Evaluation report
Bolivia - reducing maternal and infant mortality : a multi-project evaluation of 16 years of World Bank support to the health sector
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Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This report evaluates three World Bank projects that supported Bolivia's health sector over 16 years, with the aim of reducing maternal and infant mortality. The first project's outcome was rated satisfactory, and the second and third were rated moderately satisfactory. Risk to development outcome was rated moderate for all three, and Bank and Borrower performance was rated moderately satisfactory for all three. The report ends with lessons about results frameworks, results-based incentives, coordination with parallel programs, quality measures, programmatic approaches and reform-dependent project design.
Key points
- Health Sector Reform (APL 1) outcome was rated satisfactory.
- APL II and APL III outcomes were both rated moderately satisfactory.
- Risk to development outcome was moderate for all three projects.
- A results-based approach needs a clear mechanism of rewards and sanctions, otherwise it risks becoming a mere monitoring tool that could create perverse incentives.
- Coordinating with parallel programs can improve efficiency but raises concerns about attributing outcomes.
Limitations
Only the ratings and lessons are given in the abstract, so it does not report mortality figures or the methods used. It cannot tell us how much the projects changed maternal and infant mortality.
Abstract
This report spans three projects. Ratings for the first project, Health Sector Reform (APL 1) is as follows: Outcome is satisfactory, risk to development outcome is moderate, Bank and Borrower performance is both moderately satisfactory. Ratings for the second project, Sector Phase of the Health Sector Reform Program (APL II) is as follows: Outcome is moderately satisfactory, risk to development outcome is moderate, Bank and Borrower performance is both moderately satisfactory. Ratings for the third project, Expanding Access to Reduce Health Inequities (APL III) is as follows: Outcome is moderately satisfactory, risk to development outcome is moderate, Bank and Borrower performance is both moderately satisfactory. Lessons from these projects include: (i) The definition of a common results framework is useful to align the efforts of different government levels. (ii) A robust results-based approach needs to define a clear mechanism of rewards/sanctions to function well. Otherwise it risks turning into a mere monitoring tool that could lead to perverse incentives. (iii) Project design coordinating efforts with parallel programs that have similar goals has a great potential for efficiency, but it raises methodological concerns about the attribution of outcomes. (iv) While continued focus on quality objectives is certainly commendable, it needs to be accompanied by more robust outcome measures to prove quality enhancements. (v) Programmatic approaches are suitable where sector knowledge is strong, program objectives are long-term and clear, and country ownership is established. (vi) Ambitious projects partially relying on a government promise to pass a reform law are likely to need a restructuring. Reallocation of project funds in response to ad hoc government requests may lessen the logic of the results chain and risk the M&E framework from providing sufficient evidence of project achievements. (Bolivia)