In 2023, Miramax announced production of a limited series based on The Key Man – book by Wall Street Journal journalists Simon Clark and Will Louch. The book revolves around the rise and ruin of private equity firm Abraaj Capital and its former CEO Arif Naqvi, one-time darling of the global health and development community and now facing up to 291 years in prison in the US for fraud. As the book reveals, Naqvi coveted development financing and global health as opportunities to profit and maintain a glamourous inter-continental lifestyle that saw him rubbing shoulders with global leaders at Davos. He reportedly kept a picture of him and Bill Gates on the desk in his office. How did global health come to be a playground for financiers like Naqvi?
One of the key development policy trends of the past decade has been the costing of ambition. In 2014, UNCTAD calculated the costs that would be incurred to achieve sustainable development by 2030 and identified a projected funding shortfall of USD 2.5 trillion per year. The costing was updated in the aftermath of the COVID-19 pandemic to show a shortfall USD 3.9 trillion per year, then again to USD 4.2 trillion last year. Individual sectors have been dealt their own ‘financing gap’ to fill. For education, LMICs face a gap of USD 97 billion per year to achieve targets; for water and sanitation, up to USD 140 billion. Prior to COVID-19, achievement of UHC was expected to require an additional USD 176 billion per year for the world’s 54 poorest countries. And as former colleague of mine Anke Schwittay noted regarding poverty and microfinance, when you turn issues of development into financial problems then it is only logical for the solution to be financial too.
But the sheer scale of the financing gaps being calculated is far in excess of what the global ‘donor’ community might be willing to contribute. And recent trends in development aid indicate that if anything donors are moving in the opposite direction. An uptick in aid commitments during the COVID-19 pandemic reflected the in-kind costs of ‘donating’ unused (often unwanted) vaccines and PPE. Behind headline figures, aid funding was being directed away from social issues such as gender programmes and towards issues of health security considered more pressing. A trend towards using aid money to pay in-donor refugee costs has seen this use of aid treble in the past 5 years to USD 30 billion. Further increases since 2022 reflect commitments to Ukraine, which in the latest figures from 2023 received about as much aid as the next nine countries added together.
And so we come to global health and development’s ‘white knight’: the financier. The rise of finance in the global economy and in the governance of its leading states has been pronounced. Deregulation of financial services, trade and investment over the past 50 years has opened the door to vast expansion in the scale and penetration of global financial markets. Financial companies such as asset managers, private equity investors and pension funds have emerged as leading holders of equity and debt across much of the global economy, including key resources and providers of public services. The top 500 asset management companies collectively manage USD 114 trillion in assets. Private finance has become influential in national, regional and global politics, as financiers bankroll politicians and parties, lobby aggressively around public policy, and are rewarded with platforms at the highest tables of power. Global health and development has become a frontier for the expansion of a private finance sector looking for new ways to pursue growth.
Key proponents have pushed a seductive logic that private finance can address shortfalls in financing for global health and development if only the right instruments can be created to enable such investments. Gavi began issuing its IFFIm bonds in 2006, and in 2008 the International Finance Corporation (IFC), Gates Foundation, African Development Bank and German Development Finance Institution (DEG) were canvassing for private investment into Africa’s private healthcare. Parts of the finance industry have been only too happy to listen, with IFFIm bonds and the Pandemic Emergency Financing Facility proving popular with investors, while key firms like Abraaj, Quadria and TPG launched prominent initiatives to raise funds and invest on behalf of the wider private finance world.
Yet there is good reason to be sceptical. As I note with several co-authors in a new report out this week - Private Financial Actors and Financialisation in Global Health - private finance solutionism in global health downplays significant problems with the high costs being incurred by public ‘partners’, the shift in values as global health is transformed into investable projects and opportunities for financial profit, and the deepening losses in public accountability. In the report we offer a series of recommendations through which individuals and institutions concerned with global health can build new narratives, defend key values, and reassert mechanisms for accountability.
Returning to The Key Man, there is some irony to the casting of actor Dev Patel as Arif Naqvi. One of Patel’s better-known roles is in Best Exotic Marigold Hotel, based on Deborah Moggach’s novel These Foolish Things, in which he portrays the manager of a hotel on the brink of bankruptcy in Jaipur, India, falling upon a clutch of UK retirees as a lifeline when desperately searching for ways in which to keep the hotel solvent. Global health’s retirees look ready to check out and are offering a meeting with their friend the financier. Quite where that path leads is unclear, but it seems unlikely that it is going to be health for all.
The working paper "Private Financial Actors and Financialisation in Global Health" was published in January 2025. It is co-authored by Benjamin M. Hunter, David McCoy, Ana Carolina Cordilha, Anna Marriott, Victor Roy, Felix Stein and Benjamin Wood and published by UNU International Institute for Global Health.
About the author
Ben Hunter is Lecturer in International Political Economy at the University of Glasgow. He works at the intersection of health and development, with a particular interest in issues of market formation in and around healthcare. This has included research projects on the commercial intermediaries operating within markets for healthcare provision and markets for healthcare training and recruitment; the corporatisation and consequent transformations taking place within private healthcare sectors; use of development aid and public-private partnerships to promote private provision of healthcare services; and the strategic efforts underway to position countries within a globalised commercial healthcare economy. Ben has drawn attention to the financialisation processes unfolding within national healthcare systems and the broader field of global health, and the challenge this poses for equitable access to healthcare services. His book, Investor States: Global Health at the End of Aid (2023, Cambridge University Press), charts recent trends wherein states operate as, with and for investors in the healthcare provision sectors of other nations, driving the expansion of corporate-oriented models for healthcare. Prior to joining the University of Glasgow, Ben worked at University of Sussex, King’s College London and as a researcher in the UK Parliament.
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