Last week, IPPF launched their second Scorecard on the World Bank’s Reproductive Health Action Plan (RHAP). Don’t look for an actual score: IPPF used a narrative evaluation (essentially a Pass/Fail system). The Bank passed, barely.
The Bank, unsurprisingly, thinks they deserve higher marks. They’re scrambling to paint a rosier picture of their achievements in reproductive health, releasing their own progress report earlier this month.
So, how is the Bank really doing on reproductive health? It all depends on what you count, what you think the Bank’s role should be, and the impact of other Bank programs on reproductive health outcomes.
IPPF and the Bank are in disagreement whether the Bank’s investments in reproductive health are going up or down. IPPF finds that Bank funding for reproductive health is not growing with increasing investments in the health sector broadly. It will be important to make sure that Bank funding for reproductive health—particularly grants for low income countries—is on an upward trend.
At the Scorecard launch last week it became clear that we also have some definitional issues related to the Bank’s own understanding of what counts. Some staff seem to equate any investment in women’s and children’s health as “reproductive health.” And if they had their way, every road the Bank helps fund would be counted as reproductive health if it leads to a health clinic. Let’s not give the Bank too much extra credit. While it is true that there are important spillover effects from investments in nutrition, vaccines, women’s empowerment, and infrastructure, many countries also need specific investments in family planning, antenatal and safe delivery programs, and STI prevention and treatment.
Is more always better?
IPPF found that despite strong rhetoric on the Reproductive Health Action Plan being a turning point in the Bank’s commitment to reproductive health, the plan has not realized its original goals. The Bank does some very important work in reproductive health, and it could do more. For example, IPPF rightly points out the need for the Bank to incorporate reproductive health concerns more in its engagement with country governments, and specifically in Country Partnership Frameworks that outline its strategy in a country.
But just looking at Bank “investments” in reproductive health makes it seems like more is always better. Remember that Bank funding often comes in the form of loans that eventually have to be paid back by internally generated resources, taking money away from government budgets. Even the low-income country financing window IDA provides low-interest “credits” that must be repaid. So we need to be clear that if we ask the Bank do “do more” on reproductive health, it may be asking governments to borrow from future budget cycles. This is fine for urgent priorities, but in the long term governments should be funding reproductive health from their own budgets.
The Bank could do more in building its internal capacity on reproductive health. The Bank now has 21 focal points—staff members who are supposed to champion reproductive health. These focal points are key to make sure that Bank staff suggests reproductive health projects in their dialogue with country governments. But focal points at the Bank are often forced to balance many different causes, and may be stretched thin.
Do No Harm
Investments by the World Bank in other sectors can have unintended consequences on reproductive health outcomes. For example, during my time at Gender Action, I helped write a report about the World Bank funded Baku-Tbilisi-Ceyhan Export Oil Pipeline (BTC) transporting oil from the Caspian Sea to the Mediterranean. This project brought migrant construction workers to remote and impoverished areas of Azerbaijan and Georgia. One unintended consequence of the BTC pipeline was increased sex work around the workers camps, but no safeguards to protect against gender based violence, sexually transmitted infections or unintended pregnancies. I also heard undocumented rumors of increased incidence of still births and testicular cancer in Baku, near the new pipeline processing center.
At the encouragement of Gender Action and others, the World Bank is now drafting an updated Gender Safeguards Policy, which will hopefully make sure so-called gender impacts like increased sex work are anticipated for and mitigated better in the future.
So what is the score?
So what does all this mean? Basically the Bank is a “C” student who is smart but not really applying itself on reproductive health. To make the grade, the Bank needs to invest more in staff with dedicated reproductive health expertise, and give incentives to non-health staff to pay attention to reproductive health needs and impacts. They also need to start working now to put in place a new reproductive health strategy beyond 2015, when the RHAP expires.
I’m excited that IPPF’s Scorecard is helping rekindle attention on the Bank from the reproductive health community, and hopefully revive the SRHR Consultative Group on the World Bank. PAI will be watching as the Health Nutrition and Population (HNP) sector evolves into a Global Practice, and develops its next strategy. Let’s hope reproductive health fares better than in the 2007 HNP strategy update. If there is another firefight, we’ll be ready.