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Conditions on IMF loans to Guinea, Sierra Leona and Liberia over the past two decades prioritised debt repayments and building foreign exchange reserves over healthcare spending, said research by professors from three leading UK universities.
The study comes amid mounting criticism about the slow response to the world's worst outbreak of Ebola that has killed nearly 8 000 people and increasing scrutiny on how organisations could have acted differently to prevent this.
"Policies advocated by the IMF have contributed to under-funded, insufficiently staffed, and poorly prepared health systems in the countries with Ebola outbreaks," said Alexander Kentikelenis, a Cambridge University sociology professor and an author of the study published in the Lancet Global Health journal.
Read the full report.
Heavily indebted to foreign lenders after emerging from conflicts, the three countries rely partially on loans to run government services, including health centres.
As a condition for financing, the IMF imposes public sector reorganisation on debtor countries and promotes privatisation and decentralisation of services.
The study quotes a letter written at the beginning of the outbreak by authorities in Guinea to IMF managers stating "unfortunately, because of the reduction in spending, including on domestic investment, it was not possible to respect the indicative targets for spending in priority sectors".
IMF officials refused interview requests, pointing the Thomson Reuters Foundation to an online response to the study.
Read their full response.
"The IMF is working on mechanisms to allow us to move rapidly to provide more debt relief to these countries — which would free up more resources that could be used for health care spending," wrote Sanjeev Gupta, an official with the Washington-based financial institution.
Watch Gupta's full interview:
More than 20 000 people have been infected with Ebola in the three worst affected states and more than 7 800 have died in the past year, the World Health Organisation reported this week.
The study did not say how many deaths could have been avoided had the IMF not imposed changes to health spending.
Other countries in the region, including Nigeria and Senegal – who also faced cases of Ebola – had stronger healthcare systems, which were able to stop mass contagion of the epidemic, Kentikelenis said.
Gupta denied that IMF policies had caused a drop in spending on health services saying healthcare funding increased 1.6% in Liberia as a percentage of GDP, 0.7% in Guinea and 0.2% in Sierra Leone between 2010 and 2013.
He said mortality rates, child nutrition and sanitation had all improved in the three Ebola-hit nations in the past decade.
Kentikelenis, who conducted the research with other academics from Cambridge University, the London School of Hygiene and Tropical Medicine and Oxford University, said that bump in funding since 2010 came from factors beyond IMF controls, including "increased aid flows".
The IMF has pledged $430m to fight Ebola in the three worst affected countries, the study said.
