Improving healthcare, but for whom?

A new study by Wemos shows the need for the International Finance Corporation (IFC) to increase its focus on health equity, ensuring that their private investments in healthcare promote equitable and universal access. As the private sector arm of the World Bank Group, the IFC is a major development actor. Between 2017 and 2021, their investments in health increased. They focus on improving quality and availability of health services and products, but almost never consider whether everyone can access them. Only one of the 88 IFC projects in health in this period mentions equitable access as an expected development impact.

Shared concerns

Many development institutions support private investments in health in low- and middle-income countries, often without expressing a clear vision on how these investments contribute to Universal Health Coverage (UHC). Marco Angelo, global health advocate at Wemos: “We undertook this inventory study because like many other civil society organisations (CSOs), we are concerned about the implications of privatisation and commercialisation of healthcare services.”

Equitable access only mentioned once as expected development impact

When it comes to health, the IFC invests in five areas: the manufacturing of medical commodities, private healthcare providers, financial intermediaries, Public-Private Partnerships and private insurance companies.

The study shows that the largest part of IFC investments goes to the manufacturing and supply of healthcare products. These investments have potential to strengthen health systems and have increased since the Covid-19 pandemic. “But”, Marco continues, “the IFC also invests in areas whose contribution to UHC and specifically equitable access is less likely. While IFC projects focus on improving quality and availability of health services and products, only one out of 88 projects mentions equitable access as an expected development impact.”

Our recommendations

In our paper we propose the following recommendations for each area of investment in the health sector:

• Investments in manufacturing and supply of healthcare products have the potential to contribute to UHC. To further promote this, these investments should meet the following criteria before approval:
  1) they lead to strengthened local production capacity;
  2) they cater to local needs; and
  3) they contribute to equitable access, including fair prices.
• Investments in private health insurers should be discontinued, as they misalign with World Bank and World Health Organization (WHO) recommendations on health financing and hamper UHC.
• Investments in Public-Private Partnerships for the provision of healthcare services should progressively be discontinued, due to their higher cost for citizens and the government, and the fiscal risks involved.
• The decision to invest in private providers should be made after considering implications on equitable access to care during the impact assessment. For example, investing in high-end private hospitals is unlikely to contribute to equitable access to healthcare and can draw scarce resources (like health workers) away from lower-level health centres.
• Finally, the support for financial intermediaries operating in the health sector poses challenges regarding transparency. We therefore recommend a disclosure of the investments made by all intermediaries.

More on this topic

• Read our publication: ‘Improving healthcare, but for whom? Inventory study on the International Finance Corporation’s investments in healthcare’
• Read our blog on the risks of commercialisation of healthcare and the need for public financing of healthcare systems for the public good

Photo by: Albert González Farran, UNAMID.