2021-06-10-世界卫生组织-Restrictive_IMF_Policies_Undermine_Eff­orts_at_Health_Systems_Strengthening_HSS_9页_1mb

IMF Policies and Health Systems Strengthening

Restrictive policies imposed by the IMF (International Monetary Fund) have hindered efforts to strengthen health systems (HSS) in developing countries. This paper argues that these policies, rooted in conservative fiscal and monetary doctrines (especially since the 1980s), prioritize short-term fiscal balance and low inflation at the expense of long-term public investment needed for health infrastructure and universal health coverage.

Key Problems with IMF Policies

1. Focus on Fiscal Balance and Low Inflation: IMF conditions require governments to balance budgets, often through spending cuts and tax reductions (not increases). The pursuit of price stability (low inflation) discourages both public and private investment.
2. Consequences for Growth and Investment: These policies lead to lower real interest rates, making credit less accessible for businesses and investments. This reduces GDP output, employment, and tax revenues, limiting governments' ability to fund HSS.
3. Lack of Empirical Basis for Inflation Targets: Critics argue the IMF lacks solid evidence to justify target inflation rates like 5-7% as optimal or necessary. High growth rates can accompany moderately high inflation (up to 15-30% some studies suggest), while low inflation targets may excessively constrain growth and public spending.
4. The "Sacrifice Ratio": The paper emphasizes the real-world costs ("sacrifice ratio") of pursuing low inflation, including lower GDP growth, fewer tax revenues, and reduced public investment precisely when increased investment is needed for HSS. These trade-offs often occur without public debate or consideration of alternative policies.
5. Impact on Health: The resulting low and chronically insufficient health budgets and dilapidated infrastructure directly undermine the ability of countries to achieve universal health coverage, despite international commitments.

Conclusion

The paper concludes that IMF policies, designed originally for fixed exchange rates and later repurposed for crisis management, are misaligned with health system needs. IMF policies effectively constrain a country's ability to generate domestic resources and undertake the long-term public investment required for robust health systems. The paper calls on developed country donors and finance ministries (like the US Treasury) to pressure the IMF to change these restrictive policies to support health system strengthening and improved health outcomes in developing countries.