Babar, Zaheer-Ud-Din

Baines, Darrin

University of Huddersfield Repository

Access thebmj.com - Baines and Babar: Why medical practitioners should be interested in the WorldBank August  31, 20 17A new series looks at the World Bank’s expanding role in global healthGiven t he complexit ies of  global polit ics and t he uncert aint ies of  int ernat ional relat ions, why should medical pract it ioners beint erest ed in t he World Bank? In a series of  f ive papers, Sridhar and colleagues do much t o answer t his vit al quest ion by analysingt he bank’s expanding role in global healt h. T heir work is a welcome updat e of  Kamran Abbasi’s 1999 BMJ series on t he role of  t hebank in int ernat ional healt h. [1]Sridhar et  al and Abbasi perform in-dept h analyses t hat  highlight  t he import ance of priorit ies, polit ics, and money in shaping globalhealt h policy. In a 1999 BMJ edit orial responding t o Abbasi’s review of World Bank operat ions, Robin St ot t , a consult ant  physician,quest ioned t he bank’s role in global healt h, it s performance in t his sect or, and whet her economic policies init iat ed by t he bankimproved t he healt h of  t he poor. [2] St ot t  st at ed t hat  much could be improved in t he bank’s operat ion, part icularly it s economicreforms and it s promot ion of quasi-market s for healt hcare provision.Sridhar et  al’s lat er analysis describes how t he bank responded t o such challenges while ent ering t wo new phases in it sdevelopment . Bet ween 2000 and 2010, t he organisat ion worked t o achieve t he millennium development  goals t hroughcollaborat ion wit h ot her st akeholders. [3][4] From 2010 unt il now, t he bank has cooperat ed wit h government s t o achieve universalhealt h coverage by using a range of innovat ive f inancing inst rument s. [5][6]An import ant  st ep forward for t he World Bank is it s current  policy of  exploring innovat ive ways of  solving global healt h problems(unpublished report , June 2017) For example, t he Bangladesh Healt h, Populat ion and Nut rit ion Sect or Program (HPNSDP) is a $7.7bngovernment  led programme, which received an est imat ed $400m from t he bank. T he programme has a st rong pharmaceut icalcomponent  t hat  involves st rengt hening t he access and affordabilit y of  medicines. One of t he aut hors of  t his opinion piece wasfunded by t he bank t o survey drug pricing, availabilit y, and affordabilit y, using t he WHO/HAI met hodology. T his example of  t he WorldBank working t o solve real life problems and invest ing in evidence t o inform policy decisions is a very posit ive development .T he evolut ion of t he World Bank raises new quest ions about  it s approach. For example, will bank policy be cohesive in t erms oflinking it s init iat ives for st ruct ural adjust ment , privat isat ion, and t he public good? What  will universal healt h coverage andst rengt hened healt h syst ems look like for upcoming generat ions? How will t he bank work wit h t he World Healt h Organizat ion,individual government s, and non-government al organizat ions in t he fut ure? As many of t he World Bank’s init iat ives are new, f inalanswers t o t he above quest ions are not  available yet .While individual programmes are being evaluat ed and reviewed, t he big pict ure will t ake a while t o be drawn. In t he meant ime, howshould t he medical profession react  t o t he bank’s current  pat h of  progression? T he art icles by Sridhar et  al suggest  t hat  recentdevelopment s in t he bank’s operat ions are reframing t he pract ice of  large scale medicine and t he delivery of  healt h services forglobal problems. Big, evaluat ed, privat ely backed healt hcare programmes are not  usually focused on individuals in t he same way ast he personalised pract it ioner-pat ient  relat ionship. Whet her t his difference is a mat t er of  concern is an issue t hat  t he medicalprofession—along wit h economist s, et hicist s, epidemiologist s, sociologist s, and t he like—should discuss openly. What  mayemerge is what  Sridhar et  al refer t o as a “clear t ension” bet ween “t he premise t hat  healt h is a human right  and t he bank’s focuson ret urn on invest ment  and product ivit y.” As t his t ension plays out , ongoing scrut iny will be required.S o u rc e :D a te :K e ywo rd :b m j .c o mTh u rs d a y 3 1 , Au g u s t 2 0 1 7U n i ve rs i ty o f H u d d e rs fi e l dArti c l e  P a g e  1 o f  54 0 0 2 8 8 2 9 6  - AN G S M I  - A19 78 6  - 1R e p ro d u c e d  b y G o rk a n a  u n d e r  l i c e n c e  f ro m  th e  N L A (n e ws p a p e rs ), C L A (m a g a zi n e s ), F T (F i n a n c i a l  Ti m e s /f t.c o m ) o r  o th e r  c o p yr i g h t o wn e r. N o  f u rth e r  c o p yi n g  (i n c l u d i n g  p r i n ti n g  o f  d i g i ta l  c u tti n g s ), d i g i ta lre p ro d u c ti o n /f o rwa rd i n g  o f  th e  c u tti n g  i s  p e rm i tte d  e xc e p t u n d e r  l i c e n c e  f ro m  th e  c o p yr i g h t o wn e r. Al l  F T c o n te n t i s  c o p yr i g h t Th e  F i n a n c i a l  Ti m e s  L td .In all forms of vigorous analysis, t he pros and t he cons of  a sit uat ion must  be fully explored. In examining t he World Bank’s evolvingpolicies and act ivit ies, bot h t he posit ive and t he pot ent ially negat ive should be discussed openly. T o dat e, t he process ofevaluat ion and public crit ique has helped t he bank rapidly change it s approach t o t he benefit  of  many millions of  people worldwide.[7]In conclusion, if  one caveat  needs t o be st at ed, it  is simply t his: current  met hods of  economic appraisal, healt h planning, andsyst ems st rengt hening may need enhancing signif icant ly before t hey can properly support  t he World Bank’s vision for globalhealt h. T his lat t er challenge is one, we believe, t he medical profession should ardent ly champion. Darrin Baines, professor of health economics, Bournemouth University    Zaheer-Ud-Din Babar, professor in medicines and healthcare at the Department of Pharmacy, Schoolof Applied Sciences, University of Huddersfield    Competing Interests : Professor Babar has worked as a consultant to the World Bank’s pharmaceutical pricing and strengtheningprogramme in Bangladesh.Ref erences:1. Abbasi K. T he World Bank and world healt h: changing sides. BMJ 1999;318:865-9.2. St ot t  R. T he World Bank: Friend or foe t o t he poor? BMJ 1999;318:822.3. Harman S. The World Bank and HIV/AIDS: setting a global agenda. 1st  ed. London: Rout ledge, 2010.4. World Bank. The Africa Multi-Country AIDS Program 2000-2006: results of the World Bank’s response to a development crisis. WorldBank, 2007.5. Hort on R. Off line: t he Kim doct rine. Lancet 2014;384:840.6. Clift  C. WHO, the World Bank and universal health coverage. London: Chat ham House, 2013.7. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R, 2009. Medicine prices, availabilit y, and affordabilit y in 36 developing andmiddle-income count ries: a secondary analysis. Lancet 2009;373(9659):240-9. Fe at ure d, Global he alt h  Ronnie Cowan: Drug  policy reform is required, we can’tafford to delay for longRichard Smith: A critique of Cyril Chantler’s plan for savingthe NHS S o u rc e :D a te :K e ywo rd :b m j .c o mTh u rs d a y 3 1 , Au g u s t 2 0 1 7U n i ve rs i ty o f H u d d e rs fi e l dArti c l e  P a g e  2  o f  54 0 0 2 8 8 2 9 6  - AN G S M I  - A19 78 6  - 1R e p ro d u c e d  b y G o rk a n a  u n d e r  l i c e n c e  f ro m  th e  N L A (n e ws p a p e rs ), C L A (m a g a zi n e s ), F T (F i n a n c i a l  Ti m e s /f t.c o m ) o r  o th e r  c o p yr i g h t o wn e r. N o  f u rth e r  c o p yi n g  (i n c l u d i n g  p r i n ti n g  o f  d i g i ta l  c u tti n g s ), d i g i ta lre p ro d u c ti o n /f o rwa rd i n g  o f  th e  c u tti n g  i s  p e rm i tte d  e xc e p t u n d e r  l i c e n c e  f ro m  th e  c o p yr i g h t o wn e r. Al l  F T c o n te n t i s  c o p yr i g h t Th e  F i n a n c i a l  Ti m e s  L td .Comment and opinion from The BMJ's international community of readers, authors,and editorsC AT EG OR IESBMJ Clinical EvidenceBrexitChinaChrist mas appealClimat e changeColumnist sEdit ors at  largeFrom t he archiveFrom t he ot her sideGlobal healt hGuest  writ ersJunior doct orsLit erat ure and medicineMedical et hicsMet aphor wat chMSFNHSOpen dat aPart nership in pract icePat ient  perspect ivesReaders' edit orRichard Lehman's weekly review of medical journalsSout h AsiaSt udent sT he BMJ t odayT he King's fundSearch BMJ Opinion SearchS o u rc e :D a te :K e ywo rd :b m j .c o mTh u rs d a y 3 1 , Au g u s t 2 0 1 7U n i ve rs i ty o f H u d d e rs fi e l dArti c l e  P a g e  3 o f  54 0 0 2 8 8 2 9 6  - AN G S M I  - A19 78 6  - 1R e p ro d u c e d  b y G o rk a n a  u n d e r  l i c e n c e  f ro m  th e  N L A (n e ws p a p e rs ), C L A (m a g a zi n e s ), F T (F i n a n c i a l  Ti m e s /f t.c o m ) o r  o th e r  c o p yr i g h t o wn e r. N o  f u rth e r  c o p yi n g  (i n c l u d i n g  p r i n ti n g  o f  d i g i ta l  c u tti n g s ), d i g i ta lre p ro d u c ti o n /f o rwa rd i n g  o f  th e  c u tti n g  i s  p e rm i tte d  e xc e p t u n d e r  l i c e n c e  f ro m  th e  c o p yr i g h t o wn e r. Al l  F T c o n te n t i s  c o p yr i g h t Th e  F i n a n c i a l  Ti m e s  L td .T oo much medicineUS healt hcareInformation for AuthorsBMJ Opinion provides comment  and opinion writ t en by T he BMJ's int ernat ional communit y of  readers, aut hors, and edit ors.We welcome submissions for considerat ion. Your art icle should be clear, compelling, and appeal t o our int ernat ional readership ofdoct ors and ot her healt h professionals. T he best  pieces make a single t opical point . T hey are well argued wit h new insight s.S o u rc e :D a te :K e ywo rd :b m j .c o mTh u rs d a y 3 1 , Au g u s t 2 0 1 7U n i ve rs i ty o f H u d d e rs fi e l dArti c l e  P a g e  4  o f  54 0 0 2 8 8 2 9 6  - AN G S M I  - A19 78 6  - 1R e p ro d u c e d  b y G o rk a n a  u n d e r  l i c e n c e  f ro m  th e  N L A (n e ws p a p e rs ), C L A (m a g a zi n e s ), F T (F i n a n c i a l  Ti m e s /f t.c o m ) o r  o th e r  c o p yr i g h t o wn e r. N o  f u rth e r  c o p yi n g  (i n c l u d i n g  p r i n ti n g  o f  d i g i ta l  c u tti n g s ), d i g i ta lre p ro d u c ti o n /f o rwa rd i n g  o f  th e  c u tti n g  i s  p e rm i tte d  e xc e p t u n d e r  l i c e n c e  f ro m  th e  c o p yr i g h t o wn e r. 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N o  f u rth e r  c o p yi n g  (i n c l u d i n g  p r i n ti n g  o f  d i g i ta l  c u tti n g s ), d i g i ta lre p ro d u c ti o n /f o rwa rd i n g  o f  th e  c u tti n g  i s  p e rm i tte d  e xc e p t u n d e r  l i c e n c e  f ro m  th e  c o p yr i g h t o wn e r. Al l  F T c o n te n t i s  c o p yr i g h t Th e  F i n a n c i a l  Ti m e s  L td .

Baines and Babar: Why medical practitioners should be interested in the World Bank

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