|Bolivia<br>|Social Investment Fund<br>|1990|95.6|10.0|
|Brazil|Northwest Region Integrated Devel-<br>||||
||opment Program First Phase Health<br>|1982<br>|149.0<br>|13.0<br>|
|Brazil<br>|Second Health<br>|1984<br>|123.6<br>|57.5<br>|
|Brazil<br>|Northeast Basic Health Services<br>|1986<br>|129.7|_59.5_|
|Brazil<br>|Northeast Endemic Disease Control<br>|1988|218.0|109.0|
|Brazil<br>|Amazon Basin Mlarda Control<br>|1989|198.0|150.0|
|Brazil|ond Northeast Basic Health Ser-<br>||||
||vices<br>|1990|610.6|267.0|
|Colombia<br>|Health Services Integration<br>|1986<br>|118.0|36.5|
|Colombia<br>El Sld|Community Child Care and Nutrition<br>Sil|1990<br>|40.2<br>|24.0<br>|
|avaor<br>|oca Sector Rehabilitation<br>|1991|35.6|26.0|
|Haiti|First Health|1990|33.7|28.2|
- 16 -

Project-Financed PHN Research

|Region/<br>Country|Project|Fiscal<br>Year|Total<br>Amount<br>of Project<br>(US$ million)|Amount<br>of Loan/<br>Credit<br>(USS million)|
|---|---|---|---|---|
|Haiti<br>|Economic and Social Fund<br>|1991|23.6|11.3|
|Honduras<br>|Social Investment Fund|1991|60.0|20.5|
|Jamaica<br>|Population and Health<br>|1987|12.4|10.0|
|Jamaica<br>|Social Sectors Development<br>|1990|67.0|30.0|
|Mexico|Basic Health Care|1991|249.8|180.0|
|Peu<br>|**Primary**Health Care<br>|1983|55.5|33.5|
|Venezuela|Social Development|1991|320.9|100.0|
# Policy Research Working Paper Series

|Title|Author|Date|Contact<br>for paper|
|---|---|---|---|
|WPS1 019 How Effective are Directed Credk<br>Policies in the United States?<br>A Literature Survey|Anita M. Schwarz|November<br>1992|M. Raggambi<br>37664|
|WPS1020 Another Look at Population<br>and<br>and Global Warming|Nancy Birdsall|November<br>1992|S. Rothschild<br>37460|
|WPS1021 Measuring<br>Welfare Changes<br>from<br>Commodity<br>Price Stabilizatio**n**<br>i<br>Small Open Economies|Jonathan R. Coleman<br>Chris Jones|November<br>1992|D. Gustafson<br>33714|
|WPS1022 A New Approach<br>to Evaluating<br>Trade<br>Policy|James E. Anderson<br>J. Peter Neary|November<br>1992|M. T. Sanchez<br>33731|
|WPS1023 Tariff Index Theory|James E. Anderson|November<br>1992|M. T. Sanchez<br>33731|
|WPS1024 An Exact Approach for Evaluating<br>the Benefits from Technological<br>Change|Will Martin<br>Julian M. Alston|November<br>1992|D. Gustafson<br>33714|
|WPS1025 Openness<br>and Economic<br>Performance<br>inSub-Saharan<br>Africa:<br>Evidence<br>from Time-Series<br>Cross-<br>Country Analysis|Kazi M. Matin<br>|November<br>1992|D. Ballantyne<br>38004|
|WPS1026 Financial Liberalization<br>and<br>Adjustment<br>inChile and New Zealand|Paul D. McNelis<br>Klaus Schmidt-Hebbel|November<br>1992|A. Marahon<br>31450|
|WPS1027 Lessons from Bank Privatization<br>In Mexico|Guillermo Bames|November<br>1992|W. Pitayatonakarn<br>37664|
|WPS1028 Socioeconomic<br>and Ethnic<br>Determinants<br>of Grade Repetition<br>in Bolivia and Guatemala|Harry Anthony Patrinos<br>George Psacharopoulo|November<br>1992<br>s|L. Longo<br>39244|
|WPS1029 Controlling<br>Tropical Deforestation:<br>An Analysis of Alternative<br>Policies|Robert T. Deacon|November<br>1992|P. Pender<br>37851|
|WPS1030 Measuring<br>the Effects of Urban<br>Transportation<br>Policies on the<br>Environment:<br>A Survey of Models|Alan J. Krupnick|November<br>1992|P. Pender<br>37851|
|WPS1031 Measuring<br>the Possibilities<br>of<br>Interfuel Substitution|Robert Bacon|November<br>1992|P. Pender<br>37851|
|WPS1032 East Asia and Pacific Region,<br>South Asia Region Population<br>Projections,<br>1992-93 Edition|Eduard Bos<br>My T. Vu<br>Anr. Levin|November<br>1992|0. Nadora<br>31091.|
# Policy Research Working Paper Series

|**Title**|Author|Date|Contact<br>for paper|
|---|---|---|---|
|WPS1033 Latin America and the Caribbean<br>Region (and Northern America)<br>Population Projections, 1992-93<br>Edition|My T. Vu<br>Eduard Bos<br>Ann Levin|November 1992|0. Nadora<br>31091|
|WPS1 034 Revising Financial Sector Policy<br>in Transitional Socialist Economies:<br>Will Universal Banks Prove Viable?|David H. Scott<br>|November 1992|K. Waelti<br>37664|
|WPS1035 How Import Protection Affects the<br>Philippines' Motor Vehicle Industry|Wendy E. Takacs|November 1992|D. Ballantyne<br>37947|
|WPS1 036 Output Decline in Hungary and<br>and Poland in 1990-91: Structural<br>Change and Aggregate Shocks|Simon Commander<br>Fabrizio Coricelli|November 1992|0. del Cid<br>35195|
|WPS1037 Vocational Secondary Schooling,<br>Occupational Choice, and Earnings<br>in Brazil|Ana-Maria Arrlagada<br>Adrian Ziderman|November 1992|C. Cristobal<br>33640|
|WPS1038 Determinants of Expatriate Workers'<br>Remitances in North Africa and<br>Europe|Ibrahim A. Elbadawi<br>Robert de Rezende Rocha|November 1992<br>|A. Maraiion<br>31450|
|WPS1039 Education, Extemaliies, Fertiliy,<br>and Economic Growth|Martin Weale|November 1992|PHREE<br>33680|
|WPS1040 Lessons of Trade Liberalization in<br>Latin America for Economies in<br>Transition|Jaime de Meb<br>Sumana Dhar|November 1992|D. Ballantyne<br>37947|
|WPS1041 Family Planning Success Stories in<br>Bangladesh and India|Moni Nag|November 1992|0. Nadora<br>31091|
|WPS1042 Family Planning Success in Two<br>Cities in Zaire|Jane T. Bertrand<br>Judith E. Brown|November 1992|0. Nadora<br>31091|
|WPS1043 Deriving Developing Country<br>Repayment Capacity from the Marke<br>Prices of Sovereign Debt|Stijn Claessens<br>t George Pennacchi|November 1992|R. Vo<br>33722|
|WPS1044 HospRtal Cost Functions for<br>Developing Countries|Adam Wagstaff<br>Howard Barnum|November 1992|0. Nadora<br>31091|
|WPS1 045 Social Gains from Female Education:<br>A Cross-National Study|Kalanidhi Subbarao<br>Laura Raney|November 1992|M. Abundo<br>36820|
|WPS1046 World Bank Project-Financed<br>Research on Population, Health,<br>and Nutrition|J. Price Gittinger<br>Carol Bradford|November 1992|0. Nadora<br>31091|