World Bank seeks to bridge differences over best way to improve healthcare

by Stella Dawson | | Thomson Reuters Foundation
Saturday, 12 April 2014 12:14 GMT

Lois Dama (2nd R) holds her baby daughter Rehema as she is given an injection as part of a malaria vaccine trial in the Kenya coastal town of Kilifi, November 23, 2010. REUTERS/Joseph Okanga

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World Bank wants universal healthcare as a development goal, while the U.S., Gates Foundation and others back specific, measurable targets

WASHINGTON (Thomson Reuters Foundation) - The World Bank pressed its campaign for universal health coverage at its spring meetings on Friday and sought ways to bridge a conflict over how best to raise healthcare at the same time as reducing disease and premature death.

“We must set goals that are universal and built on principles of health equity," said World Bank President Jim Yong Kim after more than three hours of panel discussion on the importance of investing in healthcare as a stepping stone toward reducing poverty.  

The World Bank and the World Health Organisation (WHO) want universal health coverage adopted by the United Nations as a new development goal from 2015. Among its backers are Japan, France and Thailand.

A report by the medical journal The Lancet released in December found that investing in healthcare brings huge dividends, far greater than expected 20 years ago. 

It estimates that 24 percent of global growth over the past decade is attributable to better healthcare and that returns for low-income countries are $20 for every single $1 invested. It recommended moving toward universal health coverage as a way to achieve health and financial protection, thus reducing poverty.

An estimated one billion people lack access to health care and about 100 million people each year face poverty due to catastrophic costs of meeting out-of-pocket health-care costs, the World Bank said.


A powerful lobby that includes the United States, Britain, many African countries and the Bill and Melinda Gates Foundation prefers an alternate approach. Rather than focusing on healthcare delivery methods, they want a development goal that is based on specific health outcomes. 

It would focus on measures that maximise healthy lives and would have specific targets such as reducing and preventing communicable diseases, reducing the number of mothers and their newborns dying in child birth and improving access to health care.

World Bank Health Director Tim Evans and WHO Director-General Margaret Chan on Friday proposed a framework for attaching measurable targets to a development goal that calls for moving toward universal health coverage by 2030.

U.N. Secretary General Ban Ki Moon appeared to endorse this approach calling universal healthcare coverage "an aspirational approach that would allow countries to build on in their own terms." At the same time, he said that "measuring results is essential."   

Backers of the alternate approach spoke of an emerging “convergence” between the two camps.

 “Those who are lined up between these two approaches do have to come together, because the two (goals) are aligned,” said Carolyn Miles, president of Save the Children USA.

Chris Elias, president of Gates Foundation’s global development programme, agreed that adding specific outcomes might provide a path forward. 

“If you are going to achieve universal health coverage, you have got to agree on what you are going to do today and tomorrow, and then move on a specific pathway toward that with measurable results,” Elias said.  

Paul Rochon, deputy minister of international development for Canada, urged policymakers drafting the post-2015 UN development goals not to lose sight of results.

“You can form a health objective at the very broad level and have 25 to 30 percent of the MDGs related to health,” he said.

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