In 1999, the World Bank Institute (WBI) launched a major learning program for Bank client countries and Bank staff on "Population, Reproductive Health and Health Sector
Reform". It aims to complement the Bank's extensive lending activities for population and reproductive health (about $500 million annually) by providing information about options, interventions and best practices to advance the reproductive health agenda in countries undergoing reform.
An important part of the learning program is to identify sector-wide changes in health systems that are required to combat deeply entrenched, systemic performance problems
that currently undermine desired reproductive health outcomes. This is a daunting challenge especially for those who have been associated with more narrowly managed
family planning and reproductive health projects, and must now champion the integration of population and reproductive health concerns in overall health sector development. To
do so, new skills will be required including knowledge about how different forms of financing, provider payments, organizational arrangements, regulation, and ways of
promoting healthy behaviors can be brought to bear to improve reproductive health. Acknowledging the immense challenge ahead, this paper does not pretend to offer an
exhaustive review of all problems involved or ways of dealing with them. Its purpose rather is to:
* explain why health sector reform prevails in many countries and why reproductive health advocates cannot ignore it; and propose a diagnostic approach for 'thinking about' reproductive health that links undesirable outcomes to their causes, as well as five categories of health reform
interventions or "levers" than can be employed to remedy them;
* illustrate the application of the reforrn categories or "levers" in countries where a concerted effort is underway to improve reproductive health outcomes; and
* contribute to a common language and understanding of reform options that can help empower advocates of reproductive health in their dialogue and negotiations with Ministries of Health, Ministries of Finance, and the international donor community.
