IMF lending undermined healthcare provision in Ebola-stricken West Africa

www.eurekalert.org/pub_releases/2014-12/uoc-ilu121914.php

Public Release: 21-Dec-2014
University of Cambridge

Writing today in the journal Lancet Global Health, researchers from Cambridge University's Department of Sociology examine the links between the International Monetary Fund (IMF) and the Ebola outbreak in West Africa.

According to the authors, joined by colleagues from Oxford University and the London School of Hygiene and Tropical Medicine, IMF programs over the years have imposed heavy constraints on the development of effective health systems of Guinea, Liberia and Sierra Leone - the cradle of the Ebola outbreak that has killed more than 6,800 since March this year.

The researchers say that economic policy reforms advocated by the IMF have undermined the capacity of health systems in these three nations - systems already fragile from legacies of conflict and state failure - to cope with infectious disease outbreaks and other such emergencies.

"A major reason why the Ebola outbreak spread so rapidly was the weakness of healthcare systems in the region, and it would be unfortunate if underlying causes were overlooked," said lead author and Cambridge sociologist Alexander Kentikelenis.

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Firstly, the IMF required economic reforms that reduced government spending. "Such policies have been extremely strict, absorbing funds that could be directed to meeting pressing health challenges," write the researchers.

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Secondly, the IMF often requires caps on the public-sector wage bill, directly impacting the capacity of these nations to hire and adequately pay key healthcare workers such as doctors and nurses. An independent evaluation of the IMF in 2007 stated that these limits are "often set without consideration of the impact on expenditures in priority areas".

"Wage limits set by the IMF have been linked to a 'brain drain' of health workers in countries that need them most.

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However, in recent months, the IMF has announced $430m of funding to help combat Ebola in West Africa, leading IMF Director Christine Lagarde to say it is "good to increase the fiscal deficit when it's a matter of curing the people [...] The IMF doesn't say that very often."

"The IMF's recent change of heart about prioritising public health instead of fiscal discipline is welcome, but this is not the first time we have heard such rhetoric from the IMF leadership. It remains to be seen whether this time is different," said Kentikelenis.