Basic services fail World's Poor by BBC News 1:01pm 22nd Sep, 2003   The real curse of world poverty is the lack of access to crucial services such as education and healthcare, the World Bank has warned.    In its latest World Development Report, an annual examination of the state of poorer economies, the World Bank has focused on provision of services.    Without improvement in services, the Bank said "freedom from illness and freedom from illiteracy - two of the most important ways poor people can escape poverty - will remain elusive to many." At the same time, even modest investments in education, sanitation, nutrition, electricity or other necessities can pay huge dividends for the developing world.    War on waste    The World Bank - whose annual joint meetings with the International Monetary Fund (IMF) are under way in Dubai - is hoping to influence the debate on the future of aid. Donor countries have pledged to increase aid over the next few years, amid warnings that the so-called Millennium Development Goal poverty reduction targets may not be met.    The goals call for a halving of global poverty, as well as broad improvements in various aspects of human development, by 2015    By arguing the case for improvements in services, the World Bank hopes to ensure that increased aid is not wasted.    Bad service    So far, the bank warns, shoddy services are responsible for incalculable suffering. World Bank chief James Wolfensohn wants to spark a debate.    Many basic services are completely lacking: 2.5 billion people worldwide have no access to improved sanitation, for example. But the real issue is the poor quality of the services that exist, the Bank said.    The Middle East, for example, spends more per head on education than any other developing region, but has some of the highest illiteracy rates.    Only 41% of Angolan children are immunised against tuberculosis, compared with close to 100% throughout the rich world.    And only 12% of births in Bangladesh are attended by skilled medical staff, compared with near-universal midwife coverage in developed economies.    Rapid improvement    A little effort can make a significant difference, the Bank said. A Mexican initiative to give cash to poor households if they attended a clinic regularly and sent children to school reduced childhood illness by 20% and increased secondary enrolment by up to 8 percentage points.    In Indonesia, revenues from oil exploration were directed to education, doubling primary school enrolment to 90%.    But economics often eliminates the incentives for such projects, leaving developing-country governments and service providers with little interest in targeting the poor.    "Services can work when poor people stand at the centre of service provision - when they can avoid poor providers, while rewarding good providers with their clientele, and when their voices are heard by politicians," said Shanta Devarajan of the World Bank's Human Development Network.    Will the World Bank's Plan Work ? By Rick Rowden, ActionAid.    Dust has barely settled on the failed global trade talks. The talks collapsed as poor countries opposed plans for new investment rules which threaten to reduce their power to regulate overseas companies.    Can the World Bank and IMF help the poor?    But the leaders of the World Bank and the International Monetary Fund seem to have missed the message that came from representatives of developing nations.    Poor countries fear that the Bank and the Fund, at their annual meetings in Dubai, will repeat the mantra of the rich world in the Mexican beach resort of Cancun.    The Bank's rhetoric sounds worthy enough. What is wrong with launching its 2004 World Development Report, entitled "Making services work for poor people"? The devil, however, is in the detail.    Misguided reform?    Hundreds of millions of people lack access to decent education, health, water and sanitation. But the Bank's solution is to propose a far bigger role for the private sector in providing these vital services.    ActionAid works in 40 countries across Africa, Asia, Latin America and the Caribbean. Experience tells us that far from helping to improve services, the Bank's plans would harm the interests of poor people. Don't just accept our view. The vast majority of wealthy countries have achieved comprehensive access to good basic services through state, rather than private initiatives.    Corporations which the Bank insists would run things better doubt that sufficient numbers of people in the third world can afford to pay for services at profitable rates.    Subsidies    Business chiefs invoke the word that brought stalemate in Cancun - subsidies - as the added carrot needed to take over from the public sector. Cancun showed poor countries' resistance to moves that undermine their own people's livelihoods    Last year the Bank approved a development strategy which seeks to use credits and subsidies to attract the private sector in its main lending operations. However, companies might still target only the better-off who can buy provision - leaving the most vulnerable still out in the cold. Despite recent contrary statements, the Bank remains vague over its position on user fees.    Yet free, universal provision increases take-up. And universal provision means that campaigning by the most vocal and influential in society benefits everyone. The Bank's internal evaluation report questions its obsession with services run for profit. Only 40 of 100 privately-run water projects were judged to promise sustainable progress.    Growing resistance    Yet the Bank and the IMF continue to champion private enterprise as a panacea. Aid to Ghana was made conditional on the government allowing firms from abroad to procure state contracts.    But Cancun showed poor countries' resistance to moves that undermine their own people's livelihoods. They see that growing insistence on privatisation in donors' loan conditions weakens poor countries' capacity to maintain their own public sector. If the Bank and the fund want better provision for the poor, and to play a major part in meeting the UN's anti-poverty goals, their work must:    examine why access to effective basic services is so often unavailable to people in rural areas.    address discrimination on the grounds of age, caste, class, ethnicity, race and religion.    publish the minutes from their board meetings -how ironic that the Bank cites inadequate accountability in services.    ensure greater involvement from the poor whose lives they purport to have at heart.    Until that happens, developing countries will suffer from private affluence and public squalor. 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