The World Bank's credibility gap
Tuesday, May 19th 2009, 11:15 AM
At the World Bank's recent annual meeting, World Bank President Robert Zoellick acknowledged that the economic crisis would hit the world's poorest people hardest. He stressed that the bank "must continue to act in real time to prevent a human catastrophe."
His speech followed bank projections that as many as 400,000 additional children will die this year as a consequence of the downturn. To help protect the poor from this crisis, the World Bank has announced it will triple its lending for health efforts from $1 to $3 billion this year.
Before the bank moves forward with this effort, it ought to consider a new report from its own Independent Evaluation Group - and then reassess its programs.
According to the report, only 27% of World Bank-supported health, nutrition and population projects are successful in Africa. For the most part, the HIV projects the bank supports in sub-Saharan Africa haven't worked. In addition, the report indicates that the World Bank does a poor job of monitoring its health-related projects and does not know the extent to which it serves the needs of the poor.
Moreover, the bank has practically withdrawn from supporting nutrition, despite its centrality to health. And it has failed to support efforts to enhance people's access to appropriate family planning.
The bank cannot credibly seek to expand these efforts in response to the economic crisis if so many of its projects do not achieve their aims.
As the bank's report also says, these failures are even more regrettable since they occur in a sector - health - in which it ought to be relatively easy to establish linkages between bank investments and real benefits for the poor. Successful immunization programs keep children from getting deadly diseases. Successful efforts to combat TB increase the share of those with TB who are treated and the share of those who are cured. Successful programs in reproductive health increase the share of births attended by skilled midwives and that take place in hospitals.
There is no magic to these indicators of success. But the bank's management is making the monitoring of project results considerably more complicated than it needs to be.
The question facing the bank's stakeholders - chief among them, the United States - is how long the bank will continue to operate in this way, resisting systematic monitoring of its public health programs' effectiveness, and what it will do to begin moving in the right direction.
Many World Bank projects deserve praise. In South Asia - where I headed the bank's health efforts - some projects met their aims and served the poor well, especially the large-scale disease control efforts to address TB, leprosy and the control of cataract blindness. Other projects in South Asia - most notably a series of nutrition projects - weren't so successful, despite the importance that was attached to them.
Before throwing good money after bad, officials must work to further enhance the quality of the bank's health, nutrition and population efforts.
The economic crisis is not, as Zoellick suggests, a reason to act with haste. Rather, at this juncture it's more important than ever that every dollar of development assistance be used wisely. Before moving forward with any new projects, World Bank shareholders and stakeholders must ensure that the quality of the bank's health-related work improves.
Skolnik is the former manager of the World Bank's work on health, nutrition, and population for the South Asia region. He is also the author of "Essentials of Global Health."