Yemen has been entrenched in a protracted conflict that has lasted for over eight years. The ongoing conflict, compounded by climate-related hazards, a cholera epidemic, and the global COVID-19 pandemic, has propelled Yemen into one of the most severe humanitarian crises in the world. In the country, nearly 22.5 million people—75% of the population—require humanitarian aid, and over 4.3 million have been displaced.  

Amidst this multifaceted crisis, Yemen's solid waste management (SWM) sector has been significantly impacted. The conflict has resulted in a severe lack of resources, impeding the provision of adequate waste management services. The repercussions of unsanitary waste collection and disposal are dire, as they pose significant risks to both public health and the environment. These risks often impact the most vulnerable segments of the population hardest.

A recent study financed by the Global Partnership for Results-Based Approaches (GPRBA) revealed several barriers exacerbating an already dire situation in the SWM sector. These barriers include fiscal constraints preventing City Cleaning and Improvement Funds (CCIFs, Yemen’s public SWM service providers) from expanding service coverage and the frequency of waste collection; residents' reluctance to pay due to concerns regarding service quality; and technical and institutional capacity constraints that result in poor planning and high operation and maintenance costs.

The study emphasized the importance of strengthening the institutional capacity of CCIFs to provide SWM services effectively. CCIFs are facing challenges due to a shortage of trained staff and limited technological systems to monitor service provision at the governorate level. Notably, none of the analyzed CCIFs has a functioning Monitoring and Information System (MIS) to assess the operational status of its services at a provincial level. 

In order to address the challenges and facilitate the transition of Yemen's SWM sector from emergency mode to sustainable SWM practices, GPRBA, through the Second Additional Financing to the Yemen Integrated Urban Services Emergency Project II (YIUSEP II), has allocated a grant of $6.6 million to three Yemeni cities: Sana’a, Aden, and Al Mukalla, targeting 1.9 million people. The grant has leveraged an additional $19.5 million from the International Development Association (IDA), enabling the acquisition of necessary machinery and equipment for CCIFs. The GPRBA grant, as part of the YIUSEP II Additional Financing package, has been declared effective.

The GPRBA grant aims to foster the long-term success and financial sustainability of CCIFs by offering essential technical assistance and results-based financing (RBF) mechanisms. Through this RBF mechanism, participating CCIFs will receive subsidies that bridge the financial gap between the rising operational cost of delivering services and the revenues generated. These subsidies will be gradually phased out over a two-year period, enabling the CCIFs to move closer towards financial self-sustainability. Besides enhancing the quality of SWM, the grant underscores the importance of increasing women's participation, linking disbursements to the number of women in technical CCIF roles.
 

Photo: Ami Vitale / World Bank

The UN Sustainable Development Goals, looking to 2030, seek to continue the progress made in addressing maternal health, child mortality and disease prevention. Donors have more than doubled their contributions to global health aid since 2000, and major advancements in health technologies and medicines have increased as well. Today, 17,000 fewer children die each day than in 1990, (1) but five million still do not live beyond their fifth birthday every year -- with Sub-Saharan Africa accounting for 80 percent of these deaths. Though the number of women who die during childbirth has decreased by 37 percent since 2000, only half of women in developing countries still do not have access to adequate health care-- with the maternal mortality rate still 14 times higher compared to women in developed countries.

Yet significant obstacles remain—from supply-side constraints such as poor infrastructure and lack of resources to demand-side constraints, including inability to pay, lack of insurance coverage, or lack of access—preventing lifesaving resources from reaching the poor in developing countries who need them most. 

Using innovative results-based financing schemes increasing access to affordable, quality health care services, GPRBA has supported reproductive health services in Uganda, Nigeria, Lesotho and Yemen:

• The Uganda Reproductive Health Voucher project implemented in the rural western part of the country, in which GPRBA partnered with KfW to fund a voucher scheme. This program involved users paying a low nominal fee for vouchers to be used for services such as pre– and post-natal care, childbirth attended by a trained medical professional, and screening and treatment of sexually transmitted diseases for couples.
• The Yemen Safe Motherhood Project also provided professional maternal health services in an urban context for pregnant women in the in Yemen was funded in an urban context in the poorest parts of Sanaa, Yemen’sthe capital city.
• GPRBA supported the Pre-Paid Health Scheme Pilot Project in Nigeria to increase access to quality basic health care in poorer parts of the country by implementing a health insurance scheme.  
• Lesotho’s New Hospital Public-Private Partnership provides access to quality health services at the state-of-the-art facility Queen ‘Mamohato Hospital in Maseru, along with support to a new national hospital and filter clinics. under a public-private partnership model in Lesotho.

(1) United Nations

Related Source on RBF Health: Health Results Innovative Trust Fund (HRITF)

News Release no. 2008/5

In Washington:
Cathy Russell, tel. (+1-202) 458 8124 crussell@worldbank.org
Ludi Joseph, tel. (+1-202) 473-7700 ljoseph@ifc.org

In Sana’a:
Samra Shaibani, sshaibani@worldbank.org

Sana’a, Yemen – June 10, 2008 – The World Bank, acting as an administrator for the Global Partnership on Output-Based Aid (GPOBA), today signed a grant agreement for US$6.23 million with two private healthcare providers in Yemen—the Saudi Yemeni Healthcare Company and the Al Mawarid Company for Educational and Health Services—and a Yemeni non-governmental organization (NGO), SOUL for the Development of Women and Children, to improve maternal care for women in some of the poorest districts of Yemen’s capital, Sana’a.

A look at how output-based aid (OBA) is being used to help the urban poor access water services

• Until recent projects funded by the municipal council and the World Bank made clean water available and affordable (Ksh3 per 20 liters), Kibera’s population relied on water collected from the Nairobi dam.  The water from the dam is not clean and made the dwellers vulnerable to contracting cholera or typhoid; and   
•  Most dwellings in Kibera do not have toilet facilities, relying instead on latrines which are just holes in the ground and each one shared by up to 50 shacks.

• In Cameroon, only about a third of the national population has access to piped water. A GPOBA pilot with a grant of over US$5 million aims to deliver new piped water connections for about 40,000 poor households. The project is the first GPOBA project to use an affermage contract, a model which transfers the operation of a national utility to a private operator while investment remains the government’s responsibility.  

• In Indonesia, two projects with grants totaling about US$ 5 million aim to help low-income communities in Jakarta and Surabaya gain access to clean water. In Jakarta, unconnected households can pay as much as 15 percent of their household income on water. Often, the water that they do have access to is overpriced by informal providers or is collected from shallow wells and contaminated. In Surabaya, the pilot project aims to extend piped water access to over 77,000 people.

• Although Morocco is a middle-income country with good access to clean and affordable water for most of the population, there are some poor communities in peri-urban settlements that faced the “last mile” paradox. So, although the water infrastructure was there, the cost of connecting to the network presented a barrier to access for poor households. In partnership with the government and the operators of water utilities in Casablanca, Meknès, and Tangiers, a GPOBA grant of US$7 million is helping over 11,000 households connect to local water networks.

• In the Philippines, the Manila Water Supply pilot will help almost 100,000 people gain access to clean, potable water. So far, 45 projects have been completed and benefited 11,000 households. As well as enjoying the benefit of 24-hour access to clean water supply, the target households have also reported financial savings and a reduction in the incidence of water-borne diseases. Encouraged by the initial success of the Manila project, the Government of the Philippines is exploring the idea of a national OBA facility to help ensure access to water for people across the country.

•  In Uganda’s capital city, Kampala, water connections for the poor will help bring access for communities in targeted urban settlements up to almost 100 percent by the project’s end.

•  In Yemen, a GPOBA grant of US$5 million will help the poor in urban and peri-urban areas gain access to safe drinking water and sanitation services. The pilot project is also being used as a model to show that tapping into private sector expertise and encouraging competition in the water sector can both serve the poor and help to reduce infrastructure costs.