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The World Bank began lending for population in the 1970s and to health in 1980s, and has since committed over $14 billion to support the health, nutrition, and population (HNP) sector. This study seeks to evaluate the relevance, effectiveness, efficiency, institutional impact, and sustainability of nearly 30 years of Bank lending and nonlending services in HNP. It attempts to address three fundamental questions: a) Have World Bank HNP projects and policy advice been relevant to promoting improved outcomes and health system performance? b) Have Bank-supported interventions been effective and efficient in achieving their stated objectives? c) Has the Bank been effective in strengthening health care institutions, and have Bank interventions been financially and institutionally sustainable? The Operation and Evaluation Department (OED) recommends substantial improvement in monitoring and evaluation of project and sector performance and increased attention to institutional development in project design and supervision. It also recommends strengthened efforts in health promotion and intersectoral interventions; a renewed emphasis on economic and sector work; greater understanding of stakeholder interests; and the forging of strategic alliances with development partners at the regional and global levels.
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