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World Bank Report Says Good Intentions Not Enough for Health Care

A new World Bank report says when it comes to health programs for the poor in developing countries, good intentions are not enough. It says too few health programs actually reach poor people. The study is entitled “Reaching the Poor: What Works, What Doesn’t and Why.”

The co-author of the report, Davidson Gwatkin, told English to Africa’s Joe De Capua that developing countries and donors should check for gaps between intentions and verifiable results.

He says, “Health professionals certainly have tried very hard over the past 20 years to reach poor population groups. But by and large, when one looks at the record seriously, one finds that coverage levels among those groups are really quite a bit lower than they are among better off groups, even for those health programs intended specifically to reach the poor. By that I mean things like immunization, attended deliveries, ante natal care.”

If the intention is to help the poor, how does the money get redirected? Mr. Gwatkin says, “It ends up largely in health programs that share the characteristics of most health programs in the United States and developed countries, as well as in the third world. Mainly it tends to be more urban oriented, physician oriented and less oriented to covering poor geographic areas and communities, and relying on institutional approaches, rather than outreach approaches into the community.”

In other words, taking an easier route by funneling money to areas with established infrastructures, rather than developing new programs.

To solve the problem, the World Bank official says, “There are several techniques that have been used with success in different settings. For example, there are ways of identifying the poor more accurately than has been possible in the past by telling what kind of house they live in, for example. A second, related technique is some countries have paid poor people who come forward for health services rather than charging them to come forward for health and education service. Another technique that seems to work rather well, least in some settings, is the mass campaign, particularly for immunizations and for bed nets. That is, rather than simply sitting in clinics and waiting for people to come.”

For example in Ghana, the Red Cross and the government raised from 3% to nearly 60% the rate of treated bed net use among children in the poorest 20% of people in a northern district. A similar program in Zambia was also very successful.