When it was established, in 1944 the International Bank for Reconstruction and Development, which would come to be known as the World Bank, had no competence in health. In its early years, the bank focused solely on assisting countries to develop and reconstruct through policies to enable economic growth. It was in the 1960s, when the idea of meeting individuals’ ‘basic needs’ became popular in development theory, that the bank began to shift its focus from the purely economic to begin investing in family planning, nutrition, health and education.
By the late 1970s, the World Bank had gone from having virtually no presence in global health to being one of the leading actors, at times – and due in part to cold war politics – even rivalling WHO in authority. However, the bank’s policies have been hotly debated and controversial. For example, not long after the 1978 Alma-Ata Conference, when WHO was mobilizing member states in support of universal primary healthcare, the bank, motivated by economic principles of cost-effectiveness, undermined WHO and UNICEF efforts by putting forward its own policy of selective primary healthcare.
The bank has come through this experience with a strong understanding of the importance that good governance, strong institutions and human capital play alongside market-oriented policies. As a result, the World Bank has reaffirmed its commitment to global health. In 2007, it completed a strategic planning process, which led to a new results-oriented strategy for health, nutrition and population. The bank is also working with other key global health actors to reduce redundancy in the global health architecture. An example of this can be seen in its joint work with WHO in the International Health Partnership (IHP+). Today, the World Bank focuses on its comparative advantages in financing, supporting public-private partnerships, insurance, logistics and incentive mechanisms. In addition, with its profound experience in various sectors, the bank also acts as a leading think tank for development, generating and disseminating knowledge and best practice.
The president of the World Bank is Robert B. Zoellick, who has held the post since 2007. The World Bank is like a cooperative, where its 186 member countries are shareholders. Economically strong countries exercise greater voting power inside the organization, according to their capital contribution to the bank’s resources and their shareholdings. The shareholders are represented by a Board of Governors, the ultimate policy-making body of the World Bank. Generally, the governors are member countries’ finance ministers or ministers of development. They meet once a year at the Annual Meetings of the Boards of Governors of the World Bank Group and the International Monetary Fund. Because the governors only meet annually, they delegate specific duties to 24 executive directors, who work onsite at the bank. The five largest shareholders, France, Germany, Japan, the United Kingdom and the United States, appoint an executive director, while the remaining member countries are represented by 19 executive directors.