Stormy Confrontation at World Bank Summit

by Ranjit Devraj

Criticism of the Bank and health priorities driven by profit have been ongoing themes of the People's Health Assembly (PHA) here, but peaked during a stormy face-off Dec. 7.

At a session between the World Bank and health activists, Bank representative Richard Lee Skolnik was treated to the display of brightly embroidered newspaper headlines that told stories of the harmful effects of the Bank's structural adjustment program (SAP) in Zimbabwe.

The headlines described rising food prices, increasing crime, and labor retrenchment -- the direct results, said presenter Mary Sandari, of the country's acceding to SAP to pay back its debts as directed by the Bank.

Skolnik responded by saying the Bank only asked Zimbabwe to manage its economy soundly and did not tell it to cut social spending.

Sandari's presentation was followed by another by Hugo Icu, a doctor from Guatemala who outlined the collapse of primary health care in his country as a direct consequence of his government's following the Bank's prescriptions.

Skolnik said the World Bank's health policies were helping poor countries like India fight leprosy, polio, tuberculosis and HIV/AIDS. At this, angry delegates to the health assembly shouted "get out" and chanted "no, no," until PHA project coordinator Zafarullah Choudhury threatened to call off the week-long PHA which ended the next day.

Skolnik was not allowed to finish his presentation. Instead, he was lectured about the need to restore the primary health care approach promoted since the 1978 "Health for all Declaration" at a global meeting at Alma Ata, Kazakhstan.

Critics say the global pledge set at that meeting -- which included primary health care for all by 2000 -- has now been all but scuttled by the Bank's approach, which deprives developing-country budgets of funds for social sectors.

"We don't want charity, but justice," said Charles Mutasa, a panelist from Zimbabwe, adding that the Bank's approach has driven many African countries into a debt trap as a result of the new global economic system.

Mutasa spoke of "exogenous" factors that made debt repayment difficult, such as floods, corruption and civil strife, the last of which "the West was so good at pioneering."

To this, Skolnik explained that "there was no substitute for good governance" and that the Bank should indeed be "hit hard" for lending money to bad regimes.

"Most of the money goes into projects like the Subic free port," he said, referring to a vast infrastructure project for business at a former U.S. military bases, north of the capital Manila.

Looking at the effects of economic reforms on health, Tujan said there has been "progressive destruction of the people's health agenda" by the private corporatization of health services, which has a curative rather than a preventive approach.

As things stand, Tujan said, he wonders if "no medicine is better than bad medicine."

A panelist from Australia, David Leggae, said that although the Bank's "trickle down" approach provided the rationale for neoliberalism and structural adjustment, it was also responsible for economic polarization and increased mortality.

There are too many fundamental flaws in the Bank's approach, he said, since it is based on the idea that "consumption could be maintained by increasing debt" and that an economic crisis could thus be deferred.

Basically, Leggae adds, the game is one of maintaining the stability and wealth of the North at the cost of the well-being and health of the South.

He said this game is backed by the Bank, the International Monetary Fund, the World Trade Organization (WTO), news corporations, money markets and rating agencies, among others.

Leggae adds that the only counteraction available to the "unfair" global trade regime, which transfers wealth to the North at the cost of social sectors in the South, is popular protest like that seen at trade and economic meetings in Seattle, Geneva, Melbourne and Paris.

He says also that people's understanding of regulatory regimes and governance structures in the global system is "essential to demand a global trading system which discriminates positively in favor of poor countries."

Leggae advised the Bank to "apologize for deaths and suffering caused by structural adjustment and stop claiming privileged access to divine truth, and acknowledge that embedded in its recommendations were its core constituency -- the privileged West."

Comments from the floor were even more biting. "There is an easy way out of all this -- the World Bank and IMF have enough resources to cancel debts," said Robert Weissman, co-director of the U.S.-based group Essential Action.

"The World Bank's own case studies showed that in the last 20 years it had made no effect even on a single district in India," pointed out Ravi Narayan from India, the Bank's biggest borrower.

Narayan said while the World Bank may not directly ask for cuts in social sectors, its adjustment programs inevitably led to governments to take on adverse fiscal policies, including inadequate financial allocations for capital and recurrent costs for the social sectors.

These same policies led to shortages in health equipment, drugs and facilities, which happened in India, Narayan says. In turn, deteriorating conditions bring down the performance of health personnel, said South African David Sanders.

Commenting on the discussion, Halfdan Mahler, the architect of the primary health care approach as director general of the World Health Organization (WHO) from 1973-1988, told IPS that the Bank was again "postponing the coming explosion" through its untenable positions.

Mahler blamed the World Bank's "hijacking of health" from the WHO in 1993 and the abandonment of the primary health approach for the crisis in public health management, especially in developing countries.