World Bank Research Papers

World Bank Research Papers-69
*Gavi, the vaccine alliance and the Global Fund to Fight AIDS, TB and Malaria are both financed by customised trust funds—financial intermediary funds (FIFs)—held at the World Bank.The World Bank financial data are collected and released by fiscal year (1 July to 30 June), while the Gavi, Global Fund, and World Health Organization data follow the calendar year.

*Gavi, the vaccine alliance and the Global Fund to Fight AIDS, TB and Malaria are both financed by customised trust funds—financial intermediary funds (FIFs)—held at the World Bank.The World Bank financial data are collected and released by fiscal year (1 July to 30 June), while the Gavi, Global Fund, and World Health Organization data follow the calendar year.The bank also provides policy lending—budgetary support that is contingent on implementation of policy reforms by the recipient government.

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Our aim is to complement Kamran Abbasi’s 1999 series on the World Bank in international health1 by expanding the themes covered and discussing changes in global health governance since the millennium.

We base our analysis on World Bank official documents and reports from its website, the World Bank archives, secondary literature on the World Bank, and conversations with numerous bank staff working in the health, nutrition, and population (HNP) sector.

Throughout his tenure, the bank has adopted innovative financing measures for health.

In this five paper series, we provide an overview of the bank’s evolving role in global health, document its turn towards innovative financing in health, and analyse the benefits and risks of such a shift.

Health was neglected during this inaugural epoch as the bank focused on large infrastructure projects rather than investment in social sector development.22 The main focus during these years was on shifting from the bank’s initial emphasis on reconstruction after the second world war towards working in low and middle income countries.

The second period from 1968 to 1980 coincided with the bank’s first loans for disease specific, nutrition, and family planning projects.23 Mc Namara moved the bank towards a poverty alleviation strategy based in social sector work, initially focusing on family planning and later selecting onchocerciasis (river blindness) as a major priority.

While some might question the importance of the World Bank in global health, it is the largest funder of global health within the UN system and the second largest funder overall (fig 1).4 5 6 7 8 9 10 Major changes in global health governance have taken place since 2000, including the creation of the Bill and Melinda Gates Foundation in 2000, Gavi, the vaccine alliance in 2000, and the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002.

Given the narrow focus of all three of these organisations,11 12 the World Bank’s comparative advantage comes to the fore; it engages in a variety of sectors and with ministries of finance to reach health goals, takes on broader non-disease specific objectives such as health sector reform, and supports efforts to strengthen the health workforce.

The US is the largest and most influential country in the World Bank, speaking on almost all subjects coming before the executive board.2 The president of the World Bank has always been an American, and the US is the only country to have veto power over decisions of the executive board.

When created, IDA’s replenishment model opened up a new channel through which the bank could be directly influenced by wealthier government members.

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