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Global Health Policy Blog


A fiery debate about the World Bank's performance in controlling malaria finally broke out on the pages of today's Lancet to mark Africa Malaria Day, after brewing behind-the-scenes for weeks. On the side of the prosecution, Amir Attaran and others accuse the Bank of failing to live up to financial pledges of support for malaria programs, misreporting statistics in its claims of success against the disease in Brazil and India, failing to apply up-to-date public health know-how in the choice of anti-malarials purchased in Bank operations, and poor design and implementation of the relatively new Global Strategy and Booster Program. In the same issue, Jean-Louis Sarbib and others offer a measured defense against each point, scrubbed so clean that a reader might think it was the work of a small army of lawyers, communications specialists and senior Bank staff.

The unfortunate result of this public flogging of the Bank may be that the institution’s management becomes even more hardened in its position that the Bank should take the lead on single-disease efforts. Bank staff working on malaria programs will now be under intense pressure to document "performance" and to demonstrate that the Bank is better at moving money than the Global Fund, and better at fighting parasites than the World Health Organization. Following the odd logic of global health in an era when advocacy is organized by disease - rather than, for example, by population group (does anyone even remember "child survival"?) or health care model ("primary care" anyone?) - the Bank has fallen deeply into the trap of making extravagant single-issue funding and performance promises that can neither be kept nor tracked. Unless the Bank can break out of this trap, it will fail to realize its potential to contribute toward the slow, unglamorous but ultimately essential development of health service delivery and financing - the platform on which any disease-specific success must rest.

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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.