The note reflects on the issue ofeffective health sector investments with sustainableresults, which based on the Bank's experience,constraints to such efforts is neither lack of money, norabsence of technology, but rather the weak national capacityto fully benefit from those investments. This has beendocumented, noting that while the Bank's Population,Health and Nutrition (PHN) portfolio assessed positiveevolutions in quantity, and quality of these PHN projects,also highlighted was the issue of serious weaknesses by theBank, in the assessment of national capacity to implementthese projects, including in the design and implementationof institutional strengthening, needed to supportinvestments in the sector. Unfortunately this weaknesspersists, as documented by the recent Operations EvaluationDepartment review of development effectiveness. Theseobservations fostered the development of a new framework forinstitutional assessment, and design of interventions forcapacity building, whose application has shown promisingresults. The note provides experiences from Niger andBurkina Faso, which entail paradigm shifts both for theBank, as well as for governments, but, while the experiencethus far seems encouraging, serious challenges remain. TheBank should ensure support to ongoing reforms fordecentralization, and integration, through the choice ofappropriate performance indicators for which local actorswill be held accountable, and continue its evolution in thecontext of innovations, and policies, focused oncost-effectiveness, and financial requirements.
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