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Discussion Paper – MAKING IT WORK: What role for MDBs in financing health for all?

By 11 April 2023June 22nd, 2023No Comments

At the occasion of the World Bank Group Spring Meetings, Global Health Advocates release a discussion paper on the role of MDBs in financing health for all. A few weeks later, we added a set of recommendations to the original paper.

As the world is recovering from the COVID-19 pandemic and moving slowly but surely into the arms of a global recession – a context also marked by deteriorating macroeconomic conditions, pressure on national budgets, and a displacement of donor funds due to the war in Ukraine; the aid funding environment for global health financing in 2023 and beyond is looking preoccupying. What’s more, many countries are projected to spend less on health than their pre-pandemic levels through 2027. Considering the scarcity of existing funding for global health and keeping in mind that more financing will need to be mobilised to achieve Sustainable Development Goal n°3 on health and wellbeing, it is essential to question how existing resources are being spent – in other words looking at their efficiency, as well as ask what the best channels to leverage are for greater impact.

The pandemic has highlighted the urgent need of collective actions and improvements to the international architecture for global health – one that is based on equity and focused on contributing to fostering equitable, universal and affordable access to health care and services, strengthening health systems, as well as ensuring the prevention, preparedness and response (PPR) to future health emergencies. It is evident that greater investments in PPR are required, including when it comes to decentralising pandemic funding, increasing manufacturing capacity in the Global South, and strengthening health systems.

In this alarming context, the landscape of development finance has to be challenged. Many countries are calling on finance institutions and development banks to better support countries vulnerable to such shocks. Beyond helping build greater resilience at country level, these actors have a vital role to play on the international stage in the pursuit of the SDGs by 2030, which means maximising their impact on development in the coming years. The challenge is also to redefine the role of MDBs in financing global health, looking at when they are most relevant and where their model need to be readjusted. Considering the broader landscape, it will also be vital to assess how they can fit within it to avoid duplication or even competition to instead increase collaboration and closing of gaps in health financing needs.

Since 2020, MDBs have disbursed tens of billions of dollars to help countries deal with the consequences of COVID-19. Funding was provided for social protection, budget support and to respond to the spread of the virus and its many consequences – a safety net which proved vital to the health of billions on the planet. Yet, their role in the Global South is nothing new. Prior to the outbreak, MDBs were already ranking amongst the biggest funders of global health, providing an essential source of financing for LMIC health budgets.

While currently necessary, MDB health financing does not come without caveats or critique. Several are linked with the negative effects of privatisation on health care and services, as well as the lack of accountability and impact assessment of these institutions and their financing mechanisms. A more cohesive and comprehensive health financing agenda also remains to be agreed. Critics have pointed out the lack of transparency of MDBs, questioning their priority setting and governance, which is mostly Global North driven and neglects civil society technical expertise despite what it could mean for a more equitable allocation of funding.

Considering their leveraging capacity, the role of MDBs in global health is meant to tremendously increase in the coming years to help close the funding gap. Though, the question remains: does the key role MDBs play in global health is ensuring that their financing have a truly equitable and sustainable impact and do they leave no one behind?

This discussion paper therefore aims at assessing the ability of MDBs to effectively contribute to achieving global health justice. It starts by giving an overview of their health-related activities with a special focus on the COVID-19 response, before interrogating how MDBs fit within the current and future global health ecosystem. It also draws attention to the conditions under which MDBs could unlock their full potential to play an active role in improving health for all, weighing risks versus opportunities.

To go further, we also encourage you to have a look at this analysis of the implementation of the World Bank’s health emergency response mechanisms during the COVID-19 crisis that was compiled by ASAPSU, another member of the ACTION partnership, as part of a coalition of 10 West African civil society organisations.