Social services


New World Bank/WHO trust fund for health: risks of misuse

5 April 2001 | Briefings

Washington, DC, 26 April, 2001 – Italy and UK are taking the lead among G7 partners to set up a global trust fund of $1 billion to provide cheaper drugs for poor countries. The world’s largest 1000 corporations are encouraged to donate at least $500,000 each, with matching grants from governments. The fund, to be jointly administered by the World Bank and WHO, is currently under discussion and is likely to be officially announced in Genoa, Italy in July during the G8 meetings.

Welcoming increased attention to the health problems of the world’s poor, some question the mechanisms and proposals being developed. Non-governmental organizations (NGOs) and academics are concerned about the disease-specific focus of the debate around the use and mobilization of extra resources for health, saying more attention needs to be given to strengthening of national health systems, effective and accountable distribution mechanisms and local sustainability. They also stress the need for long-term solutions in terms of equitable patent regimes.

The example of Rwanda, with a ratio of one doctor per 65,000 people, shows that it takes more to improve health care for the world’s poorest nations than just developing and providing cheaper drugs.

But Jeffrey Sachs, Chair of the Commission on Macroeconomics and Health takes a more narrow approach. “Ten to 20 billion dollars per year are necessary to successfully combat the diseases of Africa,” he commented at a UN Economic and Social Council (ECOSOC) special meeting on April 17. “[That is] all we need now,” he added. The conclusions of the commission, set up by WHO and based at Harvard University, are likely to heavily influence how a new global health fund will be used.

Only one week earlier, Sachs forcefully defended trade-related aspects of intellectual property rights (TRIPS) in a meeting that, according to the Washington-based group Consumer Project on Technology “was an eye-opening illustration about how much the WHO [relies on] big pharmaceutical companies in dealing with the poor.”

Meanwhile NGOs such as Oxfam and the UK-based advocacy network MEDACT are putting pressure on policy-makers to eliminate barriers that deny developing countries access to affordable medicines.

An example of a private-public sector health initiative, administered by the World Bank, is the Global Alliance for Vaccines and Immunization. Launched at the World Economic Forum in Davos a year ago, it was set up by Bill Gates foundation to provide life-saving vaccines to children. Partners, including UNICEF, WHO, the World Bank, the pharmaceutical industry, governments and Bill Gates Jr. created a financial mechanism that channels resources directly to countries “based on the policies and recommendations developed by the GAVI Board” chaired by Bill Gates.

“The World Bank will have to explain how these global funds will be compatible with national strategies developed through the poverty reduction strategy process (PRSPs),” comments Angela Wood, Bretton Woods Project, UK.

Save the Children, UK, agrees that another global trust fund for health needs to go hand in hand with investment in health systems for it to reach the intended beneficiaries and have lasting positive effects.

“In some communities, the only functioning car is the GAVI or ‘Roll back Malaria’ car while a regular ambulance service is unheard of,” comments a Save the Children staff member who recently returned to the UK from the field. “If we mobilise resources for yet another global fund, we have to get it right this time,” she adds.

As pointed out by Prof. Neil Andersson of Community Information and Epidemiological Technologies (CIET), the solutions to malaria, TB and many other diseases have more to do with the way people live, their social environment and what they have to cope with on a day-to-day basis while a virus like smallpox could be successfully eradicated by targeting the disease directly.

“There are some difficult questions to be asked, and my impression is that little thinking has gone into the ‘how’ of such [global health] funds: who is going to choose beneficiaries, by what criteria, what organizational mechanisms will be needed and how much duplication and/or undermining of existing organizations will result,” comments Dr Gill Walt, Professor of International Health Policy at London School of Health and Tropical Medicine.

The World Bank’s Operations Evaluation Unit has criticized Bank loans for Health, Nutrition and Population (HNP) in the past for not being completed to a satisfactory level and with lacking involvement of beneficiaries. A 1999 evaluation notes that “in public statements the Bank increasingly acknowledges the importance of beneficiary participation in project design and implementation …Yet, OED identified only four projects where beneficiaries were given decision-making power.”

Scarce data could create another obstacle. The World Bank publication African Development Indicators 2001, published in March this year, claims to provide “the most detailed collection on development data on Africa.” However, for social indicators, including health, it states that “sometimes surveys are limited to just the urban areas to cover only the largest cities or the capital city alone. Such indicators as immunization, rates for children under one year of age, percentage of births attended by health personnel, infant and child mortality rate and maternal death rate are often based on surveys of a handful of hospitals in urban areas.”

Tensions between high-level discussions currently taking place in Washington DC during the World Bank/IMF spring meetings and day-to-day realities on the ground are bound to come up again in the lead-up to the G8 meeting in Genoa in July. As a follow-up to the People’s Health Assembly – a global event aimed at revitalising the vision of ‘Health for All ‘attended by hundreds of NGOs last December – a letter will be circulated to world leaders calling for a shift away from disease-specific interventions towards an approach which concentrates on health systems and the underlying causes of ill-health.

Issued by:

Charlotte Carlsson,

Bretton Woods Project, +44 20 7561 7610

Washington DC 23 April – 1 May, c/o Tabard Inn, tel: 1 202 785 1277