World bank and health

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‘Onneshion’
How World Bank works.......
q
World Bank is a multilateral organization which
sanctions loans.

q
It prescribes same criteria which receipent
countries must follow.

q
Firstly, it’s focus was on the recontruction of
European economy after World War II.

q
After that, it’s focus was transferred to the
development of third world countries.
Why World Bank interested in health
sector........
Ø
WHO started their activities on the health
sector as a specialized institution, World Bank
elaborated their activities on health sector.

Ø
There are of course some intention behind
this...............

§
They consider the health sector as a key
factor of economic growth.
§
World Development Report, 1993
Investing in Health........
o
The major report of World Bank regarding
health sector.

o
It helps understand the strategy of World
Bank regarding health sector.

o
It’s very relevant to the development
discourses of present time though it was made
17 years ago.
Why health matters....
v
Healthy work force reduces production losses caused
by workers’ illness.

v
Good health permits the use of natural resources
inaccesible due to disease.

v
Sound health increases the enrollment of children in
school.

v
Healthy work force decreases the cost of treatment
and increases alternative uses of resources.
Public Health………
Public health is the science and art which deals with
preventive rather than curative aspects of health.

World Bank’s prescriptions to govt. what to do……

Immunization :
1. All children should be included.
2. EPI (Expanded Program on Immunization).
§
3. Hepatitis ‘B and Yellow fever should be
included with existing diseases.
§
School based health services :
1. Providing inexpensive medicine
§
Information and selected services for
family planning and nutrition.
#. Providing information about family
planning and hygienic way of life to the
household through edutainment (education
through entertainment).
 Popular TV artists Chanchal Chowdhury and Badhon in the drama
Bhalo Achhi Bhalo Theko

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Programs to reduce consumption of tobacco,
alcohol and other addictive substances.
a. Information Campaign…
b. Imposition of Tax…
c. Ban on Advertisement…
d. Import Controlling with tariff and
non-tariff barriers…
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AIDS prevention :

a. Provide sex education…

b. Distribution of condoms…
c. Treatment for other STD’s
(Sexually Transmitted Diseases)…
Essential clinical services……

High cost-effective diseases…

Vary from country to country due to variations of
local health needs and the level of income.
Five groups of interventions :
1. Prenatal and delivery care.
2. Family planning services.
3. Management of sick child.
4. Treatment of TB.
5. Case management of STD’s.
Estimated costs and health benefits………
Group Cost(dollars per Cost as a Approximate
capita per year) percentage of reduction in
income per burden of
capita disease
(percent)
Low-income
countries(inco
me per
capita=$350)
Public health 4.2 1.2 08
Essential clinical 7.8 2.2 24
services

total 12.0 3.4 32

Middle income
countries(inco
me per
capita=$2500)
Reforming Health System.....

q Reallocating investment:

Ø Decentralization of
q
Balancing human resources:

Ø
Improving the balance between primary care
providers and specialists.
Ø
Attracting primary care providers to underserved
areas.
§
Providing incentives
§
Including differential pay-scales
§
Giving settlement allowances
§
Sanctioning payment of expenses for continuing
o
Improving the selection, acquisition & use of drugs:

§
Creating and following national essential drugs list
consisting of a limited number of inexpencive drugs
that address the important health problems of
population.
§
Purchesing drugs competitively and reducing protection
of local pharmaceutical production of vaccines and
drugs.
§
Providing information to public and private provides &
consumers on drug use.
§
Removing financial incentives that encourages
physicians to overprescribe.
o
Generating information & research:

§
Gathering & synthesizing epedemiological and other
information necessary to monitor health status.

§
Supporting research, where needed, to generate
local solutions to local problem.
An agenda for action....
World Bank prescriptions regarded these
countries health issues.
Reforms needed in the health sector.
Examines the principle obstacles to reforms.
Outlines possible strategies for overcoming
these obstacle.
Examines the role of the international
communities in supporting improvements health
policies and programs in developing countries.
Health policy reforms in
developing countries………
v
Low-income countries:

Characteristics:

o
Little public or private insurance.
o
Out of pocket spending for drugs.
o
Traditional medicine.
o
Government roles………

Hospitals and clinics provide the bulk of

modern medical care.

In some countries private providers offer a

service that is perceived to be of higher
quality than that of provided by the public
sectors.
World bank prescription for health
reformations in low income developing
countries………
Ø
Five policies for better health are
crucial in this environment:
Proving solid primary schooling for all
children.
Investing more resources in highly cost
effective public health activities.
Shifting health spending for clinical services.
Reducing waste and inefficiency in government
health programs.
Ø
Middle-income countries:

Characteristics:

o
Out of pocket paments for health
usually account for less than a third of
total spending.
o
Some people have private insurance even
though most of the population receives
World bank prescription for
these countries………
Reduction of subsides to better off groups.

Extension of insurance.

Consumer choice.

Cost-containment.
Ø
Formaly Socialist countries:

o
Characteristic:

•
Historically the government was responsible for
both the finance and the delivery of health care in
the formerly socialist countreis of eastern europe
and the soviet union.

•
Health expenditure were financed from general
revenue.
World Bank prescription………

o
Despite this diversity the
gobernments of all the formerly
socialist countries need to consider
health sector reforms in at least
three main areas.
o
Efficiency of goverment services.
o
New modes of financing.
Macrolevel prescription of world
bank………
International assistance for health.
Improving the effectiveness of aid for
health.
International programs for researchand
development in health
Meeting the challenges of health policy
reforms.
Another side of the coin………
o
World Bank thinks globally but not
locally.

o
World Bank highlights not the welfare
of ailing people but considers them as
human capital in capitalists work
force.
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