Protecting Education and Health Spending in Low-Income Countries
IMF Blog, June 6, 2017
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- Authors: Christine Lagarde
- Published: June 6, 2017
Key findings from the IMF analysis
- Analysis of more than 25 years of data (1988–2014) indicates:
- Public health spending, as a share of GDP, has on average remained unchanged.
- Public education spending has increased by 0.32 percentage points.
- In many countries with IMF-supported programs, per capita public spending on health and education has significantly outpaced the growth of per capita income.
- Minimum financing levels for health, education, and social safety nets were included in virtually all low-income country programs, and more than two-thirds of these program targets were met.
- IMF-supported programs have helped boost social spending by:
- Unlocking additional donor financing.
- Encouraging tax reforms that create stronger and more reliable sources of government revenue.
Financing, lending, and technical assistance
- The Fund extended zero interest rates on all IMF concessional lending to help low-income countries deal with future shocks and achieve the Sustainable Development Goals (described as having been done "last year").
- The IMF provides hands-on technical assistance, helping more than 130 countries per year to generate higher public revenue for investment in hospitals, schools, and poverty reduction.
- In response to the Ebola outbreak, the IMF moved swiftly to provide the Ebola-affected countries with $380 million in financial assistance—described as “cash in the bank” to help impacted countries fight this devastating disease.
Program design, protective measures, and reform priorities
- The success of low-income country programs increasingly depends on two key factors:
- (i) Minimum levels of government spending on health, education, and social safety nets.
- (ii) Specific reform measures to protect vulnerable groups.
- The IMF identifies three areas for improvement:
- Define program targets more explicitly, using concrete, itemized spending goals.
- Example: Kenya’s 2011 program included targets for the cost of anti-retroviral treatments, spending on primary and secondary public education, and cash transfers to vulnerable children and seniors—making the program more targeted and effective.
- Improve the design of social safety nets.
- Example: Haiti — programs have pushed up expenditure for poverty reduction, and the IMF’s emergency loan in the wake of Hurricane Matthew was aimed at rebuilding basic social services.
- Deliver better outcomes by stepping up collaboration with governments and development partners.
- Example: Bangladesh — IMF collaboration with the World Bank to gauge the impact of higher food and energy prices on the social safety net.
Case examples cited
- Tanzania, Honduras, the Kyrgyz Republic: per capita public spending on health and education significantly outpaced per capita income growth in IMF-supported programs.
- Honduras: government used an extended cash transfer to cushion the impact of its fiscal adjustment (2014).
- Kenya: 2011 program with specific targets for health, education, and cash transfers.
- Haiti: IMF emergency loan post-Hurricane Matthew aimed at rebuilding basic social services.
- Bangladesh: joint IMF–World Bank work to assess impacts on social safety nets.
Policy implications and overarching message
- Safeguarding social spending is critical because women, young people, seniors, and the poor often lack the political leverage to promote their economic well-being.
- Protecting the health and skills of vulnerable groups supports stronger, more durable, and more inclusive growth.
- Combining explicit targets, better-designed social safety nets, and deeper collaboration with partners — plus greater agility in delivering support — is the recommended path forward.
- As stated in the piece: “If you want to go fast, go alone. If you want to go far, go together.”
Source: Protecting Education and Health Spending in Low-Income Countries (IMF blog post by Christine Lagarde, June 6, 2017).
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