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<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: right"
align=right><SPAN lang=EN-GB><FONT size=2>Peoples Health
Movement</FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: right"
align=right><SPAN lang=EN-GB><FONT size=2>Global Secretariat: <st1:place
w:st="on"><st1:City w:st="on">Cairo</st1:City>, <st1:country-region
w:st="on">Egypt</st1:country-region></st1:place></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: right"
align=right><SPAN lang=EN-GB><o:p><FONT size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: right"
align=right><SPAN lang=EN-GB><o:p><FONT size=2></FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: right"
align=right><SPAN lang=EN-GB><o:p><FONT size=2></FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><o:p><FONT size=2></FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><o:p><FONT size=2></FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><FONT size=2>The People’s Health Movement has strong reservations
about the World Bank Health, Nutrition and Population division’s draft 10 year
strategy, and in particular the aim to expand the influence of the Bank on
health systems policy and development. We welcome the fact that other civil
society organisations have expressed similar reservations. </FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><o:p><FONT size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><FONT size=2>Although the draft strategy claims to have benefited
from “extensive” consultation with civil society, this has not been our
experience. </FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN lang=EN-GB><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><B
style="mso-bidi-font-weight: normal"><I
style="mso-bidi-font-style: normal"><SPAN lang=EN-GB><FONT size=2>The role of
the Bank in the health sector</FONT></SPAN></I></B></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><o:p><FONT size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><FONT size=2>The World Bank is an important source of finance for
health sector development and health programme implementation in low and
middle-income countries (LMICs). It also has a significant influence on
macro-economic and fiscal policies. Any health sector strategy of the Bank
should therefore rightfully incorporate the explicit aim of strengthening health
care systems and enabling LMICs to increase health care expenditure to adequate
levels. </FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><o:p><FONT size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>We also agree with
the Bank that the proliferation of global health financing mechanisms and
initiatives obstructs the development of coherent, long-term and sustainable
health systems development agendas. Donors, global public-private initiatives
such as GAVI and the Global Fund, UN agencies, and the International Financial
Institutions (particularly the Bank, the IMF and the General Agreement on Trade
and Services) are fragmenting health care systems and pulling Ministries of
Health in different directions. <o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>We therefore welcome
the Bank’s recognition of the problems caused by uncoordinated, multiple and
over-verticalised health programmes. But, together with other actors, the Bank
must take further action to improve coordination amongst donors, rationalise the
global health architecture and strengthen the capacity of LMIC Ministries of
Health to provide effective and accountable stewardship at the country level.
<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>The Bank also
correctly emphasises the importance of multi-sectorality. Improving household
food security and access to water, sanitation and education, as well as
developing tele-communications and road infrastructrure will have profound
positive health impacts in LMICs. Here, the Bank has an important role, although
the lack of progress (in some cases, deterioration) in reducing malnutrition,
poverty and illiteracy suggests the need it to redouble its efforts in these
sectors.<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><B
style="mso-bidi-font-weight: normal"><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></B></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><B
style="mso-bidi-font-weight: normal"><I
style="mso-bidi-font-style: normal"><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt"><FONT size=2>Health systems
policies<o:p></o:p></FONT></SPAN></I></B></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><B
style="mso-bidi-font-weight: normal"><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></B></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>Although, the Bank
has an important role to play in improving health and strengthening health
systems, as noted above, it does not follow that it should provide a lead role
in advising and influencing LMICs on health systems policy.
<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><FONT
size=2><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">The historical legacy
of </SPAN><SPAN lang=EN-GB>damage done by structural adjustment programmes and
poorly conceived health sector reform packages challenges the Bank’s claims of
expertise and comparative advantage</SPAN><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt"> when it comes to “the design of health care
financing systems”, “demand-side interventions”, “health purchasing
arrangements”, the establishment of private insurance markets and developing
</SPAN><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN">“the
right financing incentives for research and development or for efficient
allocation of human resources”.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>The Bank’s track
record in these areas has been characterised by an adherence to a school of
thinking that has undermined Ministries of Health and <st1:PersonName
w:st="on">public health</st1:PersonName> principles; worsened health care
inequities; magnified the inefficiencies and market-failures associated with
commercialised health care; encouraged the fragmentation of health care
provision; and at best, tolerated the widespread existence of regressive and
poverty-creating user fees. <o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>Although the
neoliberal rhetoric of the Bank has softened, the draft health strategy betrays
a continued and inappropriate ideological bias towards the market. The document
reveals:<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l1 level1 lfo2; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">support
for the continued existence of competitive, private insurance markets in
MICs;<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l1 level1 lfo2; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">the
encouragement of so-called “production-based provider financing” in which health
care providers are financed through expressed demand (as opposed to
appropriately defined ‘needs’);<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l1 level1 lfo2; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">a
continued appetite for quasi-market purchaser-provider splits and the exposure
of public providers to market competition; <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l1 level1 lfo2; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">an
explicit statement that it will use the International Finance Corporation and
the Private Sector Development Unit to encourage further the privatisation of
health systems; and<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l1 level1 lfo2; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">an
over-emphasis on the significance and effectiveness of community-based insurance
schemes in LICs.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>Many of these
policies lack any evidence that they are capable of achieving the multiple
objectives of efficiency, effectiveness, equity and public satisfaction.
<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN lang=EN-GB><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><FONT
size=2><B style="mso-bidi-font-weight: normal"><I
style="mso-bidi-font-style: normal"><SPAN lang=EN-GB>Omissions and
gaps</SPAN></I></B><B style="mso-bidi-font-weight: normal"><I
style="mso-bidi-font-style: normal"><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt"><o:p></o:p></SPAN></I></B></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><FONT
size=2>The Bank’s policy orientation is also revealed by the omissions and gaps
in its draft health strategy. <o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><FONT
size=2>There is no mention, let alone any strategic direction, on how trends
towards widening disparities in health care consumption and expenditure in LMICs
will be reversed.<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><FONT
size=2>The ‘globalisation of health care’ which incorporates the massive
movement of scarce and skilled human resources from poor to rich countries as
well as the internal migration of skilled health workers from the public /
non-profit sector into commercial enterprises (including a growing number of
facilities catering for ‘medical tourists’ from developed countries) is not
mentioned.<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><FONT
size=2><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-fareast-language: ZH-CN">While
constant reference is made to the expanded and positive potential of the private
sector, little attention is paid to the need to strengthen public sector
management and service provision capacity. Any emphasis on the public sector is
limited to promoting the Bank’s apparent expertise in combating corruption.
Revealingly, there is no mention of the </SPAN><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN">corrupt
and unethical effects of commercializing health care systems. There is also
little distinction made between the for-profit and non-profit private sector
thereby glossing over fundamental differences between the NGO, faith-based and
commercial sectors. <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB><FONT size=2>The underlying obsession with financial incentives
reflected in the draft strategy is corroborated by an inadequate mention of
non-financial incentives, trust and public accountability mechanisms to improve
health systems performance.</FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
lang=EN-GB
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><FONT
size=2>There is also an absence of any plans or strategies to establish the
basic human infrastructure of health systems consisting of nurses, technicians,
doctors and other allied health workers, nor how different health financing
arrangements will ensure the appropriate remuneration, number, mix and
distribution of skilled personnel.<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><FONT
size=2>While the strategy states that sufficient and sustainable funding must be
raised equitably and predictably “in a way that minimizes economic distortions
(and) contributes to sound fiscal management”, there is no mention of the
controversial IMF policies that effectively cap public expenditure in ways that
prevent governments from paying their health workers an adequate living wage.
<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><FONT
size=2>While recognizing the fundamental impoverishment of both communities and
health systems in LICs, nothing is said about the need to allow LICs a realistic
chance of achieving economic growth or to establish new sources of global
financing (e.g. through a currency transaction tax or by expanding the remit of
airline taxes). Instead the focus continues to be limited to leveraging private
household finance. <o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><FONT
size=2><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN">Finally,
</SPAN><SPAN lang=EN-GB style="COLOR: black; mso-bidi-font-size: 11.0pt">despite
the World Health Organisation being the UN specialised agency for health with a
wealth of relevant experience and institutional memory, no mention is made of
WHO's comparative advantage in providing leadership in the area of health
systems strengthening and programme implementation. </SPAN><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify; mso-layout-grid-align: none"><SPAN
style="mso-bidi-font-size: 11.0pt; mso-fareast-font-family: SimSun; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><B
style="mso-bidi-font-weight: normal"><SPAN lang=EN-GB><FONT
size=2>Conclusion<o:p></o:p></FONT></SPAN></B></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN lang=EN-GB><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>There are good
reasons to oppose any positioning by the World Bank to be the lead global agency
responsible for guiding health systems policy. <o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>If the World Bank
wants to influence health systems policy, it must signal an explicit retreat
from the many failed and harmful policies of the past three decades. It needs to
recognise the limitations and perverse outcomes of markets, competition and
financial incentives (particularly in environments where regulatory capacity is
weak), and it needs to recognise the fundamental importance of public service
provision. The latter does not mean advocating for the establishment of rigid,
monolithic and bureaucratic public sector systems. There are ways to ensure
efficiency, effectiveness, accountability and responsiveness within health care
systems that are universal and public in nature (including public-public
partnerships between government and non-profit private
actors).<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>We therefore call on
the Bank to re-write its health strategy to better reflect a commitment
to:<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l0 level1 lfo1; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">Rebuild
the capacity of Ministries of Health and ensure that salary pay scales
disparities between the public and private sectors are monitored and minimised;
<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l0 level1 lfo1; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">Reign
in and reverse the commercialisation of health care, whether practised by public
or private health care providers;<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l0 level1 lfo1; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB
style="COLOR: black; mso-bidi-font-size: 11.0pt">Shape the private sector to
serve the public interest;</SPAN><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt"> <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l0 level1 lfo1; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt">Incrementally work towards health care
financing systems that are pooled at the country or provincial / state level and
which allow for optimal risk-sharing and
cross-subsidisation;<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l0 level1 lfo1; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB
style="mso-bidi-font-size: 11.0pt">Establish mechanisms to direct health care
inputs and ensure patterns of health care expenditure that are equitable and in
line with need; and<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in; TEXT-ALIGN: justify; mso-list: l0 level1 lfo1; tab-stops: list .25in"><FONT
size=2><SPAN lang=EN-GB
style="FONT-FAMILY: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN
style="mso-list: Ignore">·<SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></SPAN><SPAN lang=EN-GB style="mso-bidi-font-size: 11.0pt">Empower
communities and strengthen public accountability systems at all levels of the
health care system. <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>We look forward to
being able to engage with you further on these important issues and thank you
for your time in reading this letter.<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>Dr. David McCoy,
B.Med, M.Phil, DrPH, MFPH (<st1:country-region w:st="on"><st1:place
w:st="on">UK</st1:place></st1:country-region>)<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><FONT size=2>On behalf of the
Peoples Health Movement Global Secretariat<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><SPAN
lang=EN-GB style="mso-bidi-font-size: 11.0pt"><o:p><FONT
size=2> </FONT></o:p></SPAN></P></FONT></DIV></BODY></HTML>