Effectiveness, efficiency and sustainability of the World Bank health projects in developing countries

Background: To achieve his objectives of poverty reduction, the World Bank recognized in the late 80s the importance to invest in the health sector of his client countries, making it the world's largest international financing organization in Health, Nutrition and Population activities (HNP). However, the household poverty had doubled during the last 20 years, the mortality rate among children had increased, and HIV/Aids still ravage most African countries… So, what is wrong? How to achieve effectiveness and sustainability in World Bank Health projects in developing countries? Methods: Two field researches with qualitative interviews were conducted. The first series of interviews were conducted in an African country (Niger) with experts from the Health Ministry, the World Bank Representation in Niger, Civil Society and NGOs. The second took place at the World Bank in Washington DC (USA), mostly with staff working at the HNP Department of „Africa region“. Data from the IEG (Independent Evaluation Group) and specialized literature was also used. Results: Despite the fact that the World Bank has lent 15 USD Billion and disbursed 12 USD Billion from 1997 to 2006 in more than 500 HNP projects and programs in more than 100 client countries, one- third of his HNP projects, seven of 10 Aids projects around the world and 8 of 10 Aids projects in Africa over the last ten years have failed. Health projects outcomes in African countries are not making the gains needed to achieve economic growth or poverty reduction. The factors that caused this situation are manifold: structural, social, political and economic. Discussion/Conclusion: The failure of such projects is often attributed to structural reasons like lack in implementation procedure, management or over ambition of project objectives. The political and economic aspects are often ignored. But, there is no sustainability in health outcomes without economic sustainability.