Gittinger, J. Price & Carol Bradford 1992 'World Bank Project--Financed Research on Population,...

7/27/2019 Gittinger, J. Price & Carol Bradford 1992 'World Bank Project--Financed Research on Population, Health, And Nutriti

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l~~jJ' l X4(XPolicyResearch

WORKING PAPERSPopulatilon, ealth, nd Nutrition

PopulationndHuman esourcesDepartmentTheWorldBankNovember992WPS1046

World Bank Project-FinancedResearchon Population,Health, and Nutrition

J. PriceGittingerandCarolBradford

Most population,health,and nutritionprojects provide financefor research.Personalities of both borrowersand Bank staff- make a difference n the qualityof research.Supervision ndpeer group review also make a difference, and more best-practicesworkshopsare in order.

PolicyReah WongPapcudminatthefmndings ofwinpn ndM numgetheehan8cofide amongBankstaffandasldbexinciead dopeuuic&Thaspapw,& dbytuxbythReRab hAdvisoyStaff.cynamchsnfescauthwusrcfla 1ythdrvwsandsbohdbtWad ndcitodaoconigly.Thefindings, ntutadons,andconc1usoaetheauthomeown. Theyshouldact be aunbud to the Wodd B o , its Baud of Dims, its managmemat,or any of its mamber couantri


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r_ PolicyorhPoualn, ealth,andNutrition

WPS 1046

Thispaper-aproductofthe HealthandNutritionDivis n, PopulationandHumanResourcesDepartment- is partof a largereffort in the departmento dissemLa&teank-funded opulation,health,andnutritionresearch.Copiesof the paperare available ree from heWorld Bank, 1818HStreetNW, Washington,DC20433. Please contactOtilia Nadora,roomS6-065,extension31091(November1992, 16 pages).This reporton World Bank project-financed researchcomponenton time and of goodquality.researchon population,health, andnutrition For quality researcho be completed, t is(PuN) iLbased on a review of 109staff appraisal important hat those responsibleor supervisionreports for projectsfinarncedn fiscal 1980-91 attach a highpriority o researcheven if it is notand on selectedinterviewswith task managers. a large part of the projectin terms of budget.The reportooks at only the simplestdimensionsof project-financed esearchand examines * Research hat leads to a project outcome-researchoutcomesof onlya few projects. suchas researchneeded o justify releaseofAmongconclusionsentatively eached: funds or for a follow-onproject is more likelyto be undertakenandcompleted han is research* More than 90 percentof PHNprojectsfrom with a more generalobjective.fiscal 1980-91 inancedresearch. In countrieswhere the institutionalcapabil-* Bankexperiencewith project-financed ity exists, using a national institutiono reviewresearch n the PHN sector has been extremely researchproposalsand to administer esearchvariable: quitesuccessful n some countriesand grantscan be quite effective.Experience ndi-almosta total failurein others. Even so, some cates that some sortof peer-group eviewstriking successes ustify continuedefforts to oroducesbetter research.incorporate esearch ntoprojects and to encour-age use of that research o improveboth national * There is probablyroom for more best-PHN policy and follow-onBank-financed practicesworkshopswhere PHN staff canprojects. exchangeexperiencesabout successfuldesignand supervisionof project-financedesearch* Personalitiesmakea difference,both among components.But usuallyit will be necessary toborrowersand within he Bank.Oftensuccesses retainexperiencedconsultants o help designare associatedwith a particular personwithinthe substantial esearchcomponents.govemmentor the Bank who has taken a con-tinuingpersonalinterest in encouraging esearch. * More systematiccollectionand dissemina-tion of project-financedesearch s justified,* Supervision s crucialto good results. given the considerableamountsof money andSupervisionmust be frequentenough o keep the effort devoted o it.

ThePolicyResearchWorkingPaperSeriesdisseminateshe mdings f workunderway m heBank.Anobjective f theseriesis to get these findingsout quickly,even if presentations re less than fully polished.The findings, interpretations, ndconclusions n thesepapersdo not necessarily epresentofficialBank policy.

Producedby thePolicy ResearchDissemination enter


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World Bank Project-Financed Researchon Population, Health, and Nutrition

by

J. Price GittingerandCarol Bradford


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Tableof Contents

Proportion of Projects wlth Research ............................. 1Categories of Research Financed ............................. 1Total Value of Project-Financed Research ............................. 4Project-FinancedReseach EBperlence ............................. 4Conmnon Theme and Condusions ............................. 10Other Sector Project-Flnanced Rescarh .......................... 11Annex Projects Reviewed .......................... 13


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World Bank Project-Financed Researchon Population, Health, and NutritionThis note reports on World Bank project-fi- four of the five regions covered, the proportion ofnanced research on population, health, and nutri- projectswhich includeda research componentwastion (PHN). It is based on a review of 109 staff over 90 percent; in MENA 80 percent of theappraisal reports (SARs) for projects fLianced n projects includeda research component.fiscal years 1980 through 1991 and selectedinterviews with task managers. The projectsreviewed nclude47 in the Africa region; 13in the Categories of ResearchFinancedEast Asia and Pacific region; 15 in the South Asiaregion; 14 in the MiddleEast and North Africa For every project reviewed, the research

region; and 19 in the Latin Americaand Caribbe- proposedin the SAR was dassified by one of sixan region. In tbis note, Tu,rkey s tabulated n the categoriesor else was noted as uncategorized seeMiddleEast and North Africaregion. There were box). Projectswere reviewedand tabulatedBank-no operations in the Europe and Central Asia wide and on a regionalbasis (Table 1).region during the period reviewed. (A list of theprojects reviewed is given in the Annex.) The The categorieswere medical, demographic/projectsrepresentessentiallyall Bank financing n epidemiological, human resources (includingthe PHN sector duringthe periodunder review. studies elating o personnelpractices),managerialThe World BankencouragesPHN research (including operational research), financial, andtostrengthenord Bnkenow gebaseuPoNesechto researchneeded o prepareinformation,education,to strengthen he kcnowledgease uponWhicho and communicationIEC)programs.design cost-effectiveinvestmentsin population,

health, and nutrition; to strengthen he analyticalcapacity of borrowing governments to undertakepolicy-related PHN research; and to evaluateprogram and project performanceas a basis forimprovingfuture design.This note is an initial,exploratory urvey. tooprt oo ....... ,..-------.--It looks onlyat the simplestdimensionsof project- 9_financed esearchand examines esearchoutcomes so . .. .. 0 .. .of only a few projects. Hence, the conclusionsreached must be considered entativeand subject o , 0 ... .... ... ....revisionin the light of fuller investigation.

40 ....--- .. _ .._ . ._

Proportion of Projectswith Research 20 .... ... ... ...Virtually every project in the PHN sector A_ "t o Aduring the period reviewed contained ome provi- &"i54 W-sion for research (Figure 1). Bank-wide and in Figure 1. Proportionof projects with researchcomponentsby regionand Bank-wide.


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2 - Project-FinancedHNResearchFrequencyof Categories

Research Categories Bank-wide, he most common researchResearchproposed n the 109 SARs componentwas a managerial tudyor operationalreviewed or thisnote was categorizedn one research. Seventy-two ercent of all projectsof six categories r else noted as uncategor- reviewedncluded ne or anotherkindof manage-ized. Researchwas taken to mean special rial research. The next most common ategoriesstudiesof some sort, either as part of project of research were demographic/epidemiologicalimpleir :tationor for a broaderpurpose. includedn 48 percentof all projects nd financialstudies ncluded n 47 percentof all projects e-

MEDICAL. Includes iologicalesearch, lini- viewed. Research urning on human resourcescal studies,medical rials, etc. issues, ncludingraining f personnel,was nclud-ed in 30 percentof the projects. Studies eeded oDEMOGRAPHICGTPIDEMIOLOGICAL.ov- prepare ECmaterialswere ncludedn 16percenters surveys, ensusts,studiesdone with arge of the projects eviewed. (Preparation f the IECgroups o determinehe effectof a program, materialshemselves asnot counted s research.)etc. Includes pidemiology. In some 13 percentof the projects here was amedical esearch omponent.HUMANRESOURCES. Res archcarriedoutto determine umbers f personnelneededorto assess the skills of individuals roviding RegionalDifferencescareor otherservices.Includes ssessmentsfadditional raining needed or how existing While here are regionaldifferencesn theskillsmightbe improved. frequencyn whichcategories re includedn pro-jects, they are not strikingand p:obablyare notMANAGERLi. Studies assessingadminis- significant. In every region except MENA,trative issues, includingoperational esearch managerialtudieswere hemost requent ategoryand means to increase program efficiency. encountered. Demographic/epidemiologicalrIncludes tand-alonevaluations f projects r financial esearchwere the second nd third mostprograms. However, it was assumed hat common. It is interestingo note that financialeveryprojectwouldhavea managementnfor- studies n the Africaregion frequently evolvedmation ystem, o MIS ntended rimarily s a aroundcost recovery,a topicwhich was of greatmanagementool during project mplementa- concern o healthadmniistratorsnd governmentstionwas not included. during the decadeof the 1980s. On the otherhand, studiesof medical nsurancewere concen-FINANCIAL. Researchon programcosts or trated in Asia. Research or EECmaterialsandmeans of financinghealth care or nutrition programs angedfrom 7 percent n MENA o 40interventions. ncludes tudieson cost-recov- percent n SouthAsia. The reason or the varia-ery and health nsurance. tion is not clear, and it may be insignificant;tproveddifficulto separate ut the research eededINFORMATlON,EDUCAI7ON,AND COM- to prepareECmaterials rom he workof prepar-MUNICATION IEC). Research n informa- ing the materials hemselves.Whileno project ntion needed or IEC programs,but not prepa- MENA ncludedmedical esearch,more han onerationof the materials hemselves. in five LACprojectsdid so.


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Project-FinancedPHN Research

Table 1. Projects withResearch Componentsby Region and Category,FY'80-FY'91(Percent)EastResearch Asiaand South Bank-Category Africa Pacific Asia MENA' LAC wide

Medical 13 15 13 0 21 13Demographic/Epidemiolog-ical 43 54 47 60 47 48HumanResources 28 31 47 20 32 30Managerial 74 54 93 53 74 72Financial 55 38 27 40 53 47IEC 17 8 40 7 5 16a. IncludesTurkey.

Other 7ypes of Research Research or Follow-OnProjectsTherangeof research roposedn the SARs Bank-wide,1 percentof theSARs ncludedreviewed was extremely broad, even within the some explicitprovision for research intendedtotabulatedcategories. In populationprojects, it was facilitate preparation of a follow-on projectcommon o find provisionfor family planning (Figure2). The proportion n Africa was 28

knowledge,attitude,and practice(KAP)research. percent, in East Asia and Pacific 23 percent, inPopulation projects also included research on South Asia 20 percent, in MENA 7 percent, andmaternamortality ndon contraceptivese (clas-sified as demographic/epidemiologicalesearch).Research nto drug prescriptionpractices,distribu-tion, or formulationfigured in several projects. 100Pat.....Structural adjustmentloans with PHN activitiesoftenincludedresearch o look at the socialdimen- s ...... . .sions of adjustment. Nutrition projects, notsurprisingly, generally includednutrition-related o ...research, especially the extent of malnutrition(classified as demographic/epidemiologicale- . ................... .......search). The importanceof malariain the Ama- uzon basin led to inclusionof entomologicalre- 20 ...................... te.search in the Brazil AmazonBasin Malaria Con-trol Project. O MA. At t MC Book-lFigure 2. Proportionof projectswith follow-onproject researchcomponentsby regionandBank-wide.


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- 4 - Project-FinancedHNResearchin LAC 16 percent. The proportion f projects billion. If the amountor healthand otherPHNwith research ntendedo supportfollow-on ro- research s betweenone and twopercentof this,jects s probably onsiderablynderstatedy these that wouldcome to betweenUS$46millionandtabulations. t seemsikely hatmanySARsmight US$92million,or some US$4million o US$8be writtenin the expectation hat all research millionannually. If theseestimates re valid, itincludedwouldcontributeo the preparation f a would make the Bank, after the WorldHealthfollow-onroject nd hat it wouldbe unnecessary Organization,he largest externalfinancierofto mention it explicitly. Further, many SARs healthand otherPHN research n ThirdWorldmadeprovisionor strengtheningeneralpopula- countries.Inthe late 1980s, heWHObudget ortion, health,and nutrition lanning nd hatwould researchwasrunningbetween 60million o $70supportpreparation f follow-on rojects. millionannually. However, according o theWHO Officeof ResearchPromotion nd Devel-opment, n 1988only 3 percent of this was forTotal Value of Project-Financed Research areaswhich might ncludepolicy esearch,or onthe order of $2 million. Since Bankproject-The sourcesof data for this note do not financed esearch s dominantlyn the areas ofpermitmore thana very roughapproximationf demography/epidemiology,anagement, r fi-the totalamountofBankandIDA fundsused for nance, project-financedesearch s probably heproject-financedesearch.The SARsoftendonot leading ourceof external inance or these kindsincludeexplicitlyhe amountenvisionedor re- of research.search; insteadresearchis often includedwithotheritems such as trainingor the managementinformation ystem.SARs, of course, are state- Project-Financed Research Experiencementsof intent;whetherhe funds nvisionedwereactually xpendeds not knownon the basisof the Eight countryexperiences re presented odocumentation sed in this study. Even the provide nsight nto the effectivenessf project-ProjectCompletion eports ftendo not eport he financedesearch. Theywere selected o giveaoutcome fresearch nless t wasa very mportant range of differentkindsof projects,a range ofor contentious omponent f the project. Fre- regions, and both successfuland unsuccessfulquentlywhen nformation bout he amount o be efforts o promote esearch.spenton research s includedn an SAR, t is notclear to whatextent oan fundswill finance heresearch r if it willbe financed ntirely rom he Bangladeshgovernmentontributiono the project. The Bank-ledBangladesh opulationandHowever,whilekeepinghese imitationsn HealthConsortium,rouping13 inanciersnclud-mind, a grossapproximation f the amountof ingIDAand he Governmentlus threeexecutingfundsdevoted o PHN research rom Bank oans United Nations agencies, was instrumental nandIDA credits s attempted. In a largenumber workingout the Fourth Populationand Healthof the caseswhere it is possible o identify he Projectapprovedn fiscalyear 1991. The Fourthamount penton research, t accounts or between Project is a crucial and significant art of theone and two percentof the total project costs. FourthFive-YearPlan whichextends rom 1990Takinghis range,and assumingt applieso Bank to 1995. Almost llof the projectcomponentsreand IDAfunds, t is possibleo makean approxi- population nd healthelementsof the Five-Yearmation. Total SARproposedlending for the Plan. The Consortiums probably he longest-projects ncluded n this studywasaboutUS$4.6 lived, argest,mostcomplex, ndperhaps hemost


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Project-FinancedPHN Research -5 -

successfulexampleof donor coordinationand co- Brazil: Malaria Controlfinancingin the history of Bankoperations. Project-financed esearch in Brazil has hadPreparation of the Fourth Population and a substantialimpact in changing malaria controlHealthProject was markedby an extensiveseries 'irograms, has provided a substantial input to aof workshopswherethe issuesand prioritieswere follow-on project, and has influenced thinkingdebated. There was, for example, a three-day aboutmalariacontrol strategiesworld-wide.high level seminar for senior officials from theBangladesh Planning Commission, Ministry of Whenpreparationbegan for the NorthwestHealth and Family Welfare, and Ministry of Region Integrated DevelopmentProgram ProjectFinance. Another three-day seminar permitted financed in fiscal year 1982, there was limitedfield-level staff to articulate their views about interest amongGovernmentagencies in includingissues and priorities. Representativesof donor provision for research in the project. However,agencies met in a workshop to coordinatetheir the divisionchief concernedhad visited researchviews about issues and priorities. Finally, yet institutes n Brazil and wasconvincedmoreopera-another three-day workshop brought together tional research conducted by these institutionsdonors and governmentofficials to agree on the couldimprove he effectiveness f the anti-malariabroad-brushoutline of the major approachesand campaigns implementedby SUCAM, the semi-priorities for the five-year implementation eriod autonomousorganization esponsiblefor planningof the Fourth Project. There was a three-day and implementingcontrol programs for all theworkshop in May 1990 in conjunctionwith the endemicdiseasesin Brazil. At Bank urging, a re-World Health Assemblywhere donor representa- search component was included in the project;tivesand seniorgovernmentofficialsdiscussedhe US$2.8 million of the $37.7 was allocated fordirections and activities to be included in the "researchand evaluation."Governmentof Bangladesh'sFive-YearPlan. As the project was implemented,SUCAM,This process of extensiveconsultationwas using predominantlyproject funds, commissionedgreatly facilitatedby the availabilityof a set of 24 research at local institutions. The results of thisextensivestudieson various aspectsof the popula- research made it possible to adapt and adjust thetionand healthsector thathad been included n the SUCAM anti-malarial campaigns to be moreThird Population and Family Health Project specificto particularareasand, thus, more effec-approved in fiscal year 1986. Preparationof the tive.Third Project was not nearly so consultativeinnature as was the Fourth Project, and it was By 1987, a sizeable body of research onrecognizedat the timethat in manyareas informa- malaria had been financed by project funds.tion neededfor jointlyplanningand settingpriori- SUCAM,usingprojectfunds,sponsoreda "Malar-tieswasincompleteor unavailable. Duringimple- ia Days" conference n Brazil, whichprovedto bementationof theThirdProject, the24 studieswere highly successful. For three days, researcherscarried out either directlyby the ExternalEvalua- from all over the countrypresentedthe results oftion Unit of the Planning CommissionOater the their research. The collectedpapers were laterPopulationDevelopmentand EvaluationUnit) or published in a volume which presents one of theon contractssupervisedby the Unit. Thesestudies more comprehensiveviews of malaria controlwere critical backgrounddocumentsfor the vari- operationsever undertaken.ous workshops hrough which the approachesandpriorities of the Fourth Population and Health The"MalariaDays"conferencewasalsooneProject were agreedupon. of the first steps in the preparationof the follow-on Amazon Basin Malaria Control Project, a


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-6 - Project-FinancedHN ResearchUS$198millionprojectfor which he Banklent however,he Ministry fHealthexpressed ppre-US$150million. For the follow-on roject,10 hension bout ssuminghe oancommitmnentith-operationalesearchstudieswere commissioned out havingdirectadministrativeesponsibility.Awithprojectpreparationacilityunds. compromise asworkedoutby which he Minis-try wouldenterinto a "consultative"elationshipThe AmazonBasinMalariaControlProject withIPEA,but would tselfbe responsibleor thealsocontainsunds or researcho beadministered contracting nd administrationf the proposedas grants o research nstitutions.Changesn the studies. It was decidedo makea separateUS$2organizationf research nstitutesn Brazilhave million oan forthe project.slowed mplementationf the grant program,butrecentlyprogresshas been made in funding e- From the start implementation as slow.searchproposals. FromBoardapprovaln June1984 o loan signingtookapproximatelyixmonths,and t wasanotherThe research financedby the Northwest year beforeeffectivenessn January1986. SixRegion ntegratedDevelopment rogramProject months eforehe projectwasoriginallycheduledhad repercussionsar beyondBrazil. Theemerg- to close,41 percentof the loanfundshad beening patternof malariacontrol trategies asedon committedo 20 studies,but actualdisbursementsthe research ubstantiallynfluencedhinkingn he totalled only US$270,000. The project wasinternational alaria ommunity. revious fforts extended n additionalwo years, andclosedonto 'eradicate' malariawerebeingrecognized s December31, 1989 with the cancellationofunrealistic.Therewasa growing ppreciationhat US$279,000.At closing, he Bankhad receivedit wouldbenecessaryo shiftto malariacontrol, onlyonecompletedtudy.and hatdifferenttrategieswouldbe needed.Thesuccessof the Brazilianproject in using op- Earlyin 1989,a newadministratorwasputerational esearchto shapeeffective ocalpro- in chargeof science ndtechnologyn the Minis-gramsmade it a modelcloselyobservedby the try. He felt that policyresearchwas importantinternationalommunity. and that the loan funds should be utilizedtosupport he research. As a result, 64 researchprojectswereidentified ndertheproject. As of

Brazil: HealdtPolicy Studies this writing, reports for 23 studies have beenreceived y the Bank,but manyresearchprojectsTheNationalHealthPolicyStudiesProject havesimplybeenleft uncompleted.in Brazil,a stand-aloneartof theSecondHealthProjectapprovedn fiscalyear1984, s one of the Many implementation roblems can befewBankprojectsn anysectoraimedexclusively attributedo thg fact that the Ministry s not aat fundingpolicyresearch. It also illustrateshe researchnstitution,orhadit anyexperience ithimportanceof carefil projectdesign and close research dministration.AlthoughPEAdid havesupervision. (Thisdiscussion rawsextensively suchexperience,herespectiveolesand responsi-from a draft ProjectCompletionReporton the bilitiesof the two institutionswere not wellde-project.) fined, and coordination problems persistedthroughouthe project. ThecompromiseesignTheprojectwas appraisedointlywiththe assignedhe role of evaluatingtudy proposalsoSaoPauloBasicHealthProjectapprovedat the a coordinatingroup,CIPLAN,within heMinis-same time in fiscal year 1984. As originally try, which furthercomplicatednd delayeddeci-discussed,he projectwas to be administeredy sion-making.the GovernmentPlanningInstitute (IPEA) oranother esearchnstitution.Duringnegotiations,


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Project-FinancedHNResearch -7 -Theprojectwasalso adversely ffectedby TheNationalCenter orPreventiveMedicinepoliticalchanges nd a highinflation ate. Since was an amalgamationf five existing nstitutes,the earlyresearchcontractswerenotindexed nd noneof whichwasparticularly istinguished. owthere were long delaysin disbursement y the reorganizeds the Academyor PreventiveMedi-Ministry, many researchers abandoned their cineso that it canaward doctoraldegrees, t hasprojects or lack of funds. becomequite successfuln the eyesof the Bankstaffresponsibleor the project. It hasdevelopedIn retrospect,Bankhandlingof theproject one of the best reportingsystemson causes ofcouldhavebeenbetterand mighthavecontributed death and morbidity in the developingworld,to moreeffective mplementation.heBankcould publishes everal ournalsof high standard,andhavebeen morecareful n institutionalesignof has completedmorethan 300 scholarly tudies nthe project, and more forceful n persuadinghe such areas as operationalesearchon the Chinesegovernment f the meritsof the originaldesign. health system,vector and parasitecontrol, andOnce t wasagreedhat he Ministry fHealthwas effectivereatment egimes.to be the administering ody, the Bank should

have discussedmore often, and in greaterdetail, The ResearchCenter for Health Planningexactlywhat sorts of studies he Ministry iewed and Statisticshas also becomequite successful,as helpful o policy ormulation.The Bank hould althought wasslower n reaching highstandard.have been more consistentn its supervision nd Initially, he Centerdid not sufficiently ppreciatefollow-up.Supervision asperformed t different the need for a health informationystemnor fortimesby four different taffmemberswithdiffer- better statistics pon which o do research naly-ing backgrounds, nd supervisionmissionswere sis. Revitalized nder a new head, andrenamedoften chargedwith other activities o that they theCenter or HealthStatistics ndInformation,twereunable o devotesufficientime to the pro- nowhas an effectivedatacollectionystem nd sject. well positioned o do effectiveoperational e-search.Health policy studies were important orBrazilat the time theprojectwas formulated,nd A very interestingoutcome of the Bankcontinueo be so at present. As a result,with he creditwas the broad range of researchwhichhaslessons of this project in mind, discussions re beenundertakenwithproject undsnot envisionedproceedingwitha view o includingmajorpolicy in theSAR. Thiswasmadepossible y the strongresearch omponentn a forthcomingoan. appreciationf the SDR against he dollar whichresulted n substantialumsbecoming vailableoradditional esearch. One researchactivitybeingCidna financeds a community-basedroject n Tianjinwhich has instituted he world's largestchronicIn China, heBankhashad a verysuccessfil diseasecontrolexperiment.The study s tracingexperiencewithproject-financedesearch. cholesterolevels, smokingbehavior,and heartattackand strokemanagement.The Communica-The first PHN lendingoperation n China ble DiseaseCenters n the UnitedStates, nitiallywas the Rural Health and MedicalEducatirn- retainedas a consultantn the research,has nowProject. One componentwas to support hree becomea full partner, along with the Finnishresearch institutions, he NationalCenter for Ministryof Public Health and the Academy orPreventiveMedicine, he Research Center for PreventiveMedicine. The study thus combinesHealth Planningand Statistics,and the Sichuan researchworkers rom a developing ountrywithInstitute f ChineseMateriaMedica. rising ratesof strokeand heart disease, he indus-trialized countrywith the highest incidenceof


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- 8 - Project-FinancedPHN Research

strokeand heartdisease (Finland),and an industri- asis and tuberculosiscontrol. The TB treatmentalized country which has succeeded in reduciz.g regime to be extended on a wide scale is onestroke and heart disease (the UnitedStates). developedwithproject-financed esearchfrom thefiscalyear 1984Rural Healthand MedicalEduca-Another successful health research effort tion Project.established with the additional project funds isbeing carried out in Beijing in cooperationwithOxford University. The study Is tracing the India-Tami Nadueffects of different regimes of treating stroke onmortalityand recoverytime. TheTamilNaduIntegratedNutritionProjectin India was an innovativeand hi'ghlysuccessfulYet another study made possible with the project. It showed that large-scale, community-additionalprojectfunds is the world's largeststudy level interventions n the social sectors can work.linkinghealth practicesand causeof death. More (rhe credit becameeffectivein August 1980andthan 500,000peoplehavebeen identifiedand will closed at the end of March 1989. This sectionbe.monitoredover a twenty-yearperiod. Of key draws heavily on the Project CompletionReport

interest will be the information the study yields for the project.)about the link between smoking and mortality,sincenearlyall the existkg studiesof smokingand The project as designedincludedprovisionmortality have been carried out in industrialized for a baseline survey and formal mid-term andcountriesand may have limited applicability n a final evaluations. Partly because the mid-termdevelopingcountry. evaluation indingswere not readyuntil 1986, heywere not actedupon by project managementuntilFinally, the project has financedpart of an work began on the design of the Second Tamilongoingstudyof adult-onsetdiabeteswith cooper- Nadu Nutrition Project approved in fiscal yearation from researchers in the United Kingdom, 1990. However,the results of both the mid-termFinland,France, Italy, and the UnitedStates. and final evaluationsdid have a significantimpacton the designof the secondproject.Other Chineseprojectshave also resulted nsuccessfil project-financedresearch. The Rural TheProjectManagementUnit (PMU)had atHealth and Preventive MedicineProject (Second its disposal undsto commission mall, stand-aloneChinaHealthProject)approvedin fiscalyear 1986 researchprojects and some 40 to 60 such studiesfinanced research into alternative insurance were authorized. Most werejudgedby Bank staffschemeswhichhas influencedChineseruralhealth to be ofpoor qualityandhad onlya limitedimpactpolicy. The IntegratedRegionalHealthDevelop- on the redesignof the project. In retrospect, thement Project approved in fiscal year 1989 has fact that the PMU had great freedom in commis-funded research to determine if school-based sioning esearchand so couldact rapidlyand withprograms influencesmokingbehavioramongpar- great flexibigity lso contributedto poor researchents. Cartoonbooksaboutthe healthrisks associ- design and limitedusefulness. It indicatesthat aated with smoking were the basis for an experi- more formal research committee with qualifiedmentalcurriculum.The resultof theprogramwas members which could review proposals for rele-an immediatesharp drop in smoking amongthe vance and methodologicalsoundnesswould haveparentsof the children akingpart in the program. beena better mechanism. The fact that the stand-alone researchcomponentwasnot a very signifi-Project-financedresearch will continue to cant part of the total project may havemeant thatinfluenceChinesehealth policy. For example, a Bank staff couldnot devote sufficientsupervisionfiscalyear 1992Bankloanfocuseson schistosomi-


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Project-FinancedHNResearch - 9 -time to improve the qualityof the stand-alone policy ndmedicalesearch.The project rovidesresearchprojects. for a US$4 millionPopulationResearchFund ofinance esearch nto a rangeof topics, ncludingIt should e notedhata distinguishedroup the socio-culturalnd economicupportsor largeof evaluation tudieshavebeen published bout familiesand the determinantsof fertility andthis project.Theyshowedargedrops n undernu- contraceptive se in Nigeria. An interestingtritionandmortalityamongchildren. However, featureis that the Fund is administered y thethesestudieswerenotfundedby theproject. Nigerian nstitute or Socialand EconomicRe-search through a TechnicalCommitteewhichincludes epresentativesf themajorusergroups.Mgerla Theprojectalsosupports xtensiono other statesof researchworkat theUniversityCollegeHospi-Nigeria is another country where Bank tal of theUniversity f Ibadan. Thehospitalwasexperiencewithproject-financedesearch asbeen the firstWorldHealthOrganizationollaboratingquitesuccessful.In part thisis due to the avail- research enter orhuman eproductionn Africa.abilityof able Nigerian esearchersand senior TheHealthSystemFundProject,alsoapprovednofficialsnterestedo foster esearch nd o usethe fiscalyear 1991,and whichbecameeffectivenresults n policy ormulationnd to preparenew March 1992,has provision o supportstudies.projects. In part, it is due o a continuingnterest Evenbefore he projectbecameeffective,somein research mongheBankstaffresponsible. studieswerealreadyunderwayo supportantici-patedrequestsor grants rom he Fund.The first PHN lending operationof the1980s n Nigeria wasthe SokotoHealthProjectapprovedn fiscalyear 1985. The project nclud- Philippinesed US$1.4millionearmarkedor studies. Themoneywasused o prepare ollow-onrojects nd ThePhilippineHealthDevelopmentrojectfor majorhealthcarefinancingtudiesn Sokoto, approvedn fiscalyear1989 ncludes significantOgun,and Oyo states. Thesurveywork n Ogun policy research component. A contract forwas used extensively y Bankstaffto preparea US$1.2millionor36 studieswassignedbetweenmajorsub-sectorreport,FederalRepublicof Nge- the Departmentof Health (DOH) and the Philip-ria-HealthCare Cost,Fnancingand Utilization, pineInstitute or Developmenttudies PIDS) nwhichappearedn October1991. The resultsof mid-1991,ndwork s proceeding.the researchand the sub-sector eportare beingused as a basis for the First ReferralHospital The project builds upon the successfulProjectand a nutrition rojectnowunderprepara- implementationf a grantmadein 1988 o PIDStion. by the InternationalHealth Policy Program(IHPP), a program to encouragehealthpolicyA second endingoperationn Nigeria, he research upported y the PewCharitable rustsImo Healthand PopulationProjectapproved n and the CarnegieCorporation f NewYork, infiscal year 1989,included unds to establisha cooperationwith he WorldBank and he WorldPopulation tudiesCenter t Imo StateUniversity. HealthOrganization.Thatgrant resulted n sixThe Centerhas beenestablished, directorap- substantialtudies,mostlyby youngeresearcherspointed, nda research rogramsbeingprepared. not previouslyworkingon healthpolicy, whichhave been widely disseminated nd carefullyThe NationalPopulation roject,approved reviewed y the DOH.in fiscal year 1991, is intendedo supportboth


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- 10- Project-FinancedHNResearchFor the Bank-financedesearch, he DOH, Common Themes and Conclusionsin cooperationwith he University f the Philip-pines Schoolof Economicsnd PIDS, developed The information n which his note s basedterms of referencefor baseline studies to be can only support preliminary onclusions boutconductedn relation o the design f a corepolicy project-financedesearch. There are, however,reform packagefor the health care financing severalgeneralizations hichcanbe made:system. From his emergedhe specific tudies obe supervisedy PIDS. A ProjectSteeringCom- * Bankexperience ithproject-financede-mittee hairedby a DOHunder-secretaryas been search n thePHN sectorhas beenextre-established. The topicschosenfor the research mely variable,quite successful n somestudies ncludebeneficiary nd providerprofile countries ndalmosta totalfailure n oth-and behavior, inancial esourcebase and institu- ers. Even so, some strikingsuccessestions, the health care financing nvironment, nd can be noted,as the country xperiencesplanning models for the health care financing outlined ere have demonstrated.Thesesystem. In addition, Bank-financed esearch successes certainly justify continuedwould collect, generate, and disseminatedata efforts o incorporate esearch nto pro-

pertinent o the health care financing ystemand jects and to encourageuse of that re-the healthsystem n general. A secondary ata searchboth to improveoverallnationalinventory nd primarydata collection re part of PHNpolicy nd follow-onBank-financedthe project ctivities.The primarydata collection projects.is aimedat gathering aselinedata whichare notcollectedby governmentor private statistical * Personalitiesmake a difference, bothagencies. The data base is expectedo be main- amongborrowersand within he Bank.tainedafter completion f the projectby the DOH Quite often when there has been a suc-with USAIDassistance. Monitoring nd consul- cessfulexperience,a particular persontation activities re built into the project mple- within he governmentr within heBankmentation nd several local and national level has taken a personal and continuingworkshops re planned ollowing patterndevel- interest n encouragingesearch.opedunder the earlier HPPprogram. 0 Supervision s crucial to good results.Supervisionmust be frequentenough oZaire keep he research omponentn time andof goodquality. It is important f goodFinally, heexperiencenZairedemonstrates quality esearch s to be completedhatonce again hat the Bank can be of only limited those esponsibleor supervision ttacheffectivenessn situationswhere he overall oliti- highpriority o researcheven if it is notcal and ecenomicenvironments adverse. The a large part of the project in moneySocial Sector Project and the National AIDS terms.Control Program AssistanceProject, both ap-proved in fiscal year 1991, containedbetween 0 Research hat leads o a projectoutcomethem provision for some US$1.5 million for -such as hat needed o ustifyreleaseofresearch.Yet conditions avebeensuch hatas of fundsor for a follow-on roject-is morethisdate virtuallyno researchhas been undertak- likely to be undertakenand completeden. than is research with a more generalobjective.


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Project-FinancedHNResearch -11 -* In countrieswhere heinstitutionalapa- 1989,an outcome ot demonstratedy this studybilityexists,usinga nationalnstitutiono for the PHNsector. Of the 436 plannedstudiesreview esearchproposals nd o admin- the authorsidentified,only 184(or 42 percent)ister researchgrants c;un e quiteeffec- werecompleted nd of theseonly 84 were avail-tive. Experiencendicates omesort of able through Regional Information Centers.peer-groupeview esults nbetterquality Examination f the SARs in the PHN sectordidresearch. not yieldanything lose o sucha preciseestimateof the number f studies ncluded n projects,but* There probably s room for more "best the generalmpressionrom alkingo task manag-practices"workshopswhere PHN staff ers is that in the PHN sector, oo, manyplannedcan exchange xperiencesboutsuccess- studiesare not completed. One would be hardful design and supervision f project- pressed o collecta complete et of reports forfinancedesearch omponents.However, those PHN studieswhich were completed. Thein most cases it will probablybe neces- authorsof the education tudy were particularlysary to retainexperiencedonsultantso criticalof the fact that only 5.6 percentof theassist with the designof substantial e- completedtudies"hadanythingo do withassess-

searchcomponents. ing educationalutcomes."- More systematic ollection nddissemi- The authors ecommendedhat more atten-nation of project-financedesearch is tion be paidto the designand implementationfjustified,given he considerablemounts research componentsn educationprojects, aof moneyand effort which s devoted o conclusionwhichmanywouldprobably eel validit. for PHN projects. To facilitate his, they rec-ommendhat the Bankdevelop program o trainoperationaltaff o design tudioswithappropriateOther Sector Project-Financed Research methodologiesnd whichwoulddevelop omesticresearchcapacity. In the PHN sector, it wouldTwo other recent studiesof WorldBank appearmoreappropriateo assureaccess o suit-project-financedesearch avebeenpublished, ne able consultingervices orthe designof researcheach n the education ndagriculture ectors. componentsather than to undertakea trainingprogramsubstantial nough o teach operationalstaffhow to design esearchcomponents.TheyEducation recommendedree-standingducationalesearchprojects n larger countries. Except or the BrazilThe education tudy s WorldBankLending HealthPolicyStudiesProject hat waspart of thefor EducationResearch, 982-89 y MarlaineE. SecondHealthProject,no PHNprojectreviewedLockheedand AlastairG. Rodd. The authors for this note wasa free-standingesearch roject,reviewed 146 Bank educationprojectsinidated nor have interviewswithtask managers oundabetween iscalyear 1982 ndfiscalyear 1989. Of substantialmeasureof support for free-standingthese, 116 included esearchcomponents.The PHN researchprojects. Finally, the authorsauthorsfound that 2.2 percentof the loansand recommendmuch more attentionbe paid to dis-creditsof these 116projectswas allocatedo re- seminationf researcheportswithinhe Bankandsearch, an outcomenot muchdifferent rom the within the borrowingcountry, and that projectPHN resultsreported n thisnote. They found, completioneports containa bibliography f thehowever, hat researchas a percentage f total studiescompleted ndera project, both sugges-loan commitment eclined harplyfrom 1982 o tionswhichwouldbe applicableo the PHNsector.


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- 12 - Project-FinancedPHN ResearchAgriculture agriculturalesearch ystems; 2) an examinationon a regional asis or the ackof effectivenessfTheothermajor ecentlypublishedtudyof research omponents;3)evaluation f the effec-project-financedesearchsLending y the World tivenessof policy-basedending n the develop-Bank or AgriculturalResearch-A Review of the mentof agricultural esearch; (4)training or Bank

Years 981 hrough 987byAnthony. Pritchard. staff o increasekills n supervisionndappraisalof researchprojects;(5) expansion f the time-The extent of Bank lending to support frameofagriculturalesearch rojects;6)analysisresearchn agriculturesmuchgreaterhanit isin oftherelationshipetween omponentizeand hethe PHN sector. From 1981 hrough1987, he successof research rograms;7) developmentfBanklent for 21 free-standingesearchprojects Bankpolicyregardingsupportof biotechnologyand 209agricultural nd ruraldevelopmentro- researchordevelopingountries;8)reassessmentjectswithresearch omponents.Thetotalcostof of the Bank's nfluenceon researchprograms ttheagriculturalesearch lementsnBank-financed the internationalgriculturalesearchcenters oagricultural rojectswas $2.1 billion-25 to 50 ensureefficient seof resources;9)developingtimes he amountof project-financedesearch n methodologyo determine ostsand benefitsofPHNprojects.Additionalupport oragricultural agricultural esearchprojectsand components;researchwasprovidedhrough12educationro- (10)anevaluation f the contributionsf consul-jects, 16 policy-basedoans, and grantsto the tant experts n agriculturalesearchprojects;andConsultative roup orInternationalesearch nd (11)a reviewof the concepts ndproceduresorother nternationalnstitutions. extension-researchinkages.

Becauseof differences n the historyof To increasehe chancesof successn agri-agriculturalendingandPHN lendingwithin he cultural research projects and components,Bankandbecause ree-standingesearchprojects Pritchardsuggested ncreasedattention o: (1)are morecommonn the agricultureector,agri- administrativend proceduralproblemsduringculturestaff havea tendencyo be muchmore project tart-up; 2)adaptive ndappliedesearchdirectlynvolvedn the establishmentf research needs or thecompletearming ystem; 3)devel-institutionsand programs and in supervising oping nationalagricultural esearchplans; (4)research ctivities. supportingegionalesearchnitiatives;5)allocat-ing projectfundsfor contractand collaborativePritchard oundthatfree-standingesearch research;(6) defining taffingneeds, dentifyingprojectsweregenerally uccessfulin institution- requirements or support staff, and providingbuildingand in financingproductive esearch adequateraining ndeducationpportunities;7)programs."However, problemsn implementing developingublicawareness rogramso broadenresearchcomponentsn agriculturaland rural publicsupport or agriculturalesearch; 8) pro-developmentrojectsweresometimesevereand vidingincentivesor researchworkers o assurethe imited uccess f thesecomponentssa cause retentionof highcalibrestaff;and (9) exploringfor concern." alternativemeansofprovidingperatingunds orresearch.Pritchard adanumber frecommendations,manyof whichwouldbe inappropriatef appliedinthePHNsectorgivenhedifferent mphasisnd J. PriceGittingerscale,butsomeof whichwould oundfamiliaro CarolBradfordPHN staff. He recommended:1) continuedemphasison developmentof strong national


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Project-Financed PHN Research -13 -

Annex. Projects Reviewed

Total AmountAmount of Loan/Region/ Fiscal of Project CreditCountry Project Year (USS million) (US$ million)AFRICABenin HealthServicesDevelopment 1989 32.0 8.6Botswana FamilyHealth 1984 26.6 11.0Burkina Faso HealthServicesDevelopment 1985 28.0 26.6Burundi Populationand Health 1988 18.7 14.0Cameroon SocialDimensionsof Adjustment 1990 85.7 21.5Chad Social DevelopmentAction 1990 26.9 13.4Comoros Healthand Population 1984 3.1 2.8C6te d'Ivoire Health andDemographic 1986 29.7 22.2Ethiopia Family Health 1988 43.9 33.0Gambia NationalHealth Development 1987 20.8 5.6Gambia Women n Development 1990 15.1 7.0Ghana Health and EducationRehabilitation 1986 16.0 15.0Ghana Second Healthand Population 1991 34.3 27.0Guinea HealthServicesDevelopment 1988 22.5 19.7Guinea-Bissau Population,Healthand Nutrition 1987 4.4 4.2Kenya Integratd Rural Health and FamilyPlanning 1982 61.0 23.0Kenya ThirdPopulation 1988 28.3 12.2Kenya Fourth Population 1990 41.3 35.0Lesotho Health and Population 1985 7.4 3.5Lesotho Second Popation, Health and Nutri-tion 1990 22.1 12.1Madagascar Health SectorImprovement 1991 42.5 31.0Malawi Health 1983 8.7 6.8Malawi SecondFamily Health 1987 24.9 11.0Malawi Population,Healdthnd NutritionSec-tor Credit 1991 74.3 55.5Mali Health Development 1984 17.6 16.7Mali SecondHealth, Populationand RuralWater Supply 1991 61.4 26.6Mozambique Health and Nutrition 1989 42.5 27.0Niger Health 1986 29.3 27.8Nigeria SokotoHealth 1985 53.0 34.0Nigeria ImoHealth and Population 1989 36.8 27.6Nigeria EssentialDrugs 1990 85.1 68.1Nigeria HealthSystemFund 1991 94.5 70.0Nigeria NationalPopulation 1991 93.6 78.5Rwanda Family Health 1986 14.5 10.8Rwanda First Population 1991 26.1 19.6


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- 14 - Project-FinancedPHN ResearchTotal AmountAmount of Loan/Region/ Fiscal of Project CreditCountry Project Year (US$ million) (USS million)

Senegal Rural Health 1983 16.7 15.0Senegal HumanResourcesDavelopment 1991 37.8 35.0Sierra Leone Healthand Popuation SectorSupport 1986 5.7 5.3Tanzania Health and Nutrition 1990 70.0 47.6Togo PopulationandHealth Sector Adjust-ment 1991 52.7 14.2Uganda First Health 1988 65.5 42.5Uganda SocialCosts of Adjustment 1990 37.0 28.0Zaire National AIDS Control ProgramAssistance 1989 21.9 8.1Zaire Social Sector 1991 37.0 30.4Zambia Social Recovery 1991 20.0Zimbabwe FamilyHealth 1987 52.6 10.0Zimbabwe SecondFamily Health 1991 116.9 25.0EAST ASIA AND PACIFICChina Rural Health and MedicalEducation 1984 322.8 85.0China Rural Health and PreventiveMedi-cine 1986 177.4 80.0China IntegratedRegionalHealthDevelop-ment 1989 113.0 52.0Indonesia Third Populadon 1980 72.6 35.0Indonesia Provincial Health 1983 54.4 27.0Indonesia Fourth Population 1985 94.4 46.0Indonesia Second Health (ManpowerDevelop-ment) 198S 65.9 39.0Indonesia SecondNutrition and CommunityHealth 1986 57.5 33.4Indonesia Third Health 1989 103.5 43.5Indonesia Fifth Populadon 1991 148.4 104.0Korea Population 1980 93.4 30.0Korea Health Technology 1991 81.2 60.0Philippines Health Development 1989 108.4 70.1SOUTHASIABangladesh Third Populaton and FamilyHealth 1986 213.8 78.0Bangladesh Fourth Population nd Health 1991 601.4 180.0India SecondPopulation 1980 96.0 46.0lidia TamilNaduNutrition 1980 66.4 32.0Ildia ThirdPopulation 1984 123.5 70.0India Fourth Population 1986 89.9 51.0India Fifth(Bombay ndMadras)Popula-tion 1988 182.0 57.0


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Project-FinancedPHN Research - 15 -Total AmountAmount of Loan/Region/ Fiscal of Project CreditCountry Project Year (US$million) (US$million)

India Sixth(National amilyWelfareTraining ndSystemsDevelopment)Population 1989 182.0 124.6India Seventh opulation 1990 141.5 86.7India SecondTamilNaduNutrtion 1990 139.1 95.8India IntegratedChildDevelopmentervic-es 1991 157.5 106.0Pakistan Population 1983 28.2 18.0Pakistan FamilyHealth 1991 62.9 45.0SriLanka Health ndFamilyPlanning 1988 21.4 17.5SriLrank PovertyAlleviation 1991 85.0 57.5MIDDLEEASTANDNORTHAFRICAAlgeria PilotPublicHealth 1991 26.7 16.0Egypt SocialFund 1991 572.0 140.0Jordan PrimayHealthCare 1985 30.5 13.5Morocco HealthDevelopment 1985 47.6 28.4Morocco HealthSector nvestment 1990 171.3 104.0Oman Health 1987 30.6 13.3Tunisia Health ndPopulation 1981 12.5Tunisia PoplationandFamilyHealth 1991 63.2 26.0Tunisia HospitalResctudringandSupply 1991 49.5 30.0Turkey Health 1989 146.7 75.0YemenArabRe-public Health 1983 15.9 10.5YemenPDR HealthDevelopment 1983 10.4 7.6YemenPDR SecondHealthDevelopment 1989 7.6 4.5Yemen HealthSectorDevelopment 1990 19.1 15.0Yemen Emergency ecovery 1991 59.5 33.0LATINAMERICA NDCARIBBEANBolivia IntegratedHealthDevelopment 1990 38.6 20.0Bolivia Social nvestmentund 1990 95.6 10.0Brazil Northwest egion ntegratedDevel-opmentProgramFirstPhaseHealth 1982 149.0 13.0Brazil SecondHealth 1984 123.6 57.5Brazil NortheastBasicHealthServices 1986 129.7 59.5Brazil NortheastEndemicDiseaseControl 1988 218.0 109.0Brazil AmazonBasinMlardaControl 1989 198.0 150.0Brazil ondNortheastBasicHealthSer-vices 1990 610.6 267.0Colombia HealthServicesntegration 1986 118.0 36.5Colombia CommunityhildCareandNutrition 1990 40.2 24.0El Salvador SocialSectorRehabilitation 1991 35.6 26.0Haiti FirstHealth 1990 33.7 28.2


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- 16 - Project-Financed PHN Research

Total AmountAmount of Loan/Region/ Fiscal of Project CreditCountry Project Year (US$million) (USSmillion)Haiti Economicand SocialFund 1991 23.6 11.3Honduras Social InvestmentFund 1991 60.0 20.5Jamaica Populationand Health 1987 12.4 10.0Jamaica SocialSectorsDevelopment 1990 67.0 30.0Mexico Basic HealthCare 1991 249.8 180.0Peu PrimaryHealth Care 1983 55.5 33.5Venezuela SocialDevelopment 1991 320.9 100.0


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Policy Research Working Paper SeriesContactTitle Author Date for paper

WPS119 HowEffectivereDirected redk AnitaM.Schwarz November992 M.RaggambiPoliciesn heUnitedStates? 37664A Literature urveyWPS1020 nother ookatPopulationnd NancyBirdsall November992 S.RothschildandGlobalWarming 37460WPS1021Measuring elfareChangesrom Jonathan .Coleman November992 D.GustafsonCommodityriceStabilizationn ChrisJones 33714SmallOpenEconomiesWPS1022 NewApproacho Evaluatingrade JamesE. Anderson November992 M. T.SanchezPolicy J. PeterNeary 33731WPS1023 ariff ndexTheory JamesE.Anderson November992 M.T.Sanchez33731WPS1024 nExactApproachorEvaluating WillMartin November992 D.GustafsontheBenefitsromTechnological JulianM.Alston 33714ChangeWPS1025OpennessndEconomic KaziM.Matin November992 D. BallantynePerformancen Sub-Saharanfrica: 38004EvidenceromTime-Seriesross-CountryAnalysisWPS1026 inancial iberalizationnd PaulD.McNelis November992 A. MarahonAdjustmentnChileandNewZealandKlausSchmidt-Hebbel 31450WPS1027 essonsromBankPrivatization Guillermo ames November992 W. PitayatonakarnInMexico 37664WPS1028SocioeconomicndEthnic HarryAnthony atrinos November992 L. LongoDeterminantsf GradeRepetition George sacharopoulos 39244inBolivia ndGuatemalaWPS1029ControllingropicalDeforestation: Robert .Deacon November992 P. Pender

AnAnalysis f Alternativeolicies 37851WPS1030Measuringhe Effects f Urban AlanJ. Krupnick November992 P.PenderTransportationoliciesn the 37851Environment:Survey f ModelsWPS1031MeasuringhePossibilitiesf RobertBacon November992 P. PenderInterfuelSubstitution 37851WPS1032 astAsiaandPacificRegion, EduardBos November992 0. NadoraSouthAsiaRegionPopulation MyT.Vu 31091.Projections,992-93 dition Anr.Levin


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Policy Research Working Paper SeriesContactTitle Author Date for paper

WPS1033Latin Americaand heCaribbean My T. Vu November1992 0. NadoraRegion(andNorthernAmerica) EduardBos 31091PopulationProjections,1992-93 Ann LevinEditionWPS1 34 RevisingFinancialSector Policy DavidH. Scott November1992 K. Waeltiin TransitionalSocialistEconomies: 37664Will UniversalBanks ProveViable?WPS1035How ImportProtectionAffects he Wendy E. Takacs November1992 D. BallantynePhilippines'Motor Vehicle ndustry 37947WPS1 36 OutputDeclinen Hungaryand SimonCommander November1992 0. del Cidand Poland n 1990-91:Structural FabrizioCoricelli 35195Changeand AggregateShocksWPS1037VocationalSecondarySchooling, Ana-MariaArrlagada November1992 C. CristobalOccupationalChoice,and Earnings AdrianZiderman 33640in BrazilWPS1038Determinants f ExpatriateWorkers' IbrahimA. Elbadawi November1992 A. MaraiionRemitances n NorthAfrica and Robertde RezendeRocha 31450EuropeWPS1039Education,Extemaliies, Fertiliy, MartinWeale November1992 PHREEand EconomicGrowth 33680WPS1040Lessonsof Trade Liberalizationn Jaimede Meb November1992 D. BallantyneLatin America or Economiesn SumanaDhar 37947TransitionWPS1041Family PlanningSuccessStories n MoniNag November1992 0. NadoraBangladeshand India 31091WPS1042FamilyPlanningSuccess n Two Jane T. Bertrand November1992 0. NadoraCities n Zaire Judith E. Brown 31091WPS1043 DerivingDevelopingCountry Stijn Claessens November1992 R. VoRepaymentCapacity romthe Market GeorgePennacchi 33722Prices of SovereignDebtWPS1044HospRtal ostFunctions or AdamWagstaff November1992 0. NadoraDevelopingCountries HowardBarnum 31091WPS1 45 SocialGains rom FemaleEducation: KalanidhiSubbarao November1992 M. AbundoA Cross-NationalStudy LauraRaney 36820WPS1046 WorldBank Project-Financed J. Price Gittinger November1992 0. NadoraResearchon Population,Health, Carol Bradford 31091

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