TCS Daily


The World Bank Gets Introspective

By James Peron - January 9, 2006 12:00 AM

Time magazine recently named Bill and Melinda Gates, along with pop star Bono, as "Persons of the Year". Through their foundation, the Gateses have been pouring billions into programs designed to help the health of residents in poor nations.

But any good businessman wants to know what return various projects generate. So Gates helped finance a World Bank investigation into the efficiency of measures to improve the health of the world's poor.

The World Bank has now released that report, "Reaching the Poor: What Works, What Doesn't, and Why." And it is sure to stir controversy. Its authors studied the results of programs meant to help "poor people battle illness and disease". But what the report found was that even "programs designed to reach poor people often end up instead helping the better-off."

In a press release the World Bank said that "in almost all of the more than 20 countries surveyed, the richest 20% of the population received more, or as much as, ... the government's subsidized maternal and child healthcare services as the poorest 20%." Davidson Gwatkin, one of the co-authors of the report, said it "shows there's a huge difference between just thinking you're reaching the poor with beneficial healthcare services, and actually succeeding."

The report notes that "Few resources spent in the health sector reach the poor." And: "A fast-growing body of empirical evidence has exposed as incorrect any assumption that spending on health necessarily means reaching and serving poor people."

They note that studies of Cote d'Ivoire, Ghana, Guinea, Kenya, Madagascar, South Africa and Tanzania all have shown that government "spending on health was found to favor upper-income groups" and that "health spending was not much different in South Asia".

The report leaves unasked the question as to why the richest members of the population are receiving funds from such programs at all.

Dr. William Foege, a former head of the Centers for Disease Control who received the highest award possible from the National Academy of Sciences for his work in public health in poor countries, is now employed by Gates to advise on health issues. He agrees with the results of the report: "Over the decades, global health programs have attempted to reduce health inequities by targeting the poor, but most evaluations have shown that even programs consciously targeting the poor, end up providing more benefits for the rich."

The World Bank remains optimistic that such programs for the poor can be made to work. Abdo Yazbeck, one of the co-authors, says that their findings "mark a promising beginning that provides important grounds for hope."

On the other hand, the World Bank was founded almost six decades ago and only now is releasing reports showing that some of the most promoted programs for the poor in the history of the world are more likely to benefit the rich. It seems to have taken a businessman looking at the return on his donations that got the matter investigated. Now they just need an economist to explain to them why this is inevitable with politically-based programs.

James Peron has written for various publications around the world and is the author Exploding Population Myths. He lives in New Zealand.
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2 Comments

Same thing
It is interesting that this article is about a World Bank report called "Reaching the Poor: What Works, What doesn't and Why?" It is curious since the Bank published a report in 1998 called "Assessing AID: What Works, What Doesn't and Why." Perhaps they have never considered "aid" to be about "reaching the poor." Or perhaps they didn't like the answers in the first report (Nobel Laureate, Joe Stiglitz wrote "Assessing AID" and was reported fired since it said that only policy reform works, not project lending, the mother's milk of the Bank).

In either case, it is useful to note that all societies are essentially political, even dictatorships and absolute monarchies, so can we be surprised that elites benefit from government programs? Come on. I would be surprised if they didn't. And this is the weakness of all foreign aid. No government can avoid catering to elites and so must give them benefits from whatever it is that these governments do.

Who's running the World Bank?
Don't ya think Paul Wolfowitz being in charge has SOMETHING to do w/the changes or the report? I found it amusing that you left him out of the equasion completely and attributed it to Gates entirely.

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