World Bank President Jim Kim has been building support to achieve universal health care by 2030, and wants the bank to play a major role in helping low-income countries achieve that goal. His right hand man in that effort is Tim Evans, who Kim brought on board last June as director of health, nutrition and population.
In April, after an exhaustive recruitment and selection process, Evans was chosen to be the new senior director of the health global practice starting July 1.
Evans’ appointment was welcomed by staff and observers in global health circles. A former colleague of Kim’s at the World Health Organization, Evans has more than 20 years of experience in international health at institutions like the Rockefeller Foundation and the Harvard School of Public Health. In fact, Evans’ father, John Evans, was the first director of health programs at the World Bank. He was appointed in 1979 by Robert McNamara, the former U.S. Defense Secretary who later became World Bank President, to run the bank’s newly formed health office, a division then known as Population Health and Nutrition.
Looking back on the last 35 years of health work at the bank, the younger Evans sees the current push for UHC in low-income countries as an important next step in the evolution of the sector, as well as a critical contribution to achieving the World Bank’s goal of eradicating extreme poverty by 2030.
"We know if we don't move health systems in this direction, they are going to be a major roadblock to the achievement of the bank's goals," Evans said during an interview with Devex, citing WHO’s estimate that over 100 million people fall into poverty each year due to pay-as-you-go medical expenses.
The World Bank has made clear it supports the inclusion of UHC as a goal in the post-2015 development agenda and is already working with low-income countries to help them get there. Evans said the bank’s work will be focused on helping client countries facilitate reforms on access to financing and service delivery.
“It's an exciting moment at the bank to move forward on an agenda to not only figure out what countries need to do, but be very attentive to how they implement it, because the devil’s in the details,” he explained. The bank has been working closely with the Joint Learning Network, a group of low-income countries working together to develop implementation solutions, as well as on its own tools for countries to assess their health systems and implement reforms.
In April, the World Bank released a new tool to help countries assess their readiness for national coverage systems.
One important way the Washington, D.C.-based institution can will help these nations achieve better health delivery, Evans said, is results-based financing, which ties the disbursement of loans to specific health outcomes. That model has already been tested in countries like Argentina, Rwanda and Burundi, where it contributed to major improvements in child and maternal health.
“If you structure incentives into the delivery to achieve results- for example, coverage of the population in remote areas — systems are much more likely to achieve those results,” and countries often do it more quickly and efficiently than they would have otherwise, explained the future World Bank health chief.
While there is concern from some stakeholders about how measurable progress toward UHC will be, Evans said he is confident that the global health community will come up with “very good measures that could fit within the targets and indicators of a development agenda.”
“I think it's good for people to be cautious, to ask what we can really measure, what the strategies are, and how do we get there, because that's just good critical reflection,” he explained, pointing out that those goals should be “suitably ambitious.”
Cross-sectoral interventions ‘no-brainers’
As for concerns about whether a UHC goal could divert effort and attention from more specific health indicators, Evans doesn’t think it’s an either-or proposition.
"It's not as if because we're interested in more than one disease, you can't measure coverage,” he said. “We're just saying you need to measure coverage across multiple services, multiple diseases, in order to get a sense of that comprehensiveness, which is what populations expect.”
Within the new global practices, Evans sees the focus on delivery as essential to making the bank’s goals anything more than a pipe dream and increased collaboration across sectors as critical to ensuring the best health outcomes for client countries.
He called some of those cross-sectoral interventions “no-brainers,” like women's education and safe roads, but also mentioned less obvious areas of synergy, like promoting nutrition through agriculture, for example, or fiscal policy reforms like implementing excise taxes for tobacco.
“That's what defines the bank,” he said “We're not a health institution only, we’re not an agricultural institution only, we're not an education institution only, so the opportunity to engage and develop joint projects is part of what makes this place such an exciting institution.”
Join the Devex community and access more in-depth analysis, breaking news and business advice — and a host of other services — on international development, humanitarian aid and global health.