Ghana’s $3bn IMF deal: Did the fund kill my uncle?

Research shows IMF involvement reduces public health budgets. That’s deadly for families like mine.

An empty operating theater is seen at Winneba Trauma and Specialist Hospital in Winneba, Ghana, August 20, 2015. Doctors in Ghana will suspend a three-week strike they called to press for better conditions of service, the Ghana Medical Association (GMA) said on August 21. The 125-bed hospital is almost empty because of a partial strike by doctors who have withdrawn emergency and out-patient services to press for better pay and conditions. Picture taken August 20, 2015. REUTERS/Matthew Mpoke Bigg
An empty operating theatre at Winneba Trauma and Specialist Hospital in Winneba, Ghana, August 20, 2015 [Matthew Mpoke Bigg/Reuters]

In a pivotal moment for Ghana’s economic future, news the country was approved for a $3bn loan from the International Monetary Fund (IMF) in late May caused excitement and anticipation across the nation.

However, I found myself pensive, wrestling with a haunting question: Did the strict policies imposed by the IMF on loan-recipient nations in any way contribute to the untimely death of my uncle?

“I’m a doctor, and I couldn’t even help my only brother,” were the words my father choked out between sobs when news of the death of his younger brother who had lived in Ghana reached us in our upstate New York home. My uncle died at the age of 53 on October 25, 2021. I took in my father’s cries helplessly as we shared in mutual heartache. As an MBA graduate and medical student at the time, I pondered how all the years of education between the two of us could not put a blood pressure cuff on a man across the Atlantic. As a big-picture thinker, I was left wondering: What systemic factors played a role in his death?

Research has shown IMF involvement reduces government health spending due to the strict loan conditions that lead to cost-cutting. This has ripple effects on modern low- and middle-income nations, including fewer governmental workers, such as healthcare workers; less money for public infrastructure, including building hospital capacity and providing clean water and proper sanitation; and little funds for public goods, including medicines and diagnostic technologies. With all this in mind, it is not surprising IMF involvement leads to increased mortality rates.

My uncle had risen from his bed that morning, eaten breakfast and sat down to watch his favourite news program as he waited for his daughters to get ready so he could drop them off at school before he headed to work in Kumasi, Ghana.

Once the girls were ready, my aunt attempted to shake him awake as he had “fallen asleep” and was snoring very loudly. He was unresponsive.

The family carried him into a taxi as ambulances are not accessible in Ghana. He was dead by the time he reached the hospital. The cause of death was unclear but, given my aunt’s description of the events and family history, we suspected a stroke due to undiagnosed high blood pressure. The family pushed for an autopsy but it was never done.

My father, the son of subsistence farmers from Edubiase, a small village in the Ashanti region of Ghana, had received international merit scholarships and ultimately become a primary care physician. After years of peacefully protesting the authoritarian rule of then leader Jerry Rawlings, the threat of retaliation in Ghana drove my father to the United States in 1992.

Despite the distance, he and our family in the US maintained close contact with family back home. We visited my uncle, aunt and cousins in Kumasi as often as we could and kept in touch via phone calls and social media.

We also donated our time and resources to local hospitals whenever possible, hoping to do our part in supporting the health and wellness of people in Ghana, in addition to our clinical contributions in the US.

And yet, my father blamed himself for not being able to save his brother and for already living to an age my uncle would never get to enjoy. I felt guilty as well, until I realised just how extremely the odds were stacked against my uncle surviving a chronic illness like high blood pressure in Ghana.

Like many former colonial nations, the Ghanaian healthcare system was structured as a skeleton of care to target infectious diseases that were most likely to affect colonial occupants. Unfortunately, despite preventive healthcare being the Ghana Health Service’s purported priority, to this day, the general public has little access to the kind of prevention that would address chronic diseases like high blood pressure and diabetes due to a lack of healthcare providers, few and inadequate healthcare facilities and a lack of general health knowledge by the public.

It costs money to invest in healthcare systems. Newly-independent nations like Ghana in 1957 needed IMF loans to build basic services and infrastructure after former colonial powers and allies limited access to funds from alternative sources by branding these new nations as financial risks for seeking independence. But these loans came with stringent conditions, including strict cost-cutting measures.

These strict cost-cutting measures have never applied to Western nations that wield the most influence over IMF policy, and which have used generous spending packages to build up their own healthcare workforce and facilities.

As of late, the IMF has purported a shift from imposing strict loan conditions. However, 87 percent of the IMF’s COVID-19 loans to “developing” nations still mandate new cost-cutting measures, compounding existing global financial and healthcare inequities.

I urge the international public, the Ghanaian ministries of health and finance and global healthcare stakeholders to demand equitable IMF policies.

At the minimum, the IMF must avoid restricting healthcare spending and related costs, including, but not limited to, healthcare personnel training and salaries, facilities construction and maintenance, ambulances and transportation, public health campaigns and domestic drug manufacturing capacity, at the discretion of loan-recipient nations.

Unfortunately, my uncle did not live to see the day when accessible preventive healthcare was funded in Ghana but I hope that, through increased awareness, advocacy and systemic global change, his children – my cousins  – will.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.