Pathogenesis: A History of the World in Eight Plagues

by Jonathan Kennedy

Structural adjustment had a profoundly negative impact on public health. Governments were forced to cut social welfare budgets, including those for public health and health care. Recipient countries were often required to cap the public-sector wage bill, resulting in the emigration of large numbers of doctors and nurses to high-income countries. In the 1980s, the number of doctors in Ghana fell by half, and only one-sixth of Senegal’s nurses remained, compared to the start of the decade.[46] Structural adjustment programs frequently introduced user fees for health care that mimicked the U.S. model. As a result, the poor were unable to access even the most basic care. For example, when the World Bank forced Kenya to impose a charge of thirty-three cents to see a doctor, patient visits fell by half.[47] (The number of patients almost doubled when the fee was suspended.) And it has been shown that structural adjustment caused an increase in some infectious diseases, including TB.