Approach Paper
World Bank Support to Aging Countries
May 28, 2019
1. Introduction
Population aging – resulting from falling fertility rates, declining mortality, and
increased longevity – shapes the profile and the needs of an increasing number of
countries. How effective has the World Bank been in tailoring its toolkit to provide an
adequate response? This proposed evaluation is the first at IEG to assess the World Bank
contribution to diagnosing client countries’ demographic issues related to population
aging; 1 understanding the variance in policy needs and context specificities; and
providing vision, tools, and resources to respond to challenges in countries at different
stages of aging.
2. Background and Context
Population aging is rapidly becoming a prominent issue in many developing
countries. Thanks to dramatic improvements in nutrition, sanitation, health, education
and, more generally, economic well-being, longevity has increased everywhere in the
world while fertility has decreased in most countries, especially in Asia. 2 As a result,
aging, which seemed to be until recently a phenomenon confined to Organisation for
Economic Co-operation and Development (OECD) and Eastern European countries is
now defining societies in East Asia and Latin America. Even in regions where aging is a
more distant concern overall (such as South Asia, Africa, and the Middle East), a few
countries increasingly face aging-related challenges and more countries are forecast to
enter the aging phase of the demographic cycle in the coming decades. In fact, according
to the United Nations, population aging is one of the most significant trends of the 21st
century (UNFPA 2012).
The pace at which this phenomenon is unfolding in the developing world is
striking. United Nations estimates show that the number of people aged 60 and above
increased from 607 million in 2000 to 901 million in 2015 (an increase of 48 percent) and
it is projected to increase to 1.4 billion in 2030 and to 2.1 billion in 2050 (UN 2015a). Most
middle-income countries in East Asia are aging at record speed, much faster than
Europe and the United States did last century (transitioning from young to old in 20–25
years instead of 50–100 years) (see “aging” definitions in box 2.1). 3 Vietnam, for instance,
entered the aging phase in 2017, when the share of persons aged 60 and above reached
10 percent (UNFPA 2011); the projected growth of its elderly population between 2015
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and 2030 – over 90 percent – is one of the highest in the world (UN 2015a). 4 The map in
figure 2.1 clearly shows the magnitude of aging as a growing global phenomenon.
Box 2.1. When Is a Country “Aging”?
The United Nations refers to the share of the population over 60 to define how old a country is.
For developed countries a line drawn at age 65 is preferred, because this is normally when
people can claim social security. Thus, a country is defined as "aging" when the share of people
aged 65+ is above 7 percent, "aged" when it is 14 percent or more, and “super-aged” when it
exceeds 20 percent. Both cut-offs are arbitrary, however, because they do not consider how
healthy and functional the so-defined elderly are. Other definitions are used, such as the median
age, or the old-age dependency ratio, that is the ratio of older dependents (people older than
64) to the working-age population (people aged 15–64). The Global Monitoring Report (GMR)
2015/2016 (World Bank 2016) proposes a definition that combines trends in fertility and in the
size of the working-age population. Based on these trends, countries are classified in four stages
of the "demographic transition": pre-dividend countries (where fertility is greater than 4
births/woman); early dividend countries (with fertility lower than 4, but still increasing working
age population); late dividend countries (with shrinking working-age population, but where
fertility fell only recently); and post-dividend countries (with shrinking working-age population
and where fertility fell below replacement level, or 2.1 births/woman, three decades earlier). The
last two stages characterize aging countries. This evaluation adopts the GMR definition to select
aging countries.
Source: IEG
Population aging is a great achievement of development, but its implications for
growth, individual well-being, intragenerational equity, and the inclusiveness of the
development process need to be understood and addressed. Economic growth may be
affected via changes in the labor markets, productivity, consumption, savings, and
investments. Population aging may threaten the fiscal and social sustainability of the
social assistance and pensions systems. It has implications for gender equality and the
social contract across generations. Aging societies need to re-think how the elderly
access services and how cities are organized. In sum, population aging presents the
opportunity for longer and more prosperous lives, but “to turn this challenge into an
opportunity requires a significant change in a society’s mindset and policies”
(Holzmann 2013, p. 3).
Population aging can put downward pressures on growth, because some of the
fast-aging countries are key contributors to global GDP, such as China, Russia and
Brazil. 5 Some simulations indicate that, everything else being equal, the worldwide
annual average GDP growth rate over the next 40 years could be 1.2 percentage points
lower than it would otherwise be, because of the slowdown in population growth and
the increase in old age dependency ratios (Onder and Pestieau 2014). 6 Ultimately, the
effect of population aging on GDP growth depends on how population aging affects the
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size and productivity of the labor force, capital intensity and returns to capital,
consumption, and assets accumulation (Lee 2016) and how public policy reacts and
behaviors adjust (Lee and Mason 2017). 7
Figure 2.1. Proportion of population aged 60 or over in 2015 and 2050
Source: UN 2015b
Population aging may also have important implications for individual well-
being. Longevity has been accompanied by better health, so that as people are living
longer they are also healthier at older ages (Sanderson and Scherbov 2010). If longer
lives are also healthier lives, individuals can work longer and care for themselves. This,
however, varies by country, with recent evidence indicating that in less developed
countries the gap between life expectancy and healthy life expectancy is larger (Lancet
2017). Moreover, though the elderly are not necessarily poorer than other age groups,
there is high variability across countries (Evans and Palacios 2015). In some cases, aging
may be associated with illness, disability, social isolation, inability to be employed, and
uncertainty about income support sources. Vulnerabilities increase depending on the
coverage of the pension and health systems; the pervasiveness of informality; the
magnitude of rural-urban migration; and preferences and attitudes towards co-
residence, intergenerational support, and female labor force participation. In China, for
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instance, despite impressive economic growth during the past three decades, the rural
elderly, accounting for about 60 percent of all elderly, remained poorer and more
vulnerable than the urban elderly, owing to the large rural-urban disparities, low
savings, lack of pension, and heavy reliance on family support (Cai et al. 2012).
Population aging can also affect intergenerational inequalities. An increasing
share of elderly puts pressure on governments to reallocate resources in favor of the old
generation – for health, social protection, long-term care, and pension benefits – and to
raise taxes to fund these programs. Reforms that revisit entitlements and make the social
protection system less generous for the younger cohorts (to address the fiscal burden of
aging) affect the implicit social contract across generations and may be a source of social
tensions. 8 Ultimately, intergenerational inequalities depend on how support for the
elderly is provided for in a given society, including the extent of social programs, the
prevalent familial systems and patterns of co-residence, and the allocation of savings
and consumption across the life cycle (see Lee and Mason 2011, Lee 2016).
Population aging has important implications for gender equality. Older women
face a higher risk of poverty than men because of many factors. Because women have
longer life expectancy and typically marry older men, they are more likely to outlive their
husbands. Women have worse health than men in later life, despite a greater life
expectancy, so they are more likely to need care exactly when they are more likely to be
widowed. Moreover, because women are less likely to be in formal employment, they are
less likely to receive pension benefits and, if they do, they tend to receive lower pensions
– because of the wage gap during working age. Promoting female employment is
therefore essential to close gender gaps in both working age and old age (World Bank
2012a). It is also a potential solution to support employment in aging societies. Yet, in
aging societies there is more demand for women’s care work, which (when unpaid)
further limits women’s labor market participation or adds to women’s double burden of
being responsible for both paid and domestic labor (World Bank Group 2015). Adequate
public policies are needed to provide elderly care and support female paid employment,
thus addressing the specific vulnerabilities that an aging society entails for women
(OECD 2017).
The World Bank Group’s Role and Contribution
Aging is increasingly becoming an important area of strategic interest in the
World Bank Group. Although there is no explicit “aging strategy,” many strategic
documents refer to the urgency of addressing demographic issues related to aging. The
implementation update of the World Bank Group’s Forward Look document (World
Bank Group 2018a) refers explicitly to the challenges of aging societies and the need to
meet increased demand for new types of products and services, such as pensions and
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insurance products, as populations in emerging markets become, on average, older and
more affluent. It also refers to middle-income countries’ (MICs’) “unresolved
development challenges” and signals that “…many MICs have lost their demographic
dividend or will soon, and their pension and social protection systems are a rapidly
rising financial burden….” (World Bank Group 2018a, p. 4). The Bank Group Capital
Package (World Bank Group 2018b) highlights ensuring healthcare for an aging
population and preventing noncommunicable diseases (NCDs) as a prominent part of
the “Improving Human Endowment” pillar of the gender strategy (World Bank 2018 p.
20).
Efforts have been made to gain a deeper understanding of the implications of
aging for growth, equity, and poverty reduction. The 2015/16 Global Monitoring Report
(GMR) (World Bank and International Monetary Fund 2016) discusses population aging
as part of a broad, comprehensive framework that defines the interplay of demographic
patterns and their implications for development. The report proposes a four-category
typology of countries based on their stage in the demographic transition (see box 2.1)
and identifies policy measures for each category. It argues that, for the world to stand a
better chance of ending extreme poverty and lifting the well-being of the lower-income
people (that is, to achieve the Bank Group’s twin goals) aging countries need to adapt
their policies and institutions. This report comes 20 years after the first report on aging,
Averting the Old Age Crisis (World Bank 1994), which had taken a narrower focus on the
policy options, that is, reforming old age financial security systems to meet the goal of
protecting the old while avoiding negative impacts on growth. 9
At the regional and country levels, several World Bank reports have identified
specific challenges related to aging (box 2.2 and Appendix D and Appendix E). 10
Box 2.2. Examples of Regional and Country Work
Three regional flagship reports present in-depth analysis of the respective regions’ aging
situation and challenges. Population Aging: Is Latin America Ready? (Cotlear, ed., 2011), Live
Longer and Prosper (World Bank 2016a), and Golden Aging (Bussolo and others 2015)
highlighted the importance of enacting policies in a timely manner in Latin America and the
Caribbean, East Asia and the Pacific, and Europe and Central Asia to anticipate any potential
negative effects of population dynamics and to transform challenges into opportunities.
Several country-specific reports and Systematic Country Diagnostics have analyzed the main
challenges related to aging; consequently, aging has been addressed in many country
strategies. Half of the most recent country strategies approved in aging countries (as per GMR
definition) recognize “aging” as an issue; almost all of them refer to the importance of World
Bank support to address it. See Appendix D and Appendix E for more details.
Source: IEG.
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The World Bank has a long tradition of providing support to help client
countries face specific aging challenges. Lending and technical assistance have been
provided during the past decades for implementation of pensions reforms and for
preventing and addressing NCDs and, more recently, addressing long-term care needs.
In the period 1984–2005, the World Bank assisted 68 countries reforming their pension
systems through more than 200 loans and credits (IEG completed an evaluation of this
portfolio in 2006, OED 2006). Seventy-five additional lending operations with a Social
Insurance and Pensions theme code were approved in the period FY05–19 in 45
countries. In addition, in the period FY05–19 91 operations were approved in 44
countries with a NCD thematic code. 11
World Bank support other than for pension reforms, NCD, and long-term care is
hard to unequivocally ascribe to a strategic “aging approach”; yet it is relevant in
addressing issues affecting aging countries. For example, fiscal incentives and other
policies designed to boost female labor force participation are often promoted to close
gender gaps in employment, 12 while also addressing aging-related issues. Increasing the
efficiency of social spending may be motivated by the increasing fiscal pressures in
resource-constrained environments but may also help alleviate the fiscal cost of aging.
Supporting lifelong learning is often aimed at active workers who need to re-orient their
professional careers, but it can also help the elderly to remain active and productive.
The World Bank has also conducted policy dialogue centered on aging issues at
the regional and country levels, underpinned by analytical work and complemented by
advisory work. A stocktaking of active and completed regional, subregional and country
Advisory Services and Analytics (ASAs) with analytical focus on aging during the
period 2005–16 identified 39 activities and more than 130 World Bank publications.
IEG evaluation of issues related to aging has been very limited. Apart from an
evaluation of pension reforms (OED 2006) some recent evaluations cursorily assessed
how well Bank Group operations responded to the needs of elderly populations
(Appendix C).
3. Purpose, Objectives, and Users
This evaluation will inform the World Bank Group’s Board and Management on the
relevance, coherence, and operationalization of the World Bank support to aging countries
and contribute to the future refinement of this line of work. The World Bank is increasingly
called to offer comprehensive solutions to the deep and systemic socioeconomic challenges
its clients are facing because of population aging. 13 Providing adequate responses to aging
countries will become more of a priority as the phenomenon is accelerating.
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This evaluation has both an accountability and a learning objective. On the
accountability side, the evaluation will assess how the past and current analytical,
advisory, and operational work in aging countries meet the needs of an aging society.
The need for such an assessment was first highlighted by management in response to
the recommendations of the IEG Health, Nutrition, and Population evaluation (World
Bank 2009). 14 This importance was subsequently confirmed during IEG work program
consultations with management. On the learning side, the evaluation will discuss how
the World Bank can mobilize its resources in a timely way to provide relevant and
comprehensive responses to the needs of aging countries, based on the evaluation
findings. Improving the World Bank’s capacity to respond to its clients’ most
sophisticated requests related to their aging challenges is especially relevant today as the
World Bank has committed to ramp up its engagement with lower middle-income
countries under the World Bank Policy Package Proposal and to increase its support to
sharing development solutions for greater impact.
The evaluation findings are expected to serve as a learning opportunity for
World Bank teams working in a wide range of countries. Although the topic is of direct
relevance to country directors and other staff working in regional Vice Presidency Units
(VPUs) with high numbers of aging countries (Europe and Central Asia) and regional
VPUs where aging is rapidly becoming a major issue (East Asia and Pacific and Latin
America and the Caribbean), the lessons derived from this evaluation are of interest to
other regions (Sub-Saharan Africa, the Middle East and North Africa, South Asia) as the
aging process accelerates worldwide.
Given the multisectoral nature of the subject and broad set of policies it elicits,
intended users of this evaluation include several Global Practices (Health, Nutrition and
Population; Social Protection and Jobs; Education; Macro Trade and Investment; Poverty
and Equity; and Social Urban Rural and Resilience) and Global Solutions Groups
(Population and Development; Healthy Societies; Pensions and Social Insurance; Social
Inclusion; Gender; and Skills). The evaluation team will engage with a wide array of
relevant technical groups, teams, and experts during the preparation of the report. 15
The external audience includes client countries themselves; international
Population and Aging Institutes; agencies working on aging such as the Organisation for
Economic Co-Operation and Development (OECD), the European Commission,
specialized United Nations agencies such as the United Nations Population Fund
(UNFPA) and the United Nations Commission for Europe (UNECE); the World Health
Organization (WHO); the International Monetary Fund (IMF); and other donors active
in this agenda such as the European Union, Japan, and the Netherlands.
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4. Conceptual Framework
Based on the discussion presented in the first section, it is possible to map the
channels through which population aging can affect a country’s development outcomes
(figure 4.1). The conceptual framework will be refined as part of the evaluation’s work
based on the findings of a structured literature review (see next section) aiming at a
broader understanding of the potential impacts and opportunities of the aging process.
Figure 4.1 identifies the World Bank’s main entry points.
Population aging is the result of falling fertility rates, declining mortality, and
increased longevity (yellow box). This has implications for gross domestic product
(GDP) growth, overall well-being and economic and social equity (purple box), through
the channels discussed in the previous background section (such as a potential reduction
in employment and labor productivity, changes in savings and consumption patterns,
pressures on the health system and service delivery, and fiscal pressures – light blue
box).
Figure 4.1. Preliminary Conceptual Framework
Source: IEG
The cumulative effects can be positive or negative depending on how behaviors
change and policies adjust. First, the increase in the elderly dependency ratio could be
somewhat counterbalanced, especially in developing countries and in the early stage of
the demographic transition, by a reduction in youth dependency ratios. More
importantly, individual behaviors tend to adjust to the new reality of a longer life
expectancy, especially if increased longevity has been achieved by adding healthy years
(gray box). 16 For instance, as the life cycle lengthens, individuals may increase their
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participation in employment and retire later. They can save more or invest more in
education as returns to education increase, with positive repercussions on productivity.
Policy interventions will need to respond to the structural change induced by
population aging to stimulate positive behavioral responses and prevent potentially
adverse impacts on socioeconomic well-being (green box). How deep and widespread
these interventions should be depends on countries’ conditions, such as the degree of
formalization, structure of support systems, the existing level of urbanization and spatial
disparities, and societal expectation regarding care provision and gender roles (red box)
and the stage of the demographic transition (including how fast the society is moving
from “aging” to “aged”).
Potential policy responses identified by the 2015 GMR and other regional reports
are here classified under five main headings, and a miscellaneous category (green box).
At the macro level, fiscal reforms and adjustments in social protection systems are
necessary to increase efficiency, possibly without increasing taxes. Decisions on whether
to opt for unfunded or funded PAYG pension systems have to be made, including on how
to deal with their implications in terms of fiscal liabilities, investment of pension assets,
labor market distortions, and distributional equity – among other aspects. Pension
reforms should maintain an effective social safety net, while avoiding an increase of
labor costs and downward pressures on competitiveness and job creation. They should
also aim at providing coverage for the large informal sector characteristic of most client
countries. Health care systems need to focus on preventing and managing NCDs and
supporting behaviors to promote healthy aging. Systems and insurance for long-term
care need to be planned for. Labor market policies and programs need to support
employment (including female employment) and productivity and provide incentives to
workers and employers for later retirement. Incentives to innovation and technology to
support productivity in a context of declining employment should be considered. Pro-
immigration policies can counteract the decrease in working population. Other programs
can aim at increasing fertility. And, improving “accessibility” (a broad category
including access to information, accessible building, urban planning, affordable housing
and services, and public transport), and ensuring social inclusion of the elderly need to
be addressed. Gender considerations should be pervasive when designing and
implementing any policy and program related to aging.
The World Bank has been using multiple entry points to support client countries
undertake the various policies and programs referred to in figure 4.1 (dark blue box).
First, it has contributed to generating knowledge through analytical work. The regional-
and country-level reports focusing specifically on aging (and referred to in the
background section) typify this category; poverty assessments, public expenditure
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reviews, social assessments, jobs diagnostics, Systematic Country Diagnostics, and ad
hoc studies also play an important knowledge generation function. Second, the Bank
Group has assisted countries in defining priorities for policy and program interventions,
as reflected in policy dialogue and country partnership frameworks. Third, the World
Bank has provided financing and technical assistance to clients – through its different
lending instruments – to undertake reforms (including institutional reforms) and
implement programs. The World Bank has also promoted strategic partnerships to
advance specific policy issues with other institutions engaged in the aging agenda, such
as WHO, UNFPA, OECD, EU, and various bilateral donors.
5. Evaluation Questions and Scope
The evaluation’s overarching question is: How well is the World Bank
supporting client countries in addressing and anticipating their aging challenges? This
overarching question embeds two main sub-questions, each covering three underlying
questions:
1. How well does the World Bank diagnose aging-related challenges in client
countries? Specifically:
a. To what extent are World Bank diagnostics aligned to country needs and
priorities?
b. To what extent are World Bank diagnostics informed by the current
evidence on the challenges and opportunities of aging countries?
c. To what extent are World Bank diagnostics used to inform its strategy
and policy dialogue with the country?
2. How comprehensive, timely, and coherent is the World Bank’s operationalizing
of its support to aging countries? Specifically:
a. How comprehensive and timely are the solutions (policy options as well
as operational work) proposed by the World Bank?
b. How internally coherent are the solutions proposed by the World Bank
with respect to the instruments mobilized and across GPs?
c. How externally coherent are the solutions proposed by the World Bank
with respect to what other actors and partners are doing on the topic?
The evaluation won’t exclude any sector a priori, although it can be expected –
based on the preliminary work conducted for this approach paper – that some sectors
will be more prominently represented than others (namely the human development
sectors). The evaluation will therefore start by mapping the World Bank’s analytical,
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advisory, and operational work on aging, which may be “buried” in a variety of sector-
specific work.
The evaluation will not assess the work of IFC. The evaluation acknowledges
that the private sector may be providing services to the elderly, and that age
discrimination in the workplace is addressed in IFC performance standards. However,
the evaluation will limit its focus on the work of the World Bank to keep the scope
manageable. Yet, it will highlight situations where the diagnostics or strategic
programming point to opportunities for the private sector.
6. Evaluation Design
The evaluation will use the country as the entry point for analysis, focusing on
those client countries where aging is an issue or likely to become an issue over the next
one or two decades. The evaluation has selected as primary focus all the client countries
that the 2015 GMR identified as being in the late or post-demographic transition phase.
These include 38 “late-dividend” countries and 9 “post-dividend” countries, of which 22
in are in Europe and Central Asia, 13 are in Latin America and the Caribbean, six are in
East Asia and the Pacific, 3 in the Middle East and North Africa, 2 in Sub-Saharan Africa,
and 1 in South Asia (see Appendix B). In addition to these 47 countries, the population
of interest will also include about 10 “early-dividend” countries where the aging process
is accelerating and that are the next in line to become “late-dividend” countries based on
the GMR data. 17 This group of (tentatively) 57 countries will be the reference population
for the evaluation. Including countries where the aging process is not yet pressing is
important to assess how well-timed the World Bank’s support is to help anticipate and
preempt aging issues and to transfer lessons from countries that have already aged. 18
Where appropriate, the evaluation will consider a regional or sub-national focus (when
issues or policies are better understood at this level – as may be the case for migration,
for example).
The evaluation will use a multilevel design. Data collection and analysis will
occur at two levels: (i) for the whole reference population and (ii) for selected countries.
The country case analysis is the bedrock of the evaluation, because it is at the country
level that the World Bank tailors its support. The evaluation will select a group of 8–12
countries from the reference population to maximize variation along the following three
dimensions: (a) the nature and magnitude of the World Bank’s portfolio (so as to
represent countries with little World Bank engagement and those with strong World
Bank engagement); (b) specific macro-characteristics, prominently, how advanced a
country is in the aging process, and other relevant characteristics, such as in- and
outmigration, healthy life expectancy, female labor force participation, and old age
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income security; and (c) regional representation. To the extent that a certain level of
convergence of findings across countries will be observed, such heterogeneity can allow
for some degree of generalizability. The team will also consider testing emerging
findings from case studies on other countries in the reference population to assess
convergence and increase generalizability of findings.
The evaluation will use a mixed-methods approach that relies on both
quantitative and qualitative methods. It rests on the following building blocks:
structured literature review; structured document review; data analysis; portfolio
review; semi-structured key informant interviews and focus groups; and client surveys.
Specific methods are described below under each of the main data collection and
analysis methods. Appendix A highlights which method will be used to answer which
question.
A structured literature review will be used to identify the main policy areas
associated with aging. It will focus on policies and interventions aimed at attenuating
the potential negative socio-economic impacts of aging or leveraging its opportunities. It
will follow clear search criteria and inclusion and exclusion rules based on relevance and
quality parameters. The team will synthesize the evidence from the structured literature
review and use it to refine the conceptual framework (figure 4.1) and construct a
“benchmark” to position the World Bank’s approach (question 1b).
The structured document review will take stock of the World Bank’s diagnostic
work on aging in relevant regions and countries; technical assistance and Reimbursable
Advisory Services; strategic work (including Systematic Country Diagnostic and
Country Partnership Framework) for the reference population and at the country level;
and of activities related to ongoing partnerships. At the level of the reference
population, the structured document review will consider the main flagship reports,
while it will be more granular at the level of countries selected for the case-based
analysis. 19 The structured document review will be an input to all evaluation questions.
Data analysis will be conducted to profile different groups of countries and
country contexts. Countries will be categorized based on their specific characteristics,
especially with respect to their aging stage, but also relevant features such as in- and
outmigration, healthy life expectancy, female labor force participation, and old age
income security; this exercise will support the selection of country cases and will
complement the analysis of client needs and priorities (question 1a). Relevant
(aggregate) data will be identified through the structured literature review.
A portfolio review analysis will detect and analyze “aging-sensitive”
operations. For the reference population, the exercise will allow for an overall mapping
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and description of an aging-sensitive portfolio (based on the refined conceptual
framework), highlighting countries and thematic areas with heavy, light, and no
engagement and how this varied over time (to respond to question 2a). More detailed
portfolio review analysis will be conducted at the country case level to assess how
internally coherent the solutions proposed by the World Bank are – that is, whether its
country-level diagnostics, country strategies, operations, and advisory work logically
derive from each other (to respond to question 2b). 20
Semi-structured key informants’ interviews and focus groups will be used
strategically throughout the evaluation to guide the literature review, support portfolio
reviews and analysis, and complement findings from other sources. Key informant
interviews will help identify relevant operations and advisory work that may escape a
more traditional scanning of the portfolio. At the country level, key informant
interviews and focus groups will help answer questions associated with the
identification of country needs and priorities (question 1a), the use of World Bank
diagnostics to inform its strategy and policy dialogue (question 1c), and the World
Bank’s capacity to propose comprehensive, timely, and coherent solutions in response to
country needs and priorities (questions 2a and 2b). They will also be used to assess the
positioning of the World Bank with respect to other actors (question 2c).
Client surveys will be used, at the country level, to assess client needs, priorities,
and demand for World Bank support (question 1a). Moreover, client surveys will be
used (alongside key informant interviews and other available administrative and
portfolio data) to assess the World Bank’s capacity to propose comprehensive, timely,
and coherent solutions to client needs and priorities (questions 2a and 2b).
Several sampling and selection issues will be systematically addressed during
the evaluation. They pertain to the criteria for selection of countries, sectors, products,
and key informants as described in Appendix A.
Strength and limitations of design
The combination of methods and the multilevel design proposed will allow
robust lessons to be derived; yet, limitations from choices regarding the evaluation scope
and from the availability and quality of existing data and documentation are present.
Case studies allow for a deeper analysis of the World Bank’s support, yet they may not
provide the full picture of its work in this area. Case selection will partially rely on
external data, which may not be complete for the full range of countries, and on World
Bank documentation, which is not always either available or consistent. Excluding the
analysis of the private sector portfolio makes the scope more manageable, yet the
evaluation recognizes the importance of retaining potentially all sectors as solutions to
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aging challenges are systemic. To manage the absence of a defined aging-relevant or
‘aging-sensitive World Bank portfolio, the evaluation proposes an identification strategy
that may not always be accurate and, thus, the team will engage with management to
validate the identification of relevant portfolio to minimize inclusion and exclusion
errors. In in some cases, not enough time may have lapsed to assess the outcomes of
some recent initiatives.
7. Quality Assurance Process
This evaluation will be subject to IEG’s standard quality assurance process. This
Approach Paper has been peer-reviewed by experts and discussed informally with
management to ensure relevance of the evaluation questions, scope, and issues covered.
Detailed comments received during preparation will guide the evaluation’s work. The
detailed methodology plan will be finalized in close consultation with IEG’s methods
advisory team.
The peer reviewers are: Hervé Boulhol, Senior Economist Pensions and
Population Ageing, Directorate for Employment, Labour and Social Affairs at OECD;
David Canning, Professor of Population Sciences, and Professor of Economics and
International Health at the Harvard T.H. Chan School of Public Health; Louise Fox,
USAID’s Chief Economist and former World Bank Lead Economist (for final report); and
Ronald Lee, Professor of Demography and Jordan Family Professor of Economics, and
Director, Center for the Economics and Demography of Aging, University of California
at Berkeley.
Extensive exchange with external experts is part of the evaluation methodology.
The team will interact regularly with peer reviewers and a reference group of seasoned
professionals with expertise in aging to bring in diverse perspectives.
8. Expected Outputs, Outreach, and Tracking
The main output will be an evaluation report. This will be complemented by
literature reviews, background papers summarizing case studies, and potential learning
engagements, to be identified.
Extensive engagement with technical groups and management is expected.
Colleagues in relevant Communities of Practice and Global Solutions Groups will be
engaged throughout the evaluation to ensure relevance and comprehensiveness of the
analysis. Program Leaders will be the main channel to regularly engage with World
Bank colleagues working in this area across different practices. The evaluation team
expects extensive interaction with staff to validate instruments and approaches
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throughout the evaluation process and will share preliminary findings to ensure
relevance and buy-in.
Strong interest from countries themselves and from other donors and agencies is
also expected. Country Directors and staff working in relevant country offices will be
continuously engaged throughout the evaluation. The evaluation team aims to partner
with interested Country Management Units and relevant stakeholders in selected
country cases to ensure good understanding of the diagnostics and prioritization
process, dialogue around country needs and demand, and assessment of the World
Bank’s capacity to respond. Similarly, the evaluation team will engage with key
counterparts in other agencies to ensure complementarities with other efforts.
9. Resources
Timeline and budget
The final evaluation report is expected to be submitted to the Committee on
Development Effectiveness on January 31, 2020. The budget for delivering the study will
be about $800,000, excluding the cost of dissemination ($50,000).
Team and Skills-Mix
The evaluation will be led by Elena Bardasi and Gisela Garcia (IEGHC). The
evaluation will include a team of IEG staff, and consultants who will prepare structured
literature reviews and case studies. The core team includes Anahit Aghumian, Eduardo
Fernandez Maldonado, Ann Elizabeth Flanagan and Estelle Raimondo (IEG staff).
Expert consultants and ad-hoc support will be sought as needed during the evaluation
within and outside IEG to cover the multidimensionality of the topic. The work was
conducted under the general supervision of the IEGHC former Manager Emanuela di
Gropello, and under the overall direction of Auguste Tano Kouamé, former Director
IEGHE and Sophie Sirtaine, acting Director IEGHE .
15
References
Acemoglu, D. and P. Restrepo. 2017. Secular Stagnation? The Effect of Aging on Economic Growth in the
Age of Automation. Working Paper 23077. Cambridge MA: National Bureau of Economic
Research.
Aiyar, S., C. Ebeke, and X. Shao. 2016. The Impact of Workforce Aging on European Productivity. IMF
Working Paper 238. Washington DC: International Monetary Fund.
Bloom, David E.; Williamson, Jeffrey G. 1998. "Demographic transitions and economic miracles in
emerging Asia (English)". The World Bank economic review. -- Vol. 12, no. 3 (September 1998),
pp. 419-455.
Bloom, D., and D. Canning, 2004. ‘Global Demographic Change: Dimensions and Economic Significance.’
in Global Demographic Change: Economic Impacts and Policy Challenges, proceedings of a
symposium, sponsored by the Federal Reserve Bank of Kansas City, Jackson Hole, Wyoming,
August 26–28, pp. 9–56.
Bussolo, M., J. Koettl, and E. Sinnott. 2015. Golden Aging: Prospects for Healthy, Active, and Prosperous
Aging in Europe and Central Asia. Washington, DC: World Bank.
Cai, F., J. Giles, P. O’Keefe, and D. Wang. 2012.The elderly and old age support in rural China: Challenges
and prospects. Directions in development; human development. Washington, DC: World Bank.
http://documents.worldbank.org/curated/en/769231468215685476/The-elderly-and-old-age-
support-in-rural-China-challenges-and-prospects
Cotlear, D. (editor). 2011. Population Aging Is Latin America Ready? Washington, DC: World Bank.
Cruz, M. and S.A. Ahmed, 2016. ‘On the impact of demographic change on savings, growth, and
poverty.’ World Bank Policy Research Working Paper 7805, World Bank, Washington DC.
Eastwood, R., and M. Lipton, 2011. “Demographic Transition in Sub-Saharan Africa: How Big Will the
Economic Dividend Be?” Population Studies 65(1): 9–35
Evans, B. and R. Palacios. 2015. Who is Poorer? Poverty by Age in the Developing World. Social
Protection & Labor Policy Note 18. Washington DC: World Bank.
Flochel, Thomas; Ikeda, Yuki; Moroz, Harry Edmund; Umapathi, Nithin. 2015. Macroeconomic
implications of aging in East Asia Pacific: demography, labor markets and productivity. World
Bank, Washington DC.
Holzmann, R. 2013. A Provocative Perspective on Population Aging and Old‐Age Financial Protection.
IZA Discussion Paper 7571. Bonn: Institute for the Study of Labor.
Kelley, A., and R. Schmidt, 2007. ‘A Century of Demographic Change and Economic Growth: The Asian
Experience in Regional and Temporal Perspective,’ in Population Change, Labor Markets and
Sustainable Growth: Towards a New Economic Paradigm, edited by A. Mason and M.
Yamaguchi, 39–74. Amsterdam: Elsevier.
17
Kelly, T., A. Liapline, S. W. Tan, and H. Winkler. 2017. Reaping Digital Dividends: Leveraging the
Internet for Development in Europe and Central Asia. Washington D.C.: World Bank.
Lancet. 2017. Life, death, and disability in 2016. Volume 390, issue 10100. September 16, 2017.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32465-
0/fulltext#articleInformation
Lee, R. 2016. Macroeconomics, Aging and Growth. Chapter 2 in John Piggott and Alan Woodland, eds.,
Handbook of the Economics of Population Ageing, Amsterdam: Elsevier, pp.59-118.
Lee, R. and A. Mason. (eds. and lead authors). 2011. Population Aging and the Generational Economy: A
Global Perspective. Edward Elgar.
http://www.idrc.ca/EN/Resources/Publications/Pages/IDRCBookDetails.aspx?PublicationID=987
Lee, R. and A. Mason. 2017. Cost of Aging. Finance & Development, March 2017, Vol. 54, No. 1.
Washington DC. IMF.
Maestas, N., K. J. Mullen, and D. Powell. 2016. The Effect of Population Aging on Economic Growth, the
Labor Force and Productivity. Rand Working Paper 1063. Santa Monica: Rand Corporation.
National Research Council of the National Academies. 2012. Aging and the Macroeconomy: Long-Term
Implications of an Older Population. Washington, D.C.: The National Academies Press.
OECD. 2017. Preventing Ageing Unequally. Paris: OECD Publishing.
OED. 2006. Pension reform and the development of pension systems: an evaluation of World Bank
assistance. Washington, D.C.: World Bank.
Onder, H. and P. Pestieau. 2014. Is Aging Bad for the Economy? Maybe. Economic Premise, 144.
Washington, D.C.: World Bank.
Sanderson, W.C. and S. Scherbov. 2010. Remeasuring Aging. Science, 10 September 2010, 329, 5997, pp.
1287-1288.
Schwarz, A. M. and O. S. Arias. 2014. The Inverting Pyramid: Pension Systems Facing Demographic
Challenges in Europe and Central Asia. Washington D.C.: World Bank
Statistics Korea. 2017. 2017 Population and Housing Census. Seoul: Statistics Korea
file:///C:/Users/wb262014/Downloads/2017phc.pdf
United Nations. 2015a. World Population Aging 2015. New York: United Nations
http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.
pdf
United Nations. 2015b. World Population Prospects: The 2015 Revision. New York: United Nations
https://esa.un.org/unpd/wpp/Publications/Files/Key_Findings_WPP_2015.pdf
United Nations. 2017. World Population Prospects: The 2017 Revision. New York: United Nations
https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_KeyFindings.pdf
18
UNFPA. 2011. The aging population in Viet Nam: Current status, prognosis, and possible policy
responses. Hanoi: United Nations Population Fund Viet Nam.
https://vietnam.unfpa.org/sites/default/files/pub-pdf/Ageing%20report_ENG_FINAL_27.07.pdf
UNFPA. 2012. Ageing in the Twenty-First Century: A Celebration and A Challenge. New York: United
Nations Population Fund.
Westelius, N. J. and Y. Liu. 2016. The Impact of Demographics on Productivity and Inflation in Japan.
IMF Working Paper 16/237. Washington DC: International Monetary Fund.
World Bank. 1994. Averting the old age crisis: policies to protect the old and promote growth.
Washington DC; World Bank.
http://documents.worldbank.org/curated/en/973571468174557899/Averting-the-old-age-crisis-
policies-to-protect-the-old-and-promote-growth
World Bank. 2009. Improving Effectiveness and Outcomes for the Poor in Health, Nutrition, and
Population: An Evaluation of World Bank Group Support Since 1997. Washington DC: World
Bank.
World Bank. 2011. Growing old in an older Brazil: implications of population aging on growth, poverty, public
finance, and service delivery. Washington, DC: World Bank.
World Bank. 2012a. World Development Report Gender and Development. Washington, DC: World
Bank.
World Bank. 2012b. Country partnership strategy (FY2013-FY2016) for the Democratic Socialist Republic
of Sri Lanka. Washington, DC: World Bank.
World Bank. 2012c. Sri Lanka demographic transition: Facing the challenges of aging population with few
resources. Washington, DC: World Bank.
World Bank. 2013. Mitigating the economic impact of an aging population: Options for Bulgaria. Washington,
DC: World Bank.
World Bank. 2013. World Bank and IFC Support for Youth Employment Programs. Washington, D.C.: World
Bank.
World Bank. 2015. The active aging challenge for longer working lives in Latvia. Washington, DC: World Bank.
World Bank. 2015. World Bank Group gender strategy (FY16-23): gender equality, poverty reduction and
inclusive growth. Washington, D.C.: World Bank Group.
http://documents.worldbank.org/curated/en/820851467992505410/World-Bank-Group-gender-
strategy-FY16-23-gender-equality-poverty-reduction-and-inclusive-growth
World Bank. 2016a. Live Long and Prosper: Aging in East Asia and Pacific. Washington, DC: World Bank.
World Bank. 2016b. Demographic change in Uruguay: Economic opportunities and challenges. Washington, DC:
World Bank.
19
World Bank. 2016b. Country partnership framework for the Democratic Socialist Republic of Sri Lanka
for the period FY17-FY20. Washington, DC: World Bank.
World Bank and International Monetary Fund. 2016. Global Monitoring Report 2015/2016: Development
Goals in an Era of Demographic Change. Washington, DC: World Bank.
http://pubdocs.worldbank.org/en/503001444058224597/Global-Monitoring-Report-2015.pdf
World Bank Group. 2017a. Forward Look: A Vision for the World Bank Group in 2030—Progress and
Challenges. Washington, D.C.: World Bank.
World Bank. 2017b. Country partnership framework for Mauritius for the period FY17-FY21.
Washington, DC: World Bank.
World Bank. 2017c. Country partnership framework for the Socialist Republic of Vietnam for the period
18-FY22. Washington, DC: World Bank.
World Bank. 2017d. World Bank Group Engagement in Upper-Middle-Income Countries: Evidence from
IEG Evaluations. An IEG Synthesis Report. Washington DC: World Bank.
World Bank. 2017. A human rights-based approach to the economic security of older people in Moldova.
Washington, DC: World Bank.
World Bank. 2017. Mobile Metropolises: An IEG Evaluation of the World Bank Group’s Support for
Urban Transport. Washington, D.C.: World Bank.
World Bank. 2018. Options for aged care in China: Building an efficient and sustainable aged care system in
China. Washington, DC: World Bank.
World Bank. 2018. Country partnership framework for Poland for the period FY19-FY24. Washington,
DC: World Bank.
World Bank. 2018. Forward Look: A Vision for the World Bank Group in 2030. Implementation Update.
Washington, DC: World Bank.
World Bank. 2018. Inclusive Growth: A Synthesis of Findings from Recent IEG Evaluations. Washington,
DC: World Bank.
World Bank. 2018. World Bank Group Support to Health Services: Achievements and Challenges.
Washington, DC: World Bank.
World Bank. 2018. Sustainable Financing for Sustainable Development: World Bank Group Capital
Package Proposal. Report to Governors at 2018 Spring Meetings. Washington DC: World Bank.
World Bank. 2018. Competing in the Digital Age: Policy Implications for the Russian Federation.
Washington, D.C.: World Bank.
World Bank (forthcoming) Knowledge Flow and Collaboration Under the World Bank’s New Operating
Model. Washington, D.C.: World Bank.
20
World Bank Group. 2013. World Bank Group Strategy. Washington, DC.: World Bank.
https://openknowledge.worldbank.org/handle/10986/16095
World Health Organization. 2016. World Health Statistics 2016. Geneva: World Health Organization.
21
Appendix A. Evaluation Design Matrix and sampling approach
How well is the World Bank supporting client countries in addressing and anticipating their aging challenges?
Data Collection and Analysis
Key Questions Information Required and Sources Methods
1. How well does the World Bank diagnose aging-related challenges in client countries?
1a. To what extent are World Bank (for the Reference Population): Information on the nature Structured document review of ASA
diagnostics aligned to country needs and scope of Bank’s analytical work. Sources include work; Data analysis; Semi structured
and priorities? country and regional diagnostic and sector work (e.g. interviews; Client Surveys.
regional and country reports on aging, Poverty
Assessments, Public Expenditure Reviews, Country
Economic Memorandum, Job Diagnostic, Systematic
Country Diagnostics, etc.)
(for the Reference Population and more in-depth for
selected countries): Information on client needs, priorities,
and demand with respect to the country’s aging
challenges. Sources include Government strategies and
National Development Plans; macro, fiscal, demographic,
and socio-economic databases; (At the country level: client
surveys and country-level interviews.)
1b. To what extent are World Bank (for the Reference Population): Information on policies Structured document review of ASA
diagnostics informed by the current recommended for aging countries in Bank’s analytical work; SLR
evidence on the challenges and work. Broader literature on aging.
opportunities of aging countries?
1c. To what extent are World Bank (for the Reference Population and more in-depth for Structured document review (ASA and
diagnostics used to inform its strategy selected countries): Information on the nature and scope of SCD/CPF review); Semi structured
and policy dialogue with the country? Bank’s analytical and strategic work. Sources include interviews
country and regional diagnostic and sector work (e.g.
regional and country reports on aging, Poverty
Assessments, Public Expenditure Reviews, Country
Economic Memorandum, Job Diagnostic, Systematic
22
Country Diagnostics, etc.), review of country strategies, and
(at the country level) key informant interviews.
2. How comprehensively, timely, and coherently is the World Bank operationalizing its support to aging countries?
2a. How comprehensive and timely (for the Reference Population and more in-depth for Portfolio review; Structured document
are the solutions proposed by the selected countries): Information on lending portfolio and review; Semi structured interviews and
World Bank? assistance provided to countries in designing policy focus groups; Client surveys.
reforms or programs (including technical assistance, and
Reimbursable Advisory Services); identification of
recommended policy priorities. Sources include detailed
review of Bank’s strategic and operational work and client
perception.
2b. How internally coherent are the (for selected countries): Information on analytical work Structured document review; Portfolio
solutions proposed by the World Bank produced or supported by the Bank; identification of review; Semi structured interviews and
with respect to the instruments recommended policy priorities; information on lending focus groups; Client surveys.
mobilized and across GPs? portfolio and assistance provided to countries in designing
policy reforms or programs (including technical assistance,
and Reimbursable Advisory Services). Sources include
detailed review of Bank’s analytical, strategic and
operational work and client perception.
(for the Reference Population and more in-depth for
selected countries): Information related to incentives,
internal behaviors, tools, learning, and resources (expertise,
capacity, budgets). Internal and external perception of
existing capacity and resources.
2c. How externally coherent are the (for selected countries): Information regarding existing Semi structured interviews and focus
solutions proposed by the World Bank partnerships. Sources include formal and informal channels groups; Structured document review.
with respect to what other actors and for collaboration and knowledge exchange; internal and
partners are doing on the topic? external repositories of knowledge, fora, events; etc.
Source: IEG
23
The evaluation will adopt the following sampling approach:
Reference population
The reference population will include all the client countries that the 2015 GMR identified as
being in the late or post demographic transition phase. These include 38 “late dividend”
countries and 9 “post dividend” countries, of which 22 in ECA, 13 in LCR, 6 in EAP, 3 in
MNA, 2 in AFR, and 1 in SAR. Part of the reference population are also about 10” early
dividend” countries where the aging process is accelerating and that are the next in line to
become “late dividend” countries based on the GMR data (the final decision on the number
will be determined based on the actual distribution of the combined scored used by the GMR).
Selection of countries for case-based analysis
The evaluation will sample 8-12 countries from the reference population for case-based
analysis. These countries will be selected to maximize variation along the following three
dimensions: (a) the nature and magnitude of the Bank’s portfolio (both countries with little
and strong Bank’s engagement will be represented); (b) specific macro-characteristics
(different stages in the aging process, in- and outmigration, healthy life expectancy, female
labor force participation, and old age income security); and (c) regional representation. The
team will consult with management to confirm the validity of the selection criteria.
Sector selection
The evaluation won’t exclude any sector a priori, although it can be expected – based on the
preliminary work conducted for this approach paper– that some sectors will be more
prominently represented than others (namely the human development sectors).
Selection of key stakeholders
A matrix will be developed that maps different stakeholder groups (including potential key
informants). Purposive sampling of predetermined key informants in combination with
limited ‘snowballing’ will be used to work toward a point of saturation and arrive at a
carefully consolidated interview-based perspective on the evaluative issues.
Selection of ASA, strategy documents, and lending portfolio
The selection of flagship ASAs for in-depth review (Including analytical work: regional and
country reports on aging, Poverty Assessments, Public Expenditure Reviews, Country
Economic Memorandum, Job Diagnostic, Systematic Country Diagnostics, etc.; technical
assistance and Reimbursable Advisory Services) will be done using a combination of key word
search in the World Bank Group publication databases and operation portal, key informant
24
interviews, and the results of the SLR. The current and previous two country strategy
documents (and associated SCDs since available) for all the countries in the reference
population will be selected.
From the universe of the portfolio approved in relevant countries between FY05 and FY19, the
team will use a combination of criteria to identify the portfolio of interest. These include: (a)
theme codes (theme code 64, 522, 524, 621 and 625 on aging, pensions and social assistance,
disability, ICT solutions, and noncommunicable diseases, respectively); (b) key word search;
(c) identification of targeted beneficiaries; and (d) key informant interviews. Collaboration
with Bank colleagues in country offices, GPs and CMUs will be key to identify relevant
products which could escape a more traditional scan of the portfolio. A preliminary relevant
portfolio has been identified for this approach paper using a key word search. This exercise
has identified 133 operations that are potentially relevant (out of 1331 projects approved in
FY05-FY19 in the group of aging countries), and 294 ASA (out of 5114 for the same group of
countries over the same period). Abstracts, PDO and components of ASA and WB projects
approved between FY05-FY19 were scanned for the following words: active aging, healthy
aging; aged care services; ageing; age-related risks; aging, aging population, rapid aging;
caregivers; demographic issues, demographic challenges, demographic transition,
demographic change; dependency ratio; elderly, elder support; entitlements; family policies;
family support; fiscal sustainability; intergenerational; lifelong learning, life-long learning;
longevity; long-term care; LTC; noncommunicable, non-communicable, NCD; old age; older
population; pension, social pension, pension scheme, pension reform, pension program;
population profile; retiree; retirement; shrinking, shrinking population; social care; social
insurance; social security; voluntary savings. The other criteria will need to complement the
key word search to generate the final portfolio.
25
Appendix B. Proposed Focus Countries
Source: Global Monitoring Report 2015/16
Note: a number of ‘early dividend’ countries will be added to this list and included in the evaluation sample.
Appendix C. Existing IEG evidence
IEG reviewed Bank’s support to pension reforms during the period 1984-2004, when most of
the Bank’s operational and analytical work was conducted in ECA and to a lesser extent in
LAC (OED 2006). That evaluation recommended to better tailor assistance to country
conditions and provide consistent policy prescriptions; increase assistance in building
capacity to ensure sustainable reforms; and, expand safety nets in countries not covered by
pension systems. The evaluation found that ‘analyses of the living conditions of the aged tended
to be perfunctory, and few studies empirically investigated the limits of formal pension coverage or
ways to increase it’ (OED 2006, p. ix). It consequently recommended the Bank to conduct
additional research on the living conditions of the aged. No IEG evaluation has reviewed
Bank’s work related to health promotion to prevent or manage non-communicable diseases
(common in aging countries), or issues of social care, social assistance or long-term care.
Recent IEG evaluations provide some evidence of limited attention of Bank Group
operations in addressing specific needs of aging populations. The IEG evaluation of Urban
Transport (World Bank 2017b), for instance, found that only 11 percent of Bank’s urban
transport projects approved between FY07–16 supported universal access for the disabled
and elderly persons. This limited attention was explained by lack of resources and team
knowledge, and different client priorities. However, projects in the EAP and LAC Regions
stood out as those that most frequently incorporated universal access design features. IEG’s
synthesis review of Bank’s support in middle income countries (World Bank 2017c) notes
that the issue of aging population is a typical second-generation challenge in these
countries; yet, there is scarce available evidence on results achieved in this area. The IEG
synthesis of findings on inclusive growth (World Bank 2018b) notes that only 30 percent of
job competitiveness interventions identify the target beneficiaries, one third of which being
youth or elderly. The most recent IEG evaluation of World Bank support to health services
(World Bank 2018c) found that although the World Bank’s portfolio is overall aligned with
the country health priorities it tends to under prioritize noncommunicable diseases and
injuries.
27
Appendix D. Areas of emphasis in regional and country reports
Table D.1. Regional reports
Region Areas of emphasis
The report raised three social policy concerns for the region associated to
LAC: Population Aging: Is
population aging: care and support to aging populations, including poverty in
Latin America Ready?
old ages; the changes in health status and healthcare demand; and, increasing
(Cotlear, ed., 2011)
public expenditures and associated fiscal pressures.
EAP: Live Longer and
The report discussed the diverse societal and public policy challenges and reform
Prosper (World Bank
options for East Asia and Pacific countries as they address aging.
2016a)
The report examined obstacles for societies to reap the full benefits of increased
longevity. This latter report takes the view that, while many challenges are real
ECA: Golden Aging
and urgent, adequate policies can mitigate the possible negative impacts of a
(Bussolo and others 2015)
smaller and older workforce on growth and savings, the labor force, innovation,
poverty and inequality, and intergenerational solidarity.
Source: IEG
Table D.2. Select country reports
Country Areas of emphasis
Fiscal pressures on the public health and pensions systems; opportunities to
Brazil (2011)
increase labor market and public education effectiveness
Threats on labor supply and productivity growth; fiscal pressures on key public
Bulgaria (2013)
services; high incidence of poverty among the elderly population.
Efficiency of informal and formal arrangements for aged care services across
China (2018)
income groups and urban vs. rural areas
Maintaining employment and productivity; high health inequalities; disparities in
Latvia (2015)
employment rates and underdeveloped education for elderly workers.
Maintaining adequate economic security and living standard of the elderly; high
Moldova (2017)
out-migration.
Sri Lanka (2012) Functioning of the labor markets and the social safety net system
Uruguay (2016) Impacts on the social protection system, demand for health care and education;
functioning of the labor market; macroeconomic environment
Source: IEG from World Bank 2011, World Bank 2013a; World Bank 2018a; World Bank 2015; World Bank 2017a; World Bank
2012b; World Bank 2016b.
Appendix E. Preliminary SCD and CPF review
The universe of country strategy documents and associated SCDs approved since FY2000 for
the 47 focused countries were scanned for the same keywords used to identify the potentially
relevant lending and ASA portfolio (i.e. active aging, healthy aging; aged care services;
ageing; age-related risks; aging, aging population, rapid aging; caregivers; demographic
issues, demographic challenges, demographic transition, demographic change; dependency
ratio; elderly, elder support; entitlements; family policies; family support; fiscal sustainability;
intergenerational; lifelong learning, life-long learning; longevity; long-term care; LTC;
noncommunicable, non-communicable, NCD; old age; older population; pension, social
pension, pension scheme, pension reform, pension program; population profile; retiree;
retirement; shrinking, shrinking population; social care; social insurance; social security;
voluntary savings). Two hundred and 10 country strategy related documents were scanned
in total, including 58 SCD (table E.1).
The latest available CPF for each country (or group of countries, in the case of the
Organization of Eastern Caribbean States) was read in full and coded in NVivo. A total of 37
CPFs were analyzed, searching for a preliminary answer to question 2. A codebook was
developed to systematize the coding across different documents. This codebook laid out the
node structure used in NVivo, as well as definitions followed to warrant coding in the
documents. Each coded document was subsequently summarized in a Word document.
Preliminary results of the CPF review are presented in table E.2 below. A lot of nuance
brought to the analysis by using NVivo has been lost in presenting an overview of the results.
A CPF mentioning aging once, in passing (e.g. Moldova), and a CPF that significantly engages
with the topic (e.g. Poland) both have been marked with an ‘x’ for ‘aging diagnosis’. The same
is true for the potentially relevant support. A question mark in the table indicates that the CPF
document refer to potential support focusing on aging-related topics, but no specific activities
were identified.
Overall, while 21 CPFs (including Dominica as part of the OECS CPF) mentioned aging, there
is great diversity in the extent to which the topic is presented. In Poland, Bulgaria, Mauritius,
Sri Lanka, China, and Vietnam, for instance, the topic takes up a significant portion of the
CPFs’ development challenge diagnosis. While in other cases, it is only mentioned in passing.
We found several instances of Bank support directly linked to aging. In Bulgaria’s CPF, for
example, the intervention logic on educational support states: “Against the backdrop of a
rapidly aging and declining population, Bulgaria needs to equip its future cohorts of labor
market entrants with the skills and competencies that would help the country make a
significant leap in boosting employment and labor productivity.” (p. 36) The same can be
found in Uruguay’s CPF: “[T]here is a need for concerted efforts to improve access to quality
education and expand early childhood development programs […]. This reprioritization is of
particular importance given that ongoing population aging will increase the relative
proportion of elderly versus the working age population.” (p. 27) Poland’s CPF puts health
care reform directly in the realm of aging through its intervention logic: “Population aging,
and a high prevalence of non-communicable diseases place a new set of challenges for health
services in Poland, by increasing and altering the demand for care. This will require a different
strategy and one that enables productive aging.” (p. 44)
Figure E.1. Frequency of relevant key words in country strategy documents
Source: IEG
Note: “Others” includes the following key words: entitlement, shrinking, and intergenerational.
30
Table E.1. Most recent country strategy documents in focus countries
Source: IEG
Table E.2. Preliminary Review of Most Recent Country Strategies in focus countries
Source: IEG
32
Endnotes
1IEG conducted an evaluation on demographic issues in 2009 (World Bank 2009), which focused
mostly on issues of high fertility.
2 According to the projections of the United Nations, Population Division (UN 2017), significant gains
in life expectancy have been achieved in recent years in all regions of the World. Globally, life
expectancy at birth rose by 3.6 years between 2000-2005 and 2010-2015, or from 67.2 to 70.8 years. The
greatest gains were in Africa, where life expectancy rose by 6.6 years between these two periods after
rising by less than 2 years over the previous decade. Life expectancy in Africa in 2010-2015 stood at
60.2 years, compared to 71.8 in Asia, 74.6 in Latin America and the Caribbean, 77.2 in Europe, 77.9 in
Oceania and 79.2 in Northern America. The World Health Organization presents even largest gains,
but very similar trends (World Health Organization 2016).
3Notable is the case of South Korea, where – according to the 2017 Census – the working age
population aged 15-64 showed a drop for the first time. In the meantime, the proportion of the
population aged 65 or more increased to 14.2 percent, marking South Korea’s transition from an
aging to an aged society as per UN definition. This transition happened in just 17 years – the fastest
ever recorded so far. Indeed, it was only in 2000 when the percentage of citizens aged 65+ surpassed 7
percent (Statistics Korea 2017).
4Forty countries that in 2015 were in the early transition phase (as per GMR classification) are
projected to have more than 7 percent of the population aged 65+ in 2050 (in 3 of them the share of
those aged 65+ will be more than 14 percent). Many of these countries will be in Asia (Indonesia,
Bangladesh, India, Bhutan, Nepal, Myanmar, Cambodia, Philippines), in Latin America and the
Caribbean (Mexico, Peru, Bolivia, Dominican Republic, Ecuador, Nicaragua, Paraguay), and in ECA
(Tajikistan, Mongolia, Turkmenistan), but several will be also in the Middle East (Egypt, Algeria,
Jordan, Libya) and even in Sub-Saharan Africa (Botswana, Cabo Verde, South Africa).
5In China and Brazil, the old-age dependency ratio is projected to increase from 13 percent in 2015 to
nearly 40 percent and 33.8 percent respectively in 2050 (UN 2017).
6These calculations are based on the decomposition of the GDP historical growth rates in three
components—labor productivity, population growth, and growth in labor force participation rate. To
calculate a counterfactual GDP reflecting demographic changes the first component is held constant,
while the second and third component reflect future projections in demographic changes instead of
the current figures. Note that the per capita GDP growth rate would be less (0.4 percent per year)
because of the fall in total population. (While population aging likely lead to a decline in the growth
rate of GDP, it may not lead to a decline in the growth rate of GDP per capita, because of a decrease
in total population.) Behavioral adjustments (such as postponing retirement) can further attenuate the
estimated impacts.
7 The impact of population aging on GDP growth can occur through several channels. First, it can be
determined by a higher dependency ratio (in principle, fewer workers in a fixed population produce
less output, which implies a decrease of per capita GDP with a higher dependency ratio). Another
33
channel is through reduction in labor productivity, if older cohorts are less productive than younger
cohorts. A third one can be via a reduction in aggregate savings (as old people dissave after
retirement), although with a declining population savings can decline to maintain the same
capital/labor ratio (plus individual may increase their savings propensity, in consideration of a longer
life expectancy). All these effects are compounded by an increased spending for social programs.
Empirically, the macro-economic effect on aging is not clear-cut. Aiyar and others (2016) find that
workforce aging in Europe reduced growth in labor productivity via its negative effect on Total
Factor Productivity (TFP) growth (the estimated impact being 0.2 percentage point reduction in TFP
every year over the next two decades). A negative relationship between aging of the working
population and TFP is also found for Japan (Westelius and Liu 2016). For the US, Maestas and others
(2016) estimated that 10 percent growth in the percentage of the population aged 60+ decreased GDP
growth per capita by 5.5 percent; two thirds of this variation were due to a reduction in labor
productivity, while one third to slowing labor force growth. A review of the literature of
macroeconomic effects of aging in the US established, however, that productivity effects are likely to
be negligible, but called for further empirical investigation (National Research Council, 2012). Indeed,
other researchers did not find a negative impact of population aging on growth. Using a sample of
169 countries, Acemoglu and Restrepo (2017) run regressions of the change in (log) GDP per capita
from 1990 to 2015 on the change in the ratio of the population above 50 to those between the ages of
20 and 49. They found that countries that are undergoing rapid population aging experienced more
rapid technological change, which may have counterbalanced the negative effect of population aging
on economic growth (they recognized, however, that this is not a causal effect).
8The 2019 World Development Report on the Changing Nature of Work observes that social
contracts in Eastern Europe and East Asia would need to create mechanisms to finance the protection
and care of the elderly in a sustainable manner (World Bank Group 2018).
9The report famously promoted the development of three pillars of old age security: a public
managed system with mandatory participation with the main goal of reducing poverty among the
old; a privately managed mandatory savings system; and a voluntary savings component.
10The examples provided in Box 2.2 and Appendixes D and E are not exhaustive. Many reports will
be an input for this evaluation, including pensions reports (such as Schwartz and Arias 2014) and
reports that have analyzed how specific developments may be at play in aging societies (such as the
contribution of digital technologies to lifelong learning and supporting productivity in the labor
market, World Bank 2017 and World Bank 2018).
11
According to a portfolio review commissioned by the Aging Community of Practice, seventy-seven
lending operations with aging components were active or completed during the period 2005-2016.
This stocktaking includes projects in pensions and NCDs and was not validated during the
preparation of this Approach Paper. .
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12Incentives for married women to participate in the labor market include, for example, moving from
joint to separate taxation of earnings (which lower the tax burden on the secondary earner, typically
the wife, within a married couple), and increasing the availability of publicly subsidized childcare.
13Examples of this demand includes: China’s Health Reform Program for Results (P154984, $600M,
approved in FY17), designed to respond to pressing issues related to chronic diseases, ageing and
affordability; the Anhui Aged Care System Demonstration Project (P154716, $118M, approved in
FY18) supports the developing and managing of a diversified, three-tiered aged care service delivery
system for the elderly, particularly those with limited functional ability; and a P4R (P162349, $220M)
under preparation for Ghizou province to provide equitable access to a basic package of aged care
services, and to strengthen the quality and efficiency of the aged care system. The Bank is
increasingly offering RASs in this area in many ECA countries, as evidenced by examples in Estonia
(P158968), Latvia (P149711), Romania (P147650) but also elsewhere like Chile (P159331), Seychelles
(P157794). Policy dialogue around the topic is ongoing in several other countries, including Russia
and Poland, but also Colombia, Vietnam and Sri Lanka.
14In its comments, management remarked on the importance for evaluation to focus also on
emerging issues such as aging of the population in developing countries, as “…in countries that are
significantly advanced through the demographic transition, clients increasingly request advice and
financing, financial protection, labor markets, and long-term care needs to address the ongoing
demographic and epidemiological shifts resulting in an aging society.” (World Bank 2009, p. xxvi).
15
The Aging Community of Practice (CoP) has been reported to be currently idle and to function
mostly as a distribution list. The evaluation aims at spurring a broad conversation among experts
across several sectors and possibly contributing to revitalize the CoP.
16
For example, Sanderson and Scherbov (2010) make the point that as life expectancy lengthens, if a person’s
age is defined by the number of years left to live (as opposed to those already lived), each successive cohort is,
at a given age, relatively younger than the previous one. As a result, this longer life expectancy also translates
in longer activity rates.
17As discussed in box 1, the GMR uses aggregated data on fertility and working age population to
rank countries and classify them in 4 phases of the demographic dividend.
18
According to the UN projections, twenty-one additional countries will be in the “aging” category
by 2030 and another twelve by 2040. The list includes: Argentina, Turkey, Panama, El Salvador,
Grenada, Suriname, Ecuador, Venezuela, Dominican Republic, Mexico, Peru, Iran, Algeria,
Myanmar, Paraguay, Nicaragua, India, Indonesia, Bolivia, Samoa, Uzbekistan, Bangladesh, Bhutan,
Cabo Verde, Cambodia, Honduras, Libya, Maldives, Nepal, Philippines, South Africa, Tonga and
Turkmenistan.
19For the reference population, the SDR will also assess the consistency of the use of an ‘aging’
labeling across regions and global practices and between the Bank’s strategic documents and its
operational, analytical and advisory work.
35
20From the universe of the portfolio approved in relevant countries between FY05 and FY19, the team
will use a combination of criteria to identify the portfolio of interest. These include: (a) theme codes
(theme code 64, 522, 524, 621 and 625 on aging, pensions and social assistance, disability, ICT
solutions, and noncommunicable diseases, respectively); (b) key word search; (c) identification of
targeted beneficiaries; and (d) key informant interviews. Collaboration with Bank colleagues in
country offices, GPs and CMUs will be key to identify relevant products which could escape a more
traditional scan of the portfolio. A preliminary relevant portfolio has been identified for this approach
paper using a key word search. This exercise has identified 133 operations that are potentially
relevant (out of 1331 projects approved in FY05-FY19 in the group of aging countries), and 294 ASA
(out of 5114 for the same group of countries over the same period). Abstracts, PDO and components
of ASA and WB projects approved between FY05-FY19 were scanned for the following words: active
aging, healthy aging; aged care services; ageing; age-related risks; aging, aging population, rapid
aging; caregivers; demographic issues, demographic challenges, demographic transition,
demographic change; dependency ratio; elderly, elder support; entitlements; family policies; family
support; fiscal sustainability; intergenerational; lifelong learning, life-long learning; longevity; long-
term care; LTC; noncommunicable, non-communicable, NCD; old age; older population; pension,
social pension, pension scheme, pension reform, pension program; population profile; retiree;
retirement; shrinking, shrinking population; social care; social insurance; social security; voluntary
savings. The other criteria will need to complement the key word search to generate the final
portfolio.
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