The World Bank and world health: Focus on South Asia---II: India and Pakistan

Publisher Website
Google Scholar
Abstract
India: diversity and disease India's vastness, diversity, and poverty are challenges that the World Bank has responded to with huge sums of money. With cumulative loans of more than $44bn, India is the bank's largest single borrower. Even in fiscal year 1998 (from June 1997 to June 1998), when an exchange of nuclear tests with neighbouring Pakistan resulted in the temporary freezing of bank loans to the region, lending reached a record $3bn. India is also the recipient of the largest sum of interest free credits from the International Development Association. By April 1998, India had received 167 loans and 223 development credits, with 84 ongoing projects amounting to $14.5bn. Power projects accounted for 24% of lending, and health, nutrition, and population programmes received 14%. 2 3 View larger version: In this window In a new window The states of India “The nuclear sanctions won't have greatly affected India,” argues Dr Anthony Measham, the bank's chief health adviser in the country. “Sanctions don't affect ongoing projects. The only ones that are affected are the new projects, and we are continuing all ongoing work. We're working in a harmonious way to overcome problems; we're an apolitical organisation.” The other crucial factor is that foreign investment accounts for 1-1.5% of India's gross domestic product; it accounts for a much larger proportion of Pakistan's. India's population has an “enormous” burden of disease, especially in communicable diseases like AIDS and leprosy, and in women of reproductive age. Malnutrition is another major challenge: figures indicate that half of children under 5 are undernourished, and around a third of newborns are of low birthweight. It also exemplifies the variability between states (table 1). While the Tamil Nadu Integrated Nutrition Programme has been described by the bank as “highly effective,” Bihar, Rajasthan, and Utter Pradesh, in the Hindi speaking belt of northern India (figure), are struggling to improve their malnutrition rates. One factor holding back progress, the bank believes, is that although public sector spending on nutrition has increased, it remains markedly below what is needed. Moreover, the bank believes that India has historically made “an inadequate effort to address public health problems.” Over the years, spending on health has amounted to around 1.5% of gross domestic product, with an even lower proportion being spent on public health. Even those few public health measures that have been funded have had limited efficacy because of poor execution. Fundamentally, the bank's view is that “the institutional base for health services is weak,”non-governmental organisations are underutilised, and finally, but perhaps most significantly, the private sector is “gigantic,” virtually completely unregulated, and offers “some of the best and the worst care seen anywhere.” Richard Skolnik, the bank's health, nutrition, and population sector leader for South Asia, explains the bank's approach: “In India, we started with specific disease control programmes because we thought they would have a definite and very quick impact on the health of very poor people, without prejudicing the outcome of the health system in a bad direction. Simultaneously, we began moving the health system in the right direction.” View this table: In this window In a new window Table 1 Regional diversity in India.4 States are listed in descending order of infant mortality References ↵ Abbasi K .Focus on South Asia—I. Bangladesh.BMJ1998; 318:1066–1069. ↵World Bank announces fiscal year 1998 lending results for South Asia region.www.worldbank.org/html/extdr/extme/1883.htm (Accessed 14 April 1999.) ↵India is World Bank's single largest borrower at $44bnPress Trust of India 1998 June 8. World Bank .Improving women's health in India. In: Washington, DC:World Bank,1996(Development in practice series.) ↵ Vital Statistics Division .Census of India 1991, series 1: India.New Delhi:RGI (Office of the Registrar General),1992(Occasional paper 2.) ↵ Vital Statistics Division .Sample registration system: fertility and mortality indicators 1992.New Delhi:RGI (Office of the Registrar General),1994. ↵ Conly SR .Falling short: the World Bank's role in population and reproductive health. In: Washington, DC:Population Action International,1998. ↵World Bank “falling short” to improve reproductive health: New report cites “lack of attention to population concerns.” http://www.interaction.org/md/articles/mar2398/md032398.html (Accessed 11 September 1998.) Tinker AG .Improving women's health in Pakistan. In: Washington, DC:World Bank,1998(Health, nutrition, and population series.) ↵ Health, Nutrition and Population Unit, South Asia .Pakistan: towards a health sector strategy.Washington, DC:World Bank,1998. ↵World Bank to provide $300m for SAP phase-2. Dawn, 1999 April 6. ↵ Ministry of Health .National health policy.Islamabad:Government of Pakistan,1997.

This publication has 1 reference indexed in Scilit: