United States seeks to roll back reproductive health
Washington D.C., April 25 -- At a board meeting Tuesday to discuss the "The World Bank Strategy for Health, Nutrition and Population Results", the U.S. tried, single-handedly, to roll back internationally agreed language dating from the Cairo Population Conference of 1994, which is endorsed by the World Bank.
The language in the Cairo Conference's "Program of Action" was adopted in 1994 by 179 countries, including the United States.
Yesterday, the U.S. Executive Director, Eli Whitney Debevoise II, objected to the internationally agreed language of Cairo, specifically the words "reproductive health services" and "reproductive rights". The United States tried to introduce new language on "age appropriate" provision of services, which would curtail provision of services to adolescents.
See comments for full story and the statement of the World Bank Executive Directors
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Statement by Executive Directors: Svein Aass, Gino Alzetta, Eckhard Deutscher, Giovanni Majnoni, Alexis Kohler, Caroline Sergeant and Herman Wijffels
Date of Meeting: April 24, 2007
Healthy Development: The World Bank Strategy for Health, Nutrition and Population Results
Providing assistance in the health sector is one of the World Bank’s core businesses, and as such it is fundamental that the Bank’s has a comprehensive and operational strategy to guide its work in this important field. We therefore welcome and support the new Strategy for Health, Nutrition and Population (HNP) and agree with the focus areas identified as the Bank’s comparative advantage, as well as the attention given to results. We thank the team working on the Strategy for the constructive bilateral consultations throughout its preparation and also warmly welcome the new Vice President for Human Development, Ms. Joy Phumaphi, to the Bank.
The recent controversies surrounding the Bank’s work in Sexual and Reproductive Health (SRH) have caused great concern. Active engagement in SRH is central to generating successful development outcomes, and to the achievement of almost all the MDGs. Marginalization and eventual exclusion of the family planning agenda from the Bank’s health strategy could lead to its exclusion from the international development agenda as well as from many key national development documents.
The Bank needs to be fully committed to providing client countries with assistance in this field - indeed, emphasis on SRH should be an integral part of any health system strengthening. We believe that the Corrigendum provides sufficient assurance that the Bank’s commitment to SRH remains intact and expect it to replace the chapter on the same subject in the Strategy document. However, it should be noted that the process leading to the Corrigendum has certainly not been optimal.
We therefore ask management to ensure that its communication efforts on the HNP-Strategy will explicitly deliver the message that the Bank continues to play a central role in ensuring access to all reproductive services. We believe that a public statement from senior management on their commitment to this issue is warranted. Finally, it is also important that the Bank, in its dialogue with client countries, makes its commitment to the Cairo Consensus and to the protection of sexual and reproductive rights absolutely clear and will provide countries with whatever support, technical or financial, they request.
We are supportive of the Strategy’s focus on strengthening health systems, and we believe that the Bank has an important role in being the “glue” that supports the integration of the multiple health related programs in client countries. We also understand that the Bank needs to be more selective in its engagement in partnerships. However, this should not be taken too far, as we need to achieve a balance of focus between health systems strengthening and disease control. Moreover, on the selectivity we need more clarification on its practical implications and think this issue has to be discussed with the Board, for example in a Progress Report (see last section).
Ensuring the availability of human resources for health is an important part of the health system strengthening agenda. It provides a key entry point for analysis and policy dialogue around organization, management and financing of health care delivery. The Bank has a unique comparative advantage and responsibility in this area through its technical, governance and macro-economic expertise and its potential in policy leverage. In Africa in particular, there are critical shortages of qualified health personnel and we expect that the implementation of this strategy will contribute to ending these shortages.
We are supportive of the need to strengthen public policy in order to ensure public-private synergies. Many countries are still working on the basis of a centralized public sector delivery service model while in reality services are being delivered by a wide range of private providers who are poorly guided by appropriate public regulation and oversight mechanisms. We would welcome joint work between the WHO and the Bank to better advise countries on the most appropriate model for service delivery, on the basis of its health sector characteristics. In addition, we think that the strategy could be more explicit on the way it will deal with provision of medicine, in support of local production and distribution, as well as in improving purchasing structures.
The fact that the Board has not been provided with more complete information on the Strategy’s possible budget implications is, in our view, quite disappointing. We think that it is of fundamental importance that when new strategies are presented for support, that the Board be informed about the funding required to implement those strategies – in fact it should be an integral part of such documents. The Supplemental Note’s brief discussion of budget implications is by no means sufficient. Last week the Board gave its support for a new strategy on the Financial Sector, which included complete information on funding requirements, including the sources of funding. In our view, all new strategies brought to the Board should provide similar information. By the same token, we would also have liked to have more detailed information on the Strategy’s human resource implications. Can Management comment on both issues?
We appreciate the consultation process which took place during the strategy’s preparation phase. It will be important to ensure a full and comprehensive consultation as we move forward with implementation.
Aid architecture and partnerships
We welcome the attention given to collaboration and cooperation with development partners, which is central to the Strategy’s successful implementation. This is particularly true now in the new aid architecture, within which the Bank needs to refocus on its comparative advantage. We look forward to follow-up work on the Bank’s strategic or supportive role in the health architecture, and on the collaboration arrangements that it will establish with partners. Going forward, it is crucial that the attention given to collaboration and cooperation be translated into real work on the ground and we expect the Bank to put greater emphasis on engaging in joint efforts with development partners, for example in joint analytical work, as stated in the conclusions of the 2007 International Conference on Social Health Protection in Developing Countries. In this regard, the Bank should not concentrate only on the partnerships that it leads but it should also support initiatives led by others.
We think that the Bank’s continued partnership with the main co-sponsored programs linked to the WHO; the Special Program for Research & Training in Tropical Diseases (TDR), and the Special Program of Research, Development and Research Training in Human Reproduction (HRP) is vital, as well as participation in the African Program for Onchocerciasis Control (APOC). The Alliance for Health System, an initiative that in 2005 evolved into WHO, is another example which in its capacity of performing health systems research for achieving health-related MDGs deserves strong support from the Bank. Moreover, we think that the Bank should have a role in innovative financing (as UNITAID, AMC, and IFFIM).
On the health "scaling up" process, the Bank has brought together development partners several times in Tunis, Paris, Brussels, etc. Donors have always responded to the requests of the Bank in this area, and a number of concrete proposals have been made for working together on a pilot basis in some countries. We are left with the impression that this initiative has disappeared, by the sole decision of the Bank, without explanation. We think this issue is crucial because it is linked to the coordination and harmonization agenda and because it is instrumental in providing further impetus to cooperation between donors (including Global Funds) at country level. How will the Bank follow through on this initiative, especially in the perspective of the Accra meeting (2008)?
Follow up of the Strategy
We would like to emphasize that the World Bank strategy for Health, Nutrition and Population has to be a collective strategy for all the components of the Bank. All professionals working in Human Development, in the hub as well as in the regions, have to be part of it, being associated and giving their input to the implementation process. Ultimately, the choices made by Staff and client countries will determine for the implementation of the strategy.
There is a need for clear guidance and a specific follow up on the way that strategy will be translated, for each country, on the ground and in the operations. Here, the results matrix, as presented in Annex J, will prove to be a central tool, which we expect to be duly taken into account in the Bank’s work at the country level. Moreover, we think this offers an opportunity to discuss the way that a thematic network can assume a much stronger lead and monitoring role in relation with the regional networks of the Bank. We would like concrete proposals from Staff on how it could give stronger guidance and monitor the implementation of the strategy. We think that a progress report is needed, in no more than a year, in order for the Board to have a clear view of the implementation process, inside the Bank as well as with partners, especially on the progress made on the collaboration arrangements. This Progress Report should also reflect the IEG review of the Bank’s work in the health sector.
We will continue to closely monitor the implementation of the new HNP Strategy, in particular within the framework of Country Assistance Strategies and programs.
Specific questions:
On the insurance – labor link: paragraph 113 of the strategy implies that it can distort labor markets and have implications for the fiscal sustainability. Could staff expand on this position?
The second is about the issue of fragmentation which is raised in the paragraph 107 of the strategy. The paragraph only deals with the fragmentation of insurers, but we think that also fragmentation of providers is an equally important problem. What is the staff’s view on this?
I'm antiwolfowitz. In fact, I am one of his cruelest detractors. But I don't see why this should be an issue. Forcing birth control on unwilling populations, through the cash of unwilling taxpayers, isn't right from either end of it. The Dadoud guy seemed to have his head screwed on right, in my opinion, and I support him. It amazes me that the WB staff do not realize that there are actual normal people out there who do not support this anti-human life activity that will only bring European-style population problems onto third-world populations that don't have the option of living off European-style reserves and European-style immigrant influxes that can take care of the inevitable imbalances that rapidly grow imbalanced due to birth control. Why does the WB insist that this policy is something good and assume that getting rid of it is 'a scandal' when in fact, large numbers of normal people, in both first and third world countries, do not favor it, and are hardly the 'evil' that WB staff insist? This makes me think you all live in a leftist bubble that is out of tune with the diverse realities of the real world. Pretending we don't exist does not make it so.
My friend, it appears that you basically anti-from-this-planet in the first place. The bank does not force birth control upon unwilling countries, but if you have 11 or 12 children that are malnourished and dying like flies, family planning may be a good idea. Have you ever noticed the scarceness of resources on this planet? I guess that's hard to understand whe you have never left Ohio, where water comes from the tap and food from Safeways. It is a shame that we have to rely on the Europeans to stand up for basic human and women's rights!!
My my what foolish assumptions you make. Ohio! You think Ohio? And only someone from Ohio can have my opinions? I love it! Number one, be very careful that you don't fall into Malcolm Brown-style condescension to the supposedly Rush-Limbaugh-listening masses of the heartland, I promise you that's exactly what the heartland is looking for to make an issue of. Number two, I am an urban hipster living the punk rock life in a major U.S. nonflyover city who is pro-life. Believe it or not, we're out there.
Getting outside your personal attacks and assumptions, let's look at the issues: Very few 'voluntary' programs are truly voluntary when you are dealing with very poor women. Number two, abortion damages people's psyches, so right there, you are gonna get some bills from that. Better to fork out welfare payments for the ten kids or open orphanages. There is no scarcity of resources in capitalist places, only in socialist places like Venezuela and Zimbabwe where 'fairness' is advertised. You get the equality of the grave with those guys. Lastly, every single human being, no matter how small, no matter how weak, has an inherent right to life, not just ones that have managed to live a week past birth or however bureaucratically the Europeans define it. They've got a death-spiral population problem, so it's not for them to advise other people to take their recipes. I favor a culture of life.
(1) "There is no scarcity of resources in capitalist places"
Very funny to those who live in areas where ground water levels are depleting in an appalling speed, fuel wood and forests disappear, soil is eroding and all this fuelling civil unrest and wars about resources. I have no clue where you come from (dont really care either), but it is quite evident that you have not been to the places you are talking about.
(2) "abortion damages people's psyches". I am sure you are a qualified psychologist... or maybe you just read too many pro-life flyers. I personally know enough women whose psyche got not deformed at all, and who are happy to have made the choice to have a child at the time THEY consider the right time, which by the way also benefits the child.
I've been working in development cooperation - both official and non-governmental - for more than 15 years. I am amazed how simple the world can look to someone like you. Sad.
United States seeks to roll back reproductive health language
Washington D.C., April 25 -- At a board meeting Tuesday to discuss the "The World Bank Strategy for Health, Nutrition and Population Results", the United States tried, single-handedly, to roll back internationally agreed language dating from the Cairo Population Conference of 1994, which is endorsed by the World Bank.
The language in the Cairo Conference's "Program of Action" was adopted in 1994 by 179 countries, including the United States.
Yesterday, the U.S. Executive Director, Eli Whitney Debevoise II, objected to the internationally agreed language of Cairo, specifically the words "reproductive health services" and "reproductive rights". The United States tried to introduce new language on "age appropriate" provision of services, which would curtail provision of services to adolescents.
A Technical Briefing held late yesterday afternoon, led by Bank staff, concluded that "reproductive health services" and "reproductive rights" should stay in the strategy paper as this language has been agreed internationally at Cairo and elsewhere. The same briefing concluded that "age appropriate" was not consistent with international agreements and could not be added.
It is understood that "reproductive health services" and "reproductive rights" - will stay in the strategy paper and will be re-submitted to the board.
Are you aware that the CAPITALIST U.S. is the world's leader in reforestation today? It's the beauty of capitalism in action. Places that used to be clear-cut for farmland are now reforested and green because food production in the states is so efficient and there's an active planting effort. The state of Vermont, for instance, was all fields and farmlands in 1900 but today is nearly all forest. Cuba, meanwhile, is a hellhole of strip mining and deforestation. Its central mountains look like lunar wastelands. It's not capitalist. Nor is Zimbabwe. Nor are any of the third world places where government is big and capitalism is repressed as evil. I can't believe you don't know any of this. Too much time behind a desk on the phone with radical-left activists? You need to open your mind to new realities.
Kid, you just dont know what you are talking about.. ;-) Go and live in some of those places, grow up and then we may continue our discussion.
P.S.: No, not too much desk but rather being in the field. And surely no telephone conversations with radical-left activists, but rather wasting time with pseudo-neocon-punks on the net.
Over&Out.
Obviously, you aren't in the field, probably never were.
It is not a matter of whether Wolfowitz should resign or not.
It is a matter that we need to get rid of central banks an crease a debt-free money system as was done in US when presidents knew what they were doing.
Watch in google video a video called The Money Master. Watch also a video called money as debt.
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