World Bank Research Papers

World Bank Research Papers-41
In 2013-14, loans from core IBRD/IDA health projects in the health and other social services sector stood at less than .4bn, out of a total loan pool of more than .8bn.21 However, the bank’s increase in overall lending for health projects—from 1% in 1985-89 to 12% in 2010-15—demonstrates a shift in its priority for health lending (table 1 Fig 4 Tracked relative spending for health, nutrition, and population (HNP) categories over the past 30 years7 (RMNCH=reproductive, maternal, newborn, and child health; WASH=water, sanitation, and hygiene) Fig 5 Average funding allocation per project from 1985 to 2015 according to each health, nutrition, and population (HNP) category7 (RMNCH=reproductive, maternal, newborn, and child health; WASH= water, sanitation, and hygiene) Using our financial analysis of the bank’s HNP portfolio and our review of literature on the World Bank in health, we have identified five major periods in its health funding history.

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(IBRD=International Bank for Reconstruction and Development; IDA=International Development Association)4 5 6 7 8 9 10 Fig 1 Funds contributed for health to the World Bank, relative to other major health organisations.

(IBRD=International Bank for Reconstruction and Development; IDA=International Development Association)4 5 6 7 8 9 10 Fig 2 Timeline of health, nutrition, and population (HNP) in the World Bank (adapted from13) (DALY= disability adjusted life year; IDA=International Development Association; UHC=universal health coverage; WDR=World Development Report) The World Bank is influential in global health for several reasons.

Firstly, it has a longstanding relation with ministries of finance, which arguably have more influence over health than do ministries of health.

For instance, the bank’s 2013 African Health Forum, on “finance and capacity for results,” brought together ministers of finance and health from 30 African countries to discuss countries’ health needs and promote the link between health interventions and economic growth.15 Secondly, technical support to countries is based on the premise of a loan package, which means that ideas about how to change health sector projects or policies are backed by the necessary resources for implementation.

Throughout his tenure, the bank has adopted innovative financing measures for health.

In this five paper series, we provide an overview of the bank’s evolving role in global health, document its turn towards innovative financing in health, and analyse the benefits and risks of such a shift.Finally, the bank has a powerful network of people who move in and out of the bank to positions in ministries of finance and health in-country.While the bank’s relative role in financing the health sector has decreased over the past two decades, owing to the growth of both development assistance for health overall and domestic resources channelled into health, the five factors detailed above have allowed it to use its lending power to catalyse change.19 A study of HIV/AIDS in Brazil and India, for example, pointed to the World Bank’s initial loans as one of the turning points in the decision of these countries to channel more domestic resources into HIV/AIDS.20 Within the bank, health claims a relatively small share of attention.The third period from 1980 to 2000 involved the application of market based solutions and privatisation to healthcare problems, including healthcare delivery; this aligned with broader trends across the bank’s wider portfolio.24 As Abbasi discussed in 1999, the bank advised, and sometimes even forced, poor countries to scale back involvement of the public sector in health through cuts to the health budget and health workers, while also encouraging revenue generation through user fees at the point of care.1 The fourth period from 2000 to 2010 focused on achieving the millennium development goals through cooperation with other stakeholders.25 For instance, the World Bank multicountry AIDS programme in Africa, established in 2000, channelled roughly

In this five paper series, we provide an overview of the bank’s evolving role in global health, document its turn towards innovative financing in health, and analyse the benefits and risks of such a shift.

Finally, the bank has a powerful network of people who move in and out of the bank to positions in ministries of finance and health in-country.

While the bank’s relative role in financing the health sector has decreased over the past two decades, owing to the growth of both development assistance for health overall and domestic resources channelled into health, the five factors detailed above have allowed it to use its lending power to catalyse change.19 A study of HIV/AIDS in Brazil and India, for example, pointed to the World Bank’s initial loans as one of the turning points in the decision of these countries to channel more domestic resources into HIV/AIDS.20 Within the bank, health claims a relatively small share of attention.

The third period from 1980 to 2000 involved the application of market based solutions and privatisation to healthcare problems, including healthcare delivery; this aligned with broader trends across the bank’s wider portfolio.24 As Abbasi discussed in 1999, the bank advised, and sometimes even forced, poor countries to scale back involvement of the public sector in health through cuts to the health budget and health workers, while also encouraging revenue generation through user fees at the point of care.1 The fourth period from 2000 to 2010 focused on achieving the millennium development goals through cooperation with other stakeholders.25 For instance, the World Bank multicountry AIDS programme in Africa, established in 2000, channelled roughly $1bn to scale up prevention, care, support, and treatment programmes in IDA eligible countries and grew to be the largest funder of HIV/AIDS within the UN system.26 Finally, from 2010 until today, the bank has focused on working with governments to achieve universal health coverage using a range of innovative financing instruments.27 28 With this emphasis on universal health coverage, the bank has reversed course on its previous user fee policy.29 Initiatives like the health results based financing project in Zimbabwe have instead used trust funds to provide grants to local health facilities that remove point-of-care user fees.15 Although traditional core lending projects are still evident, more focus is placed on dealing with specific high profile health concerns through trust funds such as the Global Financing Facility (GFF)30 and the Pandemic Emergency Financing Facility (PEF).31 The World Bank Group more broadly is reinventing itself, from a lender for major development projects to a broker for private sector investment.

Kim’s vision for the bank is to use its knowledge and capital to serve as an “honest broker” between the interests of the global market system, emerging country governments, and people in poverty, to ensure that all sides benefit.32 In the rest of this series, we take a closer look at key priorities in global health and the role of the World Bank in shaping and responding to these priorities.

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In this five paper series, we provide an overview of the bank’s evolving role in global health, document its turn towards innovative financing in health, and analyse the benefits and risks of such a shift.Finally, the bank has a powerful network of people who move in and out of the bank to positions in ministries of finance and health in-country.While the bank’s relative role in financing the health sector has decreased over the past two decades, owing to the growth of both development assistance for health overall and domestic resources channelled into health, the five factors detailed above have allowed it to use its lending power to catalyse change.19 A study of HIV/AIDS in Brazil and India, for example, pointed to the World Bank’s initial loans as one of the turning points in the decision of these countries to channel more domestic resources into HIV/AIDS.20 Within the bank, health claims a relatively small share of attention.The third period from 1980 to 2000 involved the application of market based solutions and privatisation to healthcare problems, including healthcare delivery; this aligned with broader trends across the bank’s wider portfolio.24 As Abbasi discussed in 1999, the bank advised, and sometimes even forced, poor countries to scale back involvement of the public sector in health through cuts to the health budget and health workers, while also encouraging revenue generation through user fees at the point of care.1 The fourth period from 2000 to 2010 focused on achieving the millennium development goals through cooperation with other stakeholders.25 For instance, the World Bank multicountry AIDS programme in Africa, established in 2000, channelled roughly $1bn to scale up prevention, care, support, and treatment programmes in IDA eligible countries and grew to be the largest funder of HIV/AIDS within the UN system.26 Finally, from 2010 until today, the bank has focused on working with governments to achieve universal health coverage using a range of innovative financing instruments.27 28 With this emphasis on universal health coverage, the bank has reversed course on its previous user fee policy.29 Initiatives like the health results based financing project in Zimbabwe have instead used trust funds to provide grants to local health facilities that remove point-of-care user fees.15 Although traditional core lending projects are still evident, more focus is placed on dealing with specific high profile health concerns through trust funds such as the Global Financing Facility (GFF)30 and the Pandemic Emergency Financing Facility (PEF).31 The World Bank Group more broadly is reinventing itself, from a lender for major development projects to a broker for private sector investment.Kim’s vision for the bank is to use its knowledge and capital to serve as an “honest broker” between the interests of the global market system, emerging country governments, and people in poverty, to ensure that all sides benefit.32 In the rest of this series, we take a closer look at key priorities in global health and the role of the World Bank in shaping and responding to these priorities.The bank also provides policy lending—budgetary support that is contingent on implementation of policy reforms by the recipient government.Thirdly, the World Bank has created widely accepted key concepts, such as human capital, cost effectiveness, disability adjusted life years (DALYs), and the first estimates of burden of disease in 1993.16 17 18 Fourthly, it cooperates closely with the major new institutions such as the Global Fund to Fight AIDS, TB and Malaria and Gavi, the vaccine alliance, which are trust funds (financial intermediary funds) held by the bank.The World Bank combines intellectual prestige and financial power, referred to colloquially as “ideas with teeth” or “global health on steroids.” From its first foray into health in the early 1970s to the present, the bank has become one of the largest and most influential health funders worldwide.In 2017 it is particularly important to examine its workings in global health: the re-elected President Jim Yong Kim is the first medical doctor to hold the office and is also an activist and anthropologist who has argued for the right to health.In contrast, IDA is funded by replenishments, or donor commitments, made generally every three years.Although the World Bank calls for the replenishments, they are overseen by donors (eg, United States, United Kingdom, Japan), not the World Bank or IDA recipients.

bn to scale up prevention, care, support, and treatment programmes in IDA eligible countries and grew to be the largest funder of HIV/AIDS within the UN system.26 Finally, from 2010 until today, the bank has focused on working with governments to achieve universal health coverage using a range of innovative financing instruments.27 28 With this emphasis on universal health coverage, the bank has reversed course on its previous user fee policy.29 Initiatives like the health results based financing project in Zimbabwe have instead used trust funds to provide grants to local health facilities that remove point-of-care user fees.15 Although traditional core lending projects are still evident, more focus is placed on dealing with specific high profile health concerns through trust funds such as the Global Financing Facility (GFF)30 and the Pandemic Emergency Financing Facility (PEF).31 The World Bank Group more broadly is reinventing itself, from a lender for major development projects to a broker for private sector investment.Kim’s vision for the bank is to use its knowledge and capital to serve as an “honest broker” between the interests of the global market system, emerging country governments, and people in poverty, to ensure that all sides benefit.32 In the rest of this series, we take a closer look at key priorities in global health and the role of the World Bank in shaping and responding to these priorities.The bank also provides policy lending—budgetary support that is contingent on implementation of policy reforms by the recipient government.Thirdly, the World Bank has created widely accepted key concepts, such as human capital, cost effectiveness, disability adjusted life years (DALYs), and the first estimates of burden of disease in 1993.16 17 18 Fourthly, it cooperates closely with the major new institutions such as the Global Fund to Fight AIDS, TB and Malaria and Gavi, the vaccine alliance, which are trust funds (financial intermediary funds) held by the bank.The World Bank combines intellectual prestige and financial power, referred to colloquially as “ideas with teeth” or “global health on steroids.” From its first foray into health in the early 1970s to the present, the bank has become one of the largest and most influential health funders worldwide.In 2017 it is particularly important to examine its workings in global health: the re-elected President Jim Yong Kim is the first medical doctor to hold the office and is also an activist and anthropologist who has argued for the right to health.In contrast, IDA is funded by replenishments, or donor commitments, made generally every three years.Although the World Bank calls for the replenishments, they are overseen by donors (eg, United States, United Kingdom, Japan), not the World Bank or IDA recipients.

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