Population, health, and nutrition : annual operational review for fiscal 1992

Population, health, and nutrition (PHN) lending decreased in fiscal 1992 from the record levels of fiscal 1991, in both the amount and the number of operations. Lending amounted to $961.6 million for 16 projects, compared with $1,567.6 million for 28 projects in fiscal 1991. This temporary dip in PHN lending is attributable largely to pipeline factors. Fiscal 1993 lending is projected to recapture if not exceed the fiscal 1991 level, and projections for fiscal 1993 and fiscal 1995 are for a continued increase in lending volume. PHN projects approved in fiscal 1992 have been responsive to the World Bank's objective of poverty alleviation. Collectively, fiscal 1992 projects cover the essential features of good poverty work but the depth and quality of poverty work varies across projects. Drawing from the good practices observed and lessons recorded in this year's portfolio, the review offers the following suggestions, among others, for strengthening PHN interventions to alleviate poverty: poverty information and monitoring must be accompanied by dissemination and sensitization activities to strengthen national understanding of poverty-related issues and national commitment to resolving them through the proper policy; community involvement in project design and development requires clearly defined and carefully designed institutional and procedural mechanisms, and a concerted effort to make them work; it is essential that PHN sector work identify poor and vulnerable groups and assess their needs and demands for basic health, family planning, and nutrition services; and even the most demand-driven project designs targeted to clearly identified poverty groups require promotional activities to ensure that these groups participate in and benefit from project initiatives. Health lending is now a decade old, and many innovations in PHN lending have emerged only in the past four or five years. This review demonstrates that good practices and new and promising ideas - well worth emulating - are scattered across PHN work. Overall, PHN work is moving in the right direction and the quality of work is generally seen to be improving. Welcome trends (which should be encouraged and reinforced) include serious attention to the poorest, most vulnerable populations, growing consideration of the demand of target groups, and increased attention to monitoring and evaluation of sector performance.