The World Bank and its Roles toward Health: Common Criticisms

Abstract

The World Bank (WB) was established in 1944 for the purpose of issuing long-term loans to governments for reconstruction and economic development following the Second World War (1). Over the time perspectives on development have changed dramatically. In particular, the WB’s focus began to shift to investments in health, energy, telecommunication, transport and infrastructure to earn more profit. In the field of health, the WB has focused on three areas, especially in developing countries: health, nutrition, and population. WB now has a more sophisticated view of well-being, living standards, and poverty and is committing more than 1 billion USD annually for new health projects. (2). The WB’s roles include financing, provision of information, surveillance, technical assistance and training and policy advice (3). The WB has achieved some gains in the fight against poverty. Reducing poverty focuses in part encompassing policies to promote equality but inequalities are still increasing all over the World, especially in the developing countries (4). However, the WB has faced a lot of critiques related to health. Some critiques related to health sector polices and say the bank's conditions on borrowing countries emphasize privatization and public sector contraction. This involved reducing government expenditures (in some cases for health) which have deleterious health effects (2). Other critiques related to the way of raising funds called a user charge for using public sector health services and point to evidence showing that user charges result in a decline in the uptake of services, especially among the people who are most socioeconomically deprived. The bank is also criticized for introducing DALYs to global health assessments. Critics point out that the introduction of DALYs was not based on sound methodology and that the underlying assumptions for their usefulness are weak (2, 5). Finally, the WB is also accused of bribing or conniving top government officials in the developing countries where it projects (6). There is a need for strengthening across the WB in several areas. A critical area is for the WB to strengthen its ability to work on multi-stakeholder solutions through engagement with the public sector, private sector, and citizens, and support primarily the public sector for health services. Similarly, about half of low-income countries are classified as fragile and conflict-affected, posing particular challenges. Furthermore, progress in fighting against poverty and sharing prosperity is accompanied by rising inequality in many countries. So, the WB should increase its efforts to address these issues (4). Introducing evidence into policy making is also a key issue to be strengthened for the future (5). It is also needed to strengthen the monitoring and evaluation methods in the countries.