[mgj-announce] Reason 5 to Join IMF/World Bank Protests - HIV/AIDS Crisis
rob at essential.org
Sat Aug 31 14:49:31 EDT 2002
THE IMF, WORLD BANK AND THE HIV/AIDS CRISIS
REASON NO. 5 TO JOIN THE FALL PROTESTS
AGAINST THE IMF AND WORLD BANK
SEE WWW.GLOBALIZETHIS.ORG FOR PROTEST DETAILS
How does Third World debt affect health care and HIV/AIDS treatment and prevention?
In two destructive ways: First, governments with overwhelming foreign
debt payment obligations must cut back on what they might otherwise
allocate to the healthcare sector, including funds that may be used for
HIV/AIDS prevention -- condoms, HIV testing, posters, STD treatment,
etc. They are utterly unable to address the challenge of HIV/AIDS
treatment. Second, export earnings that go to service foreign debts are
not available to pay for imports of pharmaceuticals, equipment or other products.
These problems are severely compounded by structural adjustment policies.
What is structural adjustment, and how does it affect health care expenditures?
As a condition for receiving loans, the International Monetary Fund
(IMF) and World Bank require countries to adopt austerity programs known
as structural adjustment. Key structural adjustment measures include:
privatizing government-owned enterprises and government-provided
services, slashing government spending, orienting economies to promote
exports, trade liberalization, higher interest rates, eliminating
subsidies on consumer items such as foods, fuel and medicines and tax increases.
After undergoing severe criticisms for forcing cuts in health care and
education spending, the IMF and World Bank now insist that their current
structural adjustment programs carve out social services from mandated
budget cuts. This is a disputed claim.
The focus on health care spending obscures a more important issue with
health care provision, Kolko notes. Structural adjustment policies have
stagnated economic growth and increased income and wealth inequality
throughout the developing world -- and the resultant poverty has
severely undermined the standard of living and quality of health care
for most people in poor countries.
How do fee-for-service plans and privatization affect health care provision?
Not surprisingly, charging for health care limits access. And user fees
are a central feature of the fee-for-service schemes that the IMF and
Bank push in their structural adjustment and sectoral adjustment programs.
One World Bank report argued that the pre-1980s policy of many African
states "to treat [health care] as a right of citizenry and to attempt to
provide free services to everyone ... prevents the government health
system from collecting revenues that many patients are both able and
willing to pay." Another report added, "When a service costs money,
people will think twice about demanding it."
When the World Bank mandated that Kenya impose charges of US$2.15 for
STD clinic services, attendance fell 35 to 60 percent, with similar
results seen throughout the developing world.
What does this mean in people terms?
Here is how Njoki Njoroge Njehû, who is from Kenya and now direct the 50
Years is Enough campaign, describes her experience: "When I was a young
girl growing up near Nairobi, Kenyatta Hospital was the pride of East
and Central Africa -- a sophisticated regional center of care like, say,
the Washington Hospital Center."
"When I visited my aunt there in 1997, she was sharing a bed with
another patient. Most wards have no beds because of lack of resources,
and all the beds had two people in them. Guards used to check visitors
to prevent them from bringing food in from the outside; now the guards
are gone and if you don't bring food your relatives simply won't eat. My
aunt was lucky that the dollars I brought with me could buy the
medications she was prescribed, and which we had to purchase elsewhere
and bring back to the hospital for the nurse to administer. Not everyone
has relatives in the U.S., or can get to Kenyatta, the best public
hospital in Kenya -- which is far from being one of the poorest African countries."
"In 1981, there were ten thousand people for every doctor in Kenya; by
1994 that ratio had gone up to nearly 22,000 people for every doctor. In
Uganda, just to our west, there were 661 people for every hospital bed
in 1981, while in 1994 there were 1,092 for every bed. In Ghana, a
country often touted as an example of how structural adjustment can
work, the percentage of infants with low birth weight has gone from 5%
in 1988 to 17% in the period of 1992-1995."
Does structural adjustment contribute to the spread of HIV/AIDS?
In the journal AIDS, Dr. Peter Lurie and collaborators argued yes. They
argued that the displacement of the rural sector under structural
adjustment programs -- as imports undermine local farmers and the shift
to large-scale plantations for exports further displaces the rural
population -- contributes to migration and urbanization. Many men leave
rural villages for work in big cities or in mines, contract HIV/AIDS
from casual sex partners or sex workers, and then spread the disease to
spouses in their home village. The displacement of children and young
women into the cities has led to a sharp increase in commercial sex work
and heightened rates of HIV/AIDS.
"The breakdown of health delivery systems that may accompany structural
adjustment programs also inhibits surveillance and testing for HIV,"
Lurie, et. al. add. "Even HIV screening of blood used for transfusion
can be limited; in some countries only 50 percent of blood transfusions
were screened. Funding shortages also encourage the reuse of disposable
syringes, potentially contributing to HIV transmission."
What are the solutions to these problems?
First, the debts of the poorest countries must be cancelled. Second, the
structural adjustment package must be scrapped, with countries free to
pursue policies designed to emphasize building up of the local economy
and maintaining the government's role in guaranteeing health care and
other essential services. Third, the World Bank and IMF's emphasis on
health care privatization and fee for services must be abandoned.
For more information, visit the Health Gap web site at www.healthgap.org
-- SEE WWW.GLOBALIZETHIS.ORG FOR PROTEST DETAILS --
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