The World Bank advocates a three-pronged approach to government policies for improving health in developing countries: (a) fostering an economic environment that enables households to improve their own health, with growth policies (including, where necessary, economic adjustment policies) that ensure income gains for the poor, and expanded investment in schooling, particularly for girls; (b) redirecting government spending on health to the most cost-effective programmes that help the poor, especially to low-cost, highly effective programmes such as control and treatment of infectious diseases and malnutrition; and (c) promoting greater diversity and competition in the financing and deliver of health services, with a mix between government financing of public health and essential clinical services and private supply of other services.
The World Bank's own lending for health is increasingly focusing on broad policy reforms in the health sector. For example, it supports the government of Mauritania to develop a financing plan to improve the availability of basic health services for its widely dispersed population. The share of the general recurrent budget going to the Ministry of Public Health increased from 5.5% in 1992 to 7.5% in 1996. The project is introducing community-based cost recovery in three of the country's thirteen regions as a way of improving the efficiency and quality of services. In Tunisia the government is carrying out comprehensive reforms, including granting greater management autonomy to health facilities and decentralizing resources to the regional level. The Hospital Restructuring Project is assisting the improvement of management systems and the quality of health services in the largest government hospitals, which were recently granted autonomous legal status. The project dovetails with the concurrent Population and Family Health Project, designed to improve the quality and efficiency of public health services and essential clinical care, especially for mothers and children. In Romania the Health Rehabilitation Project supports government efforts to diversify sources of health financing and thus to reduce dependence on the public budget, which is under pressure because of weak and unstable macroeconomic conditions and rising health care costs. The government is pilot testing decentralization of health sector policymaking, planning, management and evaluation.