World Bank aims to bring health care to 1.5 billion people

The World Bank has announced an ambitious commitment to help low- and middle-income countries provide 1.5 billion people with quality, affordable health services throughout their lives by 2030. It marks a major shift for the bank by doubling its previous reach and ambition — the bank’s health programming has reached around 750 million people over the last five years. It will also see the lender maintain its higher spending on health compared to prepandemic levels. In 2023, the bank spent $4.4 billion in health investments, up from $3.1 billion in 2019, according to a bank spokesperson. The 1.5 billion target to accelerate progress toward universal health coverage was announced by World Bank President Ajay Banga on Thursday during a Spring Meetings event held at the institution’s Washington headquarters. It featured ministers of health and finance from low- and middle-income countries, as well as civil society leaders. The move comes as more than half of the world’s population — about 4.5 billion people — cannot access essential health services, according to a joint World Bank and World Health Organization report. A further 2 billion people face severe financial hardship when paying out-of-pocket for the health services and products they need. “When people struggle with the cost of health care or the inability to access health care, it leads to the worst possible outcomes,” Banga said during the event. “If a child in the first 1,000 days of their existence doesn’t get the right kind of nutrition, that has an economic impact forever on that child. They earn between 15% and 20% less every year. So you’ve got to fix what is a fundamental requirement for human existence in the form of health care, and we’ve got to make it available at a price that is affordable,” Banga continued. New money? Health advocates welcomed the bank’s ambition but said achieving it will depend on international donors giving generously to the International Development Association, the bank’s lending arm for the world’s lowest-income countries, alongside other health funds. Banga has said he hopes donors will provide around $30 billion in new funding for IDA during this year’s replenishment. “It looks significant on paper, given that it is 40% more people than what IDA has reached over the past decade in around half the time,” Javier Guzman, director of global health policy at the Center for Global Development, told Devex. “However, there is no clarity on where the money will come from or if there is additional money. This is especially important given that the Global Financing Facility, the flagship program to support the health of women, children, and adolescents hosted by the bank, failed to raise the $800 million target during its replenishment last year. It only raised $445 million,” Guzman added. Joanna Carter, the executive director of advocacy group RESULTS, spoke during the bank’s Thursday session and agreed that donors must step up to the plate. “Where countries are stepping up their investment in health, this has to be an incentive for donors to do more and not an excuse to do less,” Carter said. She also warned that its targets could be counterproductive. “Targets can actually obscure inequities, so we need to ensure financing goes to the most marginalized and this only happens if it is specifically targeted to do so,” she said. U.N. Sustainable Development Goal 3.8 calls for universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all by 2030. The world is off track to meet the SDG’s health goals, according to WHO Director-General Tedros Adhanom Ghebreyesus, who also spoke at the event. “I don’t think, without very serious catch up, we may even reach the SDGs so we have to work harder,” he said. The number of people who need coverage and a lack of finance are the major challenges, but workforce shortages, aging populations, urbanization, pandemics, and climate change are also making it harder to achieve universal health care, Tedros explained. What’s changing? Where in the past the bank’s health work was confined to maternal and child health in 100 countries, the bank’s new push will see the institution support more countries and also “widen the aperture” to provide health coverage to people throughout their lives — from infancy, childhood, adolescence, and into adulthood — and will include tackling noncommunicable diseases, Banga said during the event. In order to ensure impact, the bank will also change the way it measures how many people it reaches by only counting a person who has been seen and treated by a health care worker via an in-person or telehealth visit, as opposed to building a clinic and assuming a number of people have been reached. However, CGD’s Guzman questioned this per visit approach. “The goal is not about providing sustainable access to essential health services, it comes down to reaching 1.5 billion people with an in-person visit or a telehealth consultation,” he said. In low-income countries, the bank will also focus on expanding its operations to hard-to-reach areas. In middle-income countries the bank’s work will focus more on technical assistance and using financing from the International Bank for Reconstruction and Development, the bank’s lending arm for middle-income countries, “to incentivize government investments in health and regulations that move a country forward,” according to a press release. The private sector — which, depending on the country, can account for an estimated 30% to 80% of health care provision — will be crucial to achieving the goal, Banga said. The bank will work here by helping countries set up the necessary regulatory frameworks and policies needed to entice more private investment, especially in local production of medications and protective gear and fortifying processed foods, Banga said. Primary health care Speakers during Thursday’s event called on the World Bank and other donors to finance primary health care and to support national health systems as part of the effort. For too long, donor cash has gone to vertical funds, leading to fragmentation, they said. “What we see globally is vertical programming and I think the single most impactful way to maximize our limited resources is to fund a primary health care system instead of individualized vertical diseases,” said Senait Fisseha, vice president of global programs at the Susan Thompson Buffett Foundation. Dr. Muhammad Pate, minister of health for Nigeria, asked donors to follow national government priorities. “There are some shifts that are needed, with countries at the center,” he said, adding that real progress can be made if “our supportive global partners come to back us up with financing and technical support but following [the] leadership of government and using national systems which are more sustainable,” he said. Carolyn Reynolds, co-founder of the Pandemic Action Network, told Devex that the bank’s announcement was “welcome and urgently needed.” "As health systems around the world are still reeling in the wake of the COVID-19 pandemic, and with historic reversals in development and poverty reduction, more and sustained investments in primary health care, including through a larger IDA21 replenishment, are essential to help lower-income countries recover, reduce inequality, and be better prepared for emerging climate and health threats,” she said.