World Bank Blogs Investing in health: Time for a rethink

By: Christoph Kurowski Martin Schmidt David B. Evans, November 07, 2024

Countries are entering a critical phase in achieving the health Sustainable Development Goals (SDGs), with Universal Health Coverage (UHC) at the core of these efforts. With only six years remaining to meet these goals, global progress toward UHC has been slow, and the COVID-19 pandemic has led to significant setbacks.

At this pivotal juncture, we introduce two new reports that provide a comprehensive view of trends and prospects of government investments in health for almost the entire SDG period (2015-2029). The first examines government health spending trends in 63 low- and lower-middle-income countries from 2015 to 2023, while the second offers an outlook on government health expenditure for 170 countries through 2029. In contrast to expenditure figures, spending estimates exclude obligatory contributions to social health insurance, which, however, generally constitute only a minor source of public funding for health in low-income countries (LICs) and lower middle-income countries (LMICs).

The findings from these reports reveal troubling trends across LICs and LMICs, exposing serious risks to the sustainability of health investments. Fully attaining the SDG health targets is slipping out of reach for many nations, highlighting the urgent need for decisive action to address growing financing challenges. With these targets at risk, the World Bank Group remains committed to helping countries deliver quality, affordable health services to 1.5 billion people by 2030 as part of our global mission to ensure a basic standard of care throughout every stage of life.

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FEATURE STORYJune 24, 2024

Increasing Access to Quality Health and Nutrition Services for Women and Children in Cambodia

Choeum Sreyrath, her baby in arms, talks about her role as a Village Health Support Group (VHSG) in Kampong Chhnang province. 

© Saroeun Bou, World Bank

“I am very much enjoying my work because it helps me to improve my own health and I can help pregnant women, new mothers, and children in my village to take serious care of their health,” says Choeum Sreyrath, a village health support group worker (known as VHSGs) in Chom Bok Pa Em, a village in Cambodia’s central Kampong Chhnang province.

Sreyrath is one of 4,459 VHSGs — 3,255 of them women — recruited and trained since 2021 to help Cambodian families connect with local health and nutrition services. Recognizing that the first 1,000 days — from pregnancy to a child’s second birthday — establish critical foundations for growth and development, Cambodia’s government is improving the quality and capacity of local maternal and child health and nutrition services through the Cambodia Nutrition Project.

Communities managing their own well-being

To the east in Bousra village, young mother Pleun Preut describes the support she received after finding out she was pregnant. “The VHSG advised me to have sufficiently nutritious food and to go for prenatal checks and to have enough iron pills. I went as advised. I think they are very helpful,” Preut says.

Bousra sits within Pichinda District and is one of more than 60 administration districts across nine provinces — Mondulkiri, Ratanakiri, Kratie, Stung Treng, Preah Vihear, Kampong Chhnang, Koh Kong, Pursat, and Banteay Meanchey — benefitting from the project. Central to its success has been the way Cambodia’s National Committee for Sub-National Democratic Development Secretariat (NCDDS) is collaborating with the Ministry of Health to ensure local administrations more effectively mobilize communities and resources.

“We’re proud of the way the project has strengthened public sector commitment and accountability to improve the availability and quality of priority health and nutrition services to local communities,” says H.E Kimsan Ny, Cambodia Nutrition Project Director with the NCDDS. "We’re working through existing local government structures to reduce fragmentation and enhance sustainability.”

Aligned with Cambodia’s decentralization policies, the project encourages district and municipal administrations to support commune/sangkat councils and villages to identify health issues and then plan, budget, and implement activities that will improve the well-being of their residents. For example, VHSGs are helping health centers provide outreach services to the most remote and hard to reach people by mapping first-1,000-day households, monitoring child growth, screening for malnutrition, communicating improved health and nutrition habits, and encouraging use of the Health Equity Fund, a part of the National Social Security Fund which enables greater access to essential health care.

“We have two [VHSGs] per village,” says Khleok Keosingieb, Bousra’s commune council member in charge of women’s and children’s issues. “These were elected by the Commune Committee to help with health and nutrition issues in the village. [Through them] we get relevant information faster than before, and if any issue arises that the groups can’t deal with, they seek our advice.” 

Local support for 1,000-day households

In addition to VHSGs, the project supports health centers to improve the quality of services they provide so mothers and their children get the care and information they need on health and nutrition.

“Midwives advise parents to use our services from the very first day,” says Dr. Chang Khun, head of Pichreada Health Center in Mondulkiri Province. “Mothers who give birth at the center are taught to put their newborn on their breasts within the first 24 hours and to exclusively breastfeed during the first six months. Breast milk benefits a child’s immune system and intellectual growth and provides protection against getting sick.”

Through the introduction of a new national quality enhancement monitoring system, the Ministry of Health has increased its attention to the quality of antenatal and postnatal counselling for mothers, children’s growth and development, and the nutritional status of both mothers and their children. District teams assess the performance of health facilities by measuring the availability of health workers, essential medicines and equipment, and the level of patient satisfaction. When targets are met and verified, the Ministry of Health offers service delivery grants to the facility. Assessment results demonstrate continuous improvement in both the working knowledge and skills of health workers, and satisfaction with maternal and child health and nutrition services provided to communities.

Partnerships that build human capital

The US$62.5 million dollar support is co-financed by the Royal Government of Cambodia, the Australian government, German KfW Development Bank, Global Financing Facility, and the International Development Association, the World Bank Group’s concessional lending arm.

"This project is improving human capital outcomes by increasing access to quality health and nutrition services for mothers and their babies,” says Dr. Sophonneary Prak, Cambodia Nutrition Project Director at the Ministry of Health. “Working together with the NCDDS, we have seen improvements in the availability, accessibility, affordability, and quality of health and nutrition services. We have also been able to develop national maternal and child health and nutrition guidance documents, tools, training modules, coaching packages, implementation guidelines, educational videos, and many other nutrition related materials.”

Community leadership  

Back in Chom Bok Pa Em, the sun is setting as Choeum Sreyrath sits with a group of pregnant women in her village. Many work in the local garment factory and she knows the best time to reach them is outside business hours. Nursing her own three-and-a-half-month-old child, Sreyrath explains how she applied her VHSG training in her own life. Her first born was underweight at birth and she didn’t know much about good nutrition at the time. She drank too many energy drinks to combat the tiredness. She smiles at the child in her lap as she recalls that after improving her diet, her second child was born in good health and within the optimal weight range.

“I am very proud," says Sreyrath, reflecting on her role in the community. “I see that people in our village are healthy and [they] took my advice.”

FEATURE STORY June 24, 2024

Increasing Access to Quality Health and Nutrition Services for Women and Children in Cambodia

Choeum Sreyrath, her baby in arms, talks about her role as a Village Health Support Group (VHSG) in Kampong Chhnang province. 

© Saroeun Bou, World Bank

“I am very much enjoying my work because it helps me to improve my own health and I can help pregnant women, new mothers, and children in my village to take serious care of their health,” says Choeum Sreyrath, a village health support group worker (known as VHSGs) in Chom Bok Pa Em, a village in Cambodia’s central Kampong Chhnang province.

Sreyrath is one of 4,459 VHSGs — 3,255 of them women — recruited and trained since 2021 to help Cambodian families connect with local health and nutrition services. Recognizing that the first 1,000 days — from pregnancy to a child’s second birthday — establish critical foundations for growth and development, Cambodia’s government is improving the quality and capacity of local maternal and child health and nutrition services through the Cambodia Nutrition Project.

Communities managing their own well-being

To the east in Bousra village, young mother Pleun Preut describes the support she received after finding out she was pregnant. “The VHSG advised me to have sufficiently nutritious food and to go for prenatal checks and to have enough iron pills. I went as advised. I think they are very helpful,” Preut says.

Bousra sits within Pichinda District and is one of more than 60 administration districts across nine provinces — Mondulkiri, Ratanakiri, Kratie, Stung Treng, Preah Vihear, Kampong Chhnang, Koh Kong, Pursat, and Banteay Meanchey — benefitting from the project. Central to its success has been the way Cambodia’s National Committee for Sub-National Democratic Development Secretariat (NCDDS) is collaborating with the Ministry of Health to ensure local administrations more effectively mobilize communities and resources.

“We’re proud of the way the project has strengthened public sector commitment and accountability to improve the availability and quality of priority health and nutrition services to local communities,” says H.E Kimsan Ny, Cambodia Nutrition Project Director with the NCDDS. "We’re working through existing local government structures to reduce fragmentation and enhance sustainability.”

Aligned with Cambodia’s decentralization policies, the project encourages district and municipal administrations to support commune/sangkat councils and villages to identify health issues and then plan, budget, and implement activities that will improve the well-being of their residents. For example, VHSGs are helping health centers provide outreach services to the most remote and hard to reach people by mapping first-1,000-day households, monitoring child growth, screening for malnutrition, communicating improved health and nutrition habits, and encouraging use of the Health Equity Fund, a part of the National Social Security Fund which enables greater access to essential health care.

“We have two [VHSGs] per village,” says Khleok Keosingieb, Bousra’s commune council member in charge of women’s and children’s issues. “These were elected by the Commune Committee to help with health and nutrition issues in the village. [Through them] we get relevant information faster than before, and if any issue arises that the groups can’t deal with, they seek our advice.” 

Local support for 1,000-day households

In addition to VHSGs, the project supports health centers to improve the quality of services they provide so mothers and their children get the care and information they need on health and nutrition.

“Midwives advise parents to use our services from the very first day,” says Dr. Chang Khun, head of Pichreada Health Center in Mondulkiri Province. “Mothers who give birth at the center are taught to put their newborn on their breasts within the first 24 hours and to exclusively breastfeed during the first six months. Breast milk benefits a child’s immune system and intellectual growth and provides protection against getting sick.”

Through the introduction of a new national quality enhancement monitoring system, the Ministry of Health has increased its attention to the quality of antenatal and postnatal counselling for mothers, children’s growth and development, and the nutritional status of both mothers and their children. District teams assess the performance of health facilities by measuring the availability of health workers, essential medicines and equipment, and the level of patient satisfaction. When targets are met and verified, the Ministry of Health offers service delivery grants to the facility. Assessment results demonstrate continuous improvement in both the working knowledge and skills of health workers, and satisfaction with maternal and child health and nutrition services provided to communities.

Partnerships that build human capital

The US$62.5 million dollar support is co-financed by the Royal Government of Cambodia, the Australian government, German KfW Development Bank, Global Financing Facility, and the International Development Association, the World Bank Group’s concessional lending arm.

"This project is improving human capital outcomes by increasing access to quality health and nutrition services for mothers and their babies,” says Dr. Sophonneary Prak, Cambodia Nutrition Project Director at the Ministry of Health. “Working together with the NCDDS, we have seen improvements in the availability, accessibility, affordability, and quality of health and nutrition services. We have also been able to develop national maternal and child health and nutrition guidance documents, tools, training modules, coaching packages, implementation guidelines, educational videos, and many other nutrition related materials.”

Community leadership  

Back in Chom Bok Pa Em, the sun is setting as Choeum Sreyrath sits with a group of pregnant women in her village. Many work in the local garment factory and she knows the best time to reach them is outside business hours. Nursing her own three-and-a-half-month-old child, Sreyrath explains how she applied her VHSG training in her own life. Her first born was underweight at birth and she didn’t know much about good nutrition at the time. She drank too many energy drinks to combat the tiredness. She smiles at the child in her lap as she recalls that after improving her diet, her second child was born in good health and within the optimal weight range.

“I am very proud," says Sreyrath, reflecting on her role in the community. “I see that people in our village are healthy and [they] took my advice.”