Falkenberg T, Tomson G
Department of Public Health Science, Karolinska Institute, Stockholm, Sweden.
Health Policy Plan. 2000 Mar;15(1):52-8. doi: 10.1093/heapol/15.1.52.
Within less than a decade the World Bank has become the largest single source of finance (loans) for health in low and middle income countries as well as a major player in the field of pharmaceuticals. Often 20-50% of the recurrent government health budget in developing countries is used to procure drugs. Drugs are among the most salient and cost-effective elements of health care and often a key factor for the success of a health sector reform. However, pharmaceuticals are frequently being used irrationally, mainly due to market imperfections in health care, such as information asymmetries, leading to serious health problems and a heavy financial burden on the health system. Lending priorities set by the World Bank could be used to promote public health sector reform, leading to the rational use of affordable and available drugs of good quality in developing countries. This report provides the first analysis of World Bank activity in the pharmaceutical sector worldwide. The analysis of 77 staff appraisal reports, describing the planning phase of World Bank country projects, shows that 16% of the total World Bank health, nutrition and population budget, or approximately US$1.3 billion, has been committed to loans or credits supporting pharmaceutical activities in the programme countries between 1989-95. Roughly US$1.05 billion has been committed to procurement of drugs and medical equipment. Only 5% of the total pharmaceutical sector lending is committed to software components such as drug policy work and rational use of drugs. No more than 45% of the projects were developed in collaboration with pharmaceutical expertise. The World Bank is recommended to improve its pharmaceutical sector involvement by promoting drug policy research and development including national and international dialogue on pharmaceutical issues to ensure rational use of both drugs and loans. In this, the World Bank has an advantage given its experience from working with both the private and the public sector, its in-house expertise in health economics, and lastly its ability to be listened to by governments through its power.
在不到十年的时间里，世界银行已成为低收入和中等收入国家卫生领域最大的单一资金（贷款）来源，也是制药领域的主要参与者。发展中国家政府经常性卫生预算的20%至50%通常用于采购药品。药品是医疗保健中最显著且最具成本效益的要素之一，往往也是卫生部门改革成功的关键因素。然而，药品经常被不合理使用，主要原因是医疗保健市场存在缺陷，如信息不对称，这导致了严重的健康问题以及卫生系统沉重的财务负担。世界银行设定的贷款优先事项可用于推动公共卫生部门改革，从而促使发展中国家合理使用价格合理且可获取的优质药品。本报告首次对世界银行在全球制药领域的活动进行了分析。对77份员工评估报告的分析描述了世界银行国家项目的规划阶段，结果显示，在1989年至1995年期间，世界银行卫生、营养和人口预算总额的16%，即约13亿美元，已用于为项目国家的制药活动提供贷款或信贷。约10.5亿美元已用于药品和医疗设备的采购。制药部门贷款总额中只有5%用于软件部分，如药品政策工作和合理用药。不超过45%的项目是与制药专业知识合作开展的。建议世界银行通过促进药品政策研究与开发来加强其在制药领域的参与，包括就药品问题开展国家和国际对话，以确保药品和贷款的合理使用。在这方面，世界银行具有优势，因为它在与私营和公共部门合作方面积累了经验，拥有内部卫生经济学专业知识，最后还具备凭借其影响力让各国政府倾听其意见的能力。
