As 2015 began, the world received a sobering message. Not only have the number of Ebola cases exceeded 20,000, but in some affected countries, especially Sierra Leone, the virus is still spreading.
The death toll now tops 8,000 and the usual answers to how this outbreak got so huge so quickly - poverty, bad governance, cultural practices, endemic disease in Guinea, Liberia and Sierra Leone - are giving way to a deeper questioning of the poor public health response. Critics are turning to the structural causes of weak health systems and increasingly showing that international lending policies, including and especially those employed by the IMF, should carry much of the blame.
The IMF has been active in West Africa for many years
; the first IMF loan to Liberia
was in 1963. And for almost as long, public health activists have pointed to the detrimental effects of the strings the IMF attaches to its loans, known as conditionalities
, which more often than not constrain
investment in public sector health services. As a December 2014 comment
in medical journal, the Lancet
explained, the IMF has provided support to Guinea and Sierra Leone for nearly two decades, and to Liberia for seven years. All three countries were engaged in IMF programmes when the Ebola crisis began. IMF conditionalities meant countries have had to prioritise repaying debt and interest payments over funding critical social and health services.
Countries such as Guinea, Sierra Leone and Liberia have had to limit not only the number of health workers they were able to hire (Liberia had only 60 doctors before the Ebola outbreak, Sierra Leone had 136), they've also had to cap wages to a pitifully low level to meet broader IMF policy directives. The Lancet
comment also points out that in Sierra Leone, IMF-mandated policies explicitly sought to reduce public sector employment. In 1995 -1996, the IMF required the retrenchment of 28 per cent of public employees. The World Health Organisation reported a reduction of community health workers from 0.11 per 1,000 population in 2004 to 0.02 in 2008. Caps on wage spending continued into the 2000s. The Lancet
authors state, "By 2004, [Sierra Leone] spent about 1.2 per cent of GDP less on civil service wages than the sub-Saharan African mean."