ECONOMY-HEALTH: World Bank’s Prescription for a Better World

By Marwaan Macan-Markar Reprint | | Print |

Analysis - Marwaan Macan-Markar

MEXICO CITY, Oct 3 1999 (IPS) - Like a good doctor, the World Bank has diagnosed the problems that inflict its most helpless patients – the sick and the poor of the developing world.

As a result, those living on less than one dollar a day are five times more likely to die before the age of five than those living on more than a dollar a day, it notes in its recently-released World Development Report 1999/2000.

Currently, there are 1.5 billion people in that most vulnerable category and another two billion, of the world’s six billion perople, living on less that two dollars a day.

The Bank’s prescription for a sound health system in the developing world, however, may come as a bitter pill for those it intends helping.

On the one hand, as it looks towards the new millenium, the Report underscores the priority health should receive in a country’s efforts towards development and progress.

Development thinking must move beyond economic growth to encompass important social goals, and enhanced opportunities for better health matter, it notes. And the growing importance of services means that knowledge will become more essential.

Thus investment in human capital, including health and education, will “become more important than investment in physical capital.”

On the other hand the Bank’s structural adjustment policies will compel governments to pump less money into their respective health systems – the very systems that those in the Third World have depended upon for years.

The Bank is more in favour of private health services to come to the assistance of the public.

The situation that prevails in the southern African nation of Zimbabwe at the moment serves as a pointer of how such adjustment polices impact the health sector. What was once the envy of many African nations today has become a sector despised by its people.

“Nurses in Zimbabwe must now pay for their education, so there are not nearly enough nurses going to school. Salaries have been driven down so low that nurses and doctors are being openly recruited by firms in Great Britain,” says Tony Avirgan, communications coordinator of the Washington-based organisation “The Development Gap.”

Furthermore, during the last 18 months, medical facilities in rural hospitals in a number of the countries in that region have deteriorated. Most noticeable is the absence of medicines in many, observes Avirgan.

“AIDS and malaria are the two biggest problems in Africa. But we have to ask if the World Bank is the organisation best suited to attack them,” he says. “Structural adjustment policies have disempowered governments and made them unable to play their appropriate roles in the health field.”

The Bank’s prescription for a better world in the new millenium comes as a result of important lessons that it learnt in its 50 years of development experience.

Among them was that growth does not “trickle down” in the way previous policies had predicted. There is a need, the report notes, for development strategies to deal with the essential needs of human beings.

In its comprehensive development framework for the years ahead, four crucial areas have been recognised.

For instance, sustainable development needs to be looked at beyond simply “raising per capita income at any cost.” Here, concerns for the environment, education and gender matter.

One crucial point is that governments in the developing world “have a vital role to play in the development process – such as investment in health.”

According to David Dunham of the Institute of Social Studies at the Hague, these views of the Bank are “more an extension of current thinking into health economics – which is increasingly fashionable.”

Since the early ’90s, he adds, the Bank has been moving in this direction. “The old ideas of ‘distribution with growth4 and ‘adjustment with a human face’ and that there needs to be a 4social safety net4 to catch the people who miss out, all reflect a steady move in the same direction.”

Yet, he admits, the new policies of the Bank’s agenda on health is based on one of affordability – “private services for those who are able to afford them.”

It will mean more cuts in government spending on health to fit into the “logic of economic restructuring.”

In fact, some governments in Asia already have opted to take the less politically volatile route in reducing money on health. They have chosen to cut capital expenditure, like investments, than current expenditure, like salaries.

The result of that has been “a general deterioration in facilities.”

A social scientist in the island-nation of Sri Lanka expects such a reality to be the case there, if the government has to cut its budget on health.

At the moment, Sri Lanka boasts of good health indicators for a developing country, buttressed largely by a welfare system that has been providing free health care to the public for decades. The World Development report, in fact, singles out the country for praise in this regard.

Where as the life expectancy rate averaged 59 years in the world’s low-income countries in 1997, and infant deaths averaged 82 per 1,000 live births, Sri Lanka’s life expectancy was 73 years and infant mortality was 14 per 1,000 live births -“not quite the levels of high-income countries of the world, but not far short either.”

This explains why critics of the Bank’s health policy point to its contradictory nature.

“It is not feasible to continue with the same neo-liberal market- drive economic model and say you are concerned about social goals,” says Avirgan. “The two are incompatible.”

For him, effective health care must remain in the hands of the state. And the current structural adjustment policy, which marginalises the state, is “bad medicine for health.”