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The bank that cares?

BMJ 2005; 330 doi: (Published 01 May 2005) Cite this as: BMJ 2005;330:0505208
  1. Rebecca Hope, fourth year medical student1
  1. 1University of Leeds

Chances are that most people working in health will be able to tell you something about the World Health Organization. But the World Bank? What does a bank have to do with health care? Rebecca Hope explains why it should concern doctors and medical students

“The World Bank is the new 800 lb [400 kg] gorilla in world health care,” said one senior World Health Organization representative.1 But were they right? Let's look at the numbers. Consider that the annual regular budget of the WHO, at about $900m (£500m; €700m), is approximately equal to that of a large European teaching hospital.2 The World Bank has approximately $20bn a year to play with. Fifteen per cent of these funds went into its health, nutrition, and population sector in 2004,3 making it the single largest source of funding for health care for low and middle income countries.

Your local bank

The World Bank is in the business of making loans, much like your local bank, except this bank lends to countries. Middle income countries are eligible for loans; the poorest countries can apply for interest-free loans and grants.

Unlike other international institutions, the bank can raise revenue by borrowing on international markets, as well as collecting from its 184 member states or “shareholders.” Decisions are made according to the principle of “one dollar, one vote.” This means that its five richest shareholders - the United States, Japan, Germany, the United Kingdom, and France - control the greatest share of the vote.3 The president of the bank is traditionally a US citizen: James Wolfensohn, an American, has held the post since 1995 and is to be succeeded by another American, Paul Wolfowitz, this year (see …

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