All-Party Parliamentary Group for the Prevention of Genocide and Other Crimes Against Humanity

How the World Bank is failing Africa

The World Bank was graded on its health, nutrition and population programs recently and the results weren’t good. Three-quarters of the World Bank’s health programs in Africa are failing, according to the bank’s own arm’s-length Independent Evaluation Group (IEG). While the World Bank should be commended for its transparency in releasing this report, these astonishing findings cannot be ignored.  

After evaluating a decade’s worth of the bank’s health, nutrition and population programming, the IEG found one-third of the health lending programs did not obtain a “satisfactory” ranking. In Africa, 75 per cent of health programs are failing to deliver. According to the report, “irrelevant objectives, inappropriate project designs, unrealistic targets … and an inability to measure the effectiveness of interventions” are to blame.   Beyond inefficient health programming, this means billions of dollars wasted, and millions of people still dying of diseases such as AIDS, malaria, tuberculosis, pneumonia and other preventable diseases. And, because the bank lends rather than gives money to the poor, this report confirms that low-income countries that are already reeling from the economic crisis are also going into debt for sub-par World Bank programs that are not delivering.  

Why should you care? The World Bank is the world’s largest “development” institution. Its policies and projects directly impact the lives of millions of people in developing countries across the globe. Canada alone contributes hundreds of millions to the bank each year. In 2007, our contribution to the bank was our highest ever — $1.2 billion over three years. This represents about one-tenth of our annual aid budget.  

Recently, I travelled with a parliamentary delegation to Africa, where I was able to witness World Bank health programs first-hand. The story is not all doom and gloom — we saw examples of development projects that work, such as a health clinic that provides testing for HIV/AIDS or a drug distribution centre that gets life saving drugs to the people who need them. We also saw a project that supports women’s financial independence by helping them set up their own small businesses, for example selling fresh fruits, grains and vegetables in the market.  

The projects that needed to be questioned or revamped tended to be the larger projects like the Inga Dam. This is a megaproject that, when completed, will provide hydroelectric energy to many neighbouring countries. This is laudable, but questions remain whether the millions of dollars being spent will genuinely reduce the poverty of the people of Congo. Now, I realize that the successes I saw were the exception and not the rule.  

If success is to be measured in terms of number of lives saved, we must focus on outcome-based, proven, cost-effective solutions that work to prevent needless suffering and death. We can’t afford to funnel money into an unaccountable abyss and hope for the best. The IEG report states that, although health-sector reform programs were among the worst performing, 89 per cent of infectious-disease programs (such as those fighting malaria and tuberculosis) were successful. That’s probably because we know how to succeed in these areas and we know how to measure outcomes.  

We need accountability at the World Bank and accountability for the important investments we make in foreign aid. One concrete step that I will be taking is to request that our Canadian executive directors at the World Bank appear before the standing committee on foreign affairs to explain what went wrong and how it can be fixed.   With a little over five years to go until the Millennium Development Goals deadline, we must make sure efforts to improve the health and quality of life of the world’s poorest are not being wasted. The World Bank needs to support health programs that work, that are outcome-based, and measure progress in terms of lives saved.  

Paul Dewar is the Member of Parliament for Ottawa Centre and the New Democrat foreign affairs critic. He travelled to the Democratic Republic of Congo in his capacity as Chair of the All-Party Parliamentary Group for the Prevention of Genocide and other Crimes Against Humanity.