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PubMed2001

Economics, health and development: some ethical dilemmas facing the World Bank and the international community.

The World Bank is committed to "work[ing] with countries to improve the health, nutrition and population outcomes of the world's poor, and to protect[ing] the population from the impoverishing effects of illness, malnutrition and high fertility".(1) Ethical issues arise in the interpretation of these objectives and in helping countries formulate strategies and policies. It is these ethical issues--which are often not acknowledged by commentators--that are the subject of this paper. It asks why there should be a focus on the poor, and explores the link between improving the health of the poor, and reducing health inequalities between the poor and better-off. It discusses difficult ethical issues at both the global level (including debt relief and the link between country ownership and donor commitment) and the country level (including user fees and whether providing assistance to the non-poor may in the long run be a way of helping the poor).

Developing Countries↗
PubMed1991

Poverty crisis in the Third World: the contradictions of World Bank policy.

Politicians, the mainstream media, and orthodox social science have all been telling us of a final victory of capitalism over socialism, suggesting that capitalism is the only viable option for solving the world's problems. Yet, the global capitalist system is itself entering the third decade of a profound structural crisis, the costs of which have been borne largely by the exploited and oppressed peoples of the underdeveloped periphery. While the World Bank's latest World Development Report recognizes the current poverty crisis in the third world, its "two-part strategy" for alleviating poverty is based on an inadequate analysis of how peripheral capitalist development marginalizes the basic needs of the third world poor. Hence, the World Bank's assertion that free-market policies are consistent with effective antipoverty programs does not confront the class structures and global capitalist interests bound up with the reproduction of mass poverty in the third world. The World Bank's subordination of the basic needs of the poor to free-market adjustments and reforms in fact suggests that the real purpose of its "two-part strategy" is to ensure continued extraction of surplus from third world countries by maintaining the basic structure of imperialist underdevelopment.

Developing Countries↗
PubMed2000

Excerpts from Joseph Stiglitz's speech to the World Bank, April 1999.

The Journal has published several articles critical of the World Bank and the International Monetary Fund. These articles have shown the damage caused by the neoliberal policies advocated by these agencies to the health and quality of life of the people in countries where such policies are carried out. Published here are excerpts of a speech given by Joseph Stiglitz, senior economist of the World Bank, in which he finally recognizes the damage these policies have caused in Russia, where life expectancy has fallen quite dramatically during the years of neoliberal reform. The question triggered by his speech is why the World Bank continues its neoliberal policies.

Economics↗
PubMed2002

How International Monetary Fund and World Bank policies undermine labor power and rights.

Based on reviews of hundreds of loan and project documents from the International Monetary Fund (IMF) and World Bank, this article provides detailed evidentiary support for critics who have long claimed that the international financial institutions require Third World countries to adopt policies that harm the interests of working people. After reviewing loan documents between the IMF and World Bank and 26 countries, the authors show that the institutions' loan conditionalities include a variety of provisions that undermine labor rights, labor power, and tens of millions of workers' standard of living. These include downsizing of the civil service and privatization of government-owned enterprises; promotion of labor flexibility: the notion that firms should be able to hire and fire workers, or change terms and conditions of work, with minimal regulatory restrictions; mandated wage rate reductions, minimum-wage reductions or containment, and spreading the wage gap between government employees and managers; and pension reforms, including privatization, that cut social security benefits. These labor-related policies take place in the context of broader IMF and World Bank structural adjustment packages that emphasize trade liberalization, with macroeconomic policies that further advance corporate interests at the expense of labor.

Civil Rights↗
PubMed2001

[The effect analysis of tuberculosis control project loaned by World Bank in Guangdong province].

OBJECTIVE: To evaluate the effect of tuberculosis control project loaned by World Bank in Guangdong province. METHODS: The registration and the treatment effect of pulmonary tuberculosis patients according to Guangdong tuberculosis report were analyzed. RESULTS: The above program had been conducted widespread since 1995. Over the past five years, 601,913 cases of suspicious tuberculosis patients have been received and diagnosed, in which 111,164 infectious patients (containing 91,612 newly-attacked infectious cases) were found. Just in 1999, the number of newly-attacked infectious patients was 1.2 times to that(19,858 newly-attacked infectious cases) of 1981-1990 prior to this program. And the average cure rate of infectious patients reached to 95.2%. The cure rate showed an uptrend amounting to 97.2% from 87.6%. CONCLUSION: Satisfactory effect have been achieved by the World-Bank loaned TB control project in Guangdong province.

China↗
PubMed1997

World Bank education policy: market liberalism meets ideological conservatism.

Neoliberalism does not consider education a strategic investment. World Bank discourse for Latin America lacks a medium- and long-term view and is based on a short-term cost-benefit analysis. The Bank's education policy is determined by "adjustment" of countries economies so that they can go on paying their external debts. The goal is to eliminate educational expenses for the states by keeping education for elites, breaking up and privatizing the large public education systems, and nullifying teachers' contracts. To justify its policy, the Bank argues that governments should stop financing secondary and higher education and instead focus on primary education, where investments would be more efficient. But at the same time, governments should shift the financing of primary education to the private sector. Teachers' unions are now at the forefront of opposition to the World Bank's education reforms.

Education↗
PubMedDate not supplied

Community monitoring of integrated pest management versus conventional pesticide use in a World Bank project in Indonesia.

Pesticide Action Network North America (PANNA) collaborated with a local Indonesian nongovernmental organization (NGO), Yayasan Duta Awam (YDA), in monitoring impacts of the World Bank-financed Integrated Swamps Development Project (ISDP). This paper reports the results of the community-based investigation, which found wide disparities between the World Bank's policy on pest management and its implementation. Instead of reducing farmers' reliance on pesticides as required, the ISDP led to increased intensity and frequency of pesticide use and adverse health and environmental effects from pesticide exposures. YDA and PANNA presented the findings to the Indonesian government and World Bank officials, and farmers requested training in IPM among other recommendations. After NGOs undertook joint advocacy efforts to reduce pesticide dependence in the project, the World Bank withdrew hazardous pesticides from input packages, IPM training was initiated, and community monitors became local leaders in their villages. The study demonstrates the importance and efficacy of independent community-based monitoring in documenting pesticide problems and replacing pesticides with IPM in World Bank development projects.

Agriculture↗
PubMed1998

The World Bank and global cooperation in health: the case of Bangladesh.

The final quarter of the 20th century saw a profound change in international health cooperation. The World Bank emerged and consolidated its position as the leading external financier of health-sector activities in countries of low and middle income. As a result of its resources, philosophy, and legitimacy, the World Bank leveraged fundamental reform of the health-sector agenda as well as institutional relations at global and national levels. The scope of the Bank's involvement, and the nature of its policy thrusts and investment strategy in the sector, are outlined in this paper and illustrated with specific reference to Bangladesh. This backdrop serves to raise four issues and enables us to explore their relevance to global health cooperation in the first quarter of the 21st century.

Bangladesh↗
PubMed1998

Neoliberalism revised? A critical account of World Bank conceptions of good governance and market friendly intervention.

This article examines recent World Bank reports on the role of the state in the development process, with particular reference to the rise of the East Asian newly industrializing countries and the crisis of "governance" in sub-Saharan Africa. The concepts of market friendly intervention and good governance are critically discussed, and are found to be inadequate as explanations for East Asian "success" and African "failure." The author presents an alternative explanation for the rise of the newly industrializing countries, which draws out some of the implications for the developing world.

Developing Countries↗
PubMed2003

Evaluation of the 1992-1999 World Bank Schistosomiasis Control Project in China.

The 1992-1999 World Bank Schistosomiasis Control Project in China contributed significantly to the disease control with its specific strategy and approach. An evaluation was made in this paper based on project control and surveillance data collected from all project provinces systematically year by year. Several indicators were computed, comparison was made using the 1989 survey data as the baseline, and correlation analysis was carried out on prevalence in humans, prevalence in cattle and buffaloes and infection rate of snails. From 1992 to 1998, the overall prevalence in human population, prevalence in children aged 7-14 and prevalence in cattle and buffaloes decreased by 5.74, 59.55 and 62.30%, respectively. Snail areas increased by 14.85% throughout the project period, while snail infection rate and density of infected snails decreased by 68.75 and 44.95%. Hubei province was among all eight provinces the most impressive in schistosomiasis control during the project. Results show that coverage of chemotherapy was among other factors the most directly-related to the prevalence in humans. The drug for chemotherapy-praziquantel was effective for new cases rather than reinfection. As to the overall achievement, most of the objectives set for the project had been achieved, especially the decrease in prevalence, in both human population and cattle and buffaloes. However, the achievement of snail control was not so ideal, which calls for rectification for a more applicable and practical strategy of snail control in China.

Adolescent↗
PubMed1998

Field activity cost estimates for the first 3 years of the World Bank Loan Project for schistosomiasis control in China.

The World Bank Loan Project for schistosomiasis in China commenced field activities in 1992. In this paper, we describe disease control strategies for levels of different endemicity, and estimate unit costs and total expenditure of screening, treatment (cattle and humans) and snail control for 8 provinces where Schistosoma japonicum infection is endemic. Overall, we estimate that more than 21 million US dollars were spent on field activities during the first three years of the project. Mollusciciding (43% of the total expenditure) and screening (28% of the total) are estimated to have the most expensive field activities. However, despite the expense of screening, a simple model predicts that selective chemotherapy could have been cheaper than mass chemotherapy in areas where infection prevalence was higher than 15%, which was the threshold for mass chemotherapy intervention. It is concluded that considerable cost savings could be made in the future by narrowing the scope of snail control activities, redefining the threshold infection prevalence for mass chemotherapy, defining smaller administrative units, and developing rapid assessment tools.

Animals↗
PubMed1995

The World Bank, pensions, and income (in)security in the global south.

The authors describe and analyze recent reductions and reorganizations of public pension programs in Latin America, as well as trends in pensions in the global South more broadly. They consider the role of the World Bank in the current pension "reform" process and situate the Bank's policies in the context of privatization, reduction of social budgets, and other aspects of structural adjustment. Chilean pension changes are analyzed in particular, showing that even by the Bank's criteria, the reforms have not been successful. The authors then discuss pension changes in China, where the World Bank is also deeply involved. The article concludes with the consideration of a number of arguments about pensions and support mechanisms in later life--including family support and means-tested welfarism--and argues in favor of global policy approaches, such as globally funded pensions and full access by older persons to productive and remunerated labor.

Aged↗
PubMed2005

Schistosomiasis control in China: the impact of a 10-year World Bank Loan Project (1992-2001).

China has been carrying out large-scale schistosomiasis control since the mid-1950s, but in the early 1990s, schistosomiasis was still endemic in eight provinces. A World Bank Loan Project enabled further significant progress to be made during the period 1992-2001. The control strategy was focused on the large-scale use of chemotherapy -- primarily to reinforce morbidity control -- while at the same time acting on transmission with the ultimate goal of interrupting it. Chemotherapy was complemented by health education, chemical control of snails and environmental modification where appropriate. A final evaluation in 2002 showed that infection rates in humans and livestock had decreased by 55% and 50%, respectively. The number of acute infections and of individuals with advanced disease had also significantly decreased. Although snail infection rates continued to fluctuate at a low level, the densities of infected snails had decreased by more than 75% in all endemic areas. The original objectives of the China World Bank Loan Project for schistosomiasis control had all been met. One province, Zhejiang, had already fulfilled the criteria for elimination of schistosomiasis by 1995. The project was therefore a success and has provided China with a sound basis for further control.

Animals↗
PubMed1990

Tribunal on the policies of the International Monetary Fund and the World Bank, West Berlin, September 26-29, 1988: verdict. Permanent Peoples' Tribunal.

At the request of the American Association of Jurists, the Permanent Peoples' Tribunal was called upon to consider violations of international law of the self-determination of peoples by the International Monetary Fund and the World Bank, as well as to make proposals for change. The Tribunal declared the request to be admissible, in accordance with Article 3 of the Statutes; therefore, the International Monetary Fund and the World Bank were informed, in application of the provisions of Articles 14 and 15. The Tribunal convened in West Berlin, September 26-29, 1988. Presented here is the report of the Tribunal, including its verdict and proposals for action.

Developing Countries↗
PubMed2003

Building integrated health systems in central and eastern Europe: an analysis of WHO and World Bank views and their relevance to health systems in transition.

BACKGROUND: Two questions are addressed. i) What are the views on health and health systems as expressed in the World Development Report 2000/2001 of the WB and the World Health Report 2000 and Health 21 of the World Health Organization, and how compatible are those views? ii) To what extent will compliance of CEEC and NIS with the WHO and WB recommendations result in health systems that produce maximum health for all by adequately addressing the needs of their populations? METHOD: The reports prepared by the World Bank and the World Health Organization were assessed against the theoretical framework of a needs-based public health approach. RESULTS: It is observed that the WHO and WB approaches are currently converging, although there remain differences in their respective focuses. The main merit of the WHO approach is its focus on performance and the systems approach towards health (care). The merit of the WB view is the integrated approach to health, education and poverty. It is argued that CEEC and NIS need to anticipate an ageing population and growing numbers of chronically ill. This calls for integrated health care systems and more integrated funding and payment systems. CONCLUSION: The recommendations provided in the WHR and the WDR with regard to integrated care and integrated financing remain rather abstract. Advisors of CEEC and NIS on health care reform and Western assistance projects should focus more on future needs, in order to avoid building health systems that consistently lag behind the needs of their populations.

Delivery of Health Care, Integrated↗
PubMed2005

The World Bank, pharmaceutical policies, and health reforms in Latin America.

Health care systems spend a relatively high percentage of their resources on the purchase of medicines, and the poor spend a disproportionate amount of their income on pharmaceuticals. There is ample evidence in the literature that drugs are very poorly used. World Bank-led health reforms aim at improving equity, efficiency, quality, and users' satisfaction, and it will be difficult to achieve these goals without making medicines accessible and affordable. The purpose of this article is to examine the adequacy of World Bank pharmaceutical policies, as recommended in various Bank documents, for Latin America and to examine the implementation of the policy recommendations. The authors found that the World Bank identified and recommended a set of pharmaceutical policies that matched the needs of the region. But, as revealed through fieldwork and a review of the literature, the recommended pharmaceutical interventions were left out of the health reforms, and most of the loans that included pharmaceutical interventions allocated funds only to the purchase of drugs. The authors formulate four hypotheses that may explain the lack of congruence between the recommended policies and the strategies financed by World Bank health reform loans to the Latin American region.

Drug Costs↗