Examination of Witnesses (Questions 840
- 842)
TUESDAY 22 APRIL 2008
Dr Julian Lob-Levyt, Mr Geoff Adlide, Ms Linda Bifani
and Ms Magdalena Robert
Q840 Baroness Whitaker:
It is a very sound idea, something that a government can say is
a good thing. But is there more in the WHO general machinery that
our representatives should be pushing for?
Dr Lob-Levyt: I think there is openness in the
leadership of WHO and they do recruit people from the private
sector to some extent. There are also quite deep-seated sets of
values within the multilateral system that perceives, in my view
quite incorrectly, that there are not positive values to the private
sector. It is seen in a very old-fashioned model. We need to recognise
that there are strengths and weaknesses in the public sector,
strengths and weaknesses in the private sector, and let us try
and bring out the strengths of both and be clear about what we
are trying to achieve and what skills are needed. In GAVI we desperately
need experts in procurement, experts in working the markets. We
could never have delivered the IFFIm (The International Financing
Facility for Immunisation) without having a board member from
Goldman Sachs who enabled us to be in contact with the markets,
with the financial whiz kids in London and New York who helped
us design IFFIm. You do not find that, quite frankly, in the public
health community or in the multilateral system. When we went to
the capital markets to raise our first US$1 billion on bonds,
they got the market stuff fairly quickly, they were pretty fascinated
by how you do this with eight countries and make it legally binding
and AAA rated, and they were rather impressed. They had to be
convinced, but they got it fast. They wanted to spend all their
time then asking the same questions you have been asking me: how
do you make sure you get quality vaccines to children. For them,
this was a fantastic ethical investment. We have made contact
with a completely different community that is very interested
in development now, because they have an ethical portfolio target
that they have to make for the pension funds when they buy our
bonds and they need to be able to understand and sell that. We
are going to bring a completely different community into the development
world. The private sector is a whole part of our society, the
largest part of our society, that needs to be brought into development.
Q841 Chairman:
You have obviously got a lot of knowledge and experience in the
whole area of development now and you have heard our questions
about the infrastructure and the whole strata of systems. If you
were suddenly taken out of your present job and placed in the
job of being adviser to the President of the World Bank, what
would be the advice you would give on this? I would quite like
to hear from your colleagues also, who have been fairly quiet,
to see if we can get some creative tension here! Who wants to
start?
Dr Lob-Levyt: I will go off the top of my head
and give my colleagues a chance to come in. I would probably ask
for three things. One is they need to spend more in the social
sectors. They have been spending less and less in health for various
reasons, so we want to turn that juggernaut around. For them to
be able to do that requires them to simplify their systems so
that they are less onerous on developing countries, because traditionally
it can take them years to negotiate a loan with the World Bank.
We need to change the dynamic of developing countries to be prepared
to request wider loans for the social sectors because at the moment
they are reluctant to do that.
Q842 Chairman:
Why?
Dr Lob-Levyt: There is a feeling that loans
should only be taken for other sorts of infrastructure, roads,
dams, construction, rather than for the social sectors. We need
to change that dynamic so that developing countries themselves
see the value of taking a loan in the social sectors. We need
to create a World Bank that perhaps in a more listening mode and
is able to really carefully listen to what developing countries
say. Rightly or wrongly, it has a reputation of top-down expertise
and a certain approach, which developing countries may not appreciate.
They may not naturally turn to the World Bank for advice because
of perceptions of what it has stood for in the past, but that
is changing. Let me be clear that the World Bank is an amazing
technical resource and, as I have said before, it is absolutely
vital that the World Bank engages 100 per cent on the health sector,
otherwise we will never get the development goals. They have great
expertise and their niche is clear, but they need to be supported
to do that.
Mr Adlide: I will jump in! I would say a few
things. One is creating a comparative advantage, and the comparative
advantage of the World Bank is large-scale financing, so it does
not seek to be all things to everyone in every country. The problem
that we have with the World Bank one they share with others, is
what I heard a Cambodian Health Secretary say, which was, "Please
close the gap between the rhetoric at head office and what we
see in the field", which was what Julian was just speaking
to. The people in head office are all saying, "We are all
working together, we are part of the IHP", and in the field
a team comes in from the World Bank and studies in a narrow context.
To me, that speaks to the issue of perhaps moving to a knowledge-based
approach rather than evidence-based approach, because the evidence-based
approach seems to be a global evidence picture—it can be
top-down, one-size-fits-all, whereas if you start talking about
a knowledge—and contextualised-based approach you are able
to put the country more in the driver's seat in that relationship
and able to listen, as Julian said, and able to draw the lessons
from that context that would be most appropriate. On financing,
the issue is both volume but also long-term financing. This is
the lesson, I think, we have learnt in GAVI. If I were to take
your challenge and provide some advice to the World Bank, it would
be about how we can extend the frameworks that we are talking
about in terms of grants and loans to countries and set up some
confidence there by being able to commit for 15 or 20 years. We
have always been scrambling in development to say, "Let us
get some real results, let us prove that this can work" and
sometimes it can be in an election cycle with donor governments,
it is quite short-term. The Millennium Development Goals reached
out to 2015. It is pretty obvious that we are not going to have
solved the world's development problems by 2015, but one of the
things we have learnt is that by giving a longer-term timeframe
there is potential to do it, both because it gives the countries
themselves some confidence on the extent of that external support
but also because it has that market-shaping effect too so that
other players, the private sector which is so critical to sustainable
development, is able to be conscious of the fact that there is
something out there, there is a development market out there that
we can be an active player in.
Chairman: Anyone else? No? Thank you
very much. That was very useful. If you do have any more thoughts
or ideas that you want to spell out in more detail, do write to
Mr Preston at the House of Lords and we will take that on board.
We hope to have our report in July at some stage, and you will
no doubt see it. The evidence from the session will be on the
website in a week or two's time. Thank you very much.
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