Research exposes restriction of healthcare investment in West Africa

17 January 2017

Dr Thomas Stubbs
Researcher Dr Thomas Stubbs has co-authored a paper which looks at the controversial IMF lending conditions for healthcare investment in West Africa.

A recent study, led by University of Waikato’s Dr Thomas Stubbs, shows budget reduction targets and public sector caps, insisted on by the International Monetary Fund (IMF) as loan conditions, result in reduced health spending and medical ‘brain drain’ in developing West African nations.

The research suggests that lending conditions imposed by the IMF in West Africa squeeze “fiscal space” in nations such as Sierra Leone – preventing government investment in health systems and, in some cases, contributing to an exodus of medical talent from countries that need it most.   

Dr Stubbs, a Sociology lecturer within the University’s Faculty of Arts & Social Sciences, collaborated with researchers from the Universities of Cambridge, Oxford and the London School of Hygiene & Tropical Medicine to analyse the IMF’s own primary documents and evaluate the relationship between IMF-mandated policy reforms – the conditions of loans – and government health spending in West African countries.

They found that for every additional IMF condition that is ‘binding’ – ie failure to implement means automatic loan suspension – government health expenditure per capita in the region is reduced by around 0.25%. A typical IMF programme contains 25 such reforms per year, amounting to a 6.2% reduction in health spending for the average West African country annually.

The authors of the new study, published in the journal Social Science and Medicine, say their findings show the IMF “impedes progress toward the attainment of universal health coverage”, and that – under direct IMF tutelage – West African countries underfunded their health systems.

“The IMF proclaims it strengthens health systems as part of its lending programs. Yet, inappropriate policy design in IMF programmes has impeded the development of public health systems in the region over the past two decades,” says Dr Stubbs.

A growing number of IMF loans to West Africa now include social spending targets to ensure spending on health, education and other priorities is protected. These are not binding, however, and the study found fewer than half are actually met.

“Stringent IMF-mandated austerity measures explain part of this trend. As countries engage in fiscal belt-tightening to meet the IMF’s macroeconomic targets, few funds are left for maintaining health spending at adequate levels.”

The IMF’s extended presence in West Africa – on average 13 out of 20 years per country – has caused considerable controversy among public health practitioners. “While critics stress inappropriate or dogmatic policy design that undermines health system development, the IMF has argued its reforms bolster health policy,” says Dr Stubbs.

“We show that the IMF has undermined health systems – a legacy of neglect that affects West Africa’s progress towards achieving universal health coverage, a key objective of the United Nation’s Sustainable Development Goals.”

A copy of the study can be downloaded here.

For more information, contact lead author Dr Thomas Stubbs at [email protected]

Related stories

Professor Tahu Kukutai

Immigration debate: Lack of planning catching up to us

Leading demographer says Covid-19 has exposed short-sighted population approach; calls for Māori interests to be…

Petrie dish

University of Waikato researchers win funds to help fight superbugs

University of Waikato scientists have today received a boost in the battle against antimicrobial-resistant germs.


Chair role enables Engineering to advance at the University of Waikato

Thanks to a philanthropically-funded position at the University of Waikato, Professor in Engineering Mike Duke…

University of Waikato launches new artificial intelligence research institute

The University of Waikato is bringing data to life, positioning New Zealand as an international…

Students outside Tauranga Campus

Waikato ranked top 60 in the world for research that impacts economic growth and reducing inequality

The University of Waikato has been ranked in the top 60 universities in the world…

AI story

University of Waikato installs the world’s most advanced AI System

New Zealand’s most powerful supercomputer for artificial intelligence applications has been installed at the University…

Professor Craig Cary

Waikato scientist part of team awarded prestigious Human Frontier grant

Professor Craig Cary has travelled to volcanic vents at the bottom of the ocean and…

Carma Maisey

Teachers get boost into Masters study thanks to University of Waikato Programme

Matamata Primary School teacher Carma Maisey credits the University of Waikato’s Poutama Pounamu Blended Learning…

Professor Linda Johnston

Sustainability focus for new Assistant Vice-Chancellor

The University of Waikato has appointed Professor Lynda Johnston in the new role of Assistant…

TAIAO workshop

Artificial intelligence used to tackle environmental challenges

Scientists and researchers from across New Zealand are being encouraged to use a new software…

Professor Vincent Reid and Dr Aleea Devitt

Waikato psychologists receive international honours

Two University of Waikato academics have been recognised by the Association for Psychological Science (APS),…

National research institute focused on understanding New Zealand’s population turns 10

A national research institute based at the University of Waikato responsible for understanding New Zealand’s…