2006年-世界发展银行全球_How_are_Health_Services_Financing_and_Status_Evaluated__An_Analysis_of_Implementation_Completion_Reports_of_World_Bank_Assistance_in_Health_40页_2mb

Summary of "How are Health Services, Financing and Status Evaluated?"

Core Content

This paper analyzes how the World Bank evaluates health services, financing, and health status through the Implementation Completion Reports (ICRs) of 118 health-related projects completed between fiscal years 2003 and 2005. The study focuses on the extent to which these projects measure changes in the three strategic priorities outlined in the 1997 Health, Nutrition, and Population (HNP) Strategy: improving health outcomes of the poor, enhancing health care system performance, and securing sustainable health financing.

The paper highlights the lack of comprehensive and systematic evaluation frameworks in the World Bank's health sector projects, noting that only a minority of projects included indicators for health services (42%), health financing (17%), or health status (33%). However, among those that did measure changes, most showed improvements.

Main Findings

• Measurement of Outcomes:

  • Only 42% of projects measured changes in health services.
  • 17% measured changes in health financing.
  • 33% measured changes in health status.
  • Among those that measured changes, nearly all showed improvements.

• Organizational Approaches:

  • Sector Wide Approach (SWAp) was significantly associated with improvements in both health services and health status.
    • Adjusted Odds Ratio (AOR) for health services: 14.3 (95% CI: 1.6–130.0)
    • Adjusted OR for health status: 8.9 (95% CI: 1.2–65.4)
  • Contracting mechanisms were also associated with improved health services (AOR: 4.1, 95% CI: 1.1–15.9).
  • No other organizational approach, input, or activity was found to be statistically significant in relation to improvements in health services or status.

• Project Inputs and Activities:

  • Logistics systems were associated with improvements in health status.
  • Other inputs (e.g., salaries, training, technical assistance, pharmaceuticals, equipment, buildings, software) were not found to be statistically significant in relation to health status improvements.

• Country Context:

  • Geographic region, income level, and Country Policy and Institutional Assessment (CPIA) ratings were not statistically associated with improvements in health services or status.

Key Variables and Definitions

• Health Services:

  • Indicators related to utilization, coverage, quality, efficiency, or distribution of health services.
  • Includes changes in health behaviors.

• Health Financing:

  • Indicators related to the level or type of financing for health.
  • Includes impact measures (e.g., income protection), output measures (e.g., enrollment in financing schemes), and outcome measures (e.g., cost of services).

• Health Status:

  • Indicators assessing long-term effects on health, nutrition, or fertility.
  • Examples include mortality rates, disease prevalence, and malnutrition rates.

Methodology

• Sample Selection:

  • All World Bank projects with a health component completed between FY03 and FY05 were reviewed.
  • 119 projects were initially identified, but four were excluded due to lack of HNP-specific inputs or activities.
  • The final sample included 118 projects.

• Data Collection:

  • ICRs were analyzed using a checklist to identify indicators and assess changes.
  • Data were double-entered for consistency, and discrepancies were resolved through discussion.

• Analytical Methods:

  • Unadjusted Odds Ratios (UOR) and p-values < 0.05 were used to assess statistical significance.
  • Multivariate logistic regression was used to control for confounding variables and derive adjusted odds ratios (AOR).
  • CPIA ratings were used to assess the policy and governance environment of the countries involved.

Conclusions

• The current evaluation frameworks of the World Bank's health sector projects are insufficient in capturing the strategic priorities of the 1997 HNP Strategy.
• The use of a Sector Wide Approach (SWAp) and contracting mechanisms is associated with better measurement of improvements in health services and health status.
• The World Bank should improve its monitoring and evaluation practices to better assess the impact of its health investments.
• A dedicated unit for monitoring and evaluation, similar to the Global AIDS Monitoring and Evaluation Team (GAMET), could be beneficial.

Recommendations

• Encourage policy makers to demand more rigorous monitoring and evaluation of health sector investments.
• Develop incentives for better measurement of health services, financing, and status in operational work.
• Consider establishing a specialized unit to enhance monitoring and evaluation in the health sector.