Science does not know why the current outbreak of Ebola is so durable and deadly. Perhaps the explanation is not in medicine, otherwise in the economy.
GREAT BRITAIN – An analysis of the austerity policies imposed by the International Monetary Fund (IMF) in the most affected countries shows that their national health systems were being weakened for years, paving the way for the epidemic to be even costlier than it had to be.
Over 99% of those affected by Ebola, a total of 18.603, according to the latest figures from the World Health Organization, and 6,015 deaths are from Guinea, Sierra Leone and Liberia. The first two countries have been enslaved for the past twenty years while being under an IMF aid program.
In the Liberian case, funding more recently began in 2008. But the Fund’s support always has a price, usually in the form of cuts in public spending. How have the austerity policies affected national health systems in these three countries?
That is the question a panel of the most prestigious British universities wanted to answer. To do this, they analyzed IMF policies applied in the area since the mid-nineties. Loans for states to have liquidity were accompanied by a number of conditions on spending limits or thinning of the public sector.
“While the immediate causes of the outbreak are epidemiological, we need to consider the broader context in which the disease has spread,” explains sociologist and co-author, Alexander Kentikelenisat, from the University of Cambridge.
“Why do some African countries held their epidemic sooner than the three poorest countries while Guinea, Sierra Leone and Liberia were having such long and deadly outbreaks?,” asks Kentikelenis.
For the sociologist, we must resort to more general factors to observe that the health systems of the three nations were limited and could not to contain the disease due to economic factors. “In particular, the IMF constantly demanded that the three countries imposed large budget cuts or dismissed workers in the public sector.
These policies have had a devastating impact on the development of the health system. Beyond combating the current outbreak, investment in an efficient healthcare system is the best strategy to help countries deal with health crises such as Ebola,” he says.
The study, published in the journal Lancet Global Health found several causes that have undermined the health infrastructure, paving the way for the spread of the disease.
On the one hand, the IMF imposed a series of economic reforms that drained the financial capacity of the countries most affected by Ebola. In exchange for liquidity, the priority was to spend the money to pay the foreign debt of the state and provide money to the coffers of the state, which more often than not means that foreign aid goes into the bank accounts of national and foreign elite members.
“These policies have been extremely strict, absorbing funds that could have been designed to meet the health challenges,” write the experts. Although the IMF softened its demands with a parallel program of aid for social investment and reduce extreme poverty, most of the items have not been implemented.
According to the documentation, the IMF’s program, that has studied so-called priority spending, and that has outlined about thirty social improvement targets, only accomplished about a third of the goals listed.
“In 2013, just before the outbreak of Ebola, the three countries had met the economic policies of the IMF, but none had succeeded in raising social spending despite the health situation being urgent,” explains Lawrence King, also a professor of Cambridge.
Another measure that has come to leave these societies defenseless against an attack from diseases like Ebola, has been the limitation of the public budget and thinning of the public sector to meet the expenditure ceiling demanded by the IMF.
These policies have not only led to the three countries not hire medical staff and deploy adequate infrastructure at health centers, but all three nations have seen many of their doctors leave their countries prior to the Ebola outbreak.
In Sierra Leone, the most affected country, the number of health workers went from 0.11 per 1,000 inhabitants in 2004 to just 0.02 per 1,000 just four years later, according to WHO. Before that, during the mid 1990s, the IMF imposed on the authorities of that country a reduction of public employment of 28% and limits in spending on public wages were lengthened until the last decade.
However, two months ago, at the height of the crisis, the IMF pledged to allocate 350 million euros to fight the epidemic in West Africa and its director, Christine Lagarde, said it was good to “increase the fiscal deficit when it came to heal people … The IMF does not say this very often.”
To Kentikelenis, “the recent change in IMF criteria in prioritizing public health over fiscal discipline is welcome, but it is not the first time we hear this kind of rhetoric of the leadership of the IMF. It remains to be seen whether this time it will be different“.