The World Bank & financing tuberculosis control, 1986-2017

Abstract

Background: Tuberculosis is among the leading contributors to global mortality and morbidity from infectious diseases and has had a major socioeconomic cost in recent history. The World Bank is a leading institution for global health governance and financing, but little research has concentrated on the role of the World Bank in global tuberculosis control. Methods: We tracked the development of the World Bank’s policies and associated financial flows for tuberculosis control. First, we performed a scoping review of both published and grey literature. Second, we used the World Bank’s Projects & Operations database to construct a dataset of all World Bank projects with funding allocated to the “Tuberculosis” theme from 1986 to 2017.  Finally, we analysed the World Bank’s funding patterns alongside wider funding for tuberculosis using the Institute of Health Metrics and Evaluation’s Development Assistance for Health database. Results: We identified four periods in the World Bank’s involvement in global tuberculosis control, from the recognition of tuberculosis as a global health issue to the creation of a global coalition against tuberculosis. Between 1986 and 2017 the World Bank undertook 79 projects with financing from its core lending divisions with a tuberculosis control theme or focus. Within the 79 projects, the World Bank committed 19.6% of funding, or $0.9bn, towards tuberculosis control. The World Bank has invested significantly into Direct Observation of Treatment, Short-course chemotherapy (DOTS). After the formation of private-public partnerships against tuberculosis in 2002 such as the Global Fund to Fight HIV/AIDS, TB and Malaria, the World Bank’s core financing decreased and private-public partnerships provided increasing levels of substitutive financing for tuberculosis control. Conclusions: The World Bank has been pivotal in leading global financing, garnering advocacy and creating widespread coalition in the battle against tuberculosis control in recent decades.