The World Bank's Advocacy of User Fees in Global Health, c.1975-1990

Park House (G19 on the campus map), The Courtyard Room
Tuesday 22 October 2019 (12:00-14:00)

Jennie Oldfield –

world health

Speaker: Martin Gorsky, Professor of History in the Centre for History in Public Health at the London School of Hygiene and Tropical Medicine

From the 1970s, the World Bank broadened its development lending to include health services, initially under its population programme, then through direct loans to the sector. It rapidly emerged as a dominant international actor in this field, wielding greater financial power than the World Health Organisation (WHO), despite its comparative lack of representativeness. In the 1980s a series of Bank publications addressed policy towards paying for health care, culminating in Financing Health Services in Developing Countries: An Agenda for Reform (1987). This made an economic case against the use of public funding and provision of curative services, arguing instead for a mix of third-party insurance and user charges. By the 2000s evaluations of the impact of user fees on utilisation affirmed that they had proven to be a significant barrier to access, with deleterious impacts on population health. This seminar examines why the World Bank adopted a strategy which proved so unsuccessful.

All are welcome to this free event which will include refreshments.


Martin Gorsky is Professor of History in the Centre for History in Public Health at the London School of Hygiene and Tropical Medicine. He previously worked at the Universities of Bristol, Portsmouth and Wolverhampton. 

His early research examined the roles of philanthropy and mutualism in the British hospital and social welfare system prior the National Health Service (NHS). He has since researched and published widely on different aspects of public health and health systems, including: the financing and geography of British hospitals before and after the coming of the NHS; patterns of morbidity during the English mortality transition and the response of the friendly societies; the public health poster in Poland; administration and management in the NHS; and public health in English, and particularly London’s, local government. He currently holds a Wellcome Trust Investigator Award, which is examining the intellectual and policy history of ‘health systems’, viewed from the perspective of international organisations and through country case studies.

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