World Bank and Global Health: Do Better, Not Less

Anybody with a serious illness would rather see a doctor than a banker. So why does the World Bank still think it knows best about how to eradicate disease in the Third World? Its expertise lies in lending money for big infrastructure projects, not in public health - nor in lending money for public health.

So starts the LA Times editorial based on the recent exchange in the Lancet between Amir Attaran and World Bank Vice President Jean-Louis Sarbib.OK, so if you were sick and you wanted a diagnosis or a treatment plan, you'd rather see a doctor than a banker. But if you were in need of money to buy the drugs, or to protect your family from the financial hardship of catastrophic illness, you’d to talk with someone whose main business is money and financial services. If you were very short on cash and you had to decide between treating a chronic condition and paying your child’s school tuition, again you might want to talk to someone who could help you work out the priorities and trade-offs - or find some cash in a hurry. And to prevent and treat illness, you'd want to make sure there was a health system that could train doctors and other health workers, construct and maintain health facilities, and detect infectious disease in a community. For that, you might want the government to be getting some good advice about how to finance and allocate resources for essential public health functions – from people who think about public finance, not just medicine and public health.In other words, the World Bank doesn’t have to be - and shouldn’t be - filled with public health and medical specialists to make a positive contribution to public health in developing countries. What it does have to do - and doesn’t yet do well enough - is play a constructive role in supporting governments in poor countries mobilize and use money so that fewer people get sick, and when they do, there’s somewhere for them to go.