Response to “The International Monetary Fund and the Ebola outbreak”
Authors: Sanjeev Gupta
Journal: The Lancet Global Health (2015)

There are several factual inaccuracies in the Comment by Alexander Kentikelenis and colleagues.1Kentikelenis A King L McKee M Stuckler D The International Monetary Fund and the Ebola outbreak.Lancet Glob Health. 2014; (published online Dec 22.)http://dx.doi.org/10.1016/S2214-109X(14)70377-8Google Scholar First, it is not correct to say that health-care expenditures have declined in Sierra Leone, Guinea, and Liberia. As Benedict Clements, Masahiro Nozaki, and I note in a recent blog,2Clements B Gupta S Nozaki M What happens to public health spending in IMF-supported programs? Another look.http://blog-imfdirect.imf.org/2014/12/21/what-happens-to-public-health-spending-in-imf-supported-programs-another-look/Google Scholar spending on health and education have increased faster in low-income countries with programmes supported by the International Monetary Fund (IMF) than in those without. According to IMF estimates, in Guinea, spending increased by 0·7 percentage points from 2010 to 2013, in Liberia by 1·6 points, and in Sierra Leone by 0·24 points. More generally, World Bank data3The World BankWorld development indicators.http://databank.worldbank.org/data/views/variableSelection/selectvariables.aspx?source=world-development-indicatorsGoogle Scholar show that health outcomes in sub-Saharan Africa, including the three Ebola-hit countries, have improved significantly over the past decade or so, including improvements in mortality rates (falling by about 30%), child nutrition, defined as the proportion of children aged younger than 5 years whose weight for age is more than 2 SD below the median for the international reference population ages 0–59 months (improving by 9%), and sanitation (improving by 9%). Second, it is simply not correct to say that the IMF requires caps on the public-sector wage bill. In 2007, the IMF announced a new policy on wage bill ceilings,4Martijn JK Tareq S IMF moves to clarify aid role.http://www.imf.org/external/pubs/ft/survey/so/2007/NEW0720B.htmGoogle Scholar as part of an overall effort to promote more effective and sustainable use of aid flows to low-income countries. In fact, IMF programmes in Guinea, Liberia, and Sierra Leone have not had any limits on the wage bill during the period 2000–14.5International Monetary FundThe IMF and aid to sub-Saharan Africa.http://www.imf.org/external/np/ieo/2007/ssa/eng/pdf/report.pdfGoogle Scholar The fact is that Guinea, Sierra Leone, and Liberia were doing relatively well trying to overcome years of instability, including civil wars that claimed tens of thousands of lives and had a devastating effect on social infrastructure. The arrival of Ebola put severe pressure on already fragile infrastructure and health-care systems. The IMF recognised the urgency of the situation and moved quickly to help, as Kentikelenis and colleagues note.1Kentikelenis A King L McKee M Stuckler D The International Monetary Fund and the Ebola outbreak.Lancet Glob Health. 2014; (published online Dec 22.)http://dx.doi.org/10.1016/S2214-109X(14)70377-8Google Scholar The IMF made available6IMF SurveyIMF approves $130 million for countries worst hit by Ebola.http://www.imf.org/external/pubs/ft/survey/so/2014/new092614a.htmGoogle Scholar an additional US$130 million to the three countries to fight Ebola. We are also working on mechanisms to allow us to move rapidly to provide more debt relief to these countries—which would free up more resources that could be used for health-care spending. The International Monetary Fund and the Ebola outbreakIn 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. Full-Text PDF Open AccessAll about the moneyIt's finally 2015: a year by the end of which extreme poverty and hunger are to be eradicated, maternal and child mortality are to be drastically reduced, and the trajectory of the global incidence of HIV, tuberculosis, and malaria are to be reversed. Much has been written about where the Millennium Development Goals succeeded and failed as global targets, and what has changed in the world since 2000. Much work has also been done to establish what happens next. In his synthesis report on the post-2015 agenda released last month, UN Secretary-General Ban Ki-Moon summarised and annotated this work, ultimately backing the 17 goals proposed by the Open Working Group on Sustainable Development Goals as the basis for a truly transformative agenda. Full-Text PDF Open Access