Structural adjustment: the wrong prescription for Africa?

The medical and social consequences and the wide effects of the African structural adjustment program (SAP), specifically for women and children, and examples of the impact in Zimbabwe, Zambia, and Senegal, are discussed. Structural adjustment is defined and the history of its inception is provided. Significant economic and social welfare improvement occurred during the 1960s and 1970s, and considerable decline occurred during the 1980s. The present reality is that Africa,m contrary to popular myths about being a "bottomless pit of Western charity," transfers $10 billion/year to the rich North. Debtor countries are 61% more indebted in 1990 than they were in 1982. During the 1980s, oil prices and interest rates rose dramatically, African export prices dropped, and industrialized countries set up protectionist policies. In addition, there was civil war, drought, poor leadership which put military spending before poverty reduction, and the AIDS epidemic. The Western response was to restructure debt payments in return for implementation of SAPs. Structural adjustment involved a package of trade liberalization, devaluation, removal of government subsidies and price controls, privatization, credit shortages, higher interest rates, and "cost recovery" in health and education. The theory is that economic growth will "ultimately" lead to poverty reduction. A critical view is that SAP insures debt repayment, export of cheap raw materials to the North, and may not sustain longterm economic growth. The results for the poor have been high prices for food, transportation, school and medical fees, and a decline in wages and unemployment. Land is used for exports. A solution is to reduce the debt burden, to place the needs of the poor as a top priority in SAPs, and to put pressure on the World Bank, the International Monetary Fund, and governments to consider health outcomes. Other alternatives noted in the African Framework to SAPs are to place well being and self-reliance as development goals and outcome as a product of the society's value system. Education and training and food self-sufficiency need to be assured fully. The poor need better access to land and employment opportunities. The environment must be managed effectively. Economic development must expand beyond the export of cheap primary commodities.