IMF Response to The Lancet article on "The International Monetary Fund and the Ebola Outbreak"

December 22, 2014

Sanjeev Gupta; Deputy Director, IMF Fiscal Affairs Department, also served as a member of the Lancet Commission on Investing in Health

As published in "The Lancet" journal on January 4, 2015

Dear Sir,

There are several factual inaccuracies in your article “The International Monetary Fund and the Ebola Outbreak.”

First, it is not correct to say that health care expenditures declined in these countries. As my colleagues, Benedict Clements, and Masahiro Nozaki, and I note in a recent blog, spending on health and education have increased faster in low-income countries with IMF-supported programs, than those without.

What about the Ebola-hit countries? Here too, we find an increase in health spending as a percent of GDP. In Guinea, spending increased by 0.7 percentage points, in Liberia by 1.6 points and in Sierra Leone by 0.24 points (from 2010 to 2013).

More generally, World Bank data 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 percent), child nutrition (improving by 9 percent), and sanitation (improving by 9 percent).

Second, it is simply not correct to say that the IMF requires caps on the public sector wage bill. Since 2007, the IMF announced a new policy on wage bill ceilings, as part of an overall effort to promote more effective and sustainable use of aid flows to low-income countries. In fact, IMF programs in Guinea, Liberia, and Sierra Leone have not had any limits on the wage bill during the period 2000 -2014 (See also a study by the Independent Evaluation Office).

The fact is that Guinea, Sierra Leone, and Liberia were doing relatively well trying to overcome years of instability as they emerged from conflict, including civil wars that claimed tens of thousands of lives and had a devastating impact on social infrastructure.

The arrival of Ebola put severe pressure on already fragile infrastructure and health care systems. The IMF recognized the urgency of the situation—and moved quickly to help, as you yourself note. The IMF made available an additional $130 million to the three countries to fight Ebola.

And we are doing more. The international community is helping affected countries meet their needs to fight Ebola. The IMF is 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.



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