In this newsletter from EG4H…

• A decade of health funding from the World Bank – but to what end for the poor? Damning findings from the World Bank’s Independent Evaluation Group
• WHO Director Margaret Chan’s withering critique of liberal economic governance and its impact on health
• ‘Just out’ links to the latest global economic news and events

Are you interested in helping us get the word out about the importance of economic governance for health?

Would you like to do more and join our active campaign outreach network?

We have an expanding number of ‘outreachers’ who help amplify our message. Typically they do this by:

• Forwarding information about EG4H to your own network of contacts and lists
• Encouraging people to respond to an EG4H request or to take up action on an event we are promoting.

If you are interested in joining this network of active campaigners, or can suggest organizations – or better still key people within those organizations – whom we should contact, please send an email to info@eg4health.org

Unaccountable, inefficient, and weak: a decade of World Bank funding for health, nutrition, and populations
The World Bank’s Independent Evaluation Group has just published ‘Improving effectiveness and outcomes for the poor in HNP’ – its evaluation of ten years of Bank projects for Health, Nutrition, and Population (HNP)

Since 1997 the Bank has provided $17bn for HNP. What has this massive investment achieved, and what does it tell us about the Bank’s role in governing global health?

Blind support for a Sector-Wide Approach (SWAp) to health
The IEG evaluation found that whilst the Bank’s support for SWAPs had increased since 1997, its support for Health Systems Strengthening was down by over 50%.. Moreover, only one third of Bank projects that supported health SWAPs have performed satisfactorily on meeting their health objectives. Furthermore, the Bank has absolutely no idea which programs are working or why because monitoring and evaluation by the Bank of its projects is almost completely absent.

The IEG leaves no doubt about the consequences of such weak M&E: “irrelevant objectives…inappropriate project designs [and] unrealistic targets”. The IEG’s conclusion about the Bank’s use of a SWAp is equally worrying. Complex projects (such as SWAPs) were least likely to achieve their HNP objectives.

Nutrition and Population anyone?
And what about Bank support for Nutrition and Population? Support for Nutrition is down by 50% – to just 10% of projects – reaching just 25% of developing countries with high levels of stunting; whilst Bank projects for ‘Population’ (meaning reducing fertility rates or improving access to family planning) were down to just 4% of the Bank’s portfolio of projects – reaching 25% of countries with highest fertility rates. The IEG’s summary statement says it all: “Performance of HNP support in Africa was particularly weak, with only 1 in 4 projects achieving satisfactory outcomes”.

The Bank is not learning from its mistakes
The IEG makes a pointed comment in its Report that the reasons it gives for such poor performance by the Bank are precisely the same reasons for poor performance identified by its 1999 evaluation of the HNP sector.

Who cares about the health of the poor? The Bank doesn’t.
The IEG found that only 6% of all HNP projects committed to deliver better health or nutrition to the poor in their statement of objectives. Very few actually measured whether the poor benefited in relation to the non-poor or in relation to those in areas not reached by the projects; and even fewer measured whether the poor had disproportionately benefited. Furthermore, the share of country poverty assessments with a specific health component has dropped from 80-58%.

The final message of the IEG Report says it all: “Bring the health and nutrition of the poor and the links between high fertility, poor health, and poverty back into poverty assessments”

Steadfast in the midst of perils – WHO head slams global liberal market economy
In her Keynote address at the 12th World Congress on Public Health in Istanbul in April, Margaret Chan delivered a scathing critique of the global liberal market economy.

It is remarkable that such a senior health official is prepared to be so frank in their criticism of the global economic system, and her words resonate with many of the core messages that EG4H is trying to spread.

For example, Chan argues: “The single-minded pursuit of economic growth, compounded by behaviours motivated by greed, has had negative consequences well beyond the financial and economic sectors”. EG4H makes precisely this point in relation to trade and health – read more on our website.

Chan also argues for “a fundamental re-engineering of the international systems”, to give them “a moral dimension and to invest them with social values – like equity, sustainability, community, and social justice”. Again, we are with Chan 100%. On social justice, for example, read what the EG4H has to say here.

In unambiguous terms, Chan asserts: “The market does not solve social problems. Public health does”, and draws the solution back to Primary Health Care and the value system of the Alma Ata Declaration three decades ago.

Just out! Links to the latest writing and events on economic governance for health

World Bank triples its financial support for health systems strengthening
The World Bank announced on the 24th April that it will be mobilizing up to $3.1 billion this year in health financing – approximately $2 billion more than the $1 billion it spent in 2008. According to the Bank, the extra funds “will be used to strengthen health systems in poor countries, boost their performance in preventing and treating communicable diseases, and improving child and maternal health, hygiene and sanitation”. Read the announcement here

International Civil Society position paper on global health presented to G8 health experts
In a new paper presented to G8 health experts, international CSOs are calling on the G8 to:

• Honor their financial commitments to health made in the previous G8 Summit
• Guarantee the full implementation of Health Millennium Development Goals (MDGs) by 2015,
• Ensure that the innovative financing mechanisms for health mobilise resources that are additional to Official Development Assistance
• Ensure that international health interventions are harmonized and aligned with national health plans
• Strengthen free, public-led basic health services at the community level in order to effectively promote universal access

A global fund for the health MDGs?
In a 2nd of May Comment in the Lancet, Giorgio Cometto , Gorik Ooms, Ann Starrs, and Paul Zeitz “recommend that the Global Fund and the GAVI Alliance gradually move towards becoming a global fund for all the health MDGs”, and they list some desirable features that they would like to see structure this new addition to the global economic health governance architecture. Read more…60835-7/fulltext?version=printerFriendly)

EG4Health is more than words – Here’s how you can get involved:
Add your name to our open letter to Dr Margaret Chan

Join the group – simply send an email to info@eg4health.org

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©2009 Economic Governance for Health | London