2004年-世界发展银行全球_An_Analysis_of_Pharmaceutical_Lending_by_the_World_Bank_56页_2mb

Summary of "An Analysis of Pharmaceutical Lending by the World Bank"

Core Content

This paper, authored by Rosa Rodríguez-Monguió and Juan Rovira, presents an analysis of the World Bank's pharmaceutical lending activities from FY 1999 to FY 2002. It builds on previous studies, including those by Falkenberg and Tomson, and Sabate et al., which examined the Bank's pharmaceutical lending in the past. The study aims to quantify and understand the extent of pharmaceutical financing within the Health, Nutrition, and Population (HNP) sector, and to identify areas for improvement in the Bank's operational policies related to pharmaceuticals.

Main Objectives

• To estimate the amount of pharmaceutical lending by the World Bank during FY 1999 to FY 2002.
• To analyze the pharmaceutical lending activity by sectors, regions, borrower and supplier countries, and procurement methods.
• To formulate recommendations for enhancing transparency and coherence in pharmaceutical lending practices.

Key Findings

• During FY 1999 to FY 2002, the World Bank approved 65 HNP lending projects, with a total cumulative value of US$3,298 million.
• The Bank has been financing pharmaceutical activities within the HNP portfolio since 1983.
• Pharmaceuticals accounted for 36% of the procurement of goods in the HNP sector, and 18% of the total HNP procurement activity (including goods, civil works, consulting, and other services).
• In the all sectors category, pharmaceuticals represented 11.87% of the total procurement activity, with a lower bound estimate of 11.87% and an upper bound estimate of 44.41%.
• Procurement of pharmaceuticals made up 89% of the Bank's pharmaceutical lending, while the remaining 11% was allocated to software, hardware, and laboratory equipment.
• Africa was the region with the highest percentage of HNP lending allocated to pharmaceuticals, at 28%.
• Latin America and the Caribbean followed with 15%, South Asia with 14%, East Asia with 12%, and the Middle East and North Africa with 3%.
• The Business Warehouse (BW) database was used as the primary source of data, offering more detailed and accurate information compared to previous databases.
• The study highlights that lending for procurement is the main focus of the Bank's pharmaceutical activities, while other policy aspects such as pricing, regulation, and quality control are less addressed.

Limitations of the Information

• The BW database records only the total monetary value of contracts, not specific items like pharmaceuticals, vaccines, or contraceptives.
• Unit prices and quantities of goods are not available in the BW database, making it difficult to analyze cost differences or procurement efficiency.
• Data retrieval from the BW database is limited to contracts that exceed a prior review threshold, meaning smaller contracts may not be included.
• There is a time lag between project approval and contract approval, which can affect the accuracy of data analysis.
• The BW database is updated weekly, which may result in changing data figures depending on the snapshot date used.

Key Recommendations

1. Define a standardized set of cost accounting categories to improve transparency and consistency in pharmaceutical lending.
2. Enhance the level of detail in pharmaceutical sector reporting.
3. Develop mechanisms to ensure consistency in the description of pharmaceutical activities and in the reporting of funds committed for procurement.
4. Improve the availability of unit price and quantity data to better assess procurement efficiency and cost impact.
5. Ensure that all procurement contracts, regardless of size, are documented and accessible for audit and review.

Conclusion

The World Bank plays a significant role in financing pharmaceutical activities in low- and middle-income countries. However, the lack of an explicit operational policy and the limitations of data collection and reporting pose challenges to fully understanding the impact and effectiveness of these activities. The study emphasizes the need for better data management, more detailed reporting, and alignment with the Bank's broader development goals.

References

• Falkenberg, P., & Tomson, G. (1995). World Bank pharmaceutical lending: A review of the sector's role in health financing.
• Sabate, E., et al. (2000). Financial and policy audit of World Bank pharmaceutical lending.
• World Bank. (2001). Business Warehouse database.
• World Bank. (2001). Health, Nutrition, and Population (HNP) Discussion Paper.

Annex Highlights

• The study used two snapshot dates to capture data on additional variables.
• Procurement arrangements are only recorded in the BW database if they exceed a prior review threshold.
• Procurement contracts are stored in borrower countries and may be accessed upon request.