19 July 2012

Highlights from Jim Kim at Brookings

World Bank president Jim Kim delivered remarks at the Brookings Institute yesterday and even took some time to answer a few questions. Here are a few quick highlights based on the unedited transcript:
The story about transformational change is not just a story about emerging economies, like India and China. It is broad-based and extends to countries that are landlocked, like Rwanda, a country that I’ve visited many times; that are small, like Laos, and large, like India; that don’t have natural resources, like Ethiopia. And it extends even to countries that were once mired in conflict, like Mozambique.
Building Safety Nets
We can help countries in building cost-effective safety nets that can protect people against shocks. What I learned by working in communities around the world is that the poorest are the most vulnerable to sinking even deeper into poverty. When illness afflicts a breadwinner, it compromises the future of the whole family. I’ve seen this happen so many times in my own work. Three out of five vulnerable people lack safety nets in developing countries and four out of five in the poorest countries.

Safety nets must be available on a continuous basis to increase resilience against shocks, such as ill health or financial crisis, and building them requires political will. The good news is that effective safety nets need not be costly. Flagship Mexican and Brazilian programs cost only around 0.5 percent of GDP, much less than what other countries spend on untargeted and less effective programs or fuel subsidies. The World Bank has worked with government to expand safety nets in 40 countries, and our goal is to ensure that every developing country has an effective and sustainable safety net.
Inclusive Growth
Even as an unprecedented number of people in the developing world are ascending into the middle class, segments of the poorest populations are being left behind and other segments of the middle class are at risk of falling back into poverty. As young people in Egypt and Tunisia have reminded us, even in middle-income countries development gains have been uneven and incomplete. Demands for respect of individual rights, the rule of law, and the administration of justice go hand-in-hand with inclusive development, requiring institutions to be more open and accountable. That’s why the World Bank is broadening its partnerships. Informed by the lessons of the Arab Spring, the Bank is creating a global partnership for social accountability. It’s providing seed money from IBRD income and leveraging resources from foundations and bilateral donors. This would be the first time the World Bank is allocating specific resources from its income to support a partnership with civil society.

We will try to do at the Bank what the most successful countries did during the last decade. We will work tirelessly, we will continue to learn about what works and what does not, and we will carry out bold reforms when they’re needed. And more than that, we will hold ourselves accountable to the people we serve so that we are judged by our results, not just our intentions.
Talkin' RCTs
You know, we talk a lot about evidence-based medicine. Evidence based medicine, of course, is everywhere, but it’s only about 30 years old. I mean, I remember when I started medical school in 1982 that it was just the beginning of talking about we can generate evidence around the things that we do and it’s not, you know, any longer the sort of experienced clinician who’s saying to you, well, we do this because that’s what we do.

This is now a revolution that’s happening everywhere. I mean, as you know, the randomized evaluations and data collection methods have expanded, but more generally, I think that there’s a commitment to evidence everywhere.

The other thing that I think is critical is that we have to now focus on actually delivering results on the ground. That’s everywhere, right. So, there is -- the ability to collect more evidence has really focused on results on the ground and one of the things that I was working on before I came to the World Bank was that I thought that there could be a science of how to actually deliver results in the social sector and would say many times that the thing about working in the social sector is that so often we have been very tolerant of poor execution. Great idea, put some money to it, but we haven’t really focused on the science of execution.
Education and Health (based on an audience question)
In terms of health and education, both of those areas are critical and there are two areas of expertise that, again, are areas that I’ve worked on in the past. Let me talk specifically about universal access to health care. So, next week, we have 45,000 people coming for the International Aid Society meeting. There have been enormous investments in HIV, but if you go back and look at the stuff that I was saying in 2003 and 2002 when we first started seeing those investments, what I said over and over again is the investment in HIV is our opportunity to really invest in systems. The critical thing about investing in HIV treatment was that for the first time we invested in chronic treatment, lifelong treatment for disease in the poorest countries in the world that forces you to put systems together. So, I think the discussion is moving in a great direction.

What the HIV people are now saying is well, what about MDGs four and five? What are childhood mortality and maternal mortality? What are we going to do to tackle those particular problems? And I think the most important thing is related to what I said earlier: We have to understand this as a systems and delivery problem and not as a disease problem. The asepcts of this problem that need to be handled by highly-trained physicians are actually quite narrow. The real problems are setting up the delivery systems that can not only protect people from the diseases of today, but from the diseases of tomorrow and there's enough money out there in the world that we can begin moving in that direction. That’s how I would like to see the World Bank engage. We are really good at thinking about systems, we are really good at managing processes at a country level and we’re also really good at thinking about how to set up systems that deliver. So, wouldn’t it be great if we could take all this investment in global health and in every single country build systems?

At Partners in Health, the organization I worked with before, every country we’ve gone into, and Rwanda’s a good example, we’ve gone in and said we’re going to take this money for HIV treatment and turn it into primary health care systems and I think the evidence is overwhelming that it’s both doable and cost effective. And the other thing that we’ve seen that we didn’t expect was that once we built those systems, the economy sprouted up around those health care systems and actually contributed to the economic growth of those countries.

So, one, health and education are critical to economic development in my view. I think the evidence is very good for that. But also, I think the Bank is a very unique and wonderful contribution to make, which is to say hey, folks, these really aren't medical problems, they're partly medical problems, but the big chunk of it that we can help you with is what's going to give you the long-lasting impact, protect you from future disease outbreaks, and also help to build your economy.