IMF Programs and Tuberculosis Outcomes in Post-Communist Countries

This article caught my eye because we don't hear a lot about Eastern Europe and former Soviet countries in current global health news. I was also intrigued by the finding that a money lending program was associated with an increase in TB. Not knowing much about the IMF or structural adjustment programs, I Googled the history of the IMF and found that the UC Atlas of Global Poverty has a nice synopsis here.

The article's authors point out that although people have observed negative impacts of IMF programs on health, no outcomes have been quantified until now. I'm sure we'll discuss whether they stepped up successfully! Megan Murray & Gary King have their own Perspective in which, in addition to critiquing the study, they also nicely summarize the history and function of the IMF:

"Founded in the wake of the Great Depression of the 1930s, the International Monetary Fund (IMF) was established in 1945 when government representatives met and agreed on a “framework of international economic cooperation” (http://www.imf.org/external/index.htm) designed to prevent future economic crises. Its mission was threefold: to ensure the stability of the exchange rate, to promote economic growth, and to provide financial assistance in the form of short-term loans to countries experiencing balance-of-payments difficulties. When countries borrow from the Fund, they are required to agree to conditions set by the organization, a process that the IMF refers to as “conditionality.” These conditions entail the adoption of economic policies or “structural adjustment programs” that are meant to redress the problems that led to the need for the loan and therefore to enable prompt repayment. While the conditions vary for different loans, most impose some regimen of fiscal austerity through reduced government spending, removing barriers to international trade, cutting government subsidies, and privatization."

With HIV and sub-Saharan Africa as such hot topics in the global health literature, I'm glad to see this article addressing such a different issue that has important implications.

Additional relevant links:

• What is DOTS? - WHO
• Ecological fallacy - Wikipedia
• Fixed vs. random effect model - UCSD (Word doc; has Stata examples)
• Epidemiology for the Uninitiated - BMJ ("Quantifying Disease" chapter reviews definitions of incidence, prevalence, etc)
  

The Case for Integrated Primary Health Care

[above data collection in Agincourt]

With the high hopes this blog will provide a useful forum for discussion and reflection - I henceforth declare this the first (hopefully not the last) "research perspectives in Global Health Seminar" post.

Using the scaled up delivery of HIV treatment, the authors of this article argue for the transformation of primary health care in rural Africa from a system characterized by the episodic care of infectious disease to one that manages the care of chronic illnesses. This argument is based on the notion that as mortality and morbidity due to non-communicable diseases rises and as more people receive anti-retroviral therapy, the more people will develop complications from cancer and cardiovascular disease.

I'm not convinced the mortality data from Agincourt supports the suggestion that a "substantial health transition" from communicable to non-communicable illness is underway. The numbers: between 1992 and 2005 all cause risk of death increased by 87 percent; infectious disease risk of death increased by 598% and non-communicable disease risk of death increased by 15% (with a confidence interval that includes the possibility of no increase). This is not to minimize the importance of managing non-infectious chronic illness (which is especially important when you take a long-term view), but just to take the devil's advocate position that their argument - to overhaul primary health systems in resource constrained settings - seems stretched based on the evidence.

Thoughts, reactions, comments?

Disclaimer: The views expressed herein are do not necessarily represent those held officially by IHME, or of its funder - el patron Gates, or its other funder the University of Washington, or of our bosses, supervisors or program officers. This collective (aka PBFs) make no representation concerning and does not guarantee the source, originality, accuracy, completeness or reliability of any statement, information, data, finding, interpretation, advice, opinion, or view presented. In other words - don't trust anything we say.