Economics & Development

This brief presents insights and lessons for the Networks of Practice (NoP) program in urban Ghana, based on formative research conducted in Ayawaso Central, Greater Accra Region and Atwima Nwabiagya Municipal, Ashanti Region. The research used Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) to understand and compare patient journeys in settings with and without NoPs. The NoP program has not yet expanded into urban areas, but studying patient journeys and the healthcare provider situation in urban settings provides essential information for patient oriented NoP design. Features that were found to be specific to urban districts include a higher density of health providers, a greater role of private health facilities and clinics as compared to rural areas, and higher out-of-pocket expenditure on healthcare. For successful NoP implementation, network formation in urban areas will need to be tailored to the prevailing care delivery landscape and healthcare utilization patterns. This may include upgrading selected public sector facilities to become network hubs and enhancing collaboration with private sector providers to strengthen urban networks. Urban NoPs can advance Ghana’s ambition to increase access to quality primary care, robust referral pathways, and financial protection for all healthcare users in the country. Further research in various urban and peri-urban districts of Ghana and implementation of urban NoP pilots will be beneficial for shaping an NoP program suited to urban health systems

Ratings of the Accelerating Private Investment in Agriculture Program for Ukraine were as follows: Outcome was satisfactory; Bank performance was satisfactory; M&E quality was substantial. The lessons indicate that agriculture is foundational to Ukraine’s economy and that the Program for Results (PforR) instrument was instrumental in a context of fragility, conflict, and violence (FCV), complementing government reforms, catalyzing institutional strengthening, and enabling scale-up through follow-on operations. Candid reporting in implementation status documents, open dialogue among counterparts, and agile adaptation through timely restructurings allowed swift responses to implementation challenges and shifting priorities, demonstrating the importance of proactive course correction in rapidly changing environments. Including an Investment Project Financing component alongside a PforR can strengthen delivery of integrated technical assistance by bolstering implementation capacity, monitoring and evaluation, and environmental and social systems; the absence of such support limited the effectiveness of capacity development and could be improved in future designs. Continuous capacity building on PforR principles and modalities at all levels is essential; early delays reflected underestimated complexity, limited familiarity with defining realistic and sequenced disbursement-linked results and verification, and gaps in regulatory frameworks, all of which underscore the need for sustained training and careful alignment of sequencing, timing, and budget planning. Successful PforR implementation rests on three pillars: a credible government program, a solid associated medium-term expenditure framework, and credible country systems for fiduciary and safeguards; strengthening these preconditions increases transparency, accountability, and the likelihood of sustained outcomes. The PforR emerged as a well-suited instrument in Ukraine’s complex setting once capacity was built, effectively incentivizing reforms, improving the efficiency and targeting of public expenditures, and creating synergies that maximized impact; the establishment of the State Agrarian Registry and its use in subsequent operations exemplify how institutional platforms can be leveraged and scaled. Recommendations are to sustain candid performance reporting and agile restructuring to address issues early; consider pairing future PforRs with an integrated technical assistance component to deepen institutional support; invest in ongoing capacity building on PforR mechanics, realistic target setting, verification, and sequencing; ensure preconditions are in place by anchoring programs in credible strategies, expenditure frameworks, and strong country systems; and prioritize the PforR instrument for multi-sector reforms in FCV contexts where it can incentivize government performance, align public finance with results, and lay foundations for scaled follow-on programs.

Ratings of the Integrated Landscapes Management in Lagging Regions Project for Tunisia were as follows: outcome was moderately unsatisfactory; Bank performance was moderately unsatisfactory; M&E quality was modest. Lessons and recommendations are as follows: Introduce decentralized landscape co-management gradually by sequencing and piloting activities before scale-up, ideally through a programmatic series, to fit high-risk contexts, build capacity, and avoid overambitious designs. Secure ownership of innovative approaches through extensive upstream consultations and sustained implementation support, prioritizing community-based co-management that demonstrably improves livelihoods and helps retain youth in rural areas; scale these models where they perform. Use integrated landscape approaches that align environmental, social, and economic objectives and foster collaboration across government and practice areas to enhance results and community empowerment. Establish and execute a proactive communication plan from the outset, with dedicated communication capacity, to share progress, success stories, challenges, and beneficiary feedback, thereby strengthening visibility, stakeholder buy-in, and support for adaptive management. When grievances, including gender-based violence allegations, arise, respond promptly and proportionately through immediate assessment, independent third-party review, and capacity building and training for all stakeholders, while maintaining continuity of non-implicated activities to minimize disruption. Embed a clear negative list of ineligible activities and a detailed menu of recommended sustainable land and forest management practices in project and operations manuals, including species selection and soil and water conservation measures, and ensure close collaboration between technical and environmental and social specialists with joint field visits to verify practices and use them as learning opportunities.

The development objective of Critical Bridges Resilience Project is to improve the resilience of Fiji's road network to natural hazards and climate change with a focus on critical bridges. This project has three components. 1) The first component, Resilient Bridge Infrastructure Solutions, has the following sub-components: (i) Resilient Bridge Infrastructure; and (ii) Project Management Unit. 2) The second component, Spatial and Sector Planning Tools, has the following sub-components: (i) Vulnerability Assessment and Resilient Transport Sector Strategy; (ii) VA and RTSS-informed feasibility studies and designs; and (iii) Climate-informed Asset Management Plan(s). 3) The third component, Strengthening the Enabling Environment, has the following sub-components: (i) Capacity Building for Bridge and Jetty Maintenance Inspection and Prioritization Program; and (ii) Gender Program.