Healthy targets? World Bank projects and targeted health programmes and policies in Costa Rica, Argentina, and Peru, 1980–2005

Abstract

Despite its central role in diffusing neoliberal policies and its status as an important external funder of health, the World Bank’s effect on health policies in developing countries has been little explored. I examine how the World Bank framed and funded targeting in healthcare in Costa Rica, Argentina, and Peru. Results indicate that the World Bank and national governments pursue targeting and justify its implementation differently across countries. While both national government and the World Bank cite efficiency and equity concerns as a rationale for targeting, the World Bank is more likely to invoke efficiency and cost-cutting measures. Targeting also happens against the backdrop of very different policies across these countries: coexisting with universalism in Costa Rica, growing public insurance in Peru, and a federally managed health system in Argentina. Domestic factors associated with countries’ existing health systems, in particular coverage and segmentation in the health sector, helps account for variation in both the groups/areas targeted and the discourse and rationale in national and World Bank documents. I conclude by discussing the implications of these results for our understanding of the World Bank’s influence on health policies in developing countries.