IMF Policies and Health in Sub-Saharan Africa

Abstract

Health matters. It is a fundamental human right¹ which supports economic development (Kimalu, 2001, p. 2), and although globalisation is not new (Sen, 2001), its impact on health is being increasingly scrutinised (Labonté and Tor Gerson, 2005, p. 157). Generally, trade liberalisation is welfare-enhancing because it promotes economic growth and this should, other things being equal, lead to less poverty (for a brief discussion of this assumption see Labonté in this volume). Conventional wisdom suggests (and there may be some utility in the claim) that a virtuous cycle can therefore arise in which growth promotes health which in turn promotes more growth (Labonté and Tor Gerson, 2005, p. 161): less poverty and the opportunities growth brings for greater expenditures on healthcare should both contribute to improved heath outcomes (Labonté and Tor Gerson, 2005, p. 160). At least ostensibly, the Bretton Woods institutions have sought to manage the unfolding of this virtuous cycle globally, not least by policies that have globalised free trade, sought to control (government) debt, and shape policies for better fiscal and economic management of countries. Their role in global health governance (GHG) and global health policies, therefore, would not on the surface appear automatic or obvious. However, as this chapter argues, in the case of the International Monetary Fund (IMF) this is clearly not the case, and the agency has had both a direct and indirect impact on the national health systems (NHS) of many developing countries and the ability of the poorest to access healthcare.