THE TWO PHASES OF STRUCTURAL ADJUSTMENT/157The World Bank also calculates that total annual spending of S8
per person Is more than enough to provide acceptable standards of
clinical care.
This has meant an across-the-board collapse of preventive and
curative medicine: medical supplies are lacking, working conditions
are horrendous and staff are poorly paid, if they are paid at all. Public
health facilities in sub-Saharan Africa, and some countries of Latin
America and Asia, have actually become breeding grounds for
sickness and infection. Indeed, lack of funding for medical supplies
(including syringes and bandages) and equipment and price
increases (recommended by the World Bank) for electricity, water
and fuel (necessary for sterilising instruments, for example) have
increased the likelihood of infection (including HIV).
Thanks to these Draconian austerity measures, there is now
tremendous social inequality in access to healthcare services. The
state has significantly withdrawn itself from health matters, the
already high percentage of people lacking healthcare has become
even higher, and even once eradicated infectious diseases are on the
increase. The rise in infectious disease is also linked to cuts in public
spending on preventive measures - such as improved sewers and
access to drinking water.
The infant mortality rate (IMR) is a reliable indicator of a country's
well-being. The implementation of SAPs in African countries has
entirely eliminated the advances made with great difficulty during the
previous 15 years. The most striking example is Mali, where the IMR
had dropped by 23 per cent between 1960 and 1980, and increased
by 26.5 per cent between 1980 and 1985. There are no IMR figures
for Madagascar in 1965; in 1980, however, its IMR was 71, rising to
109 in 1985-a 53 per cent hike between 1980 and 1985.
Nutrition and food security are two key factors in health. A UNICEF
study in ten countries on the effects of adjustment on health
concluded that children's nutrition had declined in eight of the ten
countries. In Zambia, between 1980 and 1984 - the very period
when SAPs were being implemented - death from malnutrition rose
by between 2 and 6 per cent for children between the ages of 0 and
11 months; and between 3 8 and 62 per cent for children between the
ages of 1 and 14 years.
By 1995, the Zambian government was spending 30 per cent less
on healthcare than ten years before. One consequence: infant
mortality has risen by 20 per cent in ten years.