Did the International Monetary Fund contribute to the West African Ebola crisis by requiring too much budget belt-tightening? That’s what several professors argue in the latest issue of medical journal The Lancet.
Three sociologists and a health expert from a trio of premier U.K.universities accuse the emergency lender of enabling the epidemic by fostering underfunded and insufficiently staffed health-care systems through the IMF’s loan programs.
Experts say weak health care systems Sierra Leone, Guinea and Liberia allowed the virulent spread of the Ebola virus. The authors of the Lancet piece acknowledge that there are many reasons for the countries’ frail health-care systems, including a history of conflict in the region.
But they also blame the economic policy prescriptions the IMF required in a raft of crisis loans the emergency lender provided to the countries over the past two decades. The bailout conditions, the authors argue, hindered rather than helped the development of the health-care systems in those nations.
The authors said the IMF’s loan programs forced countries to cut government investment in health care, discouraged employment of needed doctors and nurses by capping public sector wage costs and recommending decentralized health-care spending.
“All these effects are cumulative, contributing to the lack of preparedness of health systems to cope with infectious disease outbreaks and other emergencies,” including the Ebola epidemic, the authors wrote.
The IMF says health-care spending actually increased in each of the three countries in the years leading up to the Ebola crisis. Liberia, for example, saw its health-care spending rise by 1.6 percentage points of gross domestic product, said Sanjeev Gupta, deputy director of IMF’s Fiscal Affairs department. Mr. Gupta has also served as a member of the Lancet Commission on Investing in Health.
The senior IMF economist also said World Bank indicators show improvements in the health of Sub-Saharan Africa. The development institution shows, for example, that infant mortality rates in Liberia have fallen to 54 per 1,000 live births from over 160 in the early 1990s.
Even though Sierra Leone’s infant mortality has steadily fallen through the years to 107 per 1,000 live births, it’s still the highest in the world, according to World Bank data.
Mr. Gupta also said the IMF changed its policy in 2007 on public-sector wage caps to address long-standing criticism of the policy, years before the crisis.
“The fact is that Guinea, Sierra Leone and Liberia were doing relatively well trying to overcome years of instability as they emerged from conflict, including civil wars that claimed tens of thousands of lives and had a devastating impact on social infrastructure,” Mr. Gupta said.
The article sparked a social media squall, adding to the anti-IMF sentiment already prevalent around the globe.
But the fund also had its defenders.
Chris Blattman, an associate professor for political science at Columbia University, rebutted the authors’ claims in an online Washington Post column. “Unfortunately, this just does not really make sense if you’re familiar with the governments in these places, local politics, or more generally how weak states actually work,” he said.