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FOOD POLICY. 1990 Dec; 15(6):518-24.Faced with balance of payment problems, declining commodity prices, and a corresponding reduction in foreign exchange earnings, Nigeria implemented a structural adjustment program in 1986. This step was taken in response to encouragement from the International Monetary Fund and the World Bank, and was aimed to accomplish the following: find the true value of the official currency; overcome public sector inefficiency through improved public expenditure and parastatal rationalization; reschedule medium- and long-term debt to relieve debt burden; and encourage net foreign capital inflow while limiting foreign loans. Implementing and adhering to these macroeconomic adjustment policies has brought unprecedented inflation, lower real earnings, and increased malnutrition among lower income sectors of the population. The poor have suffered diminishing access to nutritious foods. Conscribed access to food and compromised nutritional status will most likely persist into the 1990s unless corrective policies are adopted. Appropriate policy would aim to increase the poor's access to food and limit population growth.
Social Science and Medicine. 1990; 31(6):639-48.Sub-Sahara Africa (SSA) has gone from "classical colonialism to neocolonial debt bondage." this article traces SSA's deterioration from a master-servant relationship during colonialism to the present-day "hybrid of decay and anarchy" from which people's health status and health services in the region are being asphyxiated by the debt crisis. The tragedy facing the continent is a carryover from colonialism SSA remains dependent on outside multinational forces that continue to determine her policies, extract her natural wealth, and minimally invest in the SSA region. This continued "cola-colonization" or external control of SSA has resulted in the "catastrophic" decline of most of SSA's social and economic institutions reflecting the collapse in the economies of the West. By the end of 1986, SSA owed US $200 billion or 45% of its GDP--growing to over US$600 million by the year 2000. By 1990 all SSA countries had to accept structural adjustment policies (SAP's) imposed by the International Monetary Fund and the World Bank to monitor cuts in Government public spending, remove subsidies, trade liberalization and currency devaluation all leading to "tragic declines" in the standard of living. Health services in SSA also originated from colonialism and today remains dependent on the home government's. One of the major carry-over's is the urban/rural disparity; 70% of SSA's population is rural yet most health services and providers are in the urban areas contributing to higher infant mortality rates (2-5 times) in the rural areas. The debt crisis has compounded the magnitude of the lack of health services for the majority of people. Shortages exist for all essential drugs and equipment while social services and institutions have deteriorated, aggravating the already low health status in the region. SAP's have increased starvation, epidemics and the brain drain. Perhaps there is a need for a "Marshall Plan" to help SSA out of its underdevelopment.
Lancet. 1990 Jul 7; 336(8703):56-7.In response to The Lancet's April 14 editorial on structural adjustment and health in Africa, it is surprising that the World Bank report did not include maternal mortality as a yardstick for monitoring health standards in Africa: maternal mortality seems to be a better index of social and economic development than perinatal or infant mortality. Obstetric performance was reviewed in parts of Nigeria after the introduction of the structural adjustment program (SAP). In the 1970's and early 1980's the Nigerian economy was buoyant, thanks to petroleum exports, but when oil prices slumped the government was forced to introduce SAP. As a result most of the costs that had been borne by the government were gradually passed on to individuals, of all the sectors affected health seems to have been the hardest hit. Looking at factors that might have been responsible for the rising maternal mortality rate in the Zaria area of Northern Nigeria, it was found that between 1983 and 1988 there had been no significant change in the numbers of obstetricians and obstetric residents at the Ahmadu Bello Teaching Hospital; there was a slight rise in the number of midwives. However, the number of deliveries in 1988 was only 46% of the figure for 1983, and the proportion of obstetric admissions that were complicated more than tripled. Maternal deaths at the hospital numbered 48 per year in 1983-85 and 75 in 1988, an increase of 56%. These changes in obstetric indices may not be unrelated to financial policies in hospital care. In 1983 all aspects of maternity care at the hospital were free. In 1985, following the reduction in government subsidy, fees were introduced for some services, leading to a fall in the number of pregnant women attending the hospital. By 1988 patients were asked to pay for their treatment; with the mean interval between admission and surgery increasing significantly and contributing to the high maternal morbidity and mortality rates in Zaria. (Full text modified)