Progress – Leveraging Additional Funds from IDA

In terms of overall spending on health the Bank has been one of the few to increase support to health through the fi nancial crisis with lending increasing from $2.1bn in 2006 fi scal year to $6.7bn in 2011. However, as the charts below show most of this is accounted for by spending in middle income countries.

Lending for health in Africa region increased from $614m in 2006 to $1.18bn in 2010 before falling back to under $600m in 2011. Overall IDA support has increased steadily from $9.5bn in 2006 to $16.3bn in 2011. In terms of poorer regions the share of lending going to health in Africa region has declined whilst that in South Asia region has fl uctuated with no discernible pattern. The share in some other regions – particularly Latin American and Caribbean – is much higher and has increased substantially over the period. HRITF fl ows are relatively modest in relation to overall Bank lending (the Trust Fund is expected to spend, on average, around $30m per annum over its 20 year life – around 5%

of spending on health in Africa and around 0.5% of its overall health portfolio.

Figure 10: World Bank lending to health and other services, by region World Bank lending to Health and other Services

by Region 2006-20011

MNA LAC ECA EAP SAR AFR

2010 2011

2009 2008

2007 0 2006

2,000 4,000 6,000 8,000

$ million

Source: World Bank Annual report

Figure 11: World Bank lending to health and other services, Africa and South Asia

World Bank lending to Health and other Services as % of total lending by region

AFR

The HRITF grants are clearly associated with other IDA monies (except when the HRITF grant is stand alone). As the chart shows the $209m HRITF grants have been associated with some $363m of additional IDA RBF support. When the stand alone projects are excluded $143m of HRITF grants are associated with the $363m other IDA funding a ratio of 1:2.5. However, this does not imply that the other IDA funding actually resulted from the HRITF grant.

Figure 12: Association between HRITF Grant and IDA Credit Association between HRITF and IDA Credit

HRITF

Source: HRITF Team (please see footnote⁹)

9 Evaluators consider that this table contains errors. In Rwanda, for example, the $12 million CPG and (approximately) $1.5 million impact evaluation grant were linked to 3 consecutive annual IDA Community Living Standards Grants worth $18 million total – thisa is not accounted for in the graph. In Zambia the HRITF money was always and is still linked to a pre-existing Malaria Booster IDA funded project. That project was restructured and its value went up from $19.4mil-lion to $50 mil$19.4mil-lion – this is also not showed in the graph. In both cases the IDA grant preceded the HRITF grant..

The 2008 Annual Report stated that “two governments reinstated support for health in the Country Assistance Strategy (CAS) and allocated IDA resources to health to be eligible to apply for the RBF grant funding. The $55 million in grant funding allocated from the trust fund in CY08 is estimated to have leveraged additional IDA allocations for health of roughly $30-50 million”. We were not able to verify these countries. This issue has not been reported on since.

The Trust Fund currently collects information on which IDA credits are associated with HRITF grant funds but does not necessarily assess which grants occurred because of the HRITF grants or their size was influence by it.

For example we heard from the Nigeria TTL that the IDA credit would have occurred anyway and that the HRITF grant was a welcome addition. This information is not currently shared with donors.

To assess the issue of additionality we requested TTLs to provide us information on the extent to which the explicit link with IDA affected the type and volume of funding to the health sector. We received a response from around a third of them that included examples shown in the box below.

We found some examples where the HRITF grant led to increases in the

additional IDA support (Tajikistan). We also found cases where the causality had gone the other way (Ethiopia - where the Government have been reluctant to take RBF forward

Examples from countries on leveraging resources

Would the IDA credit have happened without the HRITF credit?

It is the other way around. There would have been no RBF pilot without the IDA funded host project (Benin)

Probably. The grant was awarded in 2009, at a time when the IDA allocation was already agreed. That said, as the HRITF comes with funding for project preparation and supervision, it creates a huge incentive for our management to allocate IDA to HRITF-supported projects. It was not needed it at this time. (Benin)

It would get approved regardless of the HRITF. It was in the pipeline before HRITF grant was approved. (Sri Lanka)

In Rwanda the three annual IDA grants would have happened anyway In Zambia the Malaria Booster grant preceded the HRITF application

Would the size or content of the IDA credit have been different without the HRITF grant?

Yes for Tajikistan, the IDA grant would likely have been less than the current $10 million without the extra funds leveraged from the HRITF. And most likely the focus of the project might have been a continuation of traditional investment project without any RBF component, as this would have been impossible to do without the additional HRITF funds both for the project itself as well as preparation etc.

Is the RBF component different to what it would have been without the HRITF grant? (Would there have been any RBF component without the HRITF grant?

Or a smaller one?) Probably not (DRC)

Maybe. The HRITF money was used to design the RBF program in Benin. Without this funding, the design might have been less suited to the context (Benin)

For Tajikistan, most likely there would not have been an RBF component with only the IDA funds.

Are there any other ways in which the HRITF grant supported/influenced the development of the IDA credit or has supported the Bank’s programme?

Tajikistan – Funds leveraged from another source (see box below)

The HRITF grant supports the development of the project, which is expected to use a program approach. One of the key deliverables that the Government has indicated in its plan for the HRITF grant is a “results-based health sector plan”. Thus the grant is expected to influence the overall nature of the sector-plan, rather than just a few pilots which would explore RBF concepts. But again, it is too early to tell, how far this is really going to happen. (Sri Lanka)

What lending instrument is likely to be used for the credit: Sector Investment, Development Policy Lending or Payment for Results?

Still under discussion. This is a CAS year and the CMU is still debating about the composition of the next portfolio (DRC)

Ethiopia – Country to use P4R – it would have been SIL otherwise

Sri Lanka - We are considering P4R; but it is subject to the approval of Regional Management (as there are limits to the amount of IDA credit that can use P4R in the first couple of years). If P4R is not permitted for this operation, we are likely to use IL with Disbursement-Linked Indicators

Source: Email responses from TTLs to a short questionnaire on leveraging resources