World Bank Faces the People - Presentations - People's Health Assembly - December 2000
Panel Reaction: World Bank Faces the People
Antonio Tujan Jr.
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Thank you very much for inviting me to address this important assembly. Mr. Skolnik of the World Bank has just said that the World Bank is a major actor in poverty and health and there is a lot of good work.
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 corporatisation 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 contractualisation and other means of strangling the public health workers.
Commercialisation 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 privatised 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 marginalisation or destruction of effective primary health care. Corporatisation and privatisation of the public health system means the shift from preventive health care to a curative paradigm or the medicalisation 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. Thank you.
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