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Actress Valerie Harper calls IMF/World Bank policies a "terrible tragedy"

In a landmark move, the U.S. House of Repre- sentatives on Thursday approved a measure to pressure the International Monetary Fund (IMF) and World Bank to stop requiring that impoverished countries charge "user fees" for access to primary health services and primary education.

The anti-user fees measure is included in the Foreign Operations appropriations bill approved Thursday by the full House. It was originally introduced as an amendment in committee by Rep. Jesse Jackson, Jr. (D-IL), a staunch advocate for debt cancellation and economic justice for impoverished people around the world. This House action represents the first time that Congress has required the IMF and Word Bank to change the specific conditions they impose in borrowing countries.

User fees, charges imposed for using a health clinic or attending school, have led to increased illness, suffering and death when people cannot pay for health services, and decreased school enrollments when poor families can no longer afford to send their children to school. In a tragic example in Zambia quoted by UNICEF, a researcher observed a 14 year boy with acute malaria turned away from a health clinic for want of a 33 cent registration fee. According to the report, "within 2 hours, the boy was brought back dead."

The requirement that the worldâs most impoverished countries charge fees for primary health and education has long been one of the most controversial features of the austerity programs mandated by the IMF and World Bank. Advocates for the abolition of the fees point to scores of studies which demonstrate that their imposition forces a societyâs most impoverished families to deny their children basic education and their sick and dying health care. [See end of press release for examples of research findings.]

Although James Wolfensohn, President of the World Bank, has contended in addressing members of Congress that the Bank has abandoned user fee requirements, current documents, such as the program for Tanzania linked to the granting of limited debt relief, contradict his stance.

Under the provision adopted by the House, beginning in 2002, U.S. funding would be provided only when the heads of the World Bank and IMF certify their institutions "will not include user fees or service charges through Îcommunity financing,â Îcost sharing, Î Îcost recovery,â or any other mechanism for primary education or primary healthcare, including prevention and treatment efforts for AIDS, malaria, tuberculosis, and infant, child, and maternal well-being" in any of their programs.

Actress Valerie Harper, a RESULTS Board member and one of the leading advocates of abolishing user fees, argued to members of Congress that charging the worldâs most impoverished people for the basic health and education was a "terrible tragedy." She pointed out, "I live in one of wealthiest areas of the wealthiest country in the world, and my daughter can attend Beverly Hills High School for free. Meanwhile, women in the poorest countries of sub-Saharan Africa are told they have to come up with hard cash to send their kids to first grade or see a doctor at a clinic. We must not accept this."

Njoki Njoroge Njehu, a Kenyan who directs the 50 Years Is Enough Network, a coalition of U.S. groups opposing IMF and World Bank policies, said, "This significant step by the House brings closer the day when people throughout the Global South will be able to decide on their own priorities. We do not want to raise another generation on promises from the IMF and World Bank that the sacrifice of their education and health will be Îshort-term pain for long-term gain.â"

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Recent studies have revealed some of the damage done by user fees imposed by IMF/World Bank structural adjustment programs:

* In Kenya, introduction of a 33 cent fee for visit to outpatient health centers led to a 52 percent reduction in outpatient visits. After the fee was suspended, visits rose 41 percent.

* Introduction of user fees at rural clinics in Papua New Guinea led to a decline of about 30 percent in attendance, and although it subsequently increased it never returned to pre-fee levels. Health workers also reported a reduction in completion rates for courses of treatment.

* In Dar es Salaam, Tanzania the three public district hospitals saw attendance drop by 53.4% between the second and third quarters of 1994, when user fees were introduced.

* In Nicaragua, about a quarter of primary schoolchildren have not enrolled in primary school since charges for registration and a monthly stipend were introduced.

* In Niger, cost recovery measures implemented as part of a structural adjustment program between 1986 and 1988 had the following results: 1) a sharp decline in already very low primary school enrollment rates: these went from 17% in 1978 to 28% in 1983 to 20% in 1988; 2) drop in utilization of preventative care services; 3) increased exclusion of the most impoverished from care at Niamey Hospital, where outpatients who did not pay for care would wait an average of 24 days before seeking care while an outpatient who did have to pay for care would wait an average of 51 days; and 4) exemption systems that were applied to the benefit of urban, military, and civil service families and not for the intended beneficiaries (the most impoverished).

* UNICEF reports that in Malawi, the elimination of modest school fees and uniform requirements in 1994 caused primary enrollment to increase by about 50 percent virtually overnight ö from 1.9 million to 2.9 million. The main beneficiaries were girls. Malawi has been able to maintain near full enrollment since that time.