The International Monetary Fund and the #Ebola outbreak - The Lancet Global Health
▻http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70377-8/fulltext
Christine Lagarde peut bien, comme ses prédécesseurs, dire que la santé est prioritaire dans les actions du #FMI, la réalité est que les “conditionnalités” de son organisation ont contribué à détruire les systèmes de #santé du Sierra Leone, de la Guinée et du Liberia.
Here we review the policies advocated by the IMF before the outbreak, and examine their effect on the three health systems. The information was extracted from the IMF archives of lending agreements covering the years 1990–2014.
First, economic reform programmes by the IMF have required reductions in government spending, prioritisation of debt service, and bolstering of foreign exchange reserves. Such policies have often been extremely strict, absorbing funds that could be directed to meeting pressing health challenges. (...)
Second, to keep government spending low, the IMF often requires caps on the public-sector wage bill—and thus funds to hire or adequately remunerate doctors, nurses, and other health-care professionals. Such limits are “often set without consideration of the impact on expenditures in priority areas”, and have been linked to emigration of health personnel. In Sierra Leone, for example, IMF-mandated policies explicitly sought the reduction of public sector employment. Between 1995 and 1996, the IMF required the retrenchment of 28% of government employees (...)
Third, the IMF has long advocated decentralisation of health-care systems. The idea is to make care more responsive to local needs. Yet, in practice, this approach can make it difficult to mobilise coordinated, central responses to disease outbreaks. (...)
All these effects are cumulative, contributing to the lack of preparedness of health systems to cope with infectious disease outbreaks and other emergencies.