Robert Naiman


Sonny Callahan, the Chair of the Foreign Operations subcommittee of the House

Appropriations Committee, and Representative Nancy Pelosi, his Democratic

counterpart, disagree on a lot of issues.


they do agree that Congress should act to stop the International Monetary Fund

and the World Bank from keeping poor kids out of school in Africa.


United States House of Representatives, in the Foreign Operations appropriation,

passed legislation that would bar the International Monetary Fund and the World

Bank from imposing "user fees" on primary health care and education on

poor countries.


fees" are payments by families that the World Bank and the IMF pressure the

government in a poor country to impose for families to send their kids to

school, or to go to the hospital. These services had typically been publicly

financed. "User fees" are supposed to promote efficiency. Their

practical effect has been to deny access.


is particularly scandalous given the AIDS crisis in Africa. Some attention has

been focused on the need for more funding. But not nearly enough attention has

been paid to whether poor people have access to health care. For example, the

introduction of fees in a Nairobi clinic for sexually transmitted diseases

caused a 65% decrease in attendance for women. Yet it is well-known that failure

to treat STDs greatly increases the transmission of AIDS.


studies have shown that the imposition of user fees for school have led to

falling attendance rates. Attendance rates for girls have fallen even more.


Ghana education used to be free. After 10 years of IMF and World Bank imposed

user fees, two-thirds of rural families could not afford to send their children

to school consistently.


is a perverse disconnect here. In the U.S., there is a broad consensus across

the political spectrum in support of universal access to public education

through high school. Yet the IMF and the World Bank, institutions which get a

fifth of their funding from the U.S. taxpayer, impose "user fees" on

poor children in Africa. As the actress Valerie Harper pointed out, her daughter

goes to a public school for free – why would we keep kids out of school in

Africa because their parents can’t pay?


issue illustrates the ideological fanaticism of IMF and World Bank officials.

They continue to insist on their policy because their theoretical models

indicate that it would be more efficient to charge fees – exempting some of the

poorest – than to have education be free and fully financed by the government.


UNICEF has studied the track record of exemption schemes, and found that they

haven’t worked.


might hope that in light of this information, IMF and World Bank officials would

change their policies. But they haven’t, because practical effectiveness is less

important to them than conformity to their theories.


Clinton Administration, which has decisive influence over the IMF and the World

Bank when it wants to, could use its influence to pressure IMF and World Bank

officials for change.


far, however, the US Treasury department has failed to act. That’s why the

amendment introduced by Democratic Representative Jesse Jackson of Illinois to

the Foreign Operations appropriation, which passed with bipartisan support, is

so important.


Clinton Administration is now has two choices. It will have to pressure the IMF

and the World Bank to stop imposing user fees for primary health care and

education, or it will have to explain to Members of Congress why it unable or

unwilling to do so.


House of Representatives has also set an important precedent. In the past,

Congress has forced changes in IMF processes, requiring the publication of more

documents, for example. But with respect to specific IMF polices, it has limited

itself to exhortations which have proved ineffective. For the first time, the

House has demanded change of a specific IMF-World Bank "structural

adjustment" policy on the ground. If this effort succeeds, it could hasten

other reforms in the future.


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