Please find below a draft civil society platform on health/UHC for the new World Bank President, Jim Kim,* for your input by COB Wednesday September 26.
It is a call for the Bank to take a leadership role in helping countries achieve universal health coverage with a focus on removing barriers to access -- and it is timed to the Bank's Annual Meetings happening in Tokyo in two weeks' time. Thank you for your enthusiasm so far about this idea - some of you have shared ideas which we have already incorporated in this draft. We would welcome your priority comments on the draft -- "red line" comments only please (ie., what change(s) if any are essential to your participation in this letter, with specific text suggestions), due to the short time we have. We would like to keep the letter to one page and keep it focused on the Bank.
With Jim Kim at the World Bank we have an unprecedented opportunity to get movement on the issues many of us have been concerned about with the Bank's health operations. Global health is a "theme" at these Annual Meetings (pre-dating Kim's presidency), and there will a high level event on the importance of investment in health, and UHC. While we have a potential ally in President Kim, it is critical that we are able to demonstrate there is public pressure for him to take action on health, especially since he is likely to face some internal resistance to such an agenda.
We are hoping Kim will agree to do a "hand-in" of this petition with a photo op, so we would love to generate a large number of organizational signatures to show him there is serious demand from civil society for this agenda. *Please forward widely*, especially to Southern colleagues and coalitions, and copy me so that I can include them in the email about the final version for sign-ons. We are planning to have the draft letter translated to French as well, and will circulate that as soon as possible.
*Timeline:*
- Comment period -- now until Wed, Sept 26th
- One day for turnaround -- Thurs 27th
- Organizational sign-on period -- Friday Sept 28th through Thursday Oct 4th
- Final version ready Friday Oct 5th
- World Bank meetings the week of Oct 8th in Tokyo, hand-in to Jim Kim, date TBA
*---------------------------------*
Dear President Kim,
We, as civil society organizations working on global health at the national and international levels, call on you to open a new chapter in the World Bank’s health sector work. *Now is the moment for the Bank to become a true global leader in health – by supporting countries to achieve universal health coverage (UHC).* Universal coverage does not just mean protection from catastrophic expenditure. It means that all people, especially the poorest, are able to access quality basic health services when they are needed. Achieving UHC *is* possible in low- and middle-income countries – and it requires bold steps by national governments and the international community, including the World Bank. These include:
1. Removal of all financial barriers to accessing services, including user fees and insurance payments.
2. Robust and sustained public funding from general revenues and international aid – including innovative financing – to build and strengthen health systems to reach all people, especially the poor in rural and remote areas.
3. Investing in improved quality of care to ensure health systems deliver effective and safe services. This means investing in each segment of the health system: health workers, primary and secondary care facilities, health information systems and drug supply chains.
The Bank is well-placed to be a vocal champion of UHC by deploying its knowledge and experience in health system reform, as well as its financial support. But according to a recent evaluation only 6% of health projects from 1997 to 2007 had specific objectives to deliver outcomes for the poor. While the UHC agenda emphasizes care for all rather than targeting as the best way to improve outcomes and reach the poorest, it is crucial that Bank programs and advice impact the poorest populations in developing countries.
For too long, the Bank advised developing countries to levy user fees for health services in order to recoup costs. These “out of pocket” payments are today widely considered to be a major barrier to accessing services, especially for the poor and for women. The Bank now claims to help countries remove fees, but it places substantial pre-conditions on this support. However, there is clear demand from client countries to abolish user fees: 12 countries in sub-Saharan Africa have removed fees for maternal and/or child health services over the last decade. We understand you have recently said the World Bank will not endorse user fees for basic healthcare. We welcome this commitment and look forward to its implementation.
In its policy advice, the Bank has frequently promoted the use of voluntary health insurance schemes. Health insurance has led to universal coverage in some developed nations after extended periods of public investment. However, in developing countries, insurance premiums act as another barrier to affordable health services for large sections of the population, such as workers in the informal and agricultural sectors who are often disproportionately female. Successful community health insurance schemes such as Rwanda’s *mutelles *rely on massively scaled-up public financing to achieve real gains in coverage. In its work with countries, the Bank must now emphasize the critical role of sustained public financing in scaling up to universal health coverage.
*The 2012 World Bank Annual Meetings focus on health. We urge you to lead the Bank to:*
* *
1. Ensure that all of its programs benefit the lowest two quintiles in the countries where it works.
2. Actively support countries to offer care that is free at the point-of-use for all people.
3. Scale up its investments in quality public health systems in developing countries.
4. Support countries to expand public financing, and offer balanced policy advice which does not privilege private sector solutions over tax-financed public health systems.
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*Two comments:*
*1) I would not endorse the phrase " true global leader in health". In fact, we have maintained that the Bank should not be taking the lead in formulating global policy on health*