The International Monetary Fund (IMF) and World Bank Group (WBG) held the Civil Society Policy Forum from April 4 to 15, ahead of the organizations’ 2022 Spring Meetings, to be held in Washington, D.C. In this context, a coalition of organizations fighting for public healthcare services took the opportunity to raise the alarm about the privatization of health.
In response to the COVID-19 pandemic, the WBG increased private investment in healthcare. This is despite the fact that in many countries, privatization of healthcare has resulted in the commercialization, diminished quality, and limited access to healthcare.
During the session “The World Bank Group’s Investments in Private Healthcare Provision: What Implications for the Right to Health?”, panelists drew attention to the repercussions of privatization.
Commercialization leads to two-tiered healthcare
As the private sector arm of the WBG, the International Finance Corporation (IFC) plays a major role in development. Marco Angelo, global health advocate at Wemos, noted how IFC investments in healthcare increased during the period from 2017 to 2021. But although IFC projects focus on improving quality and availability of health services and products, Wemos found that only one out of 88 projects mentions equitable access as an expected development impact. Angelo emphasized: “while the IFC investments that go to the manufacturing and supply of healthcare products have the potential to strengthen health systems, the IFC also invests in areas whose contribution to Universal Health Coverage and specifically equitable access is less likely.”
Rossella De Falco, program officer on the right to health at the Global Initiative for Economic Social and Cultural Rights (GI-ESCR), shared findings from GI-ESCR reports on Kenya and Nigeria during the COVID-19 pandemic. In Nigeria, the gradual commercialization of healthcare services since the mid-1980s has created a dual system of care in which access is determined by socioeconomic status and wealth—health is a commodity, not a right. In both Nigeria and Kenya, the GI-ESCR report concludes, access to COVID-19 treatment, testing and vaccines is driven by such inequity. Moreover, many private facilities overcharge, issue fake tests, or use expired reagents for testing while underfunded public healthcare services remain unable to meet the demand for care.
Allana Kembabazi from the Initiative for Social and Economic Rights decried the IFC’s direction of money towards for-profit healthcare models, expressing concerns about an apparent dichotomy within the World Bank’s institutions. “One arm of the Bank is working to eradicate poverty, while another arm, the IFC, is contributing to it by promoting private investments in healthcare,” Kembabazi said. “We know that out-of-pocket payments and expensive health services result in health inequalities, so it is hard to understand why the World Bank would push these models.”
Inadequate funding and neoliberal arguments undermine public health systems
WBG panelist Andreas Seiter, Global Lead for Private Sector in the World Bank’s Health, Nutrition & Population Global Practice, observed that private healthcare is in demand and paid for by citizens who can afford it, particularly in countries where public health services delivery is weak. He agreed that for-profit health care, if left alone, can lead to inequality. Baba Aye of Public Services International highlighted that the problem is not an inherent weakness of public health systems, instead, the problem is inadequate funding and ideological arguments against public health.
There are clear ways in which entities such as the WBG and IMF can support and invest in increasing healthcare resources while strengthening public services, including offering more support for larger public investment in health.
GI-ESCR’s reports recommend that both Kenya and Nigeria increase budget expenditure on healthcare to at least 15%, in line with the Abuja Declaration. These governments should ensure universal access to health insurance, reverse current prioritization of private sector engagement in healthcare, and invest in strong, quality public healthcare systems for all.
Civil society has also identified specific areas of concern where private sector investments and interventions in global health pose significant risks. To address these risks, STOPAIDS developed a set of principles based on those areas of concern with regard to engagements wherein “aid is used to fund for-profit private sector actors to contribute to global health goals, and where there is partnership or engagement between public and private actors to achieve specific health goals and advance the Universal Health Coverage (UHC) agenda.”
Panel moderator James Cole of STOPAIDS presented those principles which state that private sector engagement in global health could be acceptable if it didn’t undermine public healthcare; was patient-centered and driven by social accountability for health, rather than based on commercial interests; had a demonstrated public health impact which is evidence-based and promotes equitable access; has strong transparency and accountability mechanisms in place; and promotes human rights. Finally, the STOPAIDS principles warn that entities such as the WBG should not promote private sector investment in health in countries where there is no effective regulation of the private health sector.
Entities such as the WBG and IMF as well as governments should heed these calls from voices on the ground and civil society around the world to enable meaningful progress towards realizing the right to health for everyone.
The comments of the Global Lead for Private Sector in the World Bank’s Health, Nutrition & Population Global Practice were amended on request.
