Much opposition has focused on the ‘one size fits all’ pattern of its policy recommendations, with too little tailoring to a country’s specific circumstances. While the use of direct policy conditions attached to loans and grants has declined under scrutiny from campaigners, informal advice from Bank staff, (especially in local offices based in developing countries) can still hold a powerful sway over governments’ policy choices.
The Bank’s promotion of ‘user fees’ has been particularly controversial. Many countries introduced fees for healthcare during the 1980s under World Bank and IMF advice. User fees have been shown to disproportionately affect the use of health services by the poorest in society.
When even the Bank’s own research showed that fees had contributed to poor people being excluded from health services, it switched to a ‘no blanket policy on user fees’ in 2004. But this policy U-turn has not been clearly communicated. And at the country level, where Bank staff interact directly with country ministries, there has been little or no support offered to with few alternative funding options available to countries who want to provide free healthcare.
Effectiveness
Even its own in-house monitoring body has concluded that progress on health has been poor. A review of the Bank’s health, nutrition and population department published in May 2009 found that too little spending was reaching the poorest people, for example.
Mission creep
By developing its own health strategies the Bank has sometimes been seen as undermining the role of the World Health Organisation.
Debt
The Bank has been the subject of worldwide campaigning for the cancellation of unpayable debts which lock so many developing countries in poverty. Critics highlight that in the past the IMF and World Bank both irresponsibly lent billions of dollars to dictators who squandered the money.
Oil, gas and mining
Another area of longstanding criticism is the Bank’s involvement in the oil, gas, and mining sectors, which can have ruinous consequences for poor and marginalised people and their environment.
Health Poverty Action says:
- The World Bank and other international institutions must stop prescribing user fees to countries as part of official or unofficial policy advice, must state this clearly, and must provide more financial assistance to scrap fees.
- The voting powers and board composition of the International Monetary Fund and World Bank must be overhauled to reflect the needs and interests of developing countries far better.
- The UK should divert its health funding from the Bank to the Global Fund, a partnership of the public and private sectors, and civil society.
- The Bank must cancel all illegitimate and unpayable debts being claimed from all developing countries, not just the debts of countries which manage to fit the criteria of the existing international debt relief scheme. The Bank should not attach strings to debt relief or loans which press governments to follow particular economic policies – such as limiting public spending or specifying how healthcare should be delivered.
Last modified: 12/01/2011
