Correspondence
Response to “The International Monetary Fund and the Ebola outbreak”
Published Online: 04 January 2015
Open Access
Article Info
There are several factual inaccuracies in the Comment by Alexander Kentikelenis and colleagues.1
First,
it is not correct to say that health-care expenditures have declined in
Sierra Leone, Guinea, and Liberia. As Benedict Clements, Masahiro
Nozaki, and I note in a recent blog,2
spending on health and education have increased faster in low-income
countries with programmes supported by the International Monetary Fund
(IMF) than in those without. According to IMF estimates, in Guinea,
spending increased by 0·7 percentage points from 2010 to 2013, in
Liberia by 1·6 points, and in Sierra Leone by 0·24 points.
More generally, World Bank data3
show that health outcomes in sub-Saharan Africa, including the three
Ebola-hit countries, have improved significantly over the past decade or
so, including improvements in mortality rates (falling by about 30%),
child nutrition, defined as the proportion of children aged younger than
5 years whose weight for age is more than 2 SD below the median for the
international reference population ages 0–59 months (improving by 9%),
and sanitation (improving by 9%).
Second, it is simply not correct to say that the IMF requires caps on the public-sector wage bill. In 2007, the IMF announced a new policy on wage bill ceilings,4
as part of an overall effort to promote more effective and sustainable
use of aid flows to low-income countries. In fact, IMF programmes in
Guinea, Liberia, and Sierra Leone have not had any limits on the wage
bill during the period 2000–14.5
The
fact is that Guinea, Sierra Leone, and Liberia were doing relatively
well trying to overcome years of instability, including civil wars that
claimed tens of thousands of lives and had a devastating effect on
social infrastructure.
The arrival of Ebola put severe
pressure on already fragile infrastructure and health-care systems. The
IMF recognised the urgency of the situation and moved quickly to help,
as Kentikelenis and colleagues note.1 The IMF made available6
an additional US$130 million to the three countries to fight Ebola. We
are also working on mechanisms to allow us to move rapidly to provide
more debt relief to these countries—which would free up more resources
that could be used for health-care spending.
References
- Kentikelenis, A, King, L, McKee, M, and Stuckler, D. The International Monetary Fund and the Ebola outbreak. Lancet Glob Health. 2014; (published online Dec 22.)http://dx.doi.org/10.1016/S2214-109X(14)70377-8.
- Clements, B, Gupta, S, and Nozaki, M. What happens to public health spending in IMF-supported programs? Another look. http://blog-imfdirect.imf.org/2014/12/21/what-happens-to-public-health-spending-in-imf-supported-programs-another-look/. ((accessed Dec 23, 2014).)
- The World Bank. World development indicators. http://databank.worldbank.org/data/views/variableSelection/selectvariables.aspx?source=world-development-indicators. ((accessed Dec 30, 2014).)
- Martijn, JK and Tareq, S. IMF moves to clarify aid role. http://www.imf.org/external/pubs/ft/survey/so/2007/NEW0720B.htm. ((accessed Dec 23, 2014).)
- International Monetary Fund. The IMF and aid to sub-Saharan Africa. http://www.imf.org/external/np/ieo/2007/ssa/eng/pdf/report.pdf. ((accessed Dec 30, 2014).)
- IMF Survey. IMF approves $130 million for countries worst hit by Ebola. http://www.imf.org/external/pubs/ft/survey/so/2014/new092614a.htm. ((accessed Dec 23, 2014).)
