Meeting the new director of Health, Nutrition and Population at the World Bank

Last Friday, a group of UK-based non-governmental organisations (NGOs) were invited to meet with Cristian Baeza, the new Director of Health, Nutrition and Population (HNP) at the World Bank.

As an author of the 2007 HNP Strategy, it is both his mandate, and his personal prerogative, to pursue its implementation. The mood was open and friendly, and we were invited to ask questions and raise concerns. Just four weeks into his new post, we were very grateful for such an opportunity and a taste of what we can expect from the World Bank on health under his leadership. Quite a lot was said, but here I will share some of my main thoughts and concerns.

His meeting with NGOs and the involvement of civil society in the development of the Reproductive Health Action Plan launched earlier this year, are indicative of an increased willingness to engage with civil society groups, such as Save the Children.

It is now important that the plans to establish a civil society HNP consultative group materialise, that its composition is representative, and that it carries enough weight to influence the policies and practices of HNP.

Cristian Baeza said he’d focus on the objectives of social protection and universal access to healthcare over the instruments applied to achieve these, promising that there was no private sector bias per se. He also pledged to try to avoid conditionalities, but acknowledged that they often do exist.

I was relieved to hear that he has a preference for the public provision of social protection, and we called for this to be reflected in the policy reforms that the World Bank supports. However, he stated that any instrument to achieve these objectives remains valid so long as the evidence proves that it is a sustainable option. Here the definition of sustainable options will be the real clincher.

For instance, we raised the question of why Liberia was being refused the long-term financial support it has requested to implement progressive financing mechanisms; Baeza was uncertain as to why this was so, and promised to follow it up. But there was the suggestion that the Bank had deemed user fee removal as unsustainable in this case. If the World Bank is unwilling to support such countries where there is not only a clear need for such reforms, as well as evidence to support them and political will for them, how can they expect to see the sustained pro-poor improvements that they are supposedly aiming for?

Baeza also said that the user fees could be retained because they can generate revenue for medical clincs’ use. We urge the World Bank to take a stronger position against user fees at the point of accessing health care, acknowledging the wealth of evidence on their regressive impact and failure to generate significant resources. Further, there is a growing basis of best practices on how these resources can be substituted at the facility level, thus his sustainability argument to support user fees no longer holds.

Our concern with HNP’s close partnership with the International Finance Corporation (IFC) was aired, and Baeza agreed that there is a fundamental tension between the IFC’s profit motive and the pro-poor incentives of HNP.

Members of the civil society groups there praised the World Bank for their Reproductive Health Action Plan and called for its implementation, asking that it show global leadership on this issue. Baeza said that reproductive health is a priority, urging groups to contact country offices of the World Bank about their support for the strategy and their plans to implement it. He asked us to be encouraging: “make it an opportunity for them, not a problem”.

Finally, Baeza assured us that the conclusions of the Independent Evaluation Group’s report were being taken seriously, namely their criticisms of the Bank’s capacity to reach the poor and their weak monitoring and evaluation systems.

He said that a taskforce has been created to analyse the impact of HNP on various variables, including socio-economic, gender, urban/rural etc,. Pilot projects are being launched to track variables such as these, which can lead to unequal access to healthcare and nutritious foods. We look forward to the findings of this review and how they inform the HNP’s practices.