Time for the World Bank to get off the fence

At the World Bank/IMF Annual meetings in Japan, there’s lots of buzzing about their health work. With Jim Yong Kim, they have a new World Bank President who has worked for the World Health Organization(WHO) and founded a very good and progressive health NGO, Partners in Health.

With the departure of Cristian Baeza as Director of Health Nutrition and Population, there are anxieties about whether a successor will take the World Bank in the better direction he was pushing it or is there a risk of going backwards?

And with the galloping momentum that the concept of Universal Health Coverage (UHC) is achieving, there is lots of confusion about how explicitly the Bank is aligning itself as part of the movement, but also whether we’re all talking about the same version of UHC.

A confusing response

I got the chance to pop a direct question to Jim Kim on whether he would champion Universal Health Coverage, based on a letter which we, and other NGOs presented to him.

His answer was confusing in that he urged us to be more ambitious and try to support health system strengthening. We all think it’s clear that this is intrinsic to UHC.

Many staff members of the Bank are clearly committed to making sure that universal health systems are built in countries and to move away from the single disease projects beloved of bilateral donors.

Free at the point of use

However there are important differences in emphasis, such as the importance of ensuring that services are always free at the point of use.

Civil society says yes, the Bank says maybe or probably. In fact, as in the latest Maya video, they say healthcare should be “affordable”.

We like these videos a lot as they remind the world that building functioning health systems should be the highest priority. But they always use the word affordable.

This is supposedly meant to be ambiguous about whether it’s affordable to the country (through pooled nation budgets) or to the individual. For many of us, they spoil the videos by implying pretty clearly that people should pay direct fees.

So it really is time for the Bank to get off the fence and say that they are wholly committed to Universal Health Coverage and that healthcare should ideally, always, rightfully, be free at the point of use.