Alexander Kentikelenis

IMF conditionality and development policy space, 1985–2014

ABSTRACT In recent years, the International Monetary Fund (IMF) has re-emerged as a central actor in global economic governance. Its rhetoric and policies suggest that the organization has radically changed the ways in which it offers financial assistance to countries in economic trouble. We revisit two long-standing controversies: Has the policy content of IMF programmes evolved to allow for more policy space? Do these programmes now allow for the protection of labour and social policies? We collected relevant archival material on the IMFs lending operations and identified all policy conditionality in IMF loan agreements between 1985 and 2014, extracting 55,465 individual conditions across 131 countries in total. We find little evidence of a fundamental transformation of IMF conditionality. The organizations post-2008 programmes reincorporated many of the mandated reforms that the organization claims to no longer advocate and the number of conditions has been increasing. We also find that policies introduced to ameliorate the social consequences of IMF macroeconomic advice have been inadequately incorporated into programme design. Drawing on this evidence, we argue that multiple layers of rhetoric and ceremonial reforms have been designed to obscure the actual practice of adjustment programmes, revealing an escalating commitment to hypocrisy.

Health inequalities after austerity in Greece

Since the beginning of economic crisis, Greece has been experiencing unprecedented levels of unemployment and profound cuts to public budgets. Health and welfare sectors were subject to severe austerity measures, which have endangered provision of as well as access to services, potentially widening health inequality gap. European Union Statistics on Income and Living Conditions data show that the proportion of individuals on low incomes reporting unmet medical need due to cost doubled from 7xa0% in 2008 to 13.9xa0% in 2013, while the relative gap in access to care between the richest and poorest population groups increased almost ten-fold. In addition, austerity cuts have affected other vulnerable groups, such as undocumented migrants and injecting drug users. Steps have been taken in attempt to mitigate the impact of the austerity, however addressing the growing health inequality gap will require persistent effort of the country’s leadership for years to come.

Structural adjustment and health: A conceptual framework and evidence on pathways

Economic reform programs designed by the International Monetary Fund and the World Bank-so-called structural adjustment programs-have formed one of the most influential policy agendas of the past four decades. To gain access to financial support from these organizations, countries-often in economic crisis-have reduced public spending, limited the role of the state, and deregulated economic activity. This article identifies the multiple components of structural adjustment, and presents a conceptual framework linking them to health systems and outcomes. Based on a comprehensive review of the academic literature, the article identifies three main pathways through which structural adjustment affects health: policies directly targeting health systems; policies indirectly impacting health systems; and policies affecting the social determinants of health. The cogency of the framework is illustrated by revisiting Greeces recent experience with structural adjustment, drawing on original IMF reports and secondary literature. Overall, the framework offers a lens through which to analyze the health consequences of structural adjustment across time, space and levels of socioeconomic development, and can be utilized in ex ante health impact assessments of these policies.

The impact of IMF conditionality on government health expenditure: A cross-national analysis of 16 West African nations

How do International Monetary Fund (IMF) policy reforms-so-called conditionalities-affect government health expenditures? We collected archival documents on IMF programmes from 1995 to 2014 to identify the pathways and impact of conditionality on government health spending in 16 West African countries. Based on a qualitative analysis of the data, we find that IMF policy reforms reduce fiscal space for investment in health, limit staff expansion of doctors and nurses, and lead to budget execution challenges in health systems. Further, we use cross-national fixed effects models to evaluate the relationship between IMF-mandated policy reforms and government health spending, adjusting for confounding economic and demographic factors and for selection bias. Each additional binding IMF policy reform reduces government health expenditure per capita by 0.248 percent (95% CIxa0-0.435 toxa0-0.060). Overall, our findings suggest that IMF conditionality impedes progress toward the attainment of universal health coverage.

The Politics of World Polity: Script-writing in International Organizations:

Sociologists have long examined how states, intergovernmental organizations (IGOs), international nongovernmental organizations (INGOs), and professional groups interact in order to institutionalize their preferred norms at the transnational level. Yet, explanations of global norm-making that emphasize inter-organizational negotiations do not adequately explain the intra-organizational script-writing—that is, the codification of norms in prescriptive behavioral templates—that underpins this process. This article opens the black box of how scripts emerge and institutionalize within IGOs. Script-writing is a function of both world-cultural frames and material interests, held by different intra-organizational actors: scientific IGO staff and state representatives in governing bodies, respectively. The interplay between these frames and interests determines whether scripts will institutionalize. In this theoretical model, world-cultural and power-political explanations are pertinent to different, mutually informing, and coexisting aspects of the script-writing process. As a corollary of our approach, we present a conceptual framework for the study of intra-IGO script-writing, which is contingent on three normative struggles: among IGO staff, within an IGO’s board of directors, and between the staff and the board. To empirically substantiate our arguments, we examine scripts on taxation and capital controls by the International Monetary Fund. We conclude by discussing the broader implications of our model for the study of international organizations and the engines of global norm-making.

Effects of Greek economic crisis on health are real

We were surprised by Liaropoulos’s conclusions about the health effects of the Greek economic crisis.1 His article contains several unreferenced assertions and contradictions, such as statements that there is “no evidence of denial of services to patients” yet “many [people] are without cover” and the church, non-governmental associations, and others are “rallying to help.”nnHe …

Impact of International Monetary Fund programs on child health

Significance This study adds to the state of the art by analyzing the impact of International Monetary Fund (IMF) programs on children’s health, mediated by their parents’ education. It is the first to combine macrodata and microdata to address this issue systematically across five dimensions of child health: water, malnutrition, shelter, sanitation, and health care access. The sample represents about 2.8 billion (about 50%) of the world’s population in year 2000. Using multilevel models, we find that, although IMF programs do not correlate directly with child health indicators, they reduce the protective effect of parental education on child health, especially in rural areas, and have a mixed impact across the five dimensions of urban child health. Parental education is located at the center of global efforts to improve child health. In a developing-country context, the International Monetary Fund (IMF) plays a crucial role in determining how governments allocate scarce resources to education and public health interventions. Under reforms mandated by IMF structural adjustment programs, it may become harder for parents to reap the benefits of their education due to wage contraction, welfare retrenchment, and generalized social insecurity. This study assesses how the protective effect of education changes under IMF programs, and thus how parents’ ability to guard their children’s health is affected by structural adjustment. We combine cross-sectional stratified data (countries, 67; children, 1,941,734) from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys. The sample represents ∼2.8 billion (about 50%) of the world’s population in year 2000. Based on multilevel models, our findings reveal that programs reduce the protective effect of parental education on child health, especially in rural areas. For instance, in the absence of IMF programs, living in an household with educated parents reduces the odds of child malnourishment by 38% [odds ratio (OR), 0.62; 95% CI, 0.66–0.58]; in the presence of programs, this drops to 21% (OR, 0.79; 95% CI, 0.86–0.74). In other words, the presence of IMF conditionality decreases the protective effect of parents’ education on child malnourishment by no less than 17%. We observe similar adverse effects in sanitation, shelter, and health care access (including immunization), but a beneficial effect in countering water deprivation.

International organizations and migrant health in Europe

International organizations have defined and managed different aspects of migrant health issues for decades, yet we lack a systematic understanding of how they reach decisions and what they do on the ground. The present article seeks to clarify the state of knowledge on the relationship between international organizations and migrant health in Europe. To do so, we review the operations of six organizations widely recognized as key actors in the field of migrant health: the European Commission, the Regional Office for Europe of the World Health Organization, the International Organization on Migration, Médecins du Monde, Médecins Sans Frontières, and the Open Society Foundation. We find that international organizations operate in a complementary fashion, with each taking on a unique role in migrant health provision. States often rely on international organizations as policy advisors or sub-contractors for interventions, especially in the case of emergencies. These linkages yield a complex web of relationships, which can vary depending on the country under consideration or the health policy issue in question.

Structural adjustment programmes adversely affect vulnerable populations: a systematic-narrative review of their effect on child and maternal health

Structural adjustment programmes of international financial institutions have typically set the fiscal parameters within which health policies operate in developing countries. Yet, we currently lack a systematic understanding of the ways in which these programmes impact upon child and maternal health. The present article systematically reviews observational and quasi-experimental articles published from 2000 onward in electronic databases (PubMed/Medline, Web of Science, Cochrane Library and Google Scholar) and grey literature from websites of key organisations (IMF, World Bank and African Development Bank). Studies were considered eligible if they empirically assessed the aggregate effect of structural adjustment programmes on child or maternal health in developing countries. Of 1961 items yielded through database searches, reference lists and organisations’ websites, 13 met the inclusion criteria. Our review finds that structural adjustment programmes have a detrimental impact on child and maternal health. In particular, these programmes undermine access to quality and affordable healthcare and adversely impact upon social determinants of health, such as income and food availability. The evidence suggests that a fundamental rethinking is required by international financial institutions if developing countries are to achieve the Sustainable Development Goals on child and maternal health.

Targeted social safeguards in the age of universal social protection: the IMF and health systems of low-income countries

Abstract In offering loans to low-income countries in exchange for policy reforms, the International Monetary Fund (IMF) typically sets the fiscal parameters within which health systems develop. In a recent report released by the organisation, the IMF claims that their programmes have promoted social protection, including access to health care. We revisit the findings presented in the IMF’s assessment. Drawing on material collected from the IMF and empirical analyses, we show that the report is methodologically flawed, unduly optimistic and potentially misleading. We conclude by reflecting on the IMF’s steadfast endorsement of targeted social assistance, despite a global tide turn towards universal social provision.