Re: The World Bank Strategy for Health, Nutrition and Population

Results

Dear Mr. Deutscher,

Thank you very much for your memo raising concerns regarding the
treatment of Sexual and Reproductive Health in the new World Bank
Strategy for Health, Nutrition and Population Results to be discussed
at the Board on April 24, 2007. We share your concerns that the
current document (including the Supplemental Note) does not fully
illustrate the Bank's strong commitment to sexual and reproductive
health.

After further consultations, we have put together the attached
proposed corrigendum to replace the section on "Renewed commitment
for Population policy in Section H of the Board document (paragraphs
152 through 161 of the Board paper) to fully capture the strong
commitment of the Bank to reproductive health, including family
planing..

I urge you to consider this corrigendum as a strong commitment of the
Bank to sexual and reproductive health and proceed with the scheduled
Board meeting on April 24, 2007. A substantial delay of the board
meeting could have serious effects on the sector's ability to respond
the work program of the entire sector.

As I expressed to you this morning, there have been various press reports recently regarding the Bank's new health, nutrition and population strategy as well as the contents of the Madagascar CAS, which I would like to clarify and set the record straight.

Regarding the Madagascar CAS, none of the editorial changes that were made at my direction changed, or intended to change, the Bank Group's program in the area of family planning.

Family planning continues to feature in the CAS. In particular, paragraph 104 of the document continues to state that "In health, [the Bank] will help the government make further progress on reducing child and maternal mortality by offering access to reproductive services ...". In addition, the CAS continues to include a Bank-supported health project that supports Government activities in the area of population and family planning, and that management expects to distribute to the Board in late April, as originally planned. This project explicitly supports government implementation of its family planning strategy, and explicitly includes as an indicator raising the proportion of women using contraceptives from a baseline of 12% to 30% by 2011.

There also has been no change to the Bank's policy on family planning. The health, nutrition and population strategy document that is currently before the Board, for discussion on April 24, has a results framework (Annex J) which includes an outcome (IV) entitled "Improved maternal, reproductive and sexual health". That results framework also explicitly references multisectoral contributions to intermediate outcomes/outputs that include "improve family planning and sexual health", where the relevant measures are identified as "contraceptive prevalence rate among women of reproductive age", "unmet need for contraception", and "prevalence rate of STIs [sexually transmitted infections] among adults and young people (15-24 years)".

Finally, let me state clearly that I am here to carry out the Bank's policies, not my own. The policy on Reproductive Health is clear. It has been endorsed by the Board and it has been in place for many years. It has been followed by the President, the staff and me, as reflected in projects and programs brought and to be brought to the Board. In fact, since last July, we have financed about $625 million of projects in the area of population and reproductive health, and we expect that number to increase to $750 million or so by the end of June. Moreover, we have more than a dozen projects that are scheduled to go to the Board between now and the end of December 2007 that will address population and reproductive health—in countries like Benin, Botswana, Chad, Cameroon, Congo, Kenya, Mali, Mozambique, Nigeria, Rwanda and Tanzania. I respect the freedom of our partner countries to decide on this subject.

I have had the fortune of making things happen under difficult conditions in my own country, so I know that development and progress can be achieved with the right leadership and effective policy advice. I remain fully committed to supporting the important work of the Bank towards creating opportunities for the people in need.