Chris Blattman

Chris Blattman

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Did the IMF cause the Ebola crisis? Of course not.

There’s been a lot of news coverage today of a Lancet op-ed that blames IMF austerity for making the Ebola crisis worse.

My reaction in The Monkey Cage:

Unfortunately, this just doesn’t really make sense if you’re familiar with the governments in these places, local politics, or more generally how weak states actually work. …it illustrates of the perils of doing research from afar, and ignoring politics.

In my experience, you don’t see this as much when people write about India or China or Iraq. Too many people know something about these countries, including newspaper and journal editors. As a writer or researcher, you don’t get away with ignoring the context: who makes the decisions, who has what incentives, and what arms of the government can actually get things done.

When it comes to Africa, however, too many people are willing to assume it’s a blank slate, and that nations dance to the tune of Western donors and banks. Or that weak states are functioning, rational bureaucracies. I think this is one reason why so many newspapers are picking up the “IMF caused the Ebola crisis” so uncritically.

Read more here.

17 Responses

  1. Simple version of the IMF-is-to-blame article: “Anything that costs money takes money away from something else.” Simple response: “Duh.”

    That was my first thought on seeing the article. It’s nice to see I’m on the same page as someone who actually knows what he’s talking about.

  2. Thanks for the response. It seems that even if 1) iNGOs/multilaterals like the World Bank are left footing the bill for certain services like health, and 2) those actors appropriately focus on “big and likely” problems rather than unforeseeables, it could still be the case that the systems critics are calling for would be better at both addressing the big/likely problems, AND the unforeseeables. It seems a favorable way to interpret the Lancet article, which is still mindful of your points, would be that the authors would argue both goals (big/likely prep, and unforeseeable prep) are better served by policies other than those supported by the international community. Although your last line in the comment (“don’t prepare for unlikely crises at the expense of…”) suggests you think there is a trade-off between the two. I admittedly know far too little about health systems to have the faintest idea which position is “more correct.”

  3. @Nathan, these are good points. Yes international actors have poured tons of money into health over the last decade. Indeed, precisely because post-conflict states are often focused on providing basic things, like security and justice, social services get picked up by non-government organizations. This is an unfortunate reality but probably the right choice, and better than no social services at all. And so yes, I’d say these organizations are partly or very responsible for any bad decisions. But “failure to prepare for Ebola” doesn’t seem like a failure to me. When you are laying out health system basics, you combat the big and likely killers first: birthing services, information on basic child health, water borne diseases, HIV/AIDS, TB, malaria, etc. You don’t prepare for unlikely crises at the expense of these.

  4. I fear I’m wading into a minefield here, primarily due to my ignorance, but…

    It seems like the Lancet op-ed suggests the IMF pushes countries to do 3 things: prioritize macro-economic reforms relative to other spending priorities; cap public sector expenditures; decentralize systems e.g. healthcare.

    Even assuming the IMF supports those things, I understand your Monkey Cage piece to say: “it’s too great a leap to say the IMF is thus to blame.” Primarily because the counter-factual (Liberia/Sierra Leone direct their own policy priorities) isn’t much more promising given low state capacity and competing post-transition priorities.

    It seems to me that doesn’t fully address the critique, however. Isn’t it possible that international agencies 1) are not to blame in the sense of being singularly responsible, yet 2) nonetheless exhibit biases in terms of what programs or policies they support/encourage developing country governments to support? For instance, quickly browsing data.worldbank.org shows tens of millions have gone to health in Liberia in the past decade, yet Liberia has a vanishingly small # of doctors, opting for decentralized systems employing health services workers instead. To some extent this likely reflects funding priorities and advice from international agencies (granted, the Lancet called out the IMF specifically, but it seems to me the point is that the international community generally promoted policies that may have left these nations less prepared for crisis).

    In other words, I am wondering if you are saying international actors had no relevant influence on the shape of public health systems in these countries (in which case, $ and technical assistance presumably affected levels, but not types, of health sector activity)? Or would you endorse the view that they have had some role, and perhaps don’t encourage optimal outcomes, but that it’s over-the-top to blame them? It seems that examples of post-conflict societies that take a more active management role vis-a-vis international institutions, and achieve rapid health gains (such as Rwanda) would support the latter interpretation…

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