Uneven health outcomes and political resistance under residual neoliberalism in Africa

Africa has suffered two decades of policy implementation associated with the "neoliberal" macroeconomic as well as micro-development paradigm, and the health status of this continent has deteriorated markedly. Notwithstanding the discrediting of such policies since the late 1990s, they continue to be applied in Africa, especially by the World Bank and IMF, through Poverty Reduction Strategy Papers and the Highly Indebted Poor Countries debt relief initiative. Evidence can be found in the inadequate fiscal allocations to the health sector; the inadequate conceptualization of health in relation to other sectors; insufficient consultation with civil society; ongoing implementation of cost-recovery and user-fee provisions; a failed strategy to access pharmaceutical products, by respecting unnecessary Trade in Intellectual Property Rights provisos; and, most importantly, glaring insufficiencies in reducing Africa's foreign debt. One reflection of the balance of forces between Washington financial agencies and African societies is the adoption of the New Partnership for Africa's Development at the urging of the South African and Nigerian governments. While the WHO has helped to research, publicize, and criticize the problems associated with durable neoliberalism in African health care, it also continues to make serious mistakes as it remains locked within the paradigm. A human rights perspective being developed by the African Social Forum is, in contrast, consistent with broader international trends in the opposition to corporate globalization.