Earlier this week the Group of Twenty leaders announced a USD 1.1 trillion booster-dose into the world economy by the end of 2010 through multilateral institutions like the International Monetary Fund (IMF). However, in July 2008, analysts from Cambridge and Yale Universities had reported that tuberculosis (TB) in countries with IMF loans rose sharply.
The strict conditions on IMF loans were blamed for thousands of extra TB deaths in Eastern Europe, and former Soviet republics. A UK TB charity backed the Public Library of Science (PLoS) study findings - but the IMF had firmly rejected them, as per a BBC news (July 2008).
David Stuckler from Cambridge University had said to BBC in July 2008 that "If we really want to create sustainable economic growth, we need first to ensure that we have taken care of people's most basic health needs."
Most alarming was when the levels of drug-resistant TB shot up in eastern Europe and former soviet union.
The BBC news further said that "in recent years, it [IMF] has offered assistance to 21 countries in the region, in the form of loans offered in exchange for the meeting of strict economic targets. The researchers claimed it was efforts to meet these targets that were undermining the fight against TB by drawing funding away from public health."
Most striking was the analysis in BBC news that "without the IMF loans, they suggested, rates would have fallen by up to 10%, meaning at least 100,000 extra deaths. Countries which accepted IMF loans averaged an 8% fall in government spending, a 7% drop in the number of doctors per head of population, and a fall in a method of TB treatment called "directly observed therapy", which is recommended by the World Health Organisation."
It is not surprising that healthcare doesn't get the mandate at forums like G-20 in the manner in which it should. Before the G-20 began, there was a growing public movement globally to put pressure on G-20 countries to put a currency transaction levy of 0.005% to raise dedicated resources for funding health programmes. This currency transaction levy of 0.005% can potentially generate USD 30-40 billion a year.
It is vital to understand the health funding in these times of global economic meltdown. The single largest donor of AIDS, TB and Malaria programmes globally - the Global Fund to fight AIDS, TB and Malaria (GFATM) has just 37.5% of its estimated budget for 2009-2010. The donor countries haven't kept their promises to fund the 'Fund'. The GFATM projected budget for 2009-2010 was USD 8 billion and it just has USD 3 billion in its kitty, falling short of USD 5 billion.
The donor countries that haven't kept their promises include the United States of America that is also the biggest defaulter. It is not that US doesn't have money, it gave about the same amount it owed to GFATM to Merrill Lynch as bail out money. It gave hundreds of times more to other private banks as bail out money. The banks distributed this amount amongst themselves as 'holiday bonuses'.
Another example comes from one of the most severely TB-HIV hard-hit regions - Africa. Despite of African governments declaring TB as an emergency, Africa as a region, faces the largest funding gap of USD 10.7 billion to fully implement the Global Plan to Stop TB by 2015.
The countries in Africa had achieved a milestone by endorsing the African Union Abuja pledge of allocating 15% of national budgets to health but they have bitterly failed to act on this pledge. Only Botswana has kept the promise of allocating 15% of the national budget to health, the rest of the countries in Africa need to keep their promises.
As per a report of the World Bank and Stop TB Partnership (December 2007), high-burden TB countries are likely to recover 9-15 times of their investment in TB control. This report indicates that the economic cost of not treating TB to Africa between 2006 and 2015 would be USD 519 billion while TB can be controlled with USD 20 billion in the same period.
It is clear that despite evidence, health is not perceived as a smart investment. Possibly imposing currency transaction levy of 0.005% can generate a pool of dedicated financial resources to strengthen health systems globally.
It is high time to be clear on what kind of a development we want for the world - a model which serves the capital interests of corporations or a model which serves the most basic needs for all, including that of healthcare?
One good analysis which further highlights this debate is from India. The Indian Prime Minister Dr Manmohan Singh gave indications of his shaking confidence in neo-liberal economic policies of liberalization- privatization-globalization in India in two meetings of Confederation of Indian Industries (CII). "He suggested that CEOs must consider placing voluntary ceilings on their salaries. He said that the gap between the rich and poor would produce social unrest. He said that for an unemployed youth a 9% growth rate didn't mean anything. He added that CEOs must not treat their wealth for personal consumption only but should consider using it for general good of society. He invoked the much forgotten 'trusteeship principle' of Mahatma Gandhi, which probably no politician in independent India has ever mentioned. Now, these thoughts would make a very sound policy if the objective was to create a humane and equitable society instead of elevating the growth rate" said Dr Sandeep Pandey, Ramon Magsaysay Awardee (2002) and a National Alliance of People's Movements (NAPM) leader.
Are G-20 leaders listening?
- Bobby Ramakant
(The author is a World Health Organization (WHO) Director General's WNTD Awardee 2008, HDN Key Correspondent and writes extensively on health and development. Email: [email protected])