[stop-imf] Letter to Rato/Wolfensohn-AIDS, Healthcare Spending and Macroeconomic
Policy
robert weissman
rob@essential.org
Fri, 13 Aug 2004 15:27:47 -0400
August 13, 2004
Rodrigo de Rato y Figaredo
Managing Director
International Monetary Fund
700 19th Street, N.W.
Washington, DC 20431
James D. Wolfensohn
President
World Bank
1818 H Street, N.W.
Washington, DC 20433
Dear Mr. Rato and Mr. Wolfensohn:
We are people with AIDS and their advocates from over 35 countries. We
write to express our concern that policies driven by macroeconomic
concerns are constraining the money available to combat HIV/AIDS and
meet other critical needs of populations in developing countries. We
appreciate your support for fighting HIV/AIDS and achieving the
Millennium Development Goals, and urge that you adopt the policies that
will enable the maximum possible resources to be available to win this
fight and achieve these goals.
As you know, in 2003, almost five million people became newly infected
with HIV, the greatest number in any one year since the beginning of the
epidemic. At the global level, the number of people living with HIV
continues to grow - from 35 million in 2001 to 38 million in 2003. In
the same year, almost three million were killed by AIDS; more than 20
million have died since the first cases of AIDS were identified in 1981.
The World Health Organization (WHO) has estimated that 6 million of us
living in the developing world need antiretroviral therapy now, yet only
440,000 people living with HIV/AIDS in these countries receive these
medications.
Global organizations and individual countries are setting ambitious
health and development goals. The WHO has set the target of getting 3
million people living with HIV/AIDS in developing countries on
anti-retroviral therapy by the end of 2005. The United States has
committed to treating 2 million people with HIV/AIDS. The United
Nations has established Millennium Development Goals that include
reversing the spread of AIDS, tuberculosis, and malaria by 2015;
reducing the child mortality rate in 2015 by two-thirds compared to
1990, and; reducing the maternal mortality in 2015 by three-quarters
compared to 1990.
Much will be required to meet these goals, including significant
financial resources, community involvement, and strong government
commitment. They will also require human resources - the doctors,
nurses, and other health care workers who provide the health services
needed to meet these goals. Unless greater attention is given to
developing human resources, these goals almost certainly will not be
met. Many low-income countries are facing serious shortages of health
care workers, which are most severe in sub-Saharan Africa, the region
hardest hit by the AIDS epidemic.
Overcoming these shortages and achieving health and development goals
will require significant financial investments. Yet macroeconomic
concerns are interfering with the ability of many African and other
countries in Asia, Latin America, the Caribbean and the former Soviet
Union to increase their health sector spending, including urgently
needed funds for HIV/AIDS and human resources. The policies include
ceilings on countries' overall spending, resulting in caps on health
sector spending, and restrictions on the civil service budget, which may
lead to freezes in health worker hiring and salaries. The ceilings may
limit the ability of countries to accept large amounts of financial
assistance, especially unexpected assistance.
We recognize that your organizations might not be directly involved in
setting ceilings on health sector spending, that these are national
decisions. However, these national decisions are the inevitable
consequence of the need to keep spending within the overall budget
ceilings that your institutions do promote. As a result of these
decisions, funds that might otherwise be channeled to the health sector
are unavailable. Consequences are measurable in ill health and even
death. We appreciate your desire to ensure macroeconomic stability, and
do not doubt that it is driven by a genuine concern for the well-being
of the poor, of ordinary people. Macroeconomic stability will not
nourish us or treat our illnesses, however. We need firstly, strong,
well-funded, health systems. Macroeconomic policies are making this
more difficult to achieve.
The effect of macroeconomic policies has been described in a recent
report by Physicians for Human Rights (PHR). We concur with PHR's
analysis and recommendations.[1] Thus, we are asking that the IMF,
World Bank, ministries of finance of developing countries, and other
partners develop new policies to ensure that macroeconomic constraints
do not limit effective and productive spending of developing countries
on health, education, and related sectors, or salaries and hiring of
workers in these areas. One possibility would be to increase
flexibility around spending limits and the macroeconomic targets, such
as inflation and fiscal deficits, upon which those limits are based.
The flexibility would enable whatever limits or targets exist to expand
to accommodate unexpected external assistance or domestic spending in
these sectors that is higher than originally planned. Another
possibility would for your organizations to revise any economic targets
- such as overall government spending or overall spending on civil
servant - to exclude these sectors. Insulating these sectors from
overall budget targets would prevent these targets from conflicting with
the imperative to increase spending for health, education, and related
areas. Targets for these sectors would remain to assist in planning.
The changed policies should be publicized among all stakeholders,
including finance, health, education, and other national ministries.
If this new policy cannot be designed and implemented immediately, we
ask that your organizations take the following steps at once. We
believe your organizations should immediately issue joint or separate
statements announcing that the IMF and World Bank will not withhold
loans or grants, suspend or cancel programs, or otherwise penalize
countries that break overall spending ceilings because of increased
spending in health, education, and other sectors and activities needed
to promote human development. Such activities include increasing salary
and benefits to health staff and hiring new health personnel. We also
would hope that these statements reiterate your support for additional
spending in these sectors, including on human resources. Your July 2004
note on "The Use of Grants in Low-Income Countries" is heartening in
this regard, as it welcomes increased grant aid to low-income countries
and recognizes that achieving the Millennium Development Goals will
sometimes require significant levels of foreign assistance. We
encourage your organizations to build on this note.
Even before a new policy is adopted, we urge you to immediately
encourage flexibility in budget ceilings in health, education, and other
sectors central to human development, as well as to urge that countries
implement a moratorium on any restrictions on hiring, salary, and
benefits in these sectors. We hope that your staff will actively share
these statements - and the understandings of the importance of increased
funding in these areas that they represent - with key government
officials, including in finance ministries.
Furthermore, we encourage your organizations to publicize the precise
nature of existing economic restraints that may limit substantially
higher country spending on health and other social sectors, and to
create mechanisms for on-going transparency of macroeconomic policies
and how they impact the health and education sectors. Such mechanisms
should welcome NGO input.
We understand that making exceptions in spending for health or
education-related programs or the acceptance of foreign assistance in
these areas would represent a departure from the IMF's and World Bank's
current policies and strategies, but we believe that such exceptions are
necessary if these countries are to adequately respond to the HIV/AIDS
epidemic. We would like to meet with you at your earliest convenience
to discuss these matters. Please direct all correspondence regarding
this letter to Gregg Gonsalves at Gay Men's Health Crisis at 119 West
24th Street, New York, NY 10011 (phone: 212-367-1169; email;
greggg@gmhc.org).
Sincerely,
D=E1rio Abarca
Ecuadorian Coalition of People Living with HIV/AIDS
Ecuador
Pablo Anamaria
National Coalition of People Living with HIV/ AIDS
Peruanos Positivos
Peru
Azita Amirieh
Persia+
Iran
Emma Basker
International Harm Reduction Development Program/Open Society Institute
USA
Julius Amoako Bekoe
Ghana AIDS Treatment Access Group (GATAG)
Ghana
Ivorine Burton
Jamaican Network of Seropositives
Jamaica
Robert Carr
Jamaica AIDS Support
Jamaica
Frika Chia
Spiritia Foundation
and
Indonesian National Network of People Living with HIV/AIDS
Indonesia
Polly Clayden
HIV I-Base
United Kingdom
Michaela Clayton
AIDS Law Unit
Legal Assistance Centre
Namibia
Vitaly Djuma
Russian Harm Reduction Network
Russian Federation
Roman Dudnik
AIDS Foundation East-West (AFEW)
Russian Federation
Olive Edwards
Jamaican Network of Seropositives
Jamaica
Lobna El Tabei
Egyptian Initiative for Personal Rights
Egypt
Jaume Fabr=E9s
Grupo de Trabajo sobre Tratamientos del VIH (gTt) Barcelona
Spain
Stu Flavell
Global Network of People Living with HIV/AIDS
The Netherlands
Joshua T. Formentera
Positive Action Foundation Philippines Inc.
Philippines
Gregg Gonsalves
Gay Men's Health Crisis
United States
Greg Gray
Asia Pacific Network of People Living with HIV/AIDS
Thailand
Mauro Guarinieri
European AIDS Treatment Group
Italy
Mark Harrington
Treatment Action Group
United States
Aruna Hewapathirane
Lanka Plus
Sri Lanka
and
Heal Project
Zambia
Hakima Himmich
Association de Lutte Contre le SIDA (ALCS)
Morocco
Rajiv Kafle
Nava Kiran Plus
Nepal
James Kamau
Kenya Treatment Access Movement (KETAM)
Kenya
Bertrand Kampoer
FISS-MST/SIDA
Cameroon
Karyn Kaplan
Thai Treatment Action Group
Thailand
Ingrid Kloet
New Mexico Poz Coalition
Planet Poz
United States
Svilen Konov
Eastern States Working Group
European AIDS Treatment Group
Bulgaria
Tapiwanashe Kujinga
Zimbabwe Activists on HIV & AIDS (ZAHA)
Zimbabwe
Philippa Lawson
United States
Edward Low
Positive Living Group
Malaysia
Sharonann Lynch
Health GAP
United States
Ambroise Mamona
Reseau National des Positifs (RENAP+)
Republique du Congo Brazzaville
Othman Mellouk
Association de Lutte Contre le SIDA (ALCS)
Morocco
Lydia Mungherera
National Forum of People Living with HIV/AIDS
Uganda
Grace Muro
PACT
Tanzania
Rolake Nwagwu
Treatment Action Movement
Nigeria
Nenet L. Ortega
Pinoy Plus Association
Philippines
Sunil Pant
Blue Diamond Society
Nepal
Gracia Violeta Ross Quiroga
International Community of Women Living with HIV/AIDS
Andean Region
Bolivia
Oswaldo Rada
The Latin American Network of People Living with HIV/AIDS (RedLa+)
and
Fundaci=F3n Vivir Mejor y Salud of Cali
Colombia
Subhasree Raghavan
Solidarity and Action Against the HIV Infection in India (SAATHII)
India
John Rock
National Association of People with AIDS
Australia
Heng Sambath
Cambodian AIDS Treatment Advocacy Group (CATAG)
Cambodia
Lucia-Maria Stirbu
National Union of Organizations of the HIV/AIDS Affected People (UNOPA)
Romania
Pervaiz Tufail
AMAL Human Development Network
Pakistan
Rian van de Braak
AIDS Foundation East-West (AFEW)
Russian Federation
Slava Vassiljev
ESPO Society
Estonia
Alice Welbourn
International Community of Women Living with HIV/AIDS (ICW)
United Kingdom
Winstone Zulu
Kara Counselling - Kabwe
Zambia
_____
[1] Physicians for Human Rights, An Action Plan to Prevent Brain Drain:
Building Equitable Health Systems in Africa, Boston, MA, June 2004
(available at: http://www.phrusa.org/campaigns/aids/pdf/braindrain.pdf)