The International Monetary Fund and the Ebola outbreak – The Lancet Global Health

Alexander Kentikelenis, Lawrence King, Martin McKee, David Stuckler

Open Access DOI: http://dx.doi.org/10.1016/S2214-109X(14)70377-8

In recent months, the International Monetary Fund (IMF) has announced US$430 million of funding to fight Ebola in Sierra Leone, Guinea, and Liberia.1 By making these funds available, the IMF aims to become part of the solution to the crisis, even if this involves a departure from its usual approach. As IMF Director Christine Lagarde said at a meeting on the outbreak, “It is good to increase the fiscal deficit when it’s a matter of curing the people, of taking the precautions to actually try to contain the disease. The IMF doesn’t say that very often.”2

Yet, could it be that the IMF had contributed to the circumstances that enabled the crisis to arise in the first place? A major reason why the outbreak spread so rapidly was the weakness of health systems in the region. There were many reasons for this, including the legacy of conflict and state failure. Since 1990, the IMF has provided support to Guinea, Liberia, and Sierra Leone, for 21, 7, and 19 years, respectively, and at the time that Ebola emerged, all three countries were under IMF programmes. However, IMF lending comes with strings attached—so-called “conditionalities”—that require recipient governments to adopt policies that have been criticised for prioritising short-term economic objectives over investment in health and education.3 Indeed, it is not even clear that they have strengthened economic performance.3

Here we review the policies advocated by the IMF before the outbreak, and examine their effect on the three health systems. The information was extracted from the IMF archives of lending agreements covering the years 1990–2014.

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