The World Bank in turmoil

Abstract

The past weeks have been turbulent for Paul Wolfowitz, head of the World Bank since June, 2005. His job now hangs by a thread after his involvement in the promotion and pay rise of his girlfriend, a former Bank employee. The controversy undermines the Bank's credibility as the leading global development institution for human health, particularly because Wolfowitz made ending government corruption his signature issue at the organisation. Adding to Wolfowitz's woes are accusations that President Bush's policies are influencing the Bank's strategy. The Bank's new 10-year plan for health, nutrition, and population—a strategy that will affect the health of millions of people—has been mired in controversy over its wording on sexual and reproductive health. Last Tuesday, European nations objected to a US effort to change the language in the health strategy, making women's access to reproductive health services, including abortions, more restrictive. The Bank's managing director, Juan José Daboub, a Wolfowitz appointee, also stands accused of watering down the reproductive health part of the strategy and deleting references to family planning in a funding proposal to tackle HIV and poverty in Madagascar. Daboub's position at the Bank must now be brought into question. Bank employees were so dismayed at the attempted manipulation of the new health strategy that they leaked information to advocacy groups to ensure intense lobbying over its wording would take place. The latest version of the health strategy, seen by health campaigners, now recognises the reproductive health rights of women. These recent events should provide an opportunity for the Bank to reflect on and improve the way it operates in the future. As well as undermining the organisation's work and demoralising its staff, the current crisis could provide an excuse for donors to delay or, worse, halt their funding commitments to the Bank. As The Lancet went to press, Wolfowitz remained determined to keep his position. He and the Bank's board of directors must remember the organisation's mission to alleviate poverty. They must do what is best for the world's poorest people and negotiate Wolfowitz's quick resignation. The World Bank's new health strategy: reason for alarm?The World Bank has a new 10-year health strategy.1 Since its previous health strategy, developed in 1997, the global health landscape has been transformed. International spending on health has increased from about US$7 billion in 2000 to almost $14 billion in 2005. While the Bank used to be the pre-eminent international health-financing agency, spending about $1·5 billion a year on health, it now operates in a more crowded field, with established players, such as WHO, UNICEF, and bilateral donor agencies, and newer players such as the US President's Emergency Fund for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill & Melinda Gates Foundation, and the GAVI Alliance. Full-Text PDF