The reality in the Region of the Americas remains challenging in this regard. Health systems are under-funded and characterized by segmentation and fragmentation in financing and service provision, with inefficiencies in the allocation and use of limited resources.
These problems result in poorer health outcomes and contribute to persistent poverty and inequities, with the greatest impact on populations in conditions of vulnerability. The way forward then is two-fold: find new public sources of funding while simultaneously increasing efficiency in health systems financing and health services organization to better respond to population needs.
Pan American Health Organization. Washington: PAHO; This in turn requires the creation of fiscal space for health investment by generating additional resources, a requisite for making the transformations needed to improve efficiency, expand access to quality health services and protect the population from out-ofpocket expenditures that lead to impoverishment. The task, however, is not simple. The World Health Report Health Systems Financing.
The path to universal coverage. On the other hand, we know well that in the Americas, the hospital-centric biomedical model of care overwhelmingly drives health investment. Funds are usually channeled preferentially to create infrastructure at the specialized levels, negatively impacting the health system's capacity to efficiently meet the population's needs. These deaths could, potentially, have been avoided if health systems offered quality and timely access to prevention at all levels of health care services primary and specialized.
Data retrieved in March The challenges to transforming this reality can seem overwhelming or impossible to achieve, especially within a context of global uncertainty, with some countries facing sluggish economic growth prospects, high levels of government debt, political and social instability, and vulnerability to the unpredictable ravages of natural disasters and disease outbreaks.
According to the International Monetary Fund, economic growth in Latin America and the Caribbean during was the third lowest in 30 years, as a result of ongoing fiscal and external adjustments in some countries and other country-specific factors.
Over the medium term, the projections show that growth is likely to remain constrained at 2. International Monetary Fund. Regional Economic Outlook. Western Hemisphere. Tale of two adjustments. Clearly in this context, the Region cannot rely solely on growth to protect and sustain the enormous social gains and reductions in inequality that have been achieved over the past 15 years.
Instead, the challenge will be to increase investment in people, particularly the poor, despite these trends, using countercyclical policy frameworks to ensure sustainable and equitable long-term growth. Washington DC: World Bank; Indeed the message from the articles included in this thematic series is that even during difficult times and economic stagnation, it is possible to increase public investment in health. PAHO, as part of its commitment to universal health, has developed a framework to help countries identify and utilize existing fiscal space for health.
Increased public resources can come from a wide range of sources, including improved tax collection by reducing evasion and elusion , new or increased public health taxes, reduced waste and corruption and increased efficiency, the prioritization of expenditure in health over other sectors, social contributions, and more.
Every country can do something according to its national context. We know from the experience of some countries that higher levels of health expenditure do not necessarily translate into better health outcomes. Thus, when we advocate for increased availability of public resources for health, we should not forget that those additional resources must be used wisely.
To advance toward universal health, resource allocation should be aimed at increasing equity by prioritizing the first level of care, seeking to improve its response capacity and moving decisively to develop integrated health service delivery networks.
Is it right that a bank should dictate global health strategy to such an extent? Some bank insiders too think that policies need to be more generous. The question is, does it go far enough? This is a major, major issue and it needs to be addressed in Africa. Campaigners like the Jubilee coalition believe that cancelling all debt for low income countries is the solution, as well as being a fitting gesture to mark the new millennium. The Jubilee coalition hopes to deliver a petition with Thus the elimination of debt without appropriate economic policies would do little to eradicate poverty.
It is our hope that HIPCs will seize this unique opportunity to exit, once and for all, from the debt rescheduling process and lay the foundation for sustainable, pro-poor growth. Originally focusing on building dams, roads, and railroads, the World Bank was frequently accused of causing environmental damage, dislocating indigenous populations—sometimes through deception or harassment—and being in a hurry to lend money.
There is no mandatory retirement age, but the first term is for five years. Unsurpisingly, most bank presidents have been prominent bankers. Mr Wolfensohn, an Australian born naturalised American, is the ninth president; he was an international investment banker until he was named by President Clinton in to head the World Bank. Wolfensohn is known for his love of the arts, his sympathy for ecological issues, and his proclaimed desire to tackle poverty and eschew profit.
He has also become famous for his eagerness to to spend time in disadvantaged countries. Criticisms must be internal and constructive I will regard externally-voiced criticism of the bank as an indication of a desire to find alternative employment. The bank is into hard business. The World Development Report identified four major problems with international health care systems: the misallocation of funds to less cost effective interventions; inefficient use of funds, such as purchasing brand name drugs, inappropriate deployment of medical staff and underutilisation of beds; inequity in access to basic health care; and the explosion of healthcare costs outpacing the growth in income.
The reason is that the poor are most likely to spend additional income in ways that enhance their health: improving their diet, obtaining safe water, and upgrading sanitation and housing. A regular criticism, however, has been that the bank has too readily judged success by the amount of lending rather than gauging it by the success of projects.
It is much simpler to measure lending. The bank argues that success is also difficult to gauge because health improvements often take years to become apparent, and other factors outside the HNP sector impinge on outcomes. The past two decades have seen the World Bank shift its focus to improving health indicators and attempt to distance itself from highly criticised policies. Kamran Abbasi , assistant editor.
Author information Copyright and License information Disclaimer. See editorial " The World Bank " on page This article has been cited by other articles in PMC. The past decade has seen it change image from uncaring bully to compassionate stakeholder, focusing on health. It has displaced the World Health Organisation as the major influence behind health policy in poor countries because of its greater funding power. Critics argue that the World Bank and International Monetary Fund increase the debt burden of those countries least able to pay, and that debt relief would be the best way to eradicate poverty.
Open in a separate window. Figure 2. Figure 1. Senior management and new technical networks at the World Bank. Figure 3. Figure 4. Cumulative growth in lending and projects in the HNP sector prices. Conclusion The past two decades have seen the World Bank shift its focus to improving health indicators and attempt to distance itself from highly criticised policies. Table 2 Countries with poorest health, according to World Bank indicators References 1.
Caulfield C. Masters of illusion: the World Bank and the poverty of nations. London: Macmillan;
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