SOFT STEP FOR CONGRESS: STRONG SLAP FOR THE WORLD BANK

Robert Naiman

Representative 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.

But 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.

The 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.

"User 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.

This 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.

UN 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.

In 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.

There 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?

The 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.

But UNICEF has studied the track record of exemption schemes, and found that they haven't worked.

You 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.

The 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.

So 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.

The 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.

The 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.