World Bank’s financing, priorities, and lending structures for global health

• The World Bank is the largest funder of global health within the UN system and the second largest funder overall • We identify five major periods in the bank’s role in global health in terms of lending, cooperation, and knowledge • Despite the entrance of major new global health organisations the bank has remained relevant through innovative financing mechanisms, close long term relations with country ministries, and developing and applying economic approaches to health • The bank’s increasing reliance on trust funds and innovative financing mechanisms, such as the Global Financing Facility, places health decision making authority in the hands of a small group of donors T he Wor ld Bank comb ines intellectual prestige and financial power, referred to colloquially as “ideas with teeth” or “global health on steroids.” From its first foray into health in the early 1970s to the present, the bank has become one of the largest and most influential health funders worldwide. In 2017 it is particularly important to examine its workings in global health: the re-elected President Jim Yong Kim is the first medical doctor to hold the office and is also an activist and anthropologist who has argued for the right to health. Throughout his tenure, the bank has adopted innovative financing measures for health. In this five paper series, we provide an overview of the bank’s evolving role in global health, document its turn towards innovative financing in health, and analyse the benefits and risks of such a shift. Our aim is to complement Kamran Abbasi’s 1999 series on the World Bank in international health by expanding the themes covered and discussing changes in global health governance since the millennium. We base our analysis on World Bank official documents and reports from its website, the World Bank archives, secondary literature on the World Bank, and conversations with numerous bank staff working in the health, nutrition, and population (HNP) sector. In this first paper, we present the first detailed analysis of the bank’s lending for health and put this into context within its governance structures, and broader role in global health over the past 40 years.