The World Bank and world health: Healthcare strategy

Publisher Website
Google Scholar
Abstract
Waves of reform The bank explains that the “optimal balance” between public and private sectors depends on the country and is different for financing and for service delivery. “Strong, direct government intervention is needed in most countries to finance public health activities and essential health, nutrition, and reproductive services, as well as to provide protection against the impoverishing effects of catastrophic illness,” says the bank, which is convinced that succesful reform goes hand in hand with greater government input in information, regulations, and financing (fig 3). By devolving service delivery to non-governmental organisations, local communities, and the private sector, governments can, the bank believes, target their limited funds at preventive public health services, providing basic services to the poor, and overseeing medical education, research and development, and quality control. View larger version: In this window In a new window Fig 3 Government roles in the health, nutrition, and population sector The bank advocates three “waves” of state reform. The first wave focuses on the privatisation of commercial enterprises; the second wave privatises public infrastructure and utilities; and the third wave continues with privatisation of state assests and utilises non-governmental and private management and investment in health, education, and pensions systems. The bank emphasises that these measures do not necessarily mean the sale of public assets, but that they encourage private co-financing and management. Paradoxically, the argument goes, governments end up having a greater role in the regulation of healthcare services. Though its health specialists might be eager to play down the bank's support of the private sector, the latest annual report is less reserved: “One of the bank's top priorities is to help stimulate the private sector. That's because the private sector is the main source of economic growth—of jobs and higher incomes. The bank encourages the private sector by advocating stable economic policies, sound government finances, and open, honest, accountable, and consistent governance, and by offering guarantees.”2 One senior bank economist explained to me: “Policy based lending is where the bank really has power—I mean brute force. When countries really have their backs against the wall, they can be pushed into reforming things at a broad policy level that normally, in the context of projects, they can't. The health sector can be caught up in this issue of conditionality.”

This publication has 0 references indexed in Scilit: