Harvey Whiteford’s One-Year World Bank Appointment Leads to New Grant
Since January 1999 Harvey Whiteford, M.D., the former Director of Mental Health in the Australian Federal Government, has been based in Washington D.C. for a a one-year appointment at World Bank headquarters. The position, sponsored by WFMH and funded by the John D. and Catherine T. MacArthur Foundation, was the first post ever created at the Bank to support attention to mental health issues in lending for health programs. As his time in Washington draws to a close and he prepares to return home, the impact of the appointment has become very clear and WFMH rates his performance as outstanding. Dr. Whiteford brought exceptional energy and focus to the job, developed it in unexpected ways, and accepted many unforeseen duties in the course of the year.
At its September meeting in Santiago, Chile, the WFMH Board heard a report from Dr. Whiteford about the scope for influencing World Bank lending policies. He felt that a total of three years investment in specialist input was desirable to reinforce mental health work within the organization and make it more likely that the Bank would eventually establish a permanent position to manage its program in this area. He also stressed that much of the work he had begun would not reach completion during his one-year term, and that a broad momentum had been developed which might be lost without consolidation.
The Board decided as a priority item to seek a renewal of the grant from the MacArthur Foundation. A second award, announced in December 1999, will support the project for two more years. It covers the appointment of a new mental health specialist and retains the services of Harvey Whiteford as an advisor on part-time basis so that he can continue with some of the international initiatives he has developed.. He is returning to Australia at the end of January 2000 to take up a half-time academic position at the University of Queensland.
World Bank Lending for Health Programs
Out of total lending of US$29 billion in the 1999 financial year, loans worth a total of US$2 billion were given for health, nutrition and population projects. The Bank has health-related lending in 90 countries. Traditionally, such loans have been concentrated in areas such as infectious disease control and reproductive health. Although the Banks research earlier this decade had identified the heavy burden of disability associated with mental disorders, until very recently this did not result in substantial changes in lending policy.
Dr. Whitefords aim, working as the Mental Health Specialist in the Health Program Development Sector, was to entrench mental health as an important part of the Banks health portfolio. He worked with three thematic groups within the organization: Health Sector Reform, Public Health and Disabilities. His duties included providing policy and technical advice, and preparing lending components for Bank health projects. In line with the Banks development and economic focus, he paid particular attention to developing the capacity of staff to assess the cost effectiveness of projects in the countries where they would be implemented. He also encouraged consideration of the availability of key pharmaceuticals, and the development of instruments to measure the mental health burden and health outcomes in various cultures.
New Projects
There is already evidence of the impact of his efforts. Prior to 1999 there was one project funded by the Bank, in Sri Lanka, specifically directed at mental health issues. In the first ten months of 1999 four projects worth a total of US$12.6 million were funded (even though the usual cycle for the preparation and approval of Bank funding is close to two years). Nine other projects, worth more than US$20 million in total, are now in the pipeline.
The recently funded projects include a US$4.8 million program in Argentina dealing with substance abuse in youth, and US$7.0 million provided to Turkey for community mental health and post-earthquake psychosocial relief work. A project worth US$380,000 for refugee mental health in Bosnia will be carried out in 2000 by WFMH Collaborating Center, the Harvard Program in Refugee Trauma. A multi-country project was also funded to allow the Transcultural Psychosocial Organization to assess the effectiveness of mental health interventions in post-conflict populations. This work will be carried out in 2000-2002 in Algeria, Bosnia, Burundi, Cambodia, Ethiopia, Gaza, India, Nepal, Sudan and Sri Lanka.
The projects still in the pipeline cover programs in three countries of Eastern Europe, three countries in Africa, and one in a Latin American country. There are also projects in the Middle East, North Africa, South Asia and Southeast Asia.
Policy Concerns
In addition to working on specific lending projects Dr. Whiteford helped to establish an international mental health policy initiative drawing on expertise from the Bank, the World Health Organization, the governments of Australia, the U.K. and U.S.A., and the governments of interested developing countries to design national-level mental health policies and plans. He hopes that, as the initiative progresses, future Bank lending and WHO technical advice will be guided by this framework.
A fundamental aspect of his work with economic policy units at the Bank was to develop conceptual frameworks which include mental health in models for human development aid and economic growth. This involved research on the role of mental health in the development of human and social capital, to demonstrate its links with social development, poverty reduction and economic growth. Such an approach has substantial potential to strengthen advocacy for mental health by connecting it with economic issues.
Working with the Banks Post-Conflict Unit, one of Dr. Whitefords interests was to develop cost-effective interventions for countries affected by war or natural disaster. The effectiveness of mental health interventions in groups affected by trauma is currently a matter of some controversy, and new attention is being directed at careful assessment of outcomes.
A Higher Profile for Mental Health
The World Bank post, by raising the profile of mental health in national health planning, influenced governments and other international aid organizations. Dr. Whiteford reported that it is especially important to appreciate the influence of the World Bank in dealing with Ministries of Finance as well as Ministries of Health in developing countries. This leverage can be used to give mental health a higher priority in the health budget process. He added that this influence is not limited to the Banks client countries. He has worked with the U.S. Department of Health and Human Services, the U.K. Department for International Development, and also the Global Forum for Health Research.
The creation of the new mental health specialist post also led to closer collaboration between the World Bank and WHOs Department of Mental Health. This in turn reinforced liaison with many other organizations, from United Nations agencies to international and national professional bodies and academic and research institutions, and also non-governmental organizations and pharmaceutical companies.
Dr. Whiteford found there was a great interest in his new position from many quarters, with requests for presentations about the structure of the World Bank and its general lending policies as well as its health programs. He made every effort to meet this demand and his willingness to do so resulted in an exceptional outreach effort.
Whiteford Elected to WFMH Board
He was elected to the Board of Directors in September, and looks forward to maintaining his connection with the Federation. He acknowledges WFMHs foresight (and particularly that of John Gates and Rachel Jenkins) in making it possible for him to take up the position at the Bank: I am grateful to the Federation for the opportunity to work in the exciting and challenging area of international mental health. I appreciate the faith the Federation placed in me, and hope that my contribution will have an ongoing impact in developing countries where the need to improve the mental health of the population is so great. I especially wish to express my appreciation for the support of the Federations Secretariat and the many members of WFMH who have given of their time and experience. I look forward to continuing my work with the World Bank and the Federation, and to maintaining contact with the many new friends I have made.