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‘No medicine is better than bad medicine’ - PHA 2000 delegates blast World Bank policies on health - Daily Alert - People's Health Assembly - 7 December 2000

Daily Alert - 7 December 2000

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‘No medicine is better than bad medicine’
PHA 2000 delegates blast World Bank policies on health

 
He came, he defended the World Bank- but failed to impress anybody at the People’s Health Assembly.
 
Senior Bank representative Richard Lee Skolnik was blasted by delegate after delegate on the third day of the Assembly blaming the Bank’s policies for the devastation of Third World economies, public health systems and the lives of the poor. And at the end of a special four hour session on ‘The World Bank faces the People’ hundreds of delegates raised their hands to say “yes” when asked whether the Bank was guilty of pursuing policies detrimental to the health of poor people around the globe.
 
“The World Bank must be dismantled” said Antonio Tujan, a long-time social activist from the Philippines pointing out how the Bank’s promotion of neo-liberal economic policies in his country had only resulted in the commercialization of health-care and benefited drug multinationals. Less than 3 percent of the US$ 1.8 billion dollars given in loans by the World Bank to the Philippines he said were being spent on public health. “No medicine is better than bad medicine” he said calling for a rejection of the Bank’s policy prescriptions.
 
“We don’t need charity but justice” said Charles Mutasa of Zimbabwe blaming the World Bank for a global economic system in which Africa was now caught in a debt trap. “The money spent by African countries on servicing debt is now four times the amount they spend on health and education” he said accusing the Bank of helping transfer resources from the poor to the rich.
 
Thelma Narayan from India called the World Bank an ‘undemocratic’ institution which functioned with no transparency and was controlled by United States which dominated most of its decision-making. She asked who will take responsibility for the disruption in the lives of people and even the deaths caused by World Bank promoted projects. Muzaffar Ahamed of Bangladesh accused institutions like the World Bank of co-opting politicians, bureaucrats, NGOs and making them into compradors. The NGO’s he said were being funded and pushed by the World Bank as the main provider of health services to the public and the role and responsibility of governments was being undermined.
 
In his speech to the PHA 2000 delegates Richard Skolnik, Regional Director for Health, Nutrition and Population for South Asia at the World Bank admitted that the Bank’s structural adjustment policies in the past did not pay attention to the its impact on the poor. “In the last ten years however the World Bank has asked governments to spend more on the social welfare projects, particularly on health” he said. He denied that the Bank recommended the wholesale privatization of health-care and said that they asked for cuts in subsidies only in sectors like power and infrastructure and not health. He added that the World Bank is the largest lender for programs to control diseases like TB, Malaria, Polio and HIV/AIDS. In Bangladesh the World Bank is the largest supporter of nutrition programs.
 
Delegates at PHA 2000 however countered Skolnik’s defence of the Bank and pointed out that its policies promoting privatization of state-owned companies, cut in subsidies to infrastructure projects and putting profits before people had affected the health of the poor all over the world. World Bank loans they said came with strings attached that weakened the role of the government and allowed only private corporations to flourish at the expense of the people.
 
“The New World Order is structured in ways that discriminate against poor countries” said David Legge of Australia pointing out that the World Bank was a key operator in the running of the global economic system that kept large portions of the world in perpetual poverty.
 
PHA 2000 delegates also called for greater cooperation between countries in the South to shake off the dependence on loans from institutions like the World Bank. The four-hour session with the World Bank representative was frequently punctuated with slogans against the Bank’s policies and applause for speakers who countered Skolnik’s defence of the Bank with specific examples of how they were actually harmful to the poor.
  

BANG! BANG!

In Hindi they call it ‘Meethi Churi’ (literally it means a ‘sweet knife’) – the art of cutting an adversary to pieces with polite words. And though there is no such term in Tagalog Antonio Tujan Jr. of the Philippines demonstrated this principle to devastating effect in his response to World Bank honcho Richard Skolnik’s attempts to justify his organisation’s policies. The following is the text of his speech.
 
The World Bank engages in a lot of anti-poverty rhetoric to cover up for the fact the damaging effects of the neoliberal policies of the Washington consensus are causing so much poverty and hardship in the Third World. But how different is its post-Washington consensus with all its rhetoric on poverty alleviation?
 
To look behind the rhetoric, let us see its actual practice. Let us look at the current World Bank program in the Philippines ending 2001 entitled “Fighting Poverty for Lasting Results” and see if this commitment to health and poverty alleviation is true. The current program covers $1.8 billion of which less than 40% has so far been drawn by our very inefficient government.
 
In this program, health covers less than 3% of the funding. And most of these funds go to projects on women’s reproduction, where inserted somewhere in the project description is its real intent of population management. So the amount and nature of the projects do not really make much difference for people’s health. In fact, the Subic Bay freeport zone, the former US naval base which has been turned into a haven for US transnational corporations like Oriental Petroleum, receives larger funding for improvement of services and infrastructure from the World Bank than all the health projects.
 
The bulk of Bank funding goes to supporting the banking sector (16%) and infrastructure (27%) which ensure the continuation of the Bank’s neoliberal policies for the country. The rural sector also receives a substantial amount (25%) but much of this goes to financing agribusiness corporations.
 
There may be a lot of debate regarding whom to blame for the debt crisis that hit the Third World countries or the Structural Adjustment Programs that sealed their doom economically and socially. But definitely, the World Bank shares much of the blame for the poverty and the destruction of people’s health.
 
First, the debt crisis itself has resulted in wide-scale immiserization of the population of Third World countries. The overall effects of the debt crisis mean the loss of jobs and livelihood and the challenge to the wellbeing and health of the population.
 
Second, forcing these countries to pay for their debts can only mean the reduction of social spending, including health. This is disastrous for these countries whose populations need more support and free health services but end up with less public health workers, facilities and supplies.
 
The adoption of the neoliberal Washington consensus has meant the implementation of a policy of rationalization of the public health service according to a market paradigm. This is implemented through several strategies such as the corporatization of health service management which passes the burden of supporting the public health system to the impoverished masses through user fees and reducing expenses by contractualization and other means of strangling the public health workers.
 
Commercialization is no longer eschewed but actively promoted as corporations are asked to support public health in exchange for product promotion. Institutions and operations that can be profitable to corporations, such tertiary hospitals and the like are privatized in order to earn revenues from the sale of state assets and reduce government spending for the upkeep. In the meantime, the public is left with no recourse but to pay increasingly expensive hospitals, tests and medicines.
 
The Washington consensus has meant the progressive destruction of the people’s health agenda. When the financial rug is pulled from under already-ineffective government health programs, the immediate effect if the marginalization or destruction of effective primary health care. Corporatization and privatization of the public health system means the shift from preventive health care to a curative paradigm or the medicalization of people’s health.
 
Before long, as in the Philippines, the HMOs and health insurance corporations proliferate and take over the health system. Furthermore, TNCs involved in medical supplies and the like bring pressure to buy up local hospitals and clinics, public or private.
 
The World Bank’s post-Washington consensus talks about poverty alleviation and health service when the core of the World Bank paradigm remains neo-liberal and the bulk of its funding ensure the implementation of this program. Unless this situation is fundamentally changed, its rhetoric and program for NGO consultation is mere lip service and political cooptation of civil society into its neoliberal corporatist program.
 
Furthermore, its program of increasing NGO participation in its projects, beyond coopting these organizations, means transferring the burden of health care on civil society from governments. While the initiatives of NGOs and people’s organizations for promoting health must be developed as the alternative to the mainstream corporatist health services, we must not allow government’s to cop out on their responsibility to provide effective health care for all.
 
After more than fifty years and various phases of development financing ending with the post-Washington consensus, the World Bank apparently cannot or does not learn from its mistakes. I wonder if no medicine then would be better than bad medicine from the World Bank.
 
I believe that the World Bank must be dismantled. It must be replaced with an international development financing agency that truly recognizes the objective of equity and genuine development for our peoples and countries. This we can achieve by promoting people’s empowerment and upholding the people’s sovereignty. Only until then can we have genuine governments of the people, and achieve the people’s health and wellbeing.
 
 

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