World Bank nutrition programs are effective, could be stronger: Report

An independent evaluation of the World Bank’s nutrition programming has found that its effectiveness is improving over time but that its knowledge work, evidence base of interventions, measurement of results, and methods for addressing nutrition in country programs can still be strengthened. The report, released in October, was produced by the bank’s Independent Evaluation Group, or IEG, which analyzes the effectiveness of the various global practice areas. The evaluation examines the efficacy of the World Bank’s nutrition-specific and nutrition-sensitive programs in reducing child undernutrition and improving nutrition determinants between 2007 and 2018. It aims to inform the design of future nutrition programs and their financing. “There’s a big question: The World Bank, or more importantly the World Bank’s client governments, have been spending $22 billion a year across multiple sectors. Does it work?” said Shawn Baker, who led the evaluation’s external review group, about the bank’s nutrition spending over the 12 fiscal years evaluated. The group is composed of people with no Word Bank affiliation. “To me, there are three big headlines that come out of [the evaluation]: Yes, it is working; in general, it’s getting better over time; but there’s room for improvement,” Baker continued, adding that the evaluation “provides confidence that these investments are working, but it also does not shy away from where there are weaknesses and areas for improvement.” The evaluation outlines how the World Bank’s nutrition programs, which have grown in size, broadened from focusing on access to food to “a more multidimensional and collaborative multisectoral agenda” that includes things such as water, sanitation, and hygiene; caregiving; and access to health services. Meera Shekar, global lead for nutrition at the World Bank, said the evaluation has helped with coalescing the wider agenda among different areas of the bank that can play a role in nutrition — such as those related to agriculture, health, social protection, education, and transportation — which had already been ongoing for the past several years. “If you’re not willing to course-correct, then you can miss huge opportunities for impact.” --— Shawn Baker, head of an external review group for World Bank nutrition programs “It really helps that nutrition is such a big part of the Human Capital Index,” Shekar said, referring to the World Bank’s measurement of the knowledge, skills, and health of people in countries around the world. “Everybody wants to contribute to human capital. … At this point, we really have very wide engagement, and any commitments from the bank side will be World Bank Group commitments.” During the evaluation process, the head of IEG reports directly to the World Bank president, with “a complete firewall” between IEG and the staffers whose work is being scrutinized, Shekar said. IEG consults with the practice group it is assessing on the design and framework of the evaluation, and Shekar offered recommendations for members of the evaluation’s external review group. After this review was complete, IEG then presented its independent recommendations to the nutrition global practice, which has a chance to respond. IEG’s work is overseen by the World Bank’s Committee on Development Effectiveness, or CODE, which holds a meeting that includes formal discussion of the results of the report. “The recommendations that are presented here [in the evaluation] are ones that we’ve said ... ‘We fully agree with the recommendations.’ No battles at all,” Shekar said. “Every year or so, we have to report back to CODE on the things that we promised to do.” CODE is then responsible for monitoring implementation of any recommendations, and the nutrition practice will report to the committee each year on its progress. The report identifies five lessons drawn from the evaluation: • The World Bank needs to more intentionally plan its nutrition support — financing and advice, as well as analytics — by focusing on nutrition determinants, social norms, behavior change, and institutional strengthening. • The targeting, continuity, and sustainability of nutrition interventions are key to achieving expected results from multisectoral nutrition approaches. • Improving the measurement of results of interventions addressing nutrition determinants and behavior change will improve nutrition outcomes in countries. • The portfolio should refocus to include more emphasis on nutrition-specific interventions, balanced with nutrition-sensitive interventions. • Knowledge work can help countries to design and expand effective nutrition policy and programming. It also made two recommendations: adjust nutrition programming in country portfolios to prioritize institutional strengthening for coordination and implementation of multisectoral nutrition interventions and to increase subnational targeting capabilities; and strengthen nutrition support to other global practice areas to increase investment emphasis on nutrition-specific interventions and increase attention on behavior change, as well as monitoring and evaluation. Shekar said it was helpful to see that the evaluation’s findings were “very positive” and showed that the bank’s nutrition work was “moving in the right direction,” while noting it found the bank needed to do more to encourage behavior change that affects nutrition. “We are in agreement with that,” Shekar said. “We plan to have an internal consultation … to see what we can do more in this space.” The evaluation is also reviewed by the external review group, which is composed of consultants who are compensated for their work and who are involved in the evaluation from the beginning of the process. They are informed of the methodology and how projects will be selected, and they are kept up to date as the evaluation is being conducted. James Levinson, a former director of nutrition at Tufts University’s International Food and Nutrition Center who participated as an external reviewer, said the whole process took about three years. Levinson said he has long been concerned about the sustainability of World Bank projects and what happens in a community after a project concludes. “The bank says: ‘OK, we’re going to go in, and we’re going to try to have a project and make a difference. And so we’re going to do a baseline survey, and then we’re going to do the project and then we’re going to evaluate at the end and see what difference it makes. And we’re going to publicize it, and then that’s the end of the project. Goodbye,’” Levinson said. “What we argued is that we should be monitoring the sustainability aspects of a project along with the project itself, and then we do an evaluation of the project at the end. But we ought to do an evaluation of the sustainability of the project by going back two years later and seeing: ‘Have these levels been maintained? Are they better or are they worse?’” Baker, who is currently head of nutrition at the U.S. Agency for International Development but began his participation with the external review group before he held that position, said it has been difficult for various World Bank global practice areas to work together — which is vital for nutrition-sensitive interventions. Also, the bank can improve the way it builds capacity with partner governments and does subnational targeting to increase positive nutrition outcomes, he said. Baker said the evaluation’s findings provide a powerful argument to country governments — whose domestic resources will be key to future progress on nutrition outcomes — that the money currently being spent is improving nutrition. “When you have robust evidence showing ‘look, what we’ve been doing is working; we’ve also pressure-tested it to see where it can [be made to] work better,’ I think that makes a very solid argument to the finance minister and the line ministries,” which fund domestic nutrition programs, Baker said. “That knowledge management piece and willingness to invest in evaluation and course correction is an incredibly important part of any nutrition programming. And certainly [for] nutrition programming of this scale, it’s very important because we design for what we think we know. … But if you’re not willing to course-correct, then you can miss huge opportunities for impact.”