[stop-imf] Why We Must Open the Meetings of the IMF and World Bank Boards: the Case of User Fees on Primary Health in Tanzania (fwd)

[Robert Weissman]

Date: Fri, 1 Jun 2001 13:47:41 -0400
From: Robert Naiman <naiman@cepr.net>

Why We Must Open the Meetings of the IMF and World
Bank Boards: the Case of User Fees on Primary
Health in Tanzania

One of the most controversial "structural
adjustment" policies promoted by the World Bank
and the IMF is the imposition of user fees on
primary health care and education. These user fees
have been associated with lower school enrollment
and reduced access to primary health care. For
some years, the World Bank, while acknowledging
problems with the implementation of user fees,
defended them in principle on the grounds that
there were, or were supposed to be, exemptions for
the poor, even though, as the World Bank was
eventually forced to admit, the track record
indicates that exemption schemes do not work.

In response to the World Bank's refusal to abandon
support for user fees on primary health and
education, in October, 2000, the United States
Congress passed legislation requiring the United
States representatives at the International
Monetary Fund and the World Bank to oppose any
loan or debt relief agreement which included "user
fees" on access to primary health care and
education. [1] This legislation was supported by a
broad array of civil society groups in the United
States, including the AFL-CIO trade union
federation, which stated, "The IMF and World Bank
should not condition one dollar of debt relief or
development financing on the creation, expansion,
or continuation of a user fee program by a
borrowing country. No loan agreement, decision
point document, or poverty reduction strategy
paper should contain such a requirement, and the
United States must make it clear to the Bank and
the Fund that future support for these initiatives
will depend on the institutions' assurances that
users fees have been eliminated. Of course, the
U.S. Executive Directors must also be instructed
to vote against any program or document that
includes user fees."  On the question of
exemptions for the poor, the AFL-CIO noted, "The
World Bank's own Operations and Evaluation
Department and its most recent World Development
Report have recognized the limited utility of
exemption programs in mitigating the harm caused
by these user fees." [2]

One month later, the "Poverty Reduction Strategy
Paper" [PRSP] for Tanzania came before the World
Bank and IMF boards. The PRSP is purported to be a
planning document prepared by developing country
governments, in consultation with the IMF and the
World Bank, with broad civil society
participation, which outlines a plan for reducing
poverty in the country in accord with the reformed
focus of the institutions on poverty reduction in
poor countries announced as part of the "enhanced"
debt relief initiative agreed to at the G7 meeting
in Cologne.

The "interim" PRSP for Tanzania had included user
fees on primary health care. Non-governmental
organizations and Members of Congress who had
supported the legislation requiring the U.S. to
oppose user fees on primary health care and
education wrote to the U.S. Treasury Department,
then still under the supervision of the Clinton
Administration, and reminded Treasury that law
required the U.S. to oppose the Tanzania PRSP if
it included user fees on primary health care. At
the time of the Board meeting, the Tanzania PRSP -
a document that supposedly resulted from a broad
consultation with civil society in Tanzania - was
a secret document.

What actually happened at the Board Meeting is
known with certainty only to those who were
present, because the Board Meetings are secret,
and no minutes are publicly available. However,
there is a summary of the discussion. This is a
secret document that is only distributed to Bank
and IMF management and government representatives.
The cover page states: "This document has a
restricted distribution and may be used by
recipients only in the performance of their
official duties. Its contents may not otherwise be
disclosed without World Bank authorization." [3]

In this case, the document was leaked to
non-governmental organizations. The summary is a
redaction of the minutes, in the sense that it
does not indicate who said what, a critical piece
of information for holding governments accountable
for what policies they support or oppose at the
institutions.

Nonetheless, in this case the summary is telling.
The summary contains the following sentence:
"Staff noted the concern of many NGOs over the
existence of user fees in the health sector but
pointed out that the poor were exempt from these
charges."

But the non-governmental organizations that were
concerned about the inclusion of user fees on
primary health care were concerned precisely
because exemption schemes have failed. Thus, while
"noting" the concern of NGOs, the institutions
were in fact completely ignoring them.

But what is even more telling is that this is the
only mention of the issue of user fees on health
care in the document. The document summarizing the
discussion is seven pages long, and has a specific
section on health care. Yet while the concern of
NGOs is noted, there is no record of any
government representatives in the meeting
registering any objection or concern. While the
summary does not tell us who said what among the
government representatives, it does tell us that
no government representative - including the
United States representative - said anything on
the subject whatsoever, unless we are to believe
that an objection or comment by the representative
of the government holding one-fifth of the shares
of the institution would not be considered
noteworthy by the staff person preparing the
summary of the discussion.

It is a remarkable fact, that even when the United
States Congress, which controls U.S.
appropriations to these institutions, went to the
trouble of passing a specific law requiring the
U.S. representative to oppose a particular policy,
the U.S. representative apparently had nothing to
say when the subject was discussed in the Board
meeting.

It might be thought that this is a matter solely
between the United States Treasury and the United
States Congress. It is not. It is precisely
because the meetings of these organizations are
secret that it is up to the discretion of the
government representatives to share what
information they like and represent their
governments as they choose.

Notes:

 [1] Public Law 106-429, Section 596. "The
Secretary of the Treasury shall instruct the
United States Executive Director at each
international financial institution (as defined in
section 1701(c)(2) of the International Financial
Institutions Act) and the International Monetary
Fund to oppose any loan of these institutions that
would require user fees or service charges on poor
people for primary education or primary
healthcare, including prevention and treatment
efforts for HIV/AIDS, malaria, tuberculosis, and
infant, child, and maternal well-being, in
connection with the institutions' lending
programs."

[2] Letter from David A. Smith, Director,
Department of Public Policy, AFL-CIO, to Timothy
Geithner, Under Secretary for International
Affairs, U.S. Treasury Department, October 11,
2000.

[3]  Summary of Discussion at the Meeting of the
Executive Directors of the Bank and IDA, November
30,2000, International Bank for Reconstruction and
Development, International Development
Association, December 15, 2000.