Unintended consequences of foreign aid often plague beneficent giving. A study published in the open-access journal PLoS Medicine has found that loans to former Soviet Union and Central and Eastern European countries made by the International Monetary Fund (IMF) between 1992 and 2002 were linked to a 16.6% rise in death rates from tuberculosis (TB).

In their analysis, David Stuckler (University of Cambridge, UK) and colleagues from Yale University, USA, also showed 13.9% increase in the number of new TB cases per year and a 13.2% increase in the total number of people with the disease per year - both of which are associated with IMF loans.

Many of the countries in the study received their first IMF loans between 1992 and 2002. The authors write that, "According to the IMF, the objective of these programs is to achieve macroeconomic stability and economic growth." According to a report from the Center for Global Development, however, achieving these goals may cause countries receiving IMF loans to withhold spending on health and social services. Countries often receive IMF loans contingent on meeting certain economic targets specified by the IMF. In order to meet these targets, the countries may reduce social spending - for example, by placing caps on public wage bills or by privatizing healthcare services.

Stuckler and colleagues analyzed health outcomes data collected by the World Health Organization (WHO), and IMF data from the World Bank's World Development Indicators. They developed models that were designed to test the relationship between TB outcomes and entry to (and exit from) IMF loan programs. The models statistically controlled for possible confounding factors, such as the level of economic development, financial desperation, and HIV/AIDS, to name a few. Studying the mechanisms that drive the increase in TB death rates, the researchers found that IMF programs are associated with an 8% decrease in government spending and a 7% decrease in the number of doctors per person. In addition, countries receiving loans had less coverage of the TB control strategy recommended by WHO called "directly observed treatment, short course" (DOTS). The reduction in TB control infrastructure made by countries receiving IMF loans could very well be a main part of the reason for the increase in TB death rates.

The authors conclude that: "The results of this analysis suggest that the IMF should take into account the potential impact of its programs on tuberculosis control systems. Although in recent years the IMF has begun to play a direct role in supporting tuberculosis and HIV/AIDS control efforts via poverty reduction programs, the IMF should critically evaluate the indirect effects of its economic programs on tuberculosis control efforts."

Megan Murray and Gary King (Harvard University, USA) write in an accompanying commentary that it is difficult to perform robust research on these types of topics. There are key limitations such as the non-random assignment of IMF loans and the fact the loans are given to countries that are already economically - and often socially - unstable. However, they conclude that, "We are convinced that at least the authors went very far in testing assumptions and mitigating uncertainties, and so the study and its conclusions should be taken seriously."

International Monetary Fund programs and tuberculosis outcomes in post-communist countries
Stuckler D, King LP, Basu S
PLoS Medicine (2008). 5(7): e143.
doi:10.1371/journal.pmed.0050143
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The effects of international monetary fund loans on health outcomes
Murray M, King G
PLoS Medicine (2008). 5(7): e162.
doi:10.1371/journal.pmed.0050162
Click Here to View Perspective Article

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: Peter M Crosta