The World Bank's pro-private market-orientated policies and its involvement in reforms that have harmed health systems in many poor countries have raised question marks over its new ten year health policy, says a Comment in this week's edition of the Lancet.
The comment is authored by Dr David McCoy, Department of Epidemiology and Public Health, University College London, UK – a member of the Steering Committee for The People's Health Movement and co-managing editor of Global Health Watch.
The comment says that while the Bank used to be the pre-eminent international health financing agency, it now operates in a crowded field with players such as WHO, UNICEF, the US President's Emergency Fund for Aids Relief (PEPFAR), and the Bill and Melinda Gates Foundation.
With these new players, the bank has stepped back to assess its role, and has announced its intention to establish itself as the lead global agency for health-systems policy development, even suggesting that WHO and UNICEF should focus on the technical aspects of disease control and health facility management.
Whilst the comment generally welcomes the bank's recognition that health systems need to be strengthened, particularly in the light of the proliferation of global health initiatives and single disease programmes, it says: "While the bank's strategy contains much to agree with, its claims to expertise and credibility in the field of health systems are troubling. Indeed, structural adjustment programmes and health sector reforms inspired by the bank have underpinned many of the current problems in poor countries."
It adds: "The Bank's continued promotion of market oriented policies and its view that health care can be reduced to a set of tradable commodities and services raise important concerns."
The comment concludes by calling on the WHO, developing country governments, donors and international NGOs to establish a coherent long term plan to repair the fragmented, inequitable and under-resourced health systems of poor countries.
An accompanying Editorial calls for the swift resignation of the World Bank's president Paul Wolfowitz in order to restore the organisation's credibility – which has been undermined by ethical lapses and accusations that President Bush's policies are influencing the Bank's strategy.
The Editorial criticises the attempted manipulation of the organisation's new 10 year health policy and says that the Bank's managing director Juan Jose Daboub is accused of attempting to water down the women's reproductive health part of the policy.
Part of the editorial reads: "Bank employees were so dismayed at the attempted manipulation of the new health strategy that they leaked information to advocacy groups to ensure intense lobbying over its wording would take place. The latest version of the health strategy, seen by health campaigners, now recognises the reproductive rights of women."
It concludes: "As well as undermining the organisation's work and demoralising its staff, the current crisis could provide an excuse for donors to delay, or worse, halt their funding commitments to the bank. As The Lancet went to press, Wolfowitz remained determined to keep his position. He and the bank's board of directors must remember the organisation's mission to alleviate poverty. They must do what is best for the world's poorest people and negotiate a quick resignation from Wolfowitz."
Journal
The Lancet