[stop-imf] Save the Children highlights WB failure

[Robert Weissman]

Save the Children UK's report Thin on the Ground is available at
http://www.savethechildren.org.uk/ (click on "Save the Children
Challenges World Bank to make its millions work" and then follow the
link in the press release)

Below:

1. Save the Children UK's press release

2. Guardian story


British charity challenges World Bank to make its millions work
3 July 2003

Save the Children, the UK's leading international children's charity,
today expressed grave concern at the failure of World Bank funded large
scale nutrition projects in Bangladesh and Uganda. The charity has been
unable to find any evidence that these multi-million dollar projects are
improving children's nutrition and is urgently calling on the World Bank
to undertake a proper review before expanding the work in these and
other countries.

Save the Children=92s call was issued following the publication of their
new report, Thin on the Ground. The report examines the evidence behind
the failing projects in Bangladesh and Uganda and based on the evidence
predicts the likely failure of a planned project in Ethiopia. Despite
the lack of evidence of success to support these projects, the Bank is
going ahead with a planned scale-up operation in Bangladesh and starting
up a new project in Ethiopia.

The researchers found that:-

After six years of implementation in Bangladesh there was no difference
in rates of malnutrition between project and non project areas

Growth monitoring charts were poorly understood by mothers and
supplementary feeding had limited impact on children=92s weight,
especially for very young children in Bangladesh

In Uganda no evaluation of the project=92s impact over the past four years
has been made public. Despite this, expansion of the project into new
areas is being discussed

In Uganda those who do the counselling are inadequately trained to
provide sound guidance to mothers

In Ethiopia, Growth Monitoring and Promotion (GMP) is a high risk
intervention because the strategy has never been evaluated in such a
resource-constrained environment and in the absence of a functioning
health system  In all three countries, the per capita cost of the
projects exceeded per capita investments on health services.

Launching the report, Fiona Weir, Save the Children's Policy and
Communications Director, said:

"It is a matter of deep concern that the World Bank has recently loaned
Bangladesh a further $124.6 million and a projected ten year investment
loan plan of $1 billion is under discussion. These projects threaten to
plunge developing countries into further debt without making any
substantial impact on malnutrition rates. The World Bank must halt the
scale up of these projects until objective reviews are completed ".

The projects use as a primary strategy Growth Monitoring and Promotion
(GMP): a process of weighing a child, charting weight, assessing growth
and providing counselling and motivation to mothers. Other components,
including supplementary feeding, are found in the projects. Researchers
found that in practice, in Bangladesh, the charts were often poorly
understood by mothers and supplementary feeding had limited impact and
low coverage. Major implementation problems were observed in Uganda and
Bangladesh and similar problems are likely in Ethiopia.

Save the Children=92s report questions whether the impressive targets for
reductions in malnutrition set for these projects can be achieved if
mothers cannot act on the knowledge and advice they are given. This may
happen either because they cannot afford a healthy diet or safe water,
or because their sick child cannot be effectively referred for treatment
because the health system is grossly underfunded. Save the Children
believes that in these circumstances, GMP, as an isolated activity, will
be problematic.

Anna Taylor, Save the Children's Nutrition Adviser said: "The World Bank
should fundamentally reconsider its current approach to addressing
malnutrition. We have to beat poverty if we are to see substantial
reductions in the numbers of malnourished children around the world."

Save the Children is also extremely concerned at the lack of
accountability for management of these projects. Decisions are made to
scale-up projects irrespective of their success. Researchers found that
the same World Bank staff can be involved in the design of the project,
the monitoring and evaluation and the design of further phases, which
can result in unsuccessful projects being replicated. The report found
that sometimes World Bank consultants had little experience of working
in the countries where projects are based,arriving with a 'one size fits
all' blueprint to solve the problems of malnutrition in any country.

Save the Children is calling on the World Bank:

To stop further scaling up of GMP in Bangladesh and Uganda projects until
objective reviews are completed, and scale the Ethiopia project down to
a pilot.
To undertake an independent review of the evidence behind current
approaches to poor child growth.

To increase accountability in the design, monitoring and evaluation of
projects, as already recommended by the World Bank's own Operations
Evaluation Department. To explore the cost effectiveness of other
alternative approaches, for example improving public health and food
security, to inform all future nutrition investment.

'Ends'

For further details contact: Sheila Boswell, 020 7716 2214 email s.boswell@=
scfuk.org.uk;

For copies of Thin on the Ground full report please call 020 7716 2280

Notes to Editors

In Ethiopia the project has not yet started. However, a similar project
was conducted by WHO, UNICEF and Ethiopian Government (1984 - 1989).
This project collapsed after the funding ended and was never fully
evaluated.

The World Bank funded projects use Growth Monitoring and Promotion (GMP)
a process of weighing a child, graphing weight, assessing growth and
providing counselling to mothers and carers.

The research was conducted under the guidance of an international group
of academics including Dr Saul Morris, London School of Hygiene and
Tropical Medicine, Professor Michael Latham, Cornell University,
Professor Patrick Kolsteren, Institute of Tropical Medicine, Dr Helen
Young, Tufts University and Dr Peter Poore. Malnutrition is associated
with the deaths of over half of the 11 million children under 5 who die
each year

'Beat Poverty' is Save the Children's campaign to raise awareness of and
fight child poverty. The Beat Poverty Campaign is calling for increased
spending on health and education for every child, more and better
overseas aid, fairer global trade rules and making children the top
priority in actions on poverty.

Find out more about Beat Poverty by visiting the website at
www.beatpoverty.org. or call 020 7701 8916

Save the Children UK is a member of the International Save the Children
Alliance, the world's leading children's rights organisation with
members in 29 countries and operational programmes in more than 100.


------

orld Bank poverty drive a failure, says report

Sarah Boseley, health editor
Thursday July 3, 2003
The Guardian (UK)

World Bank projects costing hundreds of millions of pounds and aimed at
cutting malnutrition among children in developing countries have
completely failed to make
any difference, according to a report published today.

Save the Children UK claims that the bank has not only continued with
costly but failing projects in Bangladesh and Uganda but it is planning
to expand, with a scheme
billed for Ethiopia. It claims the money could be better spent.

The World Bank both designs the programmes and lends beneficiaries the
money to carry them out, which increases their debt.

Fiona Weir, the charity's policy and communication director, said: "It
is a matter of deep concern that the World Bank has recently loaned
Bangladesh a further
$124.6m [=A375m] and a projected 10-year investment loan plan of $1bn is
under discussion.

"These projects threaten to plunge developing countries into further
debt without making any substantial impact on malnutrition rates."

John Seaman, a health advisor at Save the Children, claims that the
programmes are based on a "widely discredited" approach, which assumes
"that the child is
malnourished because the mother isn't doing something right, because she
doesn't know how to feed or lacks the food to support the child".

In areas where the programmes operate, children are registered at birth
at a centre. Their mothers then bring them in each month to be weighed.
If the children appear
severely malnourished, they become eligible for feeding. The mother then
has to bring them to the centre every day and is shown how and what to
feed her child while
the infant gets a meal.

"It's a considerable time investment for the mother," said Anna Taylor,
author of the charity report, Thin on the Ground. "The child could be
receiving food for three to
six months and she is supposed to go every day and receive messages
about how she is supposed to be caring for her child and sitting around
waiting for the meal."

The charity's research showed that only 20% of the children eligible for
extra feeding were receiving it, concluding that the World Bank has not
taken account of the
pressures on the mothers to work and take care of their home and the
rest of the family.

"Our evidence suggests that too many mothers are too poor to act on
their newly acquired knowledge about nutrition: they live in unhealthy,
unsanitary environments
lacking adequate and safe water," the report says. "They have little or
no access to health services; they are often illiterate and they have
inadequate time for childcare."

The sums of money involved are large. One project in Bangladesh which
ran from 1995-2002 had a $67m budget. It has been replaced by a second
scheme with a
budget of $124m. It could continue for 10 years, spending up to $1bn.
The Uganda project - from 1998 to this year - is worth $40m but there
are further plans to
expand provision.

Ms Taylor says that malnutrition has been improved overall in Bangladesh
by the slightly better economic position of the country as a whole. In
six years, the World
Bank programmes made no contribution, the charity's analysis of the data
shows.

The charity says that the money would be better spent on improving
healthcare systems so that children get basic immunisation, or on
getting more children into school
or improving sanitation and clean water supplies.

Milla McLachlan, the bank's nutrition adviser, rejected the criticism,
although she said it was valuable to have "constructive dialogue around
our work". New data from
the Banglandesh project, not yet made public, would show that the
project has an impact, she said. "It is quite clear that the project has
had very positive outcomes
regarding behaviour."

There had been a 35% rise in the number of women undergoing antenatal
check-ups, a doubling of those taking iron and folate supplements and a
reduction in severe
stunting.

Ms McLachlan said that the bank did not operate nutrition programmes in
isolation: it would also be funding projects to improve sanitation,
water, health and hygiene.

The education and behaviour change projects were in addition to other
efforts, she said.