BMJ Series

 

The British Medical Journal (BMJ) recently published a special issue on the World Bank's role in Global Health, which we had put together. You can find an article overview, interviews with authors, and links to the original pieces and here.

 

1. World Bank’s financing, priorities, and lending structures for global health, by Devi Sridhar, Janelle Winters & Eleanor Strong

Key messages:

  • The World Bank is the largest funder of global health within the UN system and the second largest funder overall

  • We identify five major periods in the bank’s role in global health in terms of lending, cooperation, and knowledge

  • Despite the entrance of major new global health organisations the bank has remained relevant through innovative financing mechanisms, close long term relations with country ministries, and developing and applying economic approaches to health

  • The bank’s increasing reliance on trust funds and innovative financing mechanisms, such as the Global Financing Facility, places health decision making authority in the hands of a small group of donors

Link to the article

 
Total health, nutrition, and population (HNP) funding over the past 30 years

Total health, nutrition, and population (HNP) funding over the past 30 years


2. Earmarking for global health: benefits and perils of the World Bank’s trust fund model, by Janelle Winters & Devi Sridhar

Key messages:

  • Trust funds (non-core voluntary aid) for health projects made up nearly half of the World Bank’s total funding for health and social services in 2012-13

  • The Bank has four major types of trust funds: IBRD/IDA bank executed trust funds, IBRD/IDA recipient executed trust funds, financial intermediary funds, and IFC trust funds. These funds have distinct purposes, implementation mechanisms, and accountability frameworks

  • Benefits of the trust fund system for health include its potential for enhanced flexibility, capitalising on international momentum, measurable project outcomes, and investment in innovative areas or financing mechanisms

  • Risks of the Bank’s trust fund system for health include its potential for misaligned aid allocation, reduced Bank accountability, and inadequate transparency

Link to the article

 
                    Trust funds for health: a 2012-13 snapshot

                    Trust funds for health: a 2012-13 snapshot


3. World Bank and the Global Financing Facility, by Genevie Fernandes & Devi Sridhar 

Key messages:

  • The Global Financing Facility (GFF), a multidonor trust fund, is the World Bank’s latest investment model aimed at closing the annual financing gap of $33.3bn to meet the 2030 sustainable development goals for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N)

  • The GFF offers 62 high burden countries grants if they agree to invest their IDA or IBRD credits in results focused RMNCAH-N interventions, thereby matching each $1 of grant with $4 of bank finance

  • Benefits of the GFF include promotion of universal health coverage and strengthening of health systems through increased mobilisation and harmonisation of development financing and domestic public and private resources.

  • While the GFF model incentivises borrowing for RMNCAH-N, it also works with countries rising from low to middle income status to develop sustainable strategies for increasing domestic financing

Link to the article

 
                    Main contributions to the GFF in $m

                    Main contributions to the GFF in $m


4. Health as “global public good”: Creating a market for pandemic risk?, by Felix Stein & Devi Sridhar

Key messages:

  • The World Bank’s interest in “global public goods”, such as pandemic preparedness, reflects its role as an international financial institution active in global health.

  • The bank’s forthcoming Pandemic Emergency Financing Facility (PEF) includes private sector finance in order to establish new insurance markets

  • In a pandemic outbreak, the PEF promises speedy, large scale payouts, according to predefined criteria

  • The structure of the PEF raises serious concerns, which include pulling donor money away from preventing outbreaks, complicating healthcare financing, and possibly overcharging donors for risk coverage

Link to the article

 
                           Categorisation of global public goods

                           Categorisation of global public goods


5. Universal Health Coverage, Health System Strengthening and the World Bank, by Marlee Tichenor & Devi Sridhar

Key messages:

  • In the era of sustainable development goals, the World Bank plays a pivotal role in promoting universal health coverage and strengthening health systems. In 2010, the bank provided 32% of the global health systems support budget

  • The World Bank’s health policy focus has shifted from population control (1970s), to primary healthcare direct lending (1980-6), to health reform (1987-96), to the enhancement of healthcare systems (1997-2007), to a health systems approach (2007-present)

  • The World Bank has a comparative advantage over WHO to lead the universal health coverage agenda given its access to ministries of finance, its staff expertise in measurement, its broad multisectorial portfolio, and its lending power

  • The World Bank’s expanded role in global health carries with it the risks of further privatisation of the health sector and major tension between its mandate and the right to health at the heart of universal health coverage

Link to the article

 
Financial contribution of the World Bank to health systems strengthening

Financial contribution of the World Bank to health systems strengthening