This paper reports on an analysis of how World Bank assistance at the country level has influenced health services, health financing, and status on peoples' health. The Implementation Completion Reports used to evaluate all 118 projects involving health services completed between fiscal years 2003-2005 were systematically analyzed to determine how they measured changes in health services, health financing, and health status outcomes. The results showed that few Bank-assisted projects in the health sector evaluated changes in health services, health financing, or health status, with nearly all those measuring change demonstrating improvements. In multivariate models including the type of project organization (e.g. disease program, sector wide approach), project inputs, key project activities, and contextual factors including per capita income level, geographic region, and Country Policy and Institutional Assessment ratings, there was a statistically significant association between use of a sector-wide approach (SWAp) and measurement of improvements in health services and improvements in health status. Projects that used contracting mechanisms were also more likely to show an improvement in health services. No other type of organization of project support, project input or project activity was statistically associated with measurement of improvements in health services in the multivariate analysis. The results from this analysis show that the three strategic priorities outlined in the 1997 HNP Strategy-- (i) to improve health, nutrition, and population outcomes of the poor; (ii) to enhance the performance of health care systems; and to (iii) secure sustainable health care financing, were not well measured in the evaluation frameworks of Bank assistance in health. With the development of the new HNP Strategy, the World Bank should encourage policy makers to demand more rigorous monitoring and evaluation of health sector investments with Bank funds.
