~Mental Health in World Bank Programs~
Harvey Whiteford arrived in Washington, D.C., in February to accept a one-year post as mental health specialist at the World Bank. He has taken a year’s leave of absence from his position as Commonwealth Director of Mental Health in Canberra, Australia. The post is funded by a grant to WFMH from the John D.and Catherine T. MacArthur Foundation.
Dr. Whiteford will provide brief reports for the newsletter during the year. Here he gives some background information about the Health, Nutrition and Population sector where he is working, and discusses how health programs fit into the Bank’s overall lending structure.
The World Bank, with headquarters in Washington D.C. and some 90 offices around the world, employs a staff of about 5,500 people. It lends funds to developing countries for social development, and only for projects that promise high rates of economic return to the country. The Bank was restructured in 1997, and now has four networks:
* Human Development
* Environmentally and Socially Sustainable Development
* Finance, Private Sector and Infrastructure
* Poverty Reduction and Economic Management
The Human Development Network was the first network to be set up in the new organizational structure. It brought together staff working on health, nutrition, population, education, training and social protection. The Network promotes policies and funds programs which support economic growth and the alleviation of poverty through improving the health and educational status of individuals and the provision of social safety nets. It is organized into three sectors:
* Health, Nutrition and Population (HNP)
* Education
* Social Protection
The World Bank is the single largest source of external finance for HNP in developing countries, and HNP is now one of the fastest growing areas of Bank lending. The sector has about 250 staff. The Bank has been influenced by mounting evidence that investments in health, nutrition and education contribute to individual productivity, and therefore to national economic growth. Its investments aim for allocative efficiency in lending (buying cheap health gains first), and the support of better health policy and research.
Funding for health sector reform addresses health financing and management, health information and improvements in quality, and efficiency and equity in service delivery. These initiatives must be developed and implemented in a way which is sensitive to the recipient country’s economic policies. The largest recipient countries of HNP funds between 1988 and 1998 have been India, Mexico, Brazil, Argentina, China, Bangladesh, Indonesia, Russia, Venezuela and Nigeria.
The World Bank has recently become more interested in mental health issues. Seventy-seven percent of HNP loans have been in the area of primary health care, and traditionally, the lending has been for areas such as infectious disease control and reproductive health. The publication in 1993 of the Bank’s World Development Report:Investing in Health helped to change this emphasis by focusing on the burden of disease using a standardised comparison of both mortality and morbidity, the disability adjusted life year (DALY).
Subsequent publications, especially the 1996 Global Burden of Disease report, emphasised the significant burden associated with what that report refers to as “neuropsychiatric disorders.” Five of the ten leading causes of disability worldwide are mental illnesses, accounting for a quarter of total disability and ten per cent of total burden. The burden is expected to rise to fifteen percent by the year 2020, and the rise will be particularly sharp in developing countries.
I am working within the Bank to assist staff in headquarters and in regional offices (called resident missions) to increase their understanding of mental disorders and advise on lending programs which have mental health components. I will help to develop and implement a training program on mental health for staff in the HNP Sector of the Bank, and will identify an international network of experts who can be helpful. I am also working on assembling a database of papers about effective mental health interventions as a resource for all Bank staff.
The new head of HNP, announced in March, is Chris Lovelace. He was formerly Director, Human Development for the Bank’s Europe and Central Asia region. Previously, he served as Director General of Health in New Zealand during 1992-95. I was able to meet with him on 26 March for a general discussion.
At this early stage, I am meeting with sector leaders, managers and staff working on health projects in various regions of the world to gain a perspective on the issues they face and the opportunities for incorporating mental health in lending programs. I look forward to the advice and support of WFMH members in carrying out my task.
-Harvey Whiteford