A Survey of the Impacts of IMF Structural Adjustment in Africa:

Growth, Social Spending, and Debt Relief

By Robert Naiman and Neil Watkins1

April 1999




SECTION ONE : The Impact of the IMF in Africa: Aggregates Measures

SECTION TWO: Country Experiences with IMF Structural Adjustment

SECTION THREE : Has Africa 'Turned the Corner' in Recent Years?






Figure 1. Comparison of Real GDP Per Capita Growth Rates in Non-ESAF Countries, ESAF Countries, and ESAF Countries in Africa

Figure 2. External Debt As Share of GNP, ESAF Users and All Developing Countries

Figure 3. Indicators of Debt in Zimbabwe, pre- and post-ESAF

Figure 4. Per Capita Health and Education Spending in Cote d'Ivoire under IMF adjustment, 1990-1995

Figure 5. Per Capita GDP Growth in Sub-Saharan Africa, 1996-1999

Table 1. IMF Relationship with Sub Saharan Africa, 1991-1998 (Net Transfers)


    The role of the International Monetary Fund (IMF) in managing the economies of developing countries has come under increasing criticism in the last two years, especially since the Asian financial crisis.

    Presently, increasing calls for international debt cancellation and debates over United States economic policy in Africa have focused attention on the IMF's policies in Africa, home of many of the world's poorest and most indebted countries. Several initiatives currently being considered by Congress would have the effect of reducing the role of the IMF in Africa, while others would continue and even increase its role.

    This paper relies largely on the IMF's own data to consider the results of the IMF's intervention in the economies of sub-Saharan Africa. We examine the record of countries that have participated in the IMF's Enhanced Structural Adjustment Facility (ESAF), the Fund's concessional lending facility for the least developed countries.

    Among this report's main findings:

  • Developing countries worldwide implementing ESAF programs have experienced lower economic growth than those who have been outside of these programs. African countries subject to ESAF programs have fared even worse than other countries pursuing ESAF programs; countries in Africa subject to ESAF programs have actually seen their per capita incomes decline. It will be years before these populations recover the per capita incomes that they had prior to structural adjustment.
  • While African countries urgently need to increase spending on health care, education, and sanitation, IMF structural adjustment programs have forced these countries to reduce such spending. In African countries with ESAF programs, the average amount of per capita government spending on education actually declined between 1986 and 1996.
  • Neither IMF-mandated macroeconomic policies nor debt relief under the IMF-sponsored HIPC (Heavily Indebted Poor Countries) Initiative have sufficiently reduced these countries' debt burdens. Total external debt as a share of GNP for ESAF countries increased from 71.1% to 87.8% between 1985-1995. For sub-Saharan Africa debt rose as a share of GDP from 58% in 1988 to 70% in 1996. IMF debt relief has not sufficiently reduced the debt service burden of Uganda or Mozambique, the two African HIPC countries that have proceeded furthest under the HIPC initiative. Poor countries continue to divert resources from expenditures on health care and education in order to service external debt.

In light of this track record, it appears that efforts to increase economic growth, increase access to health care and education, and reduce the burden of debt repayment are likely to fail so long as the IMF remains in control of the economic policies of countries in sub-Saharan Africa. Efforts to reduce Africa's debt burden should be coupled with efforts to reduce the role of the IMF. Debt cancellation or relief should not be conditioned upon compliance with the IMF's structural adjustment programs or policies.



   The impacts of the policies advocated by the International Monetary Fund in sub-Saharan Africa are coming under increased scrutiny. For many years non-governmental organizations concerned with African development have asked whether the policies imposed by the IMF in Africa have actually helped or hindered the objective of increasing living standards for the majority of Africans. But in the last year the credibility of the IMF has been damaged in wider circles by its role in the Asian financial crisis. Moreover, recent debate in Congress over U.S. trade and economic policy in Africa has focused attention on whether the economic model promoted in Africa by the IMF is really in the interest of most Africans. The international call for cancellation of Third World debt has grown louder in the last year, highlighting the question of whether IMF policies have contributed to increasing the external debt burden of these countries. The movement for debt cancellation has also focused increasing attention on the impacts of economic policies which the IMF imposes on African countries, since the IMF's power over these countries is greatly magnified because of their indebtedness. The present paper summarizes some of the available evidence on the debt burdens, economic growth, and other broad indicators of human welfare in countries subject to IMF programs.

What is Structural Adjustment and ESAF?

   The Enhanced Structural Adjustment Facility (ESAF) is the IMF's concessional lending facility for the least developed countries. Unlike other IMF programs, which lend at market rates, ESAF offers low interest rates (0.5%) and repayment terms of five and a half to ten years. It was established in 1987, although its predecessor, the Structural Adjustment Facility (SAF), began its operations in 1986. As a condition of receiving these loans, countries must agree to adopt IMF structural adjustment programs. Structural adjustment programs generally require countries to adopt policies such as:

  • Reductions in government spending;
  • Monetary tightening (high interest rates and/or reduced access to credit);
  • Elimination of government subsidies for food and other items of popular consumption;
  • Privatization of enterprises previously owned or operated by the government; and
  • Reductions in barriers to trade, as well as to foreign investment and ownership.

   These policies and the IMF's role in implementing them have been criticized by developing country governments and development organizations as having worsened the situation of poor and lower-income people, as well as contributing to the degradation of the natural environment.

ESAF and the HIPC Initiative
        The IMF and World Bank, in response to demands for action to address the external debt crisis of poor countries, introduced the Highly Indebted Poor Countries (HIPC) initiative in September 1996. In order to qualify for debt relief under HIPC, countries must participate in an IMF-designed structural adjustment program. The HIPC program has come under fire for providing little actual debt relief and providing it too slowly. It has also been criticized for requiring the implementation of IMF structural adjustment programs. Many proposals to "reform" HIPC would give more resources to HIPC without requiring that HIPC be delinked from ESAF and structural adjustment. Since IMF policies have increased debt while hampering economic growth and spending on health care and education, such proposals, if enacted, are likely to do more harm than good.

Is the IMF a "Proconsular Force"?

    Critics of the IMF have taken the Fund to task not only for promoting economic policies widely seen as misguided, but also for the tremendous power that the IMF wields in poor countries, literally dictating economic policy. Harvard development economist Jeffrey Sachs has criticized the IMF as a "proconsular force."(2) In response to such criticisms, the IMF often points out that the policies that it advocates are not imposed since they are implemented as a result of agreements which are negotiated with the country in question. However, especially in its negotiations with the poorest countries, the IMF has nearly all of the leverage. Disapproval by the IMF of a country's economic policies can lead to a denial of public and private international credit and development aid, since multilateral development banks, aid agencies, and private banks defer to the IMF seal of approval. While many countries might be better off if international borrowing, particularly short-term borrowing, were significantly reduced, a complete withdrawal of credit can shut down otherwise functioning enterprises.

The Internal and External Reviews

   Recent evaluations of ESAF in an internal IMF study(3) and an external review(4) released in December 1997 and March 1998, respectively, were welcomed by the Fund's critics as opportunities to assess the IMF's role. The internal review examined the macroeconomic impact of IMF-mandated economic policies on 36 sample ESAF countries(5) over the period of structural adjustment. The external review looked at some of the effects of the Fund's policies on individual countries and examined the impacts of structural adjustment on indicators of social welfare and on national ownership. The external review was prepared by analysts from the Harvard Institute for International Development, Oxford University, Free University (Amsterdam), and Yale University.

   The present paper relies primarily upon data and findings of the internal and external reviews to examine the impact of structural adjustment under IMF supported programs in sub-Saharan Africa. We begin with an examination of the performance of all African countries with ESAF programs over the period of structural adjustment, looking at such indicators as economic growth, health and education spending, and external indebtedness. We then examine more closely the impact of IMF policies in four countries - Cote d'Ivoire, Uganda, Zimbabwe, and Mozambique. The experiences of Cote d'Ivoire, Uganda, and Zimbabwe under structural adjustment were examined by the External Review, which is the primary source of data for our consideration of these countries.(6) The experience of Mozambique is also instructive since it is one of two countries in sub-Saharan Africa (Uganda is the other) that has reached the final stage under the IMF/World Bank HIPC Initiative for debt relief.

   Our assessment of the IMF's impacts on sub-Saharan Africa strongly suggests that initiatives to reduce Africa's onerous debt burden which are conditioned upon further implementation of structural adjustment policies would be counterproductive. Debt relief which is conditional upon further adherence to IMF structural adjustment programs is unlikely to be effective in redirecting resources to uses that would facilitate economic growth or reduce poverty.

The Impact of the IMF in Africa: Aggregate Measures

1. Economic Growth

One of two stated principal objectives of IMF's ESAF facility is to foster "sustainable economic growth" in the countries to which it lends.(7) Data on growth in countries with ESAF programs show that this objective has not been met:

  • Annual real per capita GDP growth averaged 0.0% for all ESAF countries over the period 1991-1995, whereas non-ESAF developing countries experienced, on average, 1.0% annual real per capita GDP growth. (Internal Review, p. 5)
  • Sub-Saharan African countries with ESAF programs experienced an average annual .3% decline in real per capita incomes over the period of IMF adjustment from 1991-1995. (8)

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Source: IMF Internal Review and H. Bredenkamp, principal author of IMF Internal Review

   The decline in the income of an average African in countries with ESAF-supported programs over the period is perhaps not surprising given that typical IMF policies in Africa required cuts in public spending, credit restraints (through higher interest rates), and elimination of food and other subsidies, all of which could be expected to reduce aggregate demand, and therefore income and output. Nonetheless, it is a policy failure that these countries can ill afford.

   One of the main goals of structural adjustment has been to reduce a country's fiscal and trade deficits to "sustainable" levels. However, trade balances have not improved for sub-Saharan Africa over the period of adjustment(9). Furthermore, IMF policies for improving trade balances often carry severe economic and social costs, since they are largely accomplished by shrinking the national economy.(10) The monetary and fiscal austerity measures required by structural adjustment have often led to recession.

   According to World Bank projections, as a result of the decline in real income growth from 1991-1995, it will now take years for Africa to reach levels of per capita income seen in the early 1980s. The World Bank forecasts that per capita incomes will grow by 1.2% annually for the next decade in sub-Saharan Africa.(11) Given the past record of achievement under IMF/World Bank adjustment, such projections may be overly optimistic. But even under these projections, it will take until 2006 merely to return to 1982 (pre-structural adjustment) levels of per capita income in sub-Saharan Africa. As the Bank has noted: "...the coming decade would only represent the recovery of ground lost over the past twenty years."(12)


2. Social Spending

   There are many urgent human needs in sub-Saharan Africa -- especially in the areas of education, health care, and sanitation -- which require increased government attention. In 1995, the adult literacy rate was 66% for men and 47% for women. Moreover, only 61% of boys and 57% of girls of primary school age attended school, on average, over the period 1993-1997. Between 1990 and 1997, only 44% of the population had access to safe drinking water, and 31% of children under five were underweight. In 1997, 17% of children died before reaching the age of five.(13) In many of the countries with structural adjustment programs, the enrollment rates and health indicators are lower than the continental averages listed above.

    There is thus an urgent need for increased attention to the provision of basic social services. However, IMF adjustment programs restrict access to health services and public education in two key ways: by reducing household incomes, and by reducing public (government) spending. When household incomes decline, poor families may pull children out of school, or defer visits to health clinics, because they are unable to pay for the services. Cuts in government spending on health and education reduces access for the poor, and the quality of public services declines.(14)

The IMF claims that in countries worldwide where it had programs over the period of adjustment from 1986-1996, "spending on education, on average, fared reasonably well."(15) The same study notes, however, that this was not the case in Africa:

  • In African countries with ESAF programs, per capita education spending actually declined by 0.7% a year on average between 1986 and 1996.(16)

Moreover, in African countries with ESAF programs, real per capita outlays on health increased on average by 2.5% a year during the same period, which was slower than the rate of growth of health spending in the other, non-African, ESAF countries.(17)


3. External Indebtedness and the HIPC Initiative

    Over the period of structural adjustment examined by the Internal Review, the external debt burden for ESAF countries worldwide has grown significantly:

  • Total external debt as a share of GNP for all ESAF users increased from 71.1% to 87.8% between 1985-1995. This compares to an increase from 34% to 39.6% for developing countries overall over the same period (see figure 2). At the same time, the share of publicly held and publicly guaranteed debt rose for ESAF countries while it declined for developing countries overall. The role of private creditors in ESAF countries shrank dramatically. (Internal Review, p. 27.) These outcomes contradict the stated goal of IMF policies, which is to reduce debt and increase the role of the private sector.

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Source:  IMF Internal Review, p. 27.

While the Internal Review does not specifically document the external debt burden for ESAF users in Africa, the external debt burden for sub-Saharan countries, most of which have participated in ESAF, has also grown over the same period:

  • The amount of total external debt outstanding for sub-Saharan Africa rose from $150.5 billion in 1988 to $227.1 billion in 1996. As a share of GDP, the region's debt increased from 58% in 1988 to 70% in 1996.(18)
  • By 1996, external debt per capita for sub-Saharan Africa (excluding South Africa) was $365, while GNP per capita was $308.(19)

     This rising and unsustainable debt burden has led to calls for debt relief from across the political spectrum. As the Economist has noted: "It has long been obvious that several countries, especially in Africa, cannot repay their debts. Their (occasional) efforts to do so impoverish already destitute people, and blight their hopes of economic take-off."(20) Partly in response to increased public pressure, the IMF and World Bank introduced the Highly Indebted Poor Countries (HIPC) initiative in September 1996. According to the Fund, this initiative "aims at reducing the debt burdens of all eligible HIPCs to sustainable levels, provided they adopt and pursue strong programs of adjustment and reform."(21)

    Under the HIPC initiative, the process of debt relief remains extremely slow. A country must pursue structural adjustment for three years to reach the "decision point," when donors agree to reduce its debts to "sustainable" levels -- and the actual relief comes only at the "completion point," after three more years of IMF-mandated reforms. Debt relief may be further delayed if the IMF declares a country is "off-track," an ever-present possibility: the Internal Review found that more than three-fourths of the countries under review had "significant interruptions" in their IMF program (p. 42).

    So far, only four countries in Africa have reached the decision point, and as of April 1999, only one - Uganda - had reached the completion point and actually received funds for debt relief, though Mozambique is projected to receive its funds later in 1999. Moreover, data released by the IMF and World Bank indicate that HIPC has not significantly reduced debt service payments in Mozambique (see "Case Study: Mozambique and Debt Relief," below). In two other African countries that have reached the decision point under HIPC - Mali and Burkina Faso - an internal IMF-World Bank report projects that debt service payments will actually increase after debt relief under HIPC.(22)

    The reforms mandated by the Fund, as shown by the indicators above, have failed to reduce the debt burden of Africa - in fact, the debt burden has increased over the period of adjustment. Coupled with the failure of the HIPC initiative to substantially reduce debt service burdens in Africa, the record of the IMF on debt reduction and growth strongly suggests that future efforts to significantly reduce and cancel debt for sub-Saharan Africa should take place outside of the framework of IMF structural adjustment.

Country Experiences with IMF Structural Adjustment

    The External Review examined the experiences of five African countries under IMF adjustment. Below, we take a closer look at three of these countries - Zimbabwe, Cote d'Ivoire, and Uganda. We also briefly consider the experience of Mozambique - a country not examined in the External Review - under the IMF/World Bank HIPC Initiative.

1. Zimbabwe

    During the 1980s, Zimbabwe's economy grew briskly: real growth averaged about 4% per year. During the early and mid-part of the decade, Zimbabwe's exports were diversified and became increasingly oriented towards manufacturing; debts were regularly repaid without the need for rescheduling; a reasonable degree of food security was attained; and the provision of educational and health services was dramatically expanded (due to major increases in government spending on social services).(23) As a result of increased government spending on health care provision in particular, health indicators showed dramatic improvement during the 1980s: the infant mortality rate declined from 100 per 1,000 live births to 50 between 1980 and 1988; life expectancy increased from 56 to 64 years (External Review, p. 179). Primary school enrollment doubled over the decade.

    The External Review summarized the achievements of the 1980s: "The core of the government's redistributive agenda was through (sic) increased public expenditures on education, health, and public sector employment. During the 1980s, much was achieved both in terms of an expansion of these expenditures and in terms of measurable indicators of performance" (p. 172).

    Though it had entered into agreements with the World Bank in the late 1980s, Zimbabwe began structural adjustment in earnest in 1991 when it signed a stand-by arrangement with the IMF in exchange for a $484 million loan. Unlike many of the countries that undertake IMF adjustment programs, Zimbabwe did not institute structural adjustment in response to a "crisis." Rather, explains Catherine Marquette, after several years of economic stagnation, Zimbabwe turned to the Fund and World Bank in an effort to "jump start economic growth."(24)

    Among the policy changes required by the IMF in exchange for the loan were cuts in Zimbabwe's fiscal deficit, tax rate reductions, and the deregulation of financial markets. The arrangement also required Zimbabwe to dismantle protections for the manufacturing sector and "deregulate" the labor market, lowering the minimum wage and eliminating certain guarantees of employment security (External Review, p. 173-176). From the IMF's point-of-view, labor market rigidity was a factor which was constraining future growth potential and keeping the fiscal deficit high in Zimbabwe.

Impact on the Economy

    IMF policies which mandated the removal of protections for the manufacturing sector, trade liberalization, and reduced government spending combined with the effects of a severe drought on agricultural production to send the Zimbabwean economy into recession in 1992 -- real GDP fell by nearly 8% that year.(25) In Zimbabwe, economic crisis actually followed rather than preceded the implementation of structural adjustment.(26)

    Among the indicators of economic performance that declined over the period of adjustment:

  • Between 1991 and 1996, manufacturing output contracted 14%;
  • Real GDP per capita declined by 5.8% from 1991-1996;(27)
  • Real GDP fell by about 1% between 1991 and 1995. (A January 1992 IMF staff report predicted 18% GDP growth over the same period);
  • Nominal and real interest rates were high and volatile throughout the period, with nominal rates often exceeding 40%. The result of high real interest rates was to reduce private domestic investment;(28) and
  • Total private investment declined by 9% in real terms between 1991-96 (External Review, p. 172-175).

    Furthermore, private per capita consumption fell by 37% between 1991-1996. As the External Review concluded, "This alone transformed the group of those who lost from the reforms from a minority to a majority" (p. 177).

    The combination of reduced protection of the manufacturing sector, the reduction in public spending, and labor market deregulation led to higher unemployment and lower real wages. Between 1991-96, formal sector employment in manufacturing fell 9% and real wages declined by 26%. Meanwhile, food prices rose much faster than other consumer prices; this disproportionately affected the rural poor, who spend a larger share of their income on food (External Review, p. 180, 182).

Impact on Health Care and Education Spending

    In order to meet the IMF's fiscal targets in the 1991 ESAF program, the government had to reduce non-interest expenditures by 46%. The External Review describes this requirement as a "draconian reduction" and found it unsurprising that Zimbabwe never met the fiscal target. Though Zimbabwe never met the IMF target, between 1990/91 and 1995/96, spending on health care declined as a share of the budget from 6.4% to 4.3%, and as a share of GDP from 3.1% to 2.1% (External Review, p. 178). The IMF's prescriptions for fiscal adjustment included reductions in the real wages of public health sector workers. As a result of the wage cuts, many doctors moved to the private health sector, and the quality of public health care dropped. As health care became less a public service and more a function of the private sector, health services became less accessible to the poor. Because non-wage health spending fell dramatically as well, shortages of prescription drugs became commonplace (External Review, p. 178).

    Compared to the previous era in which health care services were made more widely available to all Zimbabweans through increased government spending, the era of IMF adjustment was characterized by decreased access to health services. This trend was reflected in the deterioration of health indicators. For example, between 1988 and 1994, wasting (a phenomenon linked to AIDS) in children quadrupled and maternal mortality rates appear to have increased. And after many years of decline, the number of cases of tuberculosis began to rise in 1986 and by 1995 had quadrupled (External Review, p. 178-179).

    The decline in government health care spending occurred during a period of increasing need by the population for more access to health care. AIDS was spreading rapidly in Zimbabwe. Given the present cost of treating AIDS patients, the World Bank predicted that the total cost of treating Zimbabwean citizens already infected with AIDS was four times the entire 1996 government health budget(29). The IMF's fiscal targets meant that the government was unable to effectively respond to growing health needs of the population. The External Review concluded that access to health care fell under IMF adjustment, compared to the pre-IMF era: "There is no doubt that the previous trend of improving health outcomes was reversed during the period of the reform program" (p. 179).

    Government spending on education also fell sharply under IMF adjustment. Real per capita expenditure on primary and secondary education declined by 36% and 25%, respectively, between 1990/91 and 1993/94. As in the health sector, wages for teachers and educational staff fell by between 26% and 43% between 1990 and 1993.(30)

Impact on External Indebtedness

    The External review team analyzed Zimbabwe's external viability (i.e., their debt burden). The results show that on the basis of nearly every generally accepted indicator of a country's debt burden, Zimbabwe became significantly more indebted during the period of adjustment (See Figure 3). But Zimbabwe still does not qualify for the IMF/World Bank HIPC initiative.

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Source:  IMF External Review, Statistical Charts and Tables

    On April 11, 1999, the Associated Press reported that Zimbabwe had "severed ties with the International Monetary Fund and the World Bank," saying that they had "made 'unrealistic demands'" as a requirement for releasing funds.(31) A day later the Zimbabwean Finance Ministry denied the report, "in a bid to reassure markets."(32) The Wall Street Journal noted that "Other donors have indicated they would take their cue from the IMF on whether to release additional financial support," again indicating the tremendous power which the IMF wields as a result of the fact that other creditors and donors follow its lead .(33)

2. Cote d'Ivoire

    Cote d'Ivoire experienced a long period of growth following its independence in 1960, with much of its growth attributable to agricultural exports. Economic decline ensued in the early 1980s as world prices for coffee and cocoa, two of Cote d'Ivoire's main exports, fell. After a brief restoration in growth by 1985, the economic decline resumed in the late 1980s (External Review, p. 95).

    The IMF became involved in Cote d'Ivoire in November 1989, when it reached a stand-by arrangement(34) with the government, which was followed by another agreement in 1991. Following the initial stand-by arrangements with the IMF, there were six World Bank Structural Adjustment Loans from 1989-1993. Then, beginning in 1994, Cote d'Ivoire entered into an ESAF program with the IMF.

    Over the first period of adjustment, from 1989-1993, IMF fiscal adjustment requirements were introduced in an effort to reduce the government budget deficit. These included substantial reductions in current government expenditures (-30%) and capital expenditures (-15%), in addition to tax increases. Structural reforms also began during this period, including privatizations and some financial reforms.

    The objectives of the next phase (from 1994-1997), under the ESAF program , were threefold:

  • To generate a primary budget surplus(35) of 3% of GDP, "in order to finance debt service" (External review, p. 97);
  • To attain GDP growth of 5% by 1995; and
  • To "protect the most vulnerable during adjustment."

In order to reach the budget surplus target, the IMF required labor market deregulation, price decontrol, trade reform, reductions in civil service employment, and faster privatization (External Review, p. 97). The IMF also advocated devaluation of Cote d'Ivoire's currency, the Franc CFA,(36) which occurred in January 1994.

Impact on the Economy

    From 1989-1993, per capita GDP fell by 15%, pushed along by the overvaluation of the exchange rate and deterioration in the terms of trade (External Review, p. 95-96). The social impact of IMF structural adjustment on Cote d'Ivoire was severe. Between 1988-1995, the incidence and intensity of poverty doubled, with the number of people earning less than $1/day increasing from 17.8% of the population to 36.8%(37). In Abidjan, Cote d'Ivoire's largest city, the rate of urban poverty rose from 5% to 20% between 1993 and 1995 (External Review, p. 101).

Impact on Health Care and Education Spending

    Between 1990 and 1995, real per capita spending on health care fell slightly and education spending fell dramatically (External Review, p. 101, 105). During the period of IMF structural adjustment (1990-1995), real per capita public spending on education declined by more than 35%. Moreover, reductions in the wages of civil servants required by the IMF also led to a reduction in teacher salaries (External Review, p. 103). The Review points out that lower wages probably lowered teachers' motivation, and educational quality may have suffered as a result. Despite an improvement in gross enrollment in primary schools over the period 1986-1995, educational indicators overall showed poor results. By 1995, only 45% of girls from the poorest quintile of households were receiving primary education. At the secondary level, the gross enrollment rate declined from 34% to 31% between 1986 and 1995 (External Review, p. 104).

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Source:  External Review, p. 105, (data from UNICEF, "Financement des Secteurs Sociauz de Base: Suivi de l'initiative 20-20 en Cote d'Ivoire," August 1997)

As part of the policy reforms required by the Fund, user fees were introduced into the public health care system in 1991. The devaluation of the franc CFA made it especially difficult for the urban poor to pay for health care services, and as a result there was a shift towards traditional medicine. Many health problems worsened. For example, the incidence of stunted growth in children increased from 20% in 1988 to 35% in 1995. As access became more expensive, health issues became a more pressing concern. A survey by UNICEF and the Government of Cote d'Ivoire found that when women were asked to identify their problems, health ranked first (External Review, p. 103).

    The External Review concluded that in Cote d'Ivoire, "The required reductions in public expenditures were imposed on a system which was already failing to meet basic social needs."

Impact on External Indebtedness

    In the first two years of adjustment alone (from the end of 1989 to the end of 1991), Cote d'Ivoire's external debt burden grew by $3.7 billion (or from 141% to 175% of GDP).(38) In its analysis of external viability, the External Review found that Cote d'Ivoire's external debt burden increased from 132.4% to 210.8% of GDP. Before ESAF, its debt stock to export ratio was 452.8%; following ESAF, it had risen to 545.4% (External Review, p. 190).

    Although Cote d'Ivoire has completed the required three consecutive years of structural adjustment to reach its "decision point" for eligibility under the IMF/World Bank HIPC Initiative, it will not reach the "completion point" (of actually receiving debt relief) until March 2001, assuming it does not go off track from the adjustment program. Although the country has an urgent need for increased government spending on health care and education, it is unlikely that this could happen under the terms of structural adjustment.


3. Uganda

    When President Yoweri Musevini came to power in Uganda in 1986, his government faced the challenge of rebuilding an economy devastated by the dictatorships of Idi Amin and Milton Obote. Between 1971 and 1986, the Ugandan economy deteriorated. But in the ten years that followed (between 1986-1996), per capita GDP grew by roughly 40%.

    The IMF first became involved in Uganda in 1987, with a loan through its Structural Adjustment Facility (SAF), and it later extended its mission under the ESAF program from 1989-1992 and again from 1992-1997. Real per capita GDP growth averaged 4.2% in Uganda between 1992-1997, and as a result, the IMF often presents Uganda as an example of the success of its structural adjustment policies.

    As noted in the External Review, part of this rapid growth can be explained by the terrible decline of preceding years. But it is also worth looking at how various sectors of the population fared under the growth that coincided with structural adjustment in Uganda.

Impact on the Economy

    Two principal reforms mandated by the IMF arrangements were trade liberalization and the progressive reduction of export taxation. But as the external review points out, "Liberalization of cash crops had only limited beneficiaries." This was the case because only a small number of rural households grow coffee. Liberalization had little impact on rural incomes over the period of adjustment- rural per capita private incomes increased just 4% over the period from 1988/89 to 1994/95.(39)

    The IMF also mandated the privatization of state-owned industries, a process that has met particular criticism in Uganda. The Structural Adjustment Participatory Review International Network (SAPRIN), which was launched jointly with the World Bank, national governments, and Northern and Southern NGOs in 1997, has reported that the privatization process in Uganda has gone too fast and has been flawed from the start. A report by Ugandan NGOs who participated in SAPRIN found that "The privatization process in Uganda has benefitted the government and corporate interests more than the Ugandan people. . . The privatization process was rushed, and as a result, workers suffered. Some 350,000 people were retrenched and, with the private sector not expanding fast enough, unemployment sharply increased. Those laid off were not prepared for life in the private sector, with no training being provided."(40)


Impact on Health Care and Education Spending

    During the period of IMF structural adjustment, public spending on health care increased as government spending rose overall. However, health care spending did not rise as a share of the recurrent budget, and its share was slightly lower in 1994 than it had been in 1989. Government spending grew over the period but from a very low starting level at the beginning of Museveni's term: in 1986, government expenditure represented just 9% of GDP(41). At the same time prices of health care services rose much faster than inflation. This was caused in part by the large depreciation of the exchange rate from 1988-1991, which raised the cost of imported inputs in the health sector. As a result, a given level of public health spending bought fewer health services. Real per capita output in health care was lower in each of the years from 1992-1994 than it had been in 1989. (External Review, p. 139-141).

    The SAPRIN review of Uganda's experience with adjustment found that "cost-sharing," where patients are expected to pay for a portion of their health care or education, has led to less access for the poor to health care and public education. The policy of cost-sharing was introduced by the Ugandan government in response to IMF fiscal requirements and high debt service payments, which have made it difficult for the government to channel funds into payments for health care and public education. The NGOs in SAPRIN report that:

It [higher costs] has made hospitals and institutes of higher education too costly for the poor.  People testified that those who cannot pay for critical health care simply die. Cost-sharing is  also poorly administered in the hospitals, and it was pointed out that in areas where people have been unable to pay, the local hospital has simply been closed down. Citizen representatives reported that in villages where the people themselves decide on how much to pay, access to care is much better, so it is best to scrap cost-sharing, which does not benefit the poor.(42)

    Despite some limited progress in the area of health service provision during the era of adjustment,(43) general health indicators have not improved. In particular, the proportion of children who are malnourished has not declined. As the External Review observes, "This is consistent with the evidence on rural incomes which, as we have seen, suggests little change" (p. 139). Since rural incomes did not rise in tandem with increasing health care costs, the rural poor were not able to share in increased access to health service provision.

    Moreover, a declining share of the recurrent budget has been spent on education over the adjustment period, and this led to an overall reduction (over the period 1987 to 1996) in the provision of educational services per capita. (External Review, p. 140-141).

Impact on External Indebtedness

    The IMF and World Bank often present Uganda as an example of the success of its HIPC (Heavily Indebted Poor Country) debt initiative. Uganda was the first country to receive debt relief under the IMF/World Bank HIPC Initiative in April 1998, when roughly $650 million of its multilateral debt stock was forgiven.

    However, the process has, first of all, been plagued by several delays. Uganda was originally scheduled to receive debt relief in April 1997, but this was pushed back one year. This delay occurred despite the fact that Uganda had been following structural adjustment programs for nearly a decade. According to Ugandan government projections, the cost of the one year delay was $193 million in lost relief. This amount is more than double the projected spending on education or six times total government spending on health in that year.(44) With the delay, public funds were diverted from priority health care services into debt repayments.

    Moreover, less than one year after receiving relief, Uganda's debt burden has once again become unsustainable according to HIPC criteria. This is mainly because of an overestimation by the World Bank and the IMF of revenues Uganda would receive from coffee exports and from trade with the former Zaire, whose economy has recently gone into decline. The United Kingdom's Secretary of State for International Development, Clare Short, confirmed this in a statement before the British House of Commons, noting that, "the review of Uganda, which has just received debt relief, was very disappointing. As a result of the fall in world coffee prices, it is just as badly off as it was in the first place."(45) Uganda's return to an unsustainable debt service burden illustrates the problem with IMF and World Bank projections of export earnings that do not materialize, even over a period of less than a year.(46) It also shows that the debt burdens set by HIPC as "sustainable" are much too high, and that much deeper debt relief - preferably cancellation - will be necessary to set these countries on a sustainable growth path.

Case Study: Mozambique and Debt Relief

    Unlike the other countries examined in this study, Mozambique's experience with IMF structural adjustment was not examined in the External Review. But Mozambique will shortly become only the second African country to reach the final stage under the World Bank/IMF Highly Indebted Poor Countries (HIPC) Initiative, when it reaches its completion point in mid-1999. It is therefore worth examining how Mozambique has fared under this initiative, including the required conditions of structural adjustment.

    Mozambique is one of the poorest countries in the world, if not the poorest. According to the United Nations Development Program (UNDP) and UNICEF, only 37% of the population has access to clean water; 39% has access to health services; and 23% of women can read and write.(47)

    Following a decade of war supported by external powers, Mozambique began a modified form of World Bank structural adjustment in 1987, and in 1990 it entered into an IMF directed "stabilization program" under ESAF. Two of the main components of the IMF stabilization program were fiscal adjustment (cuts in government spending) and cuts in credit to the economy (through policies such as higher interest rates). As part of the fiscal adjustment process, government salaries fell. For example, a doctor on the government payroll earned $350/month in 1991, $175/month in 1993, and by 1996, took in less than $100/month. For nurses and teachers, monthly salaries fell from $110/month to $60 or $40 - levels at which it is impossible to support a family.(48)

    The IMF's primary aim in Mozambique was to contain inflation; the Fund argued that broad post-war reconstruction efforts should be scaled back on the grounds that such actions could be inflationary. While the IMF focused on stabilization policies, World Bank adjustment simultaneously mandated privatization as well as trade and investment liberalization.

Mozambique and the HIPC Initiative

    In a press release issued on April 7, 1998, the IMF announced that, along with other creditors, it had agreed to "provide exceptional support amounting to nearly US$3 billion in nominal terms in debt-service relief for Mozambique," claiming that this would "reduce the external debt burden, free budgetary resources and allow Mozambique to broaden the scope of its development effort."(49)

    While $3 billion may seem like substantial debt relief for a country as poor as Mozambique, it does not necessarily make a significant dent in the country's debt service burden. Since countries like Mozambique owe far more in external debt than they have the capacity to pay, it is quite possible to reduce their outstanding debt stock considerably, without any commensurate reduction in the net drain of resources out of the country. This happens when creditors cancel that part of the debt that was not being serviced previously. Therefore, in order to know whether poor countries -- and poor people in those countries -- actually benefit from IMF/World Bank debt relief, it is necessary to know what the impact of this debt relief is on the actual debt service paid by these countries.

    In response to criticism from non-governmental organizations, in May the IMF released estimates for these numbers.(50) According to the IMF's own projections, the actual debt service paid by Mozambique will be as high or higher in each of the years from 2000-2003 as it was in 1997.(51) Even after IMF debt relief, the government will be paying roughly as much in debt service as it is spending on health care and education.(52)

    Speaking at a conference on the issue, World Bank representative James Coates noted that more than half of all money allocated to HIPC countries went to cancel Mozambique's debt, and that more debt could not be canceled because the funds allocated under HIPC constituted the maximum that creditors could afford.(53) But the $100 million that Mozambique pays in debt service each year represents barely one-tenth of one percent of the increase in resources which the IMF alone received last year from member governments. This indicates that the lack of meaningful debt relief so far is not the result of scarce resources, but a lack of commitment to significantly reducing the debt service burden of these highly indebted and very poor countries.

Human Impact of the IMF's Policies

    The importance of debt relief can be illustrated by estimates of the results, in terms of human welfare, that could be achieved if some of the resources now spent on debt service were reallocated to spending on vital needs. In 1997, the UNDP estimated that, relieved of their debt payments, severely indebted countries in Africa could have saved the lives of 21 million people and provided 90 million girls and women with access to basic education by the year 2000.(54) In the case of Mozambique, Oxfam estimated that debt relief could save the lives of 600,000 children over seven years.(55) Other advocates of debt relief have made similar estimates: based on UNDP estimates of the impact of increased health and education spending, Jubilee 2000 estimated that if Mozambique were allowed to spend half the money on health care and education which it is now spending on debt service, it would save the lives of 115,000 children every year and 6,000 mothers giving birth.(56)


     In 1998, the IMF released a series of publications and public statements claiming credit for an "African economic renaissance" and "a turnaround in growth performance."(57) The claim from the IMF and World Bank is that structural adjustment is beginning to pay off, at least in macroeconomic terms. But examining just-released growth projections by the World Bank, one discovers that the "growth turnaround" has been short-lived. According to the World Bank, real GDP per capita grew by 1.4% in 1996, but by 1997, growth slowed to 0.4%, and in 1998, per capita incomes fell by 0.8%. The World Bank projects a further decline of 0.4% in 1999.(58) In short, if there was an "economic renaissance" for Africa, it appears to be over.

wpe7.jpg (16150 bytes)

Source:  World Bank, Global Development Finance 1999.  1999 Figures are World Bank projections

    Why has there been a sudden downturn in growth? The UN Economic Commission for Africa (ECA) reports that Africa's economic performance in 1997 showed "the fragility of the recovery and underscored the predominance of exogenous factors" in the determining African economic outcomes.(59) Africa's growth prospects are inexorably linked to world prices for its exports. IMF and World Bank structural reforms had actively promoted this strategy, known as export-led growth. The ECA also emphasized this fact: "The major thrust of economic policy making on the continent has been informed for the last decade or so by the core policy content of adjustment programs (of the type supported by the IMF and the World Bank)..."(60)

    In addition to slower growth in 1997 and 1998, recently released data indicate that the relationship between the IMF and sub-Saharan Africa has taken a turn for the worse during these years.

Table 1. IMF relationship with Sub Saharan Africa, 1991-1998 (in millions of US$)










IMF Purchases









IMF Repurchases









IMF Charges



















The Balance shows the net transfer of funds from the IMF to Sub-Saharan Africa; the negative sign indicates a net transfer from the countries to the Fund.
IMF Purchases represent new resources (loans) taken out from the IMF
IMF Repurchases represent repayments of the principal of IMF loans
IMF Charges represent repayments of the interest on IMF loans.

Source: World Bank, Global Development Finance 1999, in Jubilee 2000 Coalition, "IMF takes $1billion in two years from Africa," April 1999.

    As Table 1 shows, repayments by African governments to the IMF outpaced new resources in the past two years, resulting in a net transfer from Africa to the IMF of more than $1 billion in 1997 and 1998.(61) Meanwhile, despite increasing repayments to the IMF, total African debt continued to rise: between 1997 and 1998, Africa's debt increased by 3% to $226 billion. This occurred even as African countries paid back $3.5 billion more than they borrowed in 1998.(62)


    The data reviewed in this study suggest that the International Monetary Fund has failed in Africa, in terms of its own stated objectives and according to its own data. Increasing debt burdens, poor growth performance, and the failure of the majority of the population to improve their access to education, health care, or other basic needs has been the general pattern in countries subject to IMF programs.

    The core elements of IMF structural adjustment programs have remained remarkably consistent since the early 1980s. Although there has been mounting criticism and calls for reform over the last year and a half-- as a result of the Fund's intervention in the Asian and Russian financial crises-- no reforms of the IMF or its policies have been forthcoming. And there are as yet no indications from the Fund itself that it sees any need for reform. In fact, IMF Managing Director Michel Camdessus has repeatedly referred to the Asian economic collapse as "a blessing in disguise."(63)

    In the absence of any reform at the IMF for the foreseeable future, the need for debt cancellation for Africa is all the more urgent. This enormous debt burden consumed 4.3% of sub-Saharan Africa's GNP in 1997. If these resources had been devoted to investment, the region could have increased its economic growth by nearly a full percentage point--sadly this is more than twice its per capita growth for that year. But the debt burden exacts another price, which may be even higher than the drain of resources out of the country: it provides the means by which the IMF is able to impose the conditions of its structural adjustment programs on these desperately poor countries.

    Any debt relief that is tied to structural adjustment, or other conditionality imposed by the IMF--as it is in the HIPC initiative--could very well cause more economic harm than good to the recipients. Debt relief should be granted outside the reach of this institution, preferably without conditions. Moreover, the role of the Fund in Africa and developing countries generally, and especially its control over major economic decisions, should be drastically reduced. Any efforts to provide additional funding or authority to the IMF, before the institution has been fundamentally reformed, would be counter-productive.



On the International Monetary Fund and ESAF

The Development Gap     http://www.developmentgap.org

Essential Action    http://www.essential.org

Fifty Years is Enough Network    http://www.50years.org

Focus on the Global South   http://www.focusweb.org

Friends of the Earth   http://www.foe.org/international/international.html

International Labor Rights Fund   http://www.laborrights.org

Public Citizen   http://www.tradewatch.org

Third World Network   http://www.twnside.org.sg


On Debt Relief and Cancellation

Alternative Information and Development Centre (South Africa)     http://www.aidc.org.za

European Network on Debt and Development (EURODAD)     http://www.oneworld.org/eurodad/

Jubilee 2000 Coalition     http://www.jubilee2000uk.org


AP Worldstream, "We won't cut ties with IMF, World Bank, says Zimbabwe," April 12, 1999.

Boote, Anthony R. and Kamau Thugge, "Debt Relief for Low-Income Countries: The HIPC             Initiative," Pamphlet Series No. 51, (Washington: International Monetary Fund, 1997).

Botchwey, Kweisi, Paul Collier, Jan Willem Gunning, and Koichi Hamada, "Report of the Group of Independent Persons Appointed to Conduct an Evaluation of Certain Aspects of the Enhanced Structural Adjustment Facility," January 13, 1998.

Camdessus, Michel. "Africa: A Continent on the Move," Speech by IMF Managing Director, June 8, 1998.

"Civil Society Perspectives on Structural Adjustment Policies," Report of the Ugandan Opening National SAPRI Forum, 18-19 June 1998.

Denny, Charlotte and Larry Elliott, "Fund admits debt plans will fail poor," The Guardian (U.K.), April 19, 1999.

Dow Jones Newswires, "Zimbabwe Severs Ties With IMF, World Bank," April 11, 1999.

Engberg-Pederson, Poul et al., Limits of Adjustment in Africa: The Effects of Economic Liberalization 1986-1994, (Copenhagen : Centre for Development Research, in association with James Currey, Oxford, Heinemann, Portsmouth, N.H., 1996).

Fischer, Stanley, Ernesto Hernandez-Cata and Mohsin Khan, "Africa: Is This the Turning Point?" IMF Paper on Policy Analysis and Assessment 98/6, May 1998.

"For this relief, some thanks," The Economist, March 20, 1999.

Hanlon, Joseph, "International Monetary Fund Stabilization in the World's Poorest Country," Multinational Monitor, (Vol. 17, no. 7 and 8, July/August 1996).

"How to Fix the IMF," Forum sponsored by the Economic Policy Institute, (Washington, D.C., April 7, 1999).

International Monetary Fund, "Mozambique--Debt Service," May 1998. Table 1, "Mozambique: Debt Service on Public and Publicly Guaranteed Debt, 1995-2003."

International Monetary Fund, Press Release No. 98/12, "Debt Relief Package of Nearly US$3 Billion Approved for Mozambique," April 7, 1998.

International Monetary Fund, "The ESAF at Ten Years: Economic Adjustment and Reform in Low-Income Countries," Occasional Paper no. 156, (Washington: IMF, December 1997).

"The IMF and the Poor," Pamphlet Series No. 52, (Washington: IMF, 1998).

"IMF's Camdessus Still Describes Asian Crisis as Blessing in Disguise," The Wall Street Journal, September 24, 1998.

Jubilee 2000 Coalition, "News: Uganda Debt Unsustainable Again," February 19, 1999.

Jubilee 2000 Coalition, "Mozambique's Parliament Demands Total and Unconditional Debt Cancellation," November 12, 1998.

Jubilee 2000 Coalition, "Mozambique Gains Little or Nothing from Debt 'Relief,'" June 1998.

Marquette, Catherine, "Current Poverty, Structural Adjustment, and Drought in Zimbabwe," World Development, (Vol. 25, no.7, 1997).

Mkandawire, Thandika and Charles C. Soludo, Our Continent, Our Future: African Perspectives on Structural Adjustment, (Trenton, NJ: Africa World Press, 1999, in conjunction with CODESRIA, Dakar, Senegal, and International Development Research Center, Ottawa, Canada).

Ouattara, Alassane, "The IMF's Role in the Unfolding African Renaissance," Speech by IMF Deputy Managing Director, June 11, 1998.

Oxfam International, "Poor Country Debt Relief: False Dawn or New Hope for Poverty Reduction?", April 1997.

United Nations Development Program (UNDP), Human Development Report 1998, (New York: Oxford University Press, 1998).

UNDP, Human Development Report 1997, (New York: Oxford University Press, 1997).

UNDP, Human Development Report 1996, (New York: Oxford University Press, 1996).

UN Economic Commission for Africa, Economic Report on Africa 1998, (Addis Ababa: UNECA, 1998).

UNICEF, State of the World's Children 1999, (New York: UNICEF, 1999).

Watkins, Kevin, Break the Cycle of Poverty: Education Now, (Washington: Oxfam International, 1999).

World Bank, Global Development Finance 1999, (Washington: World Bank, 1999).

World Bank, African Development Indicators 1998/1999, (Washington: World Bank, 1998).

World Bank, Global Economic Prospects and the Developing Countries, (Washington: World Bank, 1997).

"Zimbabwe Severs Ties with the IMF," The Wall Street Journal, April 12, 1999.


1. Robert Naiman and Neil Watkins are Research Associates at the Preamble Center in Washington, D.C.

2. Comments by Jeffrey Sachs at forum, "How to Fix the IMF," sponsored by the Economic Policy Institute, Washington, D.C., April 7, 1999.

3. IMF, "The ESAF at Ten Years: Economic Adjustment and Reform in Low-Income Countries," Occasional Paper no. 156, December 1997. (Hereafter, "Internal Review")

4. Kweisi Botchwey, Paul Collier, Jan Willem Gunning, and Koichi Hamada, "Report of the Group of Independent Persons Appointed to Conduct an Evaluation of Certain Aspects of the Enhanced Structural Adjustment Facility," January 13, 1998. (Hereafter, "External Review")

5. All IMF data on ESAF countries in the present paper refer to the 36 countries considered by the IMF internal review. These countries had ESAF programs before December 31, 1994. See Internal Review, p.1 - fn 1, p.2 - fn 5, p. 3 - Box 2.

6. The other African countries examined by the External Review were Malawi and Zambia. However, in the case of Zambia, only social issues were considered. We chose to consider Zimbabwe, Uganda, and Cote d'Ivoire in this paper.

7. The other main objective of the ESAF is to promote balance of payments viability.

8. Personal communication, Hugh Bredenkamp, principal author of Internal Review.

9. In 1991, the current account deficit for sub-Saharan Africa (excluding South Africa and Nigeria) was 8.4% of GDP; in 1995, this figure was unchanged. By 1997, the current account deficit had fallen slightly, to 7.7% of GDP.

10. In general, when an economy contracts as in a recession or depression, the trade deficit will also fall, as consumers and businesses buy less of everything, including imports.

11. World Bank 1997, p. 87.

12. Ibid.

13. UNICEF 1999.

14. See "Structural Adjustment and Education," in Kevin Watkins 1999.

15. "The IMF and the Poor," 1998, p. 9.

16. Ibid.

17. Ibid, p. 9-12. The rate of growth in real per capita outlays on health spending in non-African ESAF countries was 3.3%.

18. World Bank 1998, p. 21, 176.

19. Ibid.

20. "For this relief, some thanks," The Economist, March 20, 1999.

21. Boote and Thugge 1997, p. 9.

22. An internal IMF-World Bank document leaked to reporters acknowledges that under HIPC, "The U.S. dollar amounts of debt service owed by Burkina Faso and Mali are expected to increase." See Charlotte Denny and Larry Elliott, "Fund admits debt plans will fail poor," The Guardian (U.K.), April 19, 1999, p. 21.

23. See Peter Gibbons, "Zimbabwe 1991-94," in Engberg-Pederson et al 1997, p. 349-351.

24. Marquette 1997, p. 1143.

25. Gibbons 1997, op cit, p. 359.

26. See Marquette 1997, op cit.

27. Calculation based on real GDP and population data from World Bank, African Development Indicators 1998/99. The external review reports an even steeper decline in GDP per capita - -9% - over the period 1990-1996. However, since the stabilization program began in 1991, the years 1991-1996 would seem more appropriate.

28. External Review, p. 175, citing F. Marande and K. Schmitt-Hebbel, "Zimbabwe: Fiscal Disequilibria and Low Growth," in W. Easterly et al (eds.), Public Sector Deficits and Macroeconomic Performance, New York: Oxford University Press, 1994.

29. External Review, p. 179, citing Human Development Group, World Bank, "Understanding Poverty and Human Resources in Zimbabwe," December 1996.

30. World Bank data cited by Peter Gibbons 1997, op cit, p. 384

31. Dow Jones Newswires, "Zimbabwe Severs Ties With IMF, World Bank," April 11, 1999.


AP Worldstream, "We won't cut ties with IMF, World Bank, says Zimbabwe," April 12, 1999.


"Zimbabwe Severs Ties with the IMF," Wall Street Journal, April 12, 1999, p. A17.

34. A stand-by arrangement constitutes an agreement between a government and the IMF on an outline of economic policy changes, and is a precursor to a full agreement under ESAF terms.

35. A primary budget surplus is a country's national budget surplus, excluding interest payments on the national debt.

36. The Franc CFA is a currency shared by 13 countries in West and Central Africa; it is pegged directly to the French franc. In 1994, it was devalued from 50:1 to 100:1 CFA to French francs.

37. World Bank, Poverty in Cote d'Ivoire: A Framework for Action, 1997, cited in External Review, p. 102.

38. World Bank 1998.

39. Uganda National Household Budget Survey, 1989, and Background to the Budget, 1997 cited in External Review, p. 138.

40. "Civil Society Perspectives on Structural Adjustment Policies," 1998.

41. By comparison, government spending in the United States today (federal, state and local) is about 30% of GDP.

42. "Civil Society Perspectives on Structural Adjustment Policies," op cit. On the impact of cost-sharing and user fees in Uganda, see, e.g., Oxfam, "The impact of user-fees in Uganda Kitovove Hospital," mimeo, October 1994.

43. For example, the proportion of children receiving full immunization rose by nearly 60% from 1986-1996. (External Review, p. 139)

44. See Oxfam International 1997.

45. Jubilee 2000/UK, "News: Uganda Debt Unsustainable Again," February 19, 1999.

46. Oxfam International reports that this is a pattern for the IMF: "the IMF has systematically exaggerated the export-earning potential of debtor countries, thereby understating the scale of their debt problems in an effort to minimize the costs (notably to itself) of debt relief," (in Oxfam International 1997).

47. UNDP 1998, UNICEF 1999. Figure for access to clean water represents an average from 1990-1996; figures for access to health care and literacy are for 1995.

48. Hanlon 1996.

49. International Monetary Fund, Press Release No. 98/12, April 7, 1998.

50. International Monetary Fund, "Mozambique--Debt Service," May 1998. Table 1, "Mozambique: Debt Service on Public and Publicly Guaranteed Debt, 1995-2003."

51. This table can be viewed on the IMF's website at http://www.imf.org/external/np/exr/facts/mozam/moztab.htm.

52. Oxfam International 1999, p. 163.

53. Jubilee 2000, November 12, 1998.

54. UNDP 1997, p. 93

55. Oxfam International 1997, op cit.

56. Jubilee 2000 Coalition, June 1998; UNDP 1996, pg. 113.

57. See, e.g., Ouattara 1998, Camdessus 1998; and Fischer, Hernandez-Cata and Khan 1998.

58. World Bank 1999.

59. UN Economic Commission for Africa 1998.

60. Ibid.

61. This figure is attained by subtracting IMF purchases, which represent loans taken out from the IMF, from IMF repurchases and IMF charges, which represent repayments of the principal and interest, respectively, on IMF loans.

62. World Bank 1999.

63. "IMF's Camdessus Still Describes Asian Crisis as Blessing in Disguise," The Wall Street Journal, September 24, 1998, p. A10.

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