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.


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  • The in-depth discussions we all had this past week in Tokyo on universal health coverage – and the presentations we heard from countries as diverse as Brazil, Ghana, Turkey, Thailand, Indonesia, and Vietnam – underscore that there is no one size fits all approach, and that affordability is key to both equitable and sustainable coverage.

    Whether we like it or not, someone always pays for the health system. What we all agree is that the poorest and most vulnerable people must be able to get the health care they need without financial hardship. This may mean not only removing fees at the point of use, but in many cases even paying poor families to ensure mothers can go to the clinic to deliver their babies safely or to get their children vaccinated. I look forward to continuing our conversations as we help countries achieve their aspirations for universal health coverage.

    Nicole Klingen
    Acting Director, Health, Nutrition and Population
    World Bank

  • Simon Wright

    Thanks Nicole. I think there are exciting developments at the Bank and clear commitment from most staff that we need to get fees removed for the poor, though less agreement about how quickly and how comprehensively poor countries can do it. I think civil society is really valuing the dialogue with the HNP Division on this and looks forward to working with the new Director when appointed. I think we are concerned when blogs like this one below still pop up on the Bank site, which seems to contradict the HNP Strategy.