UCL in the News: The World Bank's new health strategy: reason for alarm?

The Bank … seems intent on establishing itself as the lead global agency for health-systems policy-development. …

On the one hand, the Bank's new strategy should be welcome, given the widespread deterioration of health-care systems caused by chronic underfunding, public-sector collapse, unregulated privatisation, and the uncoordinated proliferation of global health initiatives that have fragmented the health systems of many poor countries. …

However, while the Bank's strategy contains much to agree with, its claims to expertise and credibility in the field of health systems are troubling. Indeed, structural adjustment programmes and health sector reforms inspired by the Bank have underpinned many of the current problems in poor countries. …

The Bank's continued promotion of pro-private market-oriented policies and its view that health care can be reduced to a set of tradeable commodities and services raise important concerns. …

Part of the problem is that the development of health systems is complex, slow, and ultimately dependent on reversing chronic and deeply embedded public-sector failures. It seems therefore churlish to throw criticism at the Bank, which at least is addressing the issue.

However, it would be irresponsible not to raise some alarm in view of the damage the Bank has caused to health systems, its undermining of public institutions, its allergy to universalism and equity, and its one-eyed romance with markets and financial incentives. …

The Bank should be applauded for drawing attention to health-systems strengthening. And as a development bank it has a critical part to play. But the international health community needs to debate how and where the moral vision, leadership, and technical expertise for health-systems strengthening should be developed and managed. …

David McCoy, (UCL Epidemiology & Public Health), 'The Lancet'