[afro-nets] Response by the WB to the letter from the PHM

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Response by the WB to the letter from the People's Health 
Movement
---------------------------------------------------------
 
NICHOLAS KRAFFT 
Acting Vice President
Human Development
The World Bank
Washington, DC 20433 
U.S.A.
 
February 3, 2007


David McCoy
On behalf of the Peoples Health Movement
c/o Medact
The Grayston Centre
28 Charles Square
London N1 6HT
 
Dear Dr. McCoy,
 
I want to thank you for your letter on behalf of the Peoples 
Health Movement Global Secretariat regarding the Background Note 
for a Briefing to the Committee on Development Effectiveness 
(CODE) on the Preparation of the New Bank Health, Nutrition, and 
Population (HNP) Strategy, dated May 30, 2006. This Background 
Note was presented to the CODE in June 2006. Your letter is 
timely as we are in the process of finalizing the strategy, 
which will be presented to CODE in March.
 
We welcome your support for the World Bank's explicit aim of 
strengthening health care systems in low- and middle-income 
countries. The World Bank has worked diligently to ensure that 
its new HNP strategy responds to and reflects the needs and 
challenges that the Bank's partner countries face in health, 
nutrition, and population. To this end, throughout the 
preparation of the new strategy, the Bank conducted extensive 
consultations with representatives from development partners and 
civil society - both before and after presenting to CODE in June 
2006. Furthermore, in-country consultations took place in nine 
partner countries (Argentina, Algeria, Armenia, Djibouti, India, 
Indonesia, Mali, Mexico, Tanzania) with representatives from 
governments, development partners, and civil society.
 
Bearing this in mind, I will address the key issues you identify 
in your letter on the content and direction of the new strategy.
 
* On the role of the Bank in the health sector
 
The World Bank is committed to supporting partner countries' 
efforts in strengthening health systems and creating fiscal 
space for sustainable and equitable access to health services 
for all people, particularly the poor and the vulnerable.
 
The Bank is also committed to contribute to improving donor 
harmonization and reducing fragmentation in development 
assistance for health in low- and middle-income countries. 
Harmonization and alignment with country priorities and systems 
are essential to ensure a country-led and country-owned process 
of strengthening health systems.

Furthermore, we agree that multisectorality is at the core of 
achieving the Millennium Development Goals (MDGs) and other 
priority outcomes for low- and middle-income countries. No 
sector will be able to achieve these goals alone. We are 
committed to providing advice and effective planning and 
analytical tools to partner countries in order to better 
identify obstacles in multiple sectors to achieve HNP results.
 
* On health systems
 
We believe that the leadership of strengthening health systems 
should reside at the country level. The World Bank seeks a 
collaborative division of labor among global partners and 
initiatives so that we can synergistically contribute to country 
leadership in this field. We agree with the urgent need for 
substantial increases in efforts to generate the additional 
evidence and knowledge needed to advise countries on specific 
mechanisms of health system financing and provision of services. 
The World Bank is committed to providing available evidence to 
countries to inform their decision-making in these areas. For 
example, while the Bank docs not promote any "blueprint" for 
organizing insurance, we are committed to advising partner 
countries in choosing an insurance arrangement that will protect 
people from falling into poverty due to illness. Bear in mind 
that we define insurance in a broad sense, which includes 
general tax-financed coverage, and not only contributory 
insurance.
 
* On omissions and gaps
 
The World Bank (through the Strategy's first strategic 
objective) is explicitly committed to contribute to partner 
countries' efforts in improving not only the level but also the 
distribution of HNP outcome and outputs. This means that we are 
dedicated to reducing the inequities in access to health 
services, particularly for the poor and vulnerable.
 
We recognize that many developing countries face a health crisis 
in having too few trained health workers to run their health 
systems, especially in Africa. There are a variety of factors 
which contribute to this crisis. These factors include 
insufficient money and personnel training, as well as often 
inadequate incentive frameworks in most health systems, which in 
turn can prevent a fairer, more equitable distribution of 
trained health workers across countries - especially to rural 
areas. In addition, migration of skilled health workers 
exacerbates the crisis. The Bank is committed to helping partner 
countries address this crisis by supporting country-led efforts 
to improve incentives, strengthen their health systems, and 
create fiscal space. In collaboration with our development and 
country partners, the Bank is dedicated to finding the most 
effective ways to solve the human resource crisis in low-income 
countries, particularly in Africa.
 
We believe that good health, nutrition, and population policies 
play a pivotal role in economic and human development and in 
poverty alleviation. For a century and a half, HNP improvements 
have contributed economic growth. At the same time, improved 
economic growth has enabled improvements in health outcomes.
 
In order to realize its potential , we look forward to a 
collaborative division of labor with global partners along the 
line of each organization's comparative advantages. We will 
focus our efforts on creating knowledge and policy advice, 
particularly in the following areas: health financing; health 
financing regulation; system governance; and improving household 
demand for health care.
 
Finally, we have heard from many of our partner countries and 
global partners about the need for the Bank to rise to the 
challenge of supporting country needs and strengthening health 
systems. We look forward to collaborating with UN agencies and 
other partners in this endeavor. Nevertheless, we strongly 
believe that countries lead this process.
 
I hope I have responded to the issues raised in your letter and 
have demonstrated that the Bank is following a country-driven 
development plan to improve the health and well-being of poor 
people in its partner countries. I believe you will see your 
concerns are more than adequately addressed in our latest 
version of the HNP Strategy.
 
Sincerely,
Nicholas Krafft