Since President Obama nominated Dr. Jim Yong Kim as President of the World Bank commentators have weighed in on his past writings, his nationality, his part in upholding an unjust U.S. domination of the Bank, and his qualifications. But at the heart of this presidential decision is a fundamental question of focus and mission for the World Bank. Jim Kim represents a break from the past -- as both his supporters and detractors agree -- and would surely steer the Bank in new directions. Interestingly, so too might Dr. Jose Antonio Ocampo, the Columbian economist and former UN official, leaving for the first time two heterodox candidates to head one of the World's most fraught institutions. What seems to be unsaid in discussions of Dr. Kim, however, is that the new direction is likely toward a focus the stated mission of the bank: the elimination of poverty.
A Focus on Delivering Development
Dr. Kim's career gives us a fairly clear understanding of what he would prioritize as World Bank president. He would be, without question, more expert and experienced in development than any World Bank president since its inception. He led the World Health Organization's 3x5 initiative that, as the journal The Lancet notes, "helped change forever the way we thought about AIDS." Most recently he's run the Ivy League Dartmouth College. But it is in founding Partners in Health and more recently in pioneering the field of "delivery science" in global health that we see where Kim would take the bank and the fight against global poverty.
At Partners In Health, he and the other pioneering physicians worked to break the mold on medical care in impoverished settings -- bringing world-class medicine to people when the general wisdom said it was neither feasible nor "cost effective." Again and again, Dr. Kim and PIH proved the dominant voices in the development community wrong -- showing, for example, that anti-retroviral treatment of AIDS in Africa and the Caribbean could succeed when leading economic and development experts said it was not practical or did not meet the economic conditions "test for action." Now some of these same economists are campaigning against Dr. Kim.
But to imply, as some have, that Kim's experience is somehow limited to charity shows a willful misunderstanding of what is unique about Partners in Health. The group's outlook is medical, but where Dr. Kim has worked in Rwanda, Haiti, Peru, and the former Soviet Union they have managed to transform communities: building and staffing schools, training and (against the development grain) paying community health workers through effective employment strategies, and building community-based research for development.
Later Kim brought experts in business, economics, and health together to create the Global Health Delivery Project and the Dartmouth Center for Health Care Delivery Science to bring rigorous study to the actual delivery of health care to impoverished communities.
It is in this work that we see what Dr. Kim is likely to do quite differently than other candidates as World Bank President: focus on community-level development in education, health care, infrastructure, and employment and take transformative practices to scale to change nations. And in doing so, he and others have shown that when people demand drugs or doctors or classrooms, well-done health and development can transform the relationship between people and government. To some observers this may seem obvious -- isn't this the raison d'etre of the World Bank today? And yet it is at the heart of a question about the Bank's future.
Challenging Bank Orthodoxy
The stated mission of the World Bank is poverty reduction and achieving the millennium development goals on health, education, food, and sustainability. But at the heart of the fight over the future of the Bank has been the word "growth," which appears nowhere in that mission or in its public description of itself.
Long time Bank insiders and orthodox publications like the Economist have taken to challenging Kim's credentials. Kim, they say, isn't sufficiently focused on pure economic growth. They cite his suggestion that increases in Gross Domestic Product and corporate profits have often failed to trickle down to poor communities.
But in 2012 is this really a question? Who but the most committed neoliberal economists believes that growth alone will end poverty? And to be fair, Dr. Kim has responded to his critics agreeing that, "Economic growth is vital to generate resources for investment in health, education and public goods." But he clearly has a vision beyond GDP.
Here we see the real decision in the 2012 World Bank Presidency race: a vision of the World Bank focused on community-level development results vs. a Bank focused primarily on GDP growth. Only for those who believe in the latter are folks like Larry Summers or PepsiCo's CEO Indra Nooyi "better qualified" for the job than Dr. Jim Kim.
For the GDP-purists, Dr. Ngozi Okonjo-Iweala is a better pick as a U.S.-trained free market, growth-oriented economist who spent over twenty years working at the World Bank.And yet during this time the Bank too often failed in exactly the areas the bank is supposed to be focused on: poverty reduction, health, and the Millennium Development Goals. For example:
- The most recent ten-year evaluation showed that three quarters of World Bank health programs in Africa failed by their own unambitious measures and a recent report suggest the Bank is remains focused on short-term domestic-only financing for health that undermines efforts to halt infectious disease.
- In the Bank's education efforts "fewer than half of projects have succeeded in achieving education quality, labor force, management, learning, or efficiency objectives."
- At the International Finance Corporation, the arm of the World Bank dedicated to the dubious mission of fighting poverty through financing "companies and other private sector partners" only 13% of IFC policies even had any objectives related to people in poverty. The majority (60 percent) of their advisory programs actually delivered no identifiable benefits to society, let alone to the poor.
Why? Because despite rhetoric to the contrary, the Bank's focus has often drifted from achieving development for people living in poverty. The World Bank's failures have not been lack of focus on economic growth, but a lack of focus on delivering results to communities it claims to serve.
What the Bank needs is someone willing to have audacious goals, to use the bully-pulpit of the World Bank to push for pro-poor policies, and to work to transform a massive institution into an effective institution for impoverished communities. The next Bank president will need to transform the agency's ideology and practice and move the thousands of staff and consultants along with them.
We need an expert in delivering development and cutting through policies that have failed in the past. Dr. Jim Yong Kim's track record shows he can pull off exactly that.
Regardless of the outcome this presidential decision will portend change at the Bank: a serious candidacy by Ocampo and Okonjo-Iweala challenging U.S. dominance is only positive. And hopefully a merit-based selection process will emerge in which the World Bank's board actually debates the who and the how of delivering for communities. For many of us, though, the key question is who will actually challenge the ways of doing things at the Bank.