PHA-Exch> Blocking Progress: The IMF and HIV/AIDS

[Claudio Schuftan]

From: Ted Schrecker tschrecker at sympatico.ca

 *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. The
same is true for education advocates seeking to hire more teachers (3).

 Get the full article from * Rick.Rowden at actionaid.org *

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