Structural adjustment: what effect on health? On vulnerability to HIV infection?
Int Conf AIDS 1993 Jun 6-11; 9:123 (abstract no. WS-D20-4) Elmendorf AE, Roseberry WL; World Bank, Washington D.C.
Structural adjustment reforms (SARs) are designed to increase efficiency in the use of resources by changing the structure of a country's economy. They are expected to lead to higher long term economic growth and thereby to facilitate increases in welfare. However, they have been criticized for allegedly hurting poverty-stricken populations by reducing government expenditures on social services. This paper addresses one of the social sectors affected by SARs, health. Analysis of 10 Sub-Saharan countries undergoing SARs suggests that neither economic crisis nor the resulting SARs have had a major impact on infant and child mortality. During the 1980s in African countries the health share of government expenditure was higher in adjustment years than in non-adjustment years. Economic decline and its consequence in SARs do appear to have squeezed non-personnel expenditures of Ministries of Health, especially on pharmaceuticals, and to have contributed to the decline of civil service compensation. With current knowledge, discussion of links between macroeconomic adjustment and vulnerability to HIV infection is speculative. However, there is much that reform-oriented public policies can do, within an adjustment framework, to address HIV risks. Such actions include expenditure reallocations to ensure essential public and preventive care services, including STD screening and public education.
Keywords: AEGIS, HIV Infections, Health Expenditures, Poverty, Infant Mortality, Social Welfare, Budgets, Public Policy, Child, Human, Infant, economics, ICA9 930606
WSD204
