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Commentary

Poor Countries Need Relief From World Bank’s ‘Help’ on Malaria
Roger Bate, AEI-Brookings Joint Center for Regulatory Studies, 10-18-06

Roger Bate, a senior fellow at the American Enterprise Institute, decries the World Bank's growing influence on global health programs due to its poor management and lack of expertise:

To understand the Bank's mission creep into disease control it is important to understand that the World Health Organization (WHO), until 2006, had failed to respond adequately to the treatment and prevention of most infectious diseases, notably malaria, in the developing world.

The WHO established strong credibility in its first thirty years by coordinating mass campaigns directed at the worst scourges. These 'vertical' operations gathered experts in particular diseases to design programs and then sent them to recipient countries to supervise and train local people to administer vaccines, sprays, drugs, and other medications. For example, using indoor residual spraying (IRS) with DDT, the WHO spearheaded massively successful malaria eradication campaigns in the Caribbean, Southern Europe and parts of Asia through the 1950s. Additionally the WHO led the smallpox eradication campaign from 1967 to 1980.

Since the early 1980s however, the WHO has been torn between its presence in the field, tackling disease, and its role as a standard–bearer, offering advice and advocating for sound technical practice. Suffering from mediocre leadership, financial mismanagement and confusion about its strategic direction, the Organization has gradually weakened. As a result, the Bank, assisted and advised by the WHO, wrested the initiative from the WHO on many health matters and drifted into the realm of public health and diseases programs, further clouding the lines between their core missions.

Politicization at both agencies has undermined confidence in their respective expertise. In the 1980s the WHO bowed to public outcries against top–down donor programs and environmentalists' concerns about insecticides by de–emphasizing IRS in its malaria control recommendations. The Bank joined the WHO in sidelining IRS by stigmatizing DDT and dismantling the malaria control programs it directly funded. But malaria rates soon rose4 and continued to rise for many years as both agencies were paralyzed by the fear of causing offence to their western constituencies.

The reality is that the Bank is often a "fifth wheel," duplicating or even competing with agencies having a greater core competence for disease control. The Shakow Report concluded as much about the Bank's role on HIV/AIDS, but this is summed up just as neatly in a passage of one of the Bank's own current project documents: "Activities for control of other endemic diseases already receive adequate financing from other sources such as The Global Fund for malaria and tuberculosis, or GAVI for vaccination, as well as UNICEF, [and] WHO... However, if needed, these areas would also be eligible for funding from the [Bank] credit. "It is an obvious waste of money and effort for the Bank to be chasing after other donors, who have arrived on the scene years ahead of them, with the offer of a little more money for the same projects as the other donors are already supporting.

Unfortunately, so far the Bank shows no signs of relenting, instead investing more to cover its exposed position and push through more malaria control programs. The Bank board has already been asked to approve seven this year, with another eight to be approved later in 2006.36 One African health expert at the Bank has already been threatened with re-assignment for arguing against the mantra 'malaria before all other health projects' coming from DC.

The WHO is planning the launch of a comprehensive 'cookbook' for malaria control policy later in 2006. The Bank has three choices: it can either send all of its malaria control project proposals to the WHO for technical review before obligating funds, or it can heed its own advice and transfer its entire malaria control budget to the Global Fund. Last, and most appropriate to its core competence, it can hang on to the funds and actually do the health system development that it is uniquely placed to undertake.



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