目的

世界银行（The World Bank）是全球卫生治理的重要参与主体，其与我国开展的卫生合作对促进我卫生事业发展发挥了积极作用，然而学界长期缺少关于世界银行在妇幼健康等具体卫生健康领域开展项目情况和模式特点的研究。本文旨在系统梳理世界银行2018年至2023年支持妇幼健康项目情况，对世界银行项目模式及其特点进行提炼总结，并结合两个具体项目案例开展讨论，分析该模式存在的优势与不足，并就我国提升妇幼健康水平、参与全球卫生治理提出针对性政策建议。

方法

本研究通过系统性文献分析法，梳理世界银行支持全球妇幼健康和与我国妇幼健康合作的历史沿革，并开展动因分析。依托世界银行官方项目数据库，根据世界银行项目主题分类进行检索，结合项目评审报告、实施情况评估报告等项目文件，对所得结果清理整合并进行分析，总结出世界银行妇幼健康项目模式特点。并在此基础上，选取两个典型案例“塞内加尔投资妇幼和青少年健康项目”和“中国重庆市统筹城乡发展（二期）卫生项目”对世界银行妇幼健康项目模式特点进行实证质性分析，讨论该模式存在的优势与不足，进而立足我国决策视角提出相关政策建议。

结果

2018年至2023年间， 世界银行支持的主题为“生殖与孕产妇健康”、“青少年健康”或“儿童健康”的项目共154个，累计承诺提供资金236.5亿美元。世界银行妇幼健康项目以中、低收入国家为主要合作对象，以卫生体系建设为主要支持领域，以中长期大额贷款为主要资金形式并注重援贷结合，以过程监督和独立评估为主要管理方式。合作对象方面，东部和南部非洲地区、西部和中部非洲地区在各区域中开展项目最多、涉及金额最大，巴基斯坦、印度、刚果（金）等中低收入和低收入国家合作项目和使用资金较多。支持领域方面，加强卫生体系建设是最主要举措，在已结项和完成结果评定并且设定妇幼健康评估指标的16个项目中，绝大多数项目通过提升卫生体系对于营养、产前产后检查、疾病筛查服务的供给能力和公平性，推动实现提升初级医疗服务能力、改善慢性非传染性疾病服务、促进健康公平等目标。资金形式方面，贷款占比为承诺资金总额的六成以上，项目平均金额达1.5亿美元（折合人民币约10.8亿元），平均期限超过4年；30%的项目采用了“援贷结合”的方式，涉及金额占总额的43%。管理方式方面，除使用政策融资工具的项目外，其他项目普遍设置妇幼健康相关评估指标，定期跟踪披露工作进展，并在结项时由专门团队开展独立评估，明确项目的成果和产出情况。此外，案例研究发现，塞内加尔项目和中国重庆项目均体现了世界银行模式在合作对象、支持领域、资金形式和管理方式上的显著特点。两个案例项目围绕合作国妇幼健康政策目标和面临的主要制约因素，提出了针对性举措，有效发挥了世界银行模式的优势，给项目实施地区和合作国妇幼健康水平提升带来了积极影响。

结论

世界银行妇幼健康项目实施成效总体令人满意，其模式在妇幼健康和全球卫生治理领域发挥着独特且至关重要的作用，在政策执行、长期投入、财务能力、快速响应、机制保障等方面具有其他机构难以比拟的优势。我国可加强与世界银行的融资合作和沟通对接，在服务本国健康需求和卫生体系建设的同时，推动中国企业、技术、经验走出去，为促进全球妇幼健康、深化全球卫生治理贡献中国智慧。

Objectives

The World Bank is a key participant in global health governance and has played a positive role in promoting health in China. However, there has been a long-standing lack of academic research on the World Bank's projects as well as its financing patterns in specific health areas such as women and children’s health. This paper systematically reviews the women and children’s health projects funded by the World Bank, summarizes the characteristics of its patterns in carrying out these projects, and analyzes the strengths and weaknesses of such patterns through two case studies. It then makes policy proposals for China on improving women and children’s health and broadening its engagement in global health governance.

Methods  

This study employs a systematic literature analysis to review the historical evolution of the World Bank’s support for women and children’s health and to conduct a motivational analysis. Utilizing the World Bank’s official project database, searches were performed based on the World Bank’s project theme classifications. The retrieved data were combined with project documents such as project appraisal documents, implementation status and results reports, and other relevant materials. The collected data were cleaned, integrated, and analyzed to summarize the characteristics of the World Bank’s financing patterns for women and children’s health projects. Building on this foundation, two case studies—“Senegal Investing in Maternal, Child, and Adolescent Health Project” and “Chongqing Urban Rural Integration Project II-Health”—were selected for empirical qualitative analysis. These cases were used to further examine the strengths and limitations of the World Bank’s financing patterns for women and children’s health projects.

Results  

From 2018 to 2023, the World Bank supported 154 projects themed on “reproductive and maternal health” “adolescent health” or “child health”, which amounted to $23.65 billion of financial commitments. The World Bank project financing patterns have several distinct features, as the projects primarily focus on cooperating with middle to low income countries, strengthening health systems, promoting the use of loans and particularly a combination of loans and grants, as well as continued monitoring of project implementation and independent evaluation. In terms of geographical distribution, middle to low income countries from Eastern and Southern Africa, Western and Central Africa and South Asia, such as Pakistan, India, and D.R. Congo, had the highest number of projects and the largest funding amounts. In terms of project components, strengthening health systems was the primary area of focus. Among the 16 projects that had been closed, rated and assigned with indicators related to women and children’s health, the overwhelming majority had set objectives including enhancing primary health care, improving delivery of non-communicable diseases services, and promoting health equity, by improving the accessibility and fairness of the health systems in delivering nutrition, perinatal care and screening services. In terms of funding sources, loans constituted the majority by taking up 60% of the total commitments. Each project averaged around $150 million (1.08 billion RMB) in project amount and over 4 years in project term. 30% of the projects were financed by both loans and grants, which accounted for 43% of the total commitments. In terms of management approach, almost all of the projects had set indicators related to women and children’s health except those with Development Policy Financing. This required a periodic disclosure of the project implementation status, as well as an independent evaluation upon project completion to verify the project outcomes and outputs. In addition, the case studies revealed that both the Senegal project and the China project highlighted the features of the World Bank financing patterns in terms of partnership, areas of focus, funding source and management approach. Both projects were oriented toward the objectives of the countries’ national policies on women and children’s health, and designed targeted measures to harness the strengths of the World Bank financing patterns in order to address the major obstacles, which had yielded positive outcomes for the improvement of women and children’s health in the project areas as well as the cooperating countries on a broader scale.

Conclusion  

The majority of the projects were rated satisfactory in terms of the outcomes. The World Bank’s financing patterns, which boast numerous unrivalled advantages such as strong policy execution, long-term mechanisms, budget guarantee, responsiveness and solid project management, have played a pivotal role in promoting women and children’s health as well as global health governance. It is suggested that China continue to broaden its cooperation and coordination with the World Bank to strengthen local health systems and to promote health among the domestic population. At the same time, China should also encourage its domestic companies to expand global business, and promote its technology as well as knowledge sharing among the international community, hence playing an active role in improving global women and children’s health and global health governance.