World Bank : a powerful partnership / by Bernhard Liese

WORLD BANK: a powerful partnership J[ t may seem unlikely for the World Bank - whose principal function is to provide loans for development projects in order to strengthen the economies of borrowing countries - to take a keen interest in tropical disease research and control. But health has been an important dimension of the Bank's overall efforts to promote economic development. In 1989, World Bank investment in development projects accounted for over US $20 billion. Within . this total, an important component is formed by investment in national health infra- structure and services, disease surveil- lance and control programmes, and institutional development of health systems. It was with the "discovery of the rural poor," as expressed by Mr Robert McNamara - then President of the World Bank - in a speech in Nairobi in 1974, that health activities became firmly anchored in the Bank's portfolio. Prior to that, although several rural, agricultural and irrigation projects had contained health components, the overall emphasis on health had been relatively small. Concern for health issues stemmed, first, from the new perspective on poverty which went beyond simple measures of income levels, and second, from the Bank's experience in water development pro- jects. Whenever health risks were not considered in project design, diseases WORLD HEALTH. June-July-August 1990 by Dr Bernhard Liese Senior Public Health Specialist with the World Bank, Washington D. C. such as malaria, schistosomiasis and others had emerged. By the mid-1970s, the Bank had decided that it should systematically consider the possible health impacts of Bank-supported projects, minimise any such adverse effects, and make key interventions to improve the health status of low-income groups. Between 1970 and 1980, more than 100 health components were included in Bank- financed projects, and about 30 per cent of them dealt with tropical diseases. Last year, Bank loans of about US $136 million supported tropical disease control projects in five coun- tries. Of particular importance have been projects against malaria, schisto- somiasis, leishmaniasis, Chagas disease and tuberculosis. Schistosomiasis con- trol has become an important aspect of our irrigation and dam construction projects. Control problems When the Special Programme for Research and Training in Tropical Diseases was conceived in 1974, atten- tion to tropical disease was in decline. There were serious problems in disease control technology, and work to develop new tools was not moving quickly. The World Bank became a "founding member" of the TOR, now the central international focus for tro- pical disease research. Moreover, as the Programme has matured, many of Pulling together: a simple but effective means of irrigating parched land. The World Bank has long experience in water development projects. the fruits of TOR-supported research have become incorporated in aspects of Bank-financed disease control pro- jects. I believe that "if TOR did not exist today, it would certainly have to be invented." How important TOR is to the World Bank can be measured directly; of all the World Bank's Special Grant Programmes in Health, TOR now receives the largest contribution. The Bank has also ventured into another important area of tropical disease control - the Onchocerciasis Control Programme (OCP) which covers 11 nations in West Africa. This international effort to combat river-blindness was launched after Mr McNamara saw for himself the devas- tating effects of this debilitating disease. The Bank has acted as the eo-sponsor and fund-raiser for this programme throughout its 15 years of activity. I believe the Bank's involvement with TOR, OCP and other aspects of tropical disease research and control, has demonstrated the power of such partnerships in combating tropical diseases. Bank involvement has been perceived by donors as helpful, contri- buting to efficient programme organi- zation and management. • 7