Global Social Policy Copyright (c) 2008 1468-0181 vol. 8(1): 19–24; 086085
SAGE Publications (Los Angeles, London, New Delhi and Singapore)
DOI: 10.1177/1468018107086085 http://gsp.sagepub.com
Blocking Progress: The IMF and HIV/AIDS, .....excerpts
RICK ROWDEN, ActionAid International USA
In many low-income countries, HIV/AIDS activists and broader networks of public health and education advocates have been increasingly frustrated by the inability of their countries to spend more on the public health and education systems generally, and on the additional doctors, nurses and teachers projected to be needed to fight HIV/AIDS effectively or achieve other Millennium Development Goals (MDGs) by 2015. The Joint Learning Initiative on Human Resources for Health and Development, a global study of health workforces, found that to provide the essential health interventions required to achieve the MDGs will require Africa to increase its health workforce by at least 1m additional doctors, nurses, and midwives over the current level of 600,000 health care workers (1). A similar study by the World Health Organization found that for essential health services to be provided, sub-Saharan Africa needs a total of 2.5m additional health care workers (2).
Yet such spending increases are not at all possible under the current economic policy choices. Most health and education ministries only have the budgets granted by their finance ministries, and in turn, the finance ministries explain that budgets are in line with the fiscal and monetary policy targets agreed with the International Monetary Fund (IMF).
Most low-income countries are under pressure to stay 'on track' with their IMF programs, as its essential for also accessing World Bank money or aid from the other major multilateral or bilateral donors and creditors. By playing such a gatekeeper role to all other foreign aid, the IMF's 'signal effect' has given it tremendous power beyond the amount of money in its loans. The fundamental problem is that under current IMF policy choices and spending constraints, many countries will not be able to increase expenditures or public investment in line with what is projected to be needed to fight HIV/AIDS or achieve the MDGs.
A flashpoint of controversy in recent years has been over the IMF's use of ceilings or caps on the wages for all public sector employees in the budget as among its binding loan conditions. When enforced, the national wage bill ceilings consequently constrain the levels of wages available for each of the sector budgets, including for health personnel. Therefore, even when donors are willing to finance personnel costs, such as increased salaries or new health care worker posts, countries may be prevented from using such funds because of the IMF's spending limits on wages. As the wage ceilings have made planning for ambitious scaling-up of health personnel all but impossible, the IMF has become a lightening rod for unwanted attention. Thesame is true for education advocates seeking to hire more teachers (3).
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Rick Rowden
ActionAid International USA
mailto:Rick.Rowden@actionaid.org
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Ted Schrecker
mailto:tschrecker@sympatico.ca