On a big wide plain, surrounded by hills, lived the finest herd of goats ever seen. The greatest of them were immensely hairy and roamed around, eating too much and proclaiming themselves to be the hairiest in creation. They kept the best pastures for themselves and spent a lot of time at the top of the hills, from where they could survey their minions. Anything they didn’t want would roll down the hills and on to the plain, and they considered this to be a very good thing.
Their minions were not so hairy and lived all their lives tethered to posts. All day, every day, they grazed the little that grew in the small disk around their posts. And many had to share their disk of grass with others because the posts were so close together. Sometimes, the free goats would even come and steal grass from the tethered goats, although they had plenty of their own and were free to graze anywhere.
The free goats would often discuss the conditions that the tethered goats had to live in. They would ask if the tethered goats shouldn’t have longer ropes, or even shorter ropes. They would ask if the rope should be made of different materials, perhaps cheaper ones. Once, they even tethered some of the goats with bungees, which meant that they would struggle to a little green grass only to be pulled back just as they started to eat it. This caused the tethered goats a lot of suffering but the free goats found it amusing, especially when the tethered goats hit their posts.
Every now and again, a free goat would have the temerity to suggest that all goats should be free, that none should be tethered and that the plains are subject to floods and eventually everyone will suffer, tethered or free. On such occasions, the biggest and hairiest free goat would be summoned, because he was considered to be the wisest. At least, he had the most impressive set of dried dingleberries that rattled as he walked around, a quality much prized among free goats.
This hairy goat would remonstrate with the outspoken goat and point out that great wisdom does not lie in giving the best answers to questions, or even in asking the best questions. Great wisdom lies in recognising who is the wisest and doing exactly as they do. If the wisest has long shaggy hair and a profusion of dingleberries, this is what one must emulate. As for flooding, he pronounced, the rising tide will float all goats.
And he was right, the tide rose and the goats all floated, for a while. The tethered goats were quickly submerged and the free ones ran for the hills. The water kept rising and food supplies dwindled, but the few free goats that were left ate more than ever. The one with the great dingleberries drowned because wet dingleberries don’t float. And the remaining free goats continue to live in isolated groups at the very tops of the highest hills, wondering what to do now that their hairy leader has gone.
Dingleberries are a lot less fashionable now, and even hairiness is no longer much sought after. But the ability to balance on all four feet on a very small patch of ground is considered to be a sign of great wisdom among free goats.
Showing posts with label IMF. Show all posts
Showing posts with label IMF. Show all posts
Thursday, May 13, 2010
Tuesday, October 27, 2009
Funding Health is Cheaper than Paying for Disease
To continue a theme I hit on in my last post, Reuters AlertNet lists lower respiratory infections as the top killer, accounting for more than 4 million deaths in developing countries. HIV/Aids is listed as number two, accounting for three million deaths, although serious under-reporting of HIV deaths must place a question mark over whether HIV/Aids is really number two or number one.
But the number three killer is interesting because malaria is said to be responsible for between one and five million deaths every year. Added to this, diarrhoea, at number four, kills an estimated 2.2 million people every year. So if deaths caused by poor water and sanitation were added up, they could easily be a contender for 'top killer'.
AllAfrica.com are excited at the possibility that diarrhoea may now get as much attention and funding as HIV/Aids. But funding and attention for a specific condition is missing the point. The number of people suffering and dying from diarrhoea is dwarfed by the number who suffer and die from water borne conditions and others that result from lack of decent standards of water and sanitation.
Health is not merely a matter of curing sickness; it is primarily a matter of ensuring that people live in circumstances that will maximise their health. In other words, they need a decent standard of living. Treatment and immunisation are great but they are no substitute for prevention. A lot of disease and death could be much more cheaply prevented by providing people with good water and sanitation.
Similarly, many of the lower respiratory infections that are said to comprise the top killer result from poor living and working conditions. Added together, water borne diseases and lower respiratory infections probably outnumber all other killer diseases in prevalence and mortality. So the effect of improving living and working conditions combined with improving water and sanitation would be profound.
But a health strategy that effectively consists of targeting diseases, or even risk factors, and starting with the biggest, seems to miss the reasons why so many people suffer and die unnecessarily. There isn't a need to target diarrhoea, for example, because it kills more children than HIV/Aids. There is a need to provide people with a standard of living that enables them to avoid all water borne diseases. Lower respiratory infections may be the top killer but simply vaccinating everyone and treating everyone infected will still leave people living in poor conditions.
To use a different example, malaria prevention is not just a matter of distributing bed nets. If you continue to ignore the festering pools of water that you find everywhere, your children will still go out and play in or near them when they wake up. Festering pools of water are not conducive to good overall health. The bed nets are vital in some areas but the risk of both malaria and other water borne diseases can be lowered by an improvement in sanitation and hygiene conditions.
Luckily, the WHO recommendations to which the AllAfrica article refers includes improvements in water and sanitation. But it remains to be seen if the World Bank and the International Monetary Fund (IMF) keep in step with the WHO. Since the early 1980s, these institutions have worked to reduce health, education and infrastructure in developing countries. They have concentrated on dismantling the structures which allow people to live healthy lives.
There's a sense in which health policy and funding seem to concentrate on downstream effects, particular diseases and health conditions, rather than on the upstream determinants of health.
But the number three killer is interesting because malaria is said to be responsible for between one and five million deaths every year. Added to this, diarrhoea, at number four, kills an estimated 2.2 million people every year. So if deaths caused by poor water and sanitation were added up, they could easily be a contender for 'top killer'.
AllAfrica.com are excited at the possibility that diarrhoea may now get as much attention and funding as HIV/Aids. But funding and attention for a specific condition is missing the point. The number of people suffering and dying from diarrhoea is dwarfed by the number who suffer and die from water borne conditions and others that result from lack of decent standards of water and sanitation.
Health is not merely a matter of curing sickness; it is primarily a matter of ensuring that people live in circumstances that will maximise their health. In other words, they need a decent standard of living. Treatment and immunisation are great but they are no substitute for prevention. A lot of disease and death could be much more cheaply prevented by providing people with good water and sanitation.
Similarly, many of the lower respiratory infections that are said to comprise the top killer result from poor living and working conditions. Added together, water borne diseases and lower respiratory infections probably outnumber all other killer diseases in prevalence and mortality. So the effect of improving living and working conditions combined with improving water and sanitation would be profound.
But a health strategy that effectively consists of targeting diseases, or even risk factors, and starting with the biggest, seems to miss the reasons why so many people suffer and die unnecessarily. There isn't a need to target diarrhoea, for example, because it kills more children than HIV/Aids. There is a need to provide people with a standard of living that enables them to avoid all water borne diseases. Lower respiratory infections may be the top killer but simply vaccinating everyone and treating everyone infected will still leave people living in poor conditions.
To use a different example, malaria prevention is not just a matter of distributing bed nets. If you continue to ignore the festering pools of water that you find everywhere, your children will still go out and play in or near them when they wake up. Festering pools of water are not conducive to good overall health. The bed nets are vital in some areas but the risk of both malaria and other water borne diseases can be lowered by an improvement in sanitation and hygiene conditions.
Luckily, the WHO recommendations to which the AllAfrica article refers includes improvements in water and sanitation. But it remains to be seen if the World Bank and the International Monetary Fund (IMF) keep in step with the WHO. Since the early 1980s, these institutions have worked to reduce health, education and infrastructure in developing countries. They have concentrated on dismantling the structures which allow people to live healthy lives.
There's a sense in which health policy and funding seem to concentrate on downstream effects, particular diseases and health conditions, rather than on the upstream determinants of health.
Wednesday, October 14, 2009
Born Obsolescent But Still Around, Unfortunately
Apparently a report has found that the IMFs (International Monetary Fund) fiscal and monetary policies have stifled Kenya's fight against HIV and TB. They concluded that restricting government spending on health resulted in poor health outcomes.
That's not just a conclusion, that's almost a tautology. Poor healthcare always, everywhere, gives rise to poor health outcomes. I applaud the report writers but I wonder what influence their findings and recommendations will have in the secretive and atavistic 'Bretton Woods' institutions. The report even found that HIV/Aids work is now almost totally dependent on donor funding.
Virtually anyone who has studied HIV, its spread and the almost total (but extremely expensive) failure to reduce its spread, would have, and probably have, come to the same conclusions. But what effect has research ever had on the way the IMF does its work?
The report also concludes that the IMF's policies are partly to blame for Kenya's poor economic performance. But this is true of the economic performance of every country that the IMF has interfered in. In the whole history of the IMF, they do not have one single success story. They beat on about reform, democracy and accountability. Yet they have never been reformed, they are not in the least bit democratic and they are not accountable to anyone.
It's odd that both the World Bank and the IMF can produce reports that, at the same time, boast of the great things that they have done and also admit the failures that, essentially, are the great things they have done. Anyhow, the full report is available, but keep a sick bag handy.
That's not just a conclusion, that's almost a tautology. Poor healthcare always, everywhere, gives rise to poor health outcomes. I applaud the report writers but I wonder what influence their findings and recommendations will have in the secretive and atavistic 'Bretton Woods' institutions. The report even found that HIV/Aids work is now almost totally dependent on donor funding.
Virtually anyone who has studied HIV, its spread and the almost total (but extremely expensive) failure to reduce its spread, would have, and probably have, come to the same conclusions. But what effect has research ever had on the way the IMF does its work?
The report also concludes that the IMF's policies are partly to blame for Kenya's poor economic performance. But this is true of the economic performance of every country that the IMF has interfered in. In the whole history of the IMF, they do not have one single success story. They beat on about reform, democracy and accountability. Yet they have never been reformed, they are not in the least bit democratic and they are not accountable to anyone.
It's odd that both the World Bank and the IMF can produce reports that, at the same time, boast of the great things that they have done and also admit the failures that, essentially, are the great things they have done. Anyhow, the full report is available, but keep a sick bag handy.
Thursday, July 23, 2009
International Aids Society Say They Are Doing a Great Job, Thanks for Asking
Why do the International Aids Society want us to believe that HIV funding has not distorted overall health funding and shifted attention from non-HIV issues while their partners at NAM want us to believe the opposite?
The 2009 International Aids Society (IAS) Conference has come up with a rather extraordinary conclusion: that there is “new evidence illustrating how investments in HIV have contributed to reductions in infant mortality and TB incidence, improved access to health services for women, and expanded health systems capacity”. That’s what their blog says, but they don’t appear to cite any evidence.
Spending on health, education, infrastructure and social services have been going down in Kenya since the 1980s. Many of these reductions were recommended by the World Bank and the International Monetary Fund (IMF) in the name of ‘structural adjustment’. Not that the Kenyan government was reluctant to reduce spending; the Moi regime (and the ones that followed it) couldn’t have cared less about public spending as long as the bulk of it went into the pockets of rich swindlers (otherwise known as business people and politicians).
It is true that large sums of money have been spent on HIV related treatment programmes and (far smaller sums) on HIV prevention programmes. But most of them had little or nothing to do with general health. Many of these programmes are standalone concerns, though they often tap into existing health capacity. Ok, they could have had some marginal, accidental positive affects and this requires investigation.
But in what way is this organization claiming that investments in HIV have contributed to health in general? There may be more health employees in the country but the number of GPs, nurses and health workers has not increased along with increases in the population. Worse still, many have been recruited (poached) to work with HIV, exclusively. Which “clinics and hospitals are being refurbished” with HIV funds, where are these “cadres of health workers” being mobilized, who are these health workers whose morale has been “greatly lifted”?
Was the purpose of the IAS Conference to get everyone together to have a great big feelgood session, so they could all pat each other on the backs? Maternal and child health has been disimproving since the 1980s, progress towards the Millennium Development Goals is negative. Who are these well paid and well qualified people trying to fool?
To add insult to injury, the IAS’s two day meeting on ‘Health Systems Strengthening’ was partly sponsored by the…World Bank. This is one of the organisations that has been instrumental in reducing health and other social services! There is recent damning report about the World Bank’s role in dismantling any structures that could benefit people in developing countries and privatising anything some hungry, private sector sharks can screw a bit of money out of. Most of their work has been highly detrimental but hey, they’re still doing it!
There’s a more credible article published by NAM (aidsmap.com), which also happens to be a partner of IAS. This article suggests that delivery of health care services has been seriously affected by the HIV/AIDS pandemic. This article is based on data (real data!) from the National Bureau of Economic Research at Princeton University. Maternal and child health has deteriorated since the mid 1990s in countries with high HIV prevalence. This deterioration is linked with a reduction in the number of trained health personnel and the fact that the pandemic “shifted health budgets and other resources towards caring for HIV patients”.
Personally, I prefer the article that is based on data. If the IAS produces data I’ll post it up here and people can make up their own minds what to believe.
The 2009 International Aids Society (IAS) Conference has come up with a rather extraordinary conclusion: that there is “new evidence illustrating how investments in HIV have contributed to reductions in infant mortality and TB incidence, improved access to health services for women, and expanded health systems capacity”. That’s what their blog says, but they don’t appear to cite any evidence.
Spending on health, education, infrastructure and social services have been going down in Kenya since the 1980s. Many of these reductions were recommended by the World Bank and the International Monetary Fund (IMF) in the name of ‘structural adjustment’. Not that the Kenyan government was reluctant to reduce spending; the Moi regime (and the ones that followed it) couldn’t have cared less about public spending as long as the bulk of it went into the pockets of rich swindlers (otherwise known as business people and politicians).
It is true that large sums of money have been spent on HIV related treatment programmes and (far smaller sums) on HIV prevention programmes. But most of them had little or nothing to do with general health. Many of these programmes are standalone concerns, though they often tap into existing health capacity. Ok, they could have had some marginal, accidental positive affects and this requires investigation.
But in what way is this organization claiming that investments in HIV have contributed to health in general? There may be more health employees in the country but the number of GPs, nurses and health workers has not increased along with increases in the population. Worse still, many have been recruited (poached) to work with HIV, exclusively. Which “clinics and hospitals are being refurbished” with HIV funds, where are these “cadres of health workers” being mobilized, who are these health workers whose morale has been “greatly lifted”?
Was the purpose of the IAS Conference to get everyone together to have a great big feelgood session, so they could all pat each other on the backs? Maternal and child health has been disimproving since the 1980s, progress towards the Millennium Development Goals is negative. Who are these well paid and well qualified people trying to fool?
To add insult to injury, the IAS’s two day meeting on ‘Health Systems Strengthening’ was partly sponsored by the…World Bank. This is one of the organisations that has been instrumental in reducing health and other social services! There is recent damning report about the World Bank’s role in dismantling any structures that could benefit people in developing countries and privatising anything some hungry, private sector sharks can screw a bit of money out of. Most of their work has been highly detrimental but hey, they’re still doing it!
There’s a more credible article published by NAM (aidsmap.com), which also happens to be a partner of IAS. This article suggests that delivery of health care services has been seriously affected by the HIV/AIDS pandemic. This article is based on data (real data!) from the National Bureau of Economic Research at Princeton University. Maternal and child health has deteriorated since the mid 1990s in countries with high HIV prevalence. This deterioration is linked with a reduction in the number of trained health personnel and the fact that the pandemic “shifted health budgets and other resources towards caring for HIV patients”.
Personally, I prefer the article that is based on data. If the IAS produces data I’ll post it up here and people can make up their own minds what to believe.
Friday, July 10, 2009
Circumcision: a Question of Health or Politics?
If I were a Kenyan man and someone said, "hey, you could reduce your chances of contracting HIV by 60% if you get circumcised", I don't think I'd take up the offer. Health services in Kenya have been declining since the 70s and a recent study showed that the rate of adverse effects from clinically performed circumcisions in Bungoma, Western Kenya, stood at 17%. To be fair, I also came across an article that said that the rate of adverse effects in another programme stood at below 1% but it didn't cite any authority for this claim. And in the end, you have to look at things in a pragmatic way; Kenya has not been spending much on health or other social services for several decades, personnel levels are low, training budgets are poor to non-existent, morale in the health services is terrible. Conditions just don't seem good for a mass male circumcision (MMC) campaign.
But I would also question why people who don't want to use condoms, for whatever reasons, would risk an operation that may not even give them the level of protection they need. Are people queuing up to be circumcised, perhaps, because they don't want to use condoms and they think being circumcised will obviate the need for these? The article claims that health services are "struggling to meet demand" for circumcision, which certainly doesn't inspire confidence in health services that were already stretched beyond breaking point. But apparently this campaign also tells people that circumcision only provides partial protection and that they need to continue to use condoms.
So if they don't bother getting circumcised but just use condoms instead, they would achieve higher levels of protection from HIV than if they go for circumcision and don't bother using condoms any more? Well, as I said, the campaign also involves persuading people to use condoms but we know that this is a very hard sell. In fact, condoms protect against a number of sexually transmitted infections and unplanned pregnancies, something circumcision doesn't do so well. So of course, the combination of circumcision and consistent condom use should be a good bet. But it sounds as if a mass male circumcision campaign would cost a lot of money and only benefit a relatively small part of the population (unlike condom-use campaigns, sex education, gender equality, better legislation, etc).
A writer in The UK Guardian has a soul-searching piece about how many infections and deaths could have been prevented if the HIV community had acted on evidence from the mid 80s that circumcision reduces HIV transmission rates. He asks why formal trials didn't start until nearly 20 years later and why it is at this late stage that MMC campaigns are being implemented. Well, maybe the author is right, maybe it is shocking that HIV prevention interventions that could have been implemented over two decades ago were ignored. But I don't think this author or the experts he interviewed should be so hard on themselves. There are so many reasons why HIV spread rapidly in Kenya and other countries, low rates of circumcision could only have played a small part.
For a start, we knew long before the 80s, before HIV had ever been heard of, that people who don't have enough food or water will die. We knew that sick and unhealthy people are more susceptible to disease, any disease, than healthy people. We knew that poorer people face more health risks than richer people. We knew that less well educated people were likely to have worse health than educated people. We knew that people without alternatives would take risky jobs and take more risks in their jobs. We knew that trade policies that only benefit rich countries at the expense of poor countries will make poor countries poorer (for peat's sake, it's a tautology!) and we knew many, many other things that we failed to act on. We are still failing to act on them. These issues are all, either directly or indirectly, related to HIV transmission.
Worse still, international financial institutions spent the 80s, 90s and 2000s giving loans to developing countries on condition that they reduced spending on health, education and other social services, especially infrastructure spending and personnel costs. The HIV prevention programmes that have been implemented since HIV has been identified, such as they were, required the very structures that were being dismantled and continue to be dismantled to this day!
MMC is just one possible HIV reduction programme out of many. But like all other HIV reduction programmes, it will run up against the same problems, such as lack of adequate health services, low levels of health education and adult literacy, poor infrastructure, few social services, etc. If MMC can prevent the millions of infections claimed by experts, such campaigns will require a lot more than training hundreds of masked scalpel wielders. They will need well funded health, education and social services. These latter criteria may or may not have been within reach in the 80s but now, so many years later, they are not even on the development agenda.
I'm not dismissing MMC as one possible intervention out of many. Once the controversies have been cleared up, and there are many, it may have its uses. I'm just wondering why there seems to be so much pressure to spend a lot of money on an intervention that could only benefit a relatively small minority of Kenyans, at best. About 75% are already circumcised. I also think that MMC is a pretty high risk intervention to implement in a country that has so many other health needs and so little health capacity.
The links between environmental conditions with acute respiratory infections and the links between water and sanitation with water borne diseases, for example, have been recognised for a hell of a lot longer without a damn thing being done about them. And a lot more people die from these than from HIV/AIDS. Given that the powers that be are not usually interested in cost effective measures that save many lives and vastly increase the health of many others, why would they be interested in measures that could, at most, affect a relatively small number of lives?
Why should this particular ‘missed opportunity’ receive so much attention and funding, and why now? Is it really true to say that ‘millions of lives could have been saved’ had MMC been introduced long ago. And if it is true, what about the millions more that could have been saved by attending to the many, far more serious areas of development? There seems to be something inherently more political than humanitarian about MMC.
But I would also question why people who don't want to use condoms, for whatever reasons, would risk an operation that may not even give them the level of protection they need. Are people queuing up to be circumcised, perhaps, because they don't want to use condoms and they think being circumcised will obviate the need for these? The article claims that health services are "struggling to meet demand" for circumcision, which certainly doesn't inspire confidence in health services that were already stretched beyond breaking point. But apparently this campaign also tells people that circumcision only provides partial protection and that they need to continue to use condoms.
So if they don't bother getting circumcised but just use condoms instead, they would achieve higher levels of protection from HIV than if they go for circumcision and don't bother using condoms any more? Well, as I said, the campaign also involves persuading people to use condoms but we know that this is a very hard sell. In fact, condoms protect against a number of sexually transmitted infections and unplanned pregnancies, something circumcision doesn't do so well. So of course, the combination of circumcision and consistent condom use should be a good bet. But it sounds as if a mass male circumcision campaign would cost a lot of money and only benefit a relatively small part of the population (unlike condom-use campaigns, sex education, gender equality, better legislation, etc).
A writer in The UK Guardian has a soul-searching piece about how many infections and deaths could have been prevented if the HIV community had acted on evidence from the mid 80s that circumcision reduces HIV transmission rates. He asks why formal trials didn't start until nearly 20 years later and why it is at this late stage that MMC campaigns are being implemented. Well, maybe the author is right, maybe it is shocking that HIV prevention interventions that could have been implemented over two decades ago were ignored. But I don't think this author or the experts he interviewed should be so hard on themselves. There are so many reasons why HIV spread rapidly in Kenya and other countries, low rates of circumcision could only have played a small part.
For a start, we knew long before the 80s, before HIV had ever been heard of, that people who don't have enough food or water will die. We knew that sick and unhealthy people are more susceptible to disease, any disease, than healthy people. We knew that poorer people face more health risks than richer people. We knew that less well educated people were likely to have worse health than educated people. We knew that people without alternatives would take risky jobs and take more risks in their jobs. We knew that trade policies that only benefit rich countries at the expense of poor countries will make poor countries poorer (for peat's sake, it's a tautology!) and we knew many, many other things that we failed to act on. We are still failing to act on them. These issues are all, either directly or indirectly, related to HIV transmission.
Worse still, international financial institutions spent the 80s, 90s and 2000s giving loans to developing countries on condition that they reduced spending on health, education and other social services, especially infrastructure spending and personnel costs. The HIV prevention programmes that have been implemented since HIV has been identified, such as they were, required the very structures that were being dismantled and continue to be dismantled to this day!
MMC is just one possible HIV reduction programme out of many. But like all other HIV reduction programmes, it will run up against the same problems, such as lack of adequate health services, low levels of health education and adult literacy, poor infrastructure, few social services, etc. If MMC can prevent the millions of infections claimed by experts, such campaigns will require a lot more than training hundreds of masked scalpel wielders. They will need well funded health, education and social services. These latter criteria may or may not have been within reach in the 80s but now, so many years later, they are not even on the development agenda.
I'm not dismissing MMC as one possible intervention out of many. Once the controversies have been cleared up, and there are many, it may have its uses. I'm just wondering why there seems to be so much pressure to spend a lot of money on an intervention that could only benefit a relatively small minority of Kenyans, at best. About 75% are already circumcised. I also think that MMC is a pretty high risk intervention to implement in a country that has so many other health needs and so little health capacity.
The links between environmental conditions with acute respiratory infections and the links between water and sanitation with water borne diseases, for example, have been recognised for a hell of a lot longer without a damn thing being done about them. And a lot more people die from these than from HIV/AIDS. Given that the powers that be are not usually interested in cost effective measures that save many lives and vastly increase the health of many others, why would they be interested in measures that could, at most, affect a relatively small number of lives?
Why should this particular ‘missed opportunity’ receive so much attention and funding, and why now? Is it really true to say that ‘millions of lives could have been saved’ had MMC been introduced long ago. And if it is true, what about the millions more that could have been saved by attending to the many, far more serious areas of development? There seems to be something inherently more political than humanitarian about MMC.
Wednesday, April 8, 2009
IMF: a Sixty Year Old Limping Contradiction
I don't know if it is a coincidence but last year the Americans have finally said they would allow someone other than an American to hold the position of president of the IMF (International Monetary Fund), which they have dominated for 60 years. Will the Europeans also allow a non-European to be Managing Director? At the same time, many developing countries, recipients of IMF loans, have decided that the conditions attached to the loans cause more harm than good. So they have paid back their loans (Thailand, Brazil, Venezuela, Argentina, Indonesia). If this trend continues, the IMF could cease to exist.
Is it possible that the Americans see the IMF as an obsolescent institution? Well, perhaps not. Although the IMF appears to have been limping along for some time, the global financial crisis has prompted the G20 to add half a trillion dollars to its funds. The people who are tasked with dealing with the consequences of financial and banking liberalization are also promoting them, one of the IMF's favourite conditions being financial and banking liberalization.
Contradictions have never been a problem for the IMF or the World Bank. They give loans to countries to assist 'development' at the same time as they oversee the reduction of health, education, social services and infrastructure in the same countries. These are the very areas that are in need of development but if you've got the money, you get to decide on the ‘best’ route to development; even if that route is in the opposite direction to anything that could be described as development.
It's vaguely possible that the IMF, similar institutions and donor countries will one day start listening to their recipients. After all, many recipients have had clearer insights into what they need in order to achieve development that benefits their own people. But given their behaviour to date, it seems unlikely that these unwieldy institutions will change much for the better. One might almost think that they are not designed to benefit their recipients. (Remember the Goldenberg scandal in Kenya? Ok, it’s a bit of an easy target!)
A recent issue of Africa Focus (Africa: Global Economic Crisis 1-3) makes the point that developing countries have long been worried about the subsidies that developed countries paid to its farmers (while stipulating the removal of subsidies in developing countries as a condition of receiving loans). Now they also need to worry about subsidies being paid to financial institutions and the possible subsidies to be paid to manufacturing industries, such as the automotive industry. But those who have the money, again, get to make all the rules. Worse still, they also get to break the rules they later find they don't like.
The fiscal stimulus package is designed to favour American (and perhaps Western) interests, goods and services. The fact that Americans and Westerners own or have an interest in financial and other institutions, goods and services in developing countries does not mean that those developing countries will benefit from the package. Developing countries are not allowed to protect themselves, developed countries are.
It is almost laughable that one of the conditions the IMF and World Bank like to apply is an increase in democratic accountability and good governance. These institutions have no democratic accountability and their governance has been demonstrated to be flawed over and over again. Almost laughable, but the poorest people in the world suffer from these jokers’ repeated cock-ups.
Those responsible for the way international finance works have screwed up, badly. Yet the same people and institutions are also responsible for addressing these problems and they seem to be applying the same tired and failed solutions. The IMF is supposed to continue to give loans to developing countries with the same conditions that have been so destructive in the past. Even countries who have made some progress in reducing their indebtedness will now go back to where they were, at best.
The first and most practical thing the IMF and other donors can do is to cancel debts. Really cancel them, not just tinker around with the figures. These debts stem from loans that had impossible conditions attached to them. The recipients of these loans usually end up poorer as a result of the loans and, in reality, have paid them back many times over.
It's not developing countries that need to reform, it's institutions like the IMF. If they are to be in a position to assist developing countries, they need to face up to the reality of the mess they have made. They need to be more representative, they need good governance. Or perhaps the IMF has is finished? Perhaps the IMF now realises that is is an experiment that went on sixty years too long.
Is it possible that the Americans see the IMF as an obsolescent institution? Well, perhaps not. Although the IMF appears to have been limping along for some time, the global financial crisis has prompted the G20 to add half a trillion dollars to its funds. The people who are tasked with dealing with the consequences of financial and banking liberalization are also promoting them, one of the IMF's favourite conditions being financial and banking liberalization.
Contradictions have never been a problem for the IMF or the World Bank. They give loans to countries to assist 'development' at the same time as they oversee the reduction of health, education, social services and infrastructure in the same countries. These are the very areas that are in need of development but if you've got the money, you get to decide on the ‘best’ route to development; even if that route is in the opposite direction to anything that could be described as development.
It's vaguely possible that the IMF, similar institutions and donor countries will one day start listening to their recipients. After all, many recipients have had clearer insights into what they need in order to achieve development that benefits their own people. But given their behaviour to date, it seems unlikely that these unwieldy institutions will change much for the better. One might almost think that they are not designed to benefit their recipients. (Remember the Goldenberg scandal in Kenya? Ok, it’s a bit of an easy target!)
A recent issue of Africa Focus (Africa: Global Economic Crisis 1-3) makes the point that developing countries have long been worried about the subsidies that developed countries paid to its farmers (while stipulating the removal of subsidies in developing countries as a condition of receiving loans). Now they also need to worry about subsidies being paid to financial institutions and the possible subsidies to be paid to manufacturing industries, such as the automotive industry. But those who have the money, again, get to make all the rules. Worse still, they also get to break the rules they later find they don't like.
The fiscal stimulus package is designed to favour American (and perhaps Western) interests, goods and services. The fact that Americans and Westerners own or have an interest in financial and other institutions, goods and services in developing countries does not mean that those developing countries will benefit from the package. Developing countries are not allowed to protect themselves, developed countries are.
It is almost laughable that one of the conditions the IMF and World Bank like to apply is an increase in democratic accountability and good governance. These institutions have no democratic accountability and their governance has been demonstrated to be flawed over and over again. Almost laughable, but the poorest people in the world suffer from these jokers’ repeated cock-ups.
Those responsible for the way international finance works have screwed up, badly. Yet the same people and institutions are also responsible for addressing these problems and they seem to be applying the same tired and failed solutions. The IMF is supposed to continue to give loans to developing countries with the same conditions that have been so destructive in the past. Even countries who have made some progress in reducing their indebtedness will now go back to where they were, at best.
The first and most practical thing the IMF and other donors can do is to cancel debts. Really cancel them, not just tinker around with the figures. These debts stem from loans that had impossible conditions attached to them. The recipients of these loans usually end up poorer as a result of the loans and, in reality, have paid them back many times over.
It's not developing countries that need to reform, it's institutions like the IMF. If they are to be in a position to assist developing countries, they need to face up to the reality of the mess they have made. They need to be more representative, they need good governance. Or perhaps the IMF has is finished? Perhaps the IMF now realises that is is an experiment that went on sixty years too long.
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