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

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  • Stubbs, Thomas
  • Kentikelenis, Alexander
  • Stuckler, David
  • McKee, Martin
  • King, Lawrence

Abstract

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% CI −0.435 to −0.060). Overall, our findings suggest that IMF conditionality impedes progress toward the attainment of universal health coverage.

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  • Stubbs, Thomas & Kentikelenis, Alexander & Stuckler, David & McKee, Martin & King, Lawrence, 2017. "The impact of IMF conditionality on government health expenditure: A cross-national analysis of 16 West African nations," Social Science & Medicine, Elsevier, vol. 174(C), pages 220-227.
    • Handle: RePEc:eee:socmed:v:174:y:2017:i:c:p:220-227
    DOI: 10.1016/j.socscimed.2016.12.016
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    Cited by:

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    4. Mr. Sanjeev Gupta & Michela Schena & Mr. Seyed Reza Yousefi, 2018. "Expenditure Conditionality in IMF-supported Programs," IMF Working Papers 2018/255, International Monetary Fund.
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    7. Jackson, Emerson Abraham, 2019. "Systemic health care failure as a symptom of Market Failure in Sierra Leone," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, issue Forthcomi.
    8. Chletsos, Michael & Sintos, Andreas, 2021. "Hide and seek: IMF intervention and the shadow economy," Structural Change and Economic Dynamics, Elsevier, vol. 59(C), pages 292-319.
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    10. Iasmin Goes, 2023. "Examining the effect of IMF conditionality on natural resource policy," Economics and Politics, Wiley Blackwell, vol. 35(1), pages 227-285, March.
    11. Bernhard Reinsberg & Daniel O Shaw & Louis Bujnoch, 2024. "Revisiting the security–development nexus: Human security and the effects of IMF adjustment programmes," Conflict Management and Peace Science, Peace Science Society (International), vol. 41(1), pages 72-95, January.
    12. Stubbs, Thomas & Kring, William & Laskaridis, Christina & Kentikelenis, Alexander & Gallagher, Kevin, 2021. "Whatever it takes? The global financial safety net, Covid-19, and developing countries," World Development, Elsevier, vol. 137(C).
    13. Daoud, Adel & Reinsberg, Bernhard & Kentikelenis, Alexander E. & Stubbs, Thomas H. & King, Lawrence P., 2019. "The International Monetary Fund’s interventions in food and agriculture: An analysis of loans and conditions," Food Policy, Elsevier, vol. 83(C), pages 204-218.
    14. Barlow, Pepita, 2020. "Global disparities in health-systems financing: A cross-national analysis of the impact of tariff reductions and state capacity on public health expenditure in 65 low- and middle-income countries, 199," LSE Research Online Documents on Economics 104107, London School of Economics and Political Science, LSE Library.
    15. Dumitriu Ramona & Stefanescu Razvan, 2020. "Improving IMF’s Reputation in the Context of COVID-19," Risk in Contemporary Economy, "Dunarea de Jos" University of Galati, Faculty of Economics and Business Administration, pages 230-238.
    16. Forster, Timon & Kentikelenis, Alexander E. & Stubbs, Thomas H. & King, Lawrence P., 2020. "Globalization and health equity: The impact of structural adjustment programs on developing countries," Social Science & Medicine, Elsevier, vol. 267(C).
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    18. Bhumika Muchhala, 2022. "The Structural Power of the State-Finance Nexus: Systemic Delinking for the Right to Development," Development, Palgrave Macmillan;Society for International Deveopment, vol. 65(2), pages 124-135, December.

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