IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v174y2017icp220-227.html
   My bibliography  Save this article

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

Author

Listed:
  • 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.

Suggested Citation

  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953616306876
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Vreeland,James Raymond, 2003. "The IMF and Economic Development," Cambridge Books, Cambridge University Press, number 9780521816755, April.
    2. Ernesto Crivelli & Sanjeev Gupta, 2016. "Does conditionality in IMF-supported programs promote revenue reform?," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 23(3), pages 550-579, June.
    3. Vreeland,James Raymond, 2003. "The IMF and Economic Development," Cambridge Books, Cambridge University Press, number 9780521016957, April.
    4. Valerie Mercer-Blackman & Anna Unigovskaya, 2004. "Compliance with IMF Program Indicators and Growth in Transition Economies," Emerging Markets Finance and Trade, Taylor & Francis Journals, vol. 40(3), pages 55-83, May.
    5. Helge Berger & Jakob de Haan & Jan-Egbert Sturm, 2005. "Which Variables Explain Decisions on IMF Credit? An Extreme Bounds Analysis�," TWI Research Paper Series 13, Thurgauer Wirtschaftsinstitut, Universität Konstanz.
    6. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 31(3), pages 129-137.
    7. Dreher, Axel & Walter, Stefanie, 2010. "Does the IMF Help or Hurt? The Effect of IMF Programs on the Likelihood and Outcome of Currency Crises," World Development, Elsevier, vol. 38(1), pages 1-18, January.
    8. Abouharb,M. Rodwan & Cingranelli,David, 2007. "Human Rights and Structural Adjustment," Cambridge Books, Cambridge University Press, number 9780521676717, April.
    9. Dreher, Axel, 2006. "IMF and economic growth: The effects of programs, loans, and compliance with conditionality," World Development, Elsevier, vol. 34(5), pages 769-788, May.
    10. Arpac, Ozlem & Bird, Graham & Mandilaras, Alex, 2008. "Stop Interrupting: An Empirical Analysis of the Implementation of IMF Programs," World Development, Elsevier, vol. 36(9), pages 1493-1513, September.
    11. Jan-Egbert Sturm & Helge Berger & Jakob de Haan, 2005. "Which Variables Explain Decisions On Imf Credit? An Extreme Bounds Analysis," Economics and Politics, Wiley Blackwell, vol. 17, pages 177-213, July.
    12. Oberdabernig, Doris A., 2013. "Revisiting the Effects of IMF Programs on Poverty and Inequality," World Development, Elsevier, vol. 46(C), pages 113-142.
    13. Wei, Shang-Jin & Zhang, Zhiwei, 2010. "Do external interventions work? The case of trade reform conditions in IMF supported programs," Journal of Development Economics, Elsevier, vol. 92(1), pages 71-81, May.
    14. repec:cup:apsrev:v:97:y:2003:i:02:p:189-202_00 is not listed on IDEAS
    15. Stubbs, Thomas H. & Kentikelenis, Alexander E. & King, Lawrence P., 2016. "Catalyzing Aid? The IMF and Donor Behavior in Aid Allocation," World Development, Elsevier, vol. 78(C), pages 511-528.
    16. Przeworski, Adam & Vreeland, James Raymond, 2000. "The effect of IMF programs on economic growth," Journal of Development Economics, Elsevier, vol. 62(2), pages 385-421, August.
    17. repec:aph:ajpbhl:10.2105/ajph.2004.042002_7 is not listed on IDEAS
    18. World Bank, 2015. "World Development Indicators 2015," World Bank Publications, The World Bank, number 21634.
    19. Nooruddin, Irfan & Simmons, Joel W., 2006. "The Politics of Hard Choices: IMF Programs and Government Spending," International Organization, Cambridge University Press, vol. 60(04), pages 1001-1033, October.
    20. Kentikelenis, Alexander E. & Stubbs, Thomas H. & King, Lawrence P., 2015. "Structural adjustment and public spending on health: Evidence from IMF programs in low-income countries," Social Science & Medicine, Elsevier, vol. 126(C), pages 169-176.
    21. Barro, Robert J. & Lee, Jong-Wha, 2005. "IMF programs: Who is chosen and what are the effects?," Journal of Monetary Economics, Elsevier, vol. 52(7), pages 1245-1269, October.
    22. Im, Kyung So & Pesaran, M. Hashem & Shin, Yongcheol, 2003. "Testing for unit roots in heterogeneous panels," Journal of Econometrics, Elsevier, vol. 115(1), pages 53-74, July.
    23. Abouharb,M. Rodwan & Cingranelli,David, 2007. "Human Rights and Structural Adjustment," Cambridge Books, Cambridge University Press, number 9780521859332, April.
    24. Ritha S. Khemani & Sanjeev Gupta & Calvin A McDonald & Louis Dicks-Mireaux & Marijn Verhoeven, 2000. "Social Issues in IMF-Supported Programs," IMF Occasional Papers 191, International Monetary Fund.
    25. Benson, John S., 2001. "The impact of privatization on access in Tanzania," Social Science & Medicine, Elsevier, vol. 52(12), pages 1903-1915, June.
    26. Benedict Clements & Sanjeev Gupta & Masahiro Nozaki, 2013. "What happens to social spending in IMF-supported programmes?," Applied Economics, Taylor & Francis Journals, vol. 45(28), pages 4022-4033, October.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. repec:eee:socmed:v:187:y:2017:i:c:p:296-305 is not listed on IDEAS

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:174:y:2017:i:c:p:220-227. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.