![Sample our Politics & International Relations journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5947/TOC-Subject-Sample-2021-Politics-International-Relations.jpg"})
Abstract
Multilateral Development Banks (MDBs) have been a vital source of funds for the global South in responding to the COVID-19 pandemic, particularly in the healthcare sector. Prior to the pandemic, the big MDBs’ approach to healthcare reflected the post-Washington Consensus, that is a largely neoliberal agenda perpetuating the expansion of private healthcare markets through financialization mechanisms, though with some emphasis on a minimal level of universal healthcare. We studied the MDBs’ approaches to healthcare in India to evaluate whether the pandemic resulted in: (a) a re-evaluation of their healthcare models to ensure they were fit for a pandemic; (b) a business-as-usual approach; or (c) a disaster capitalism response exploiting the current socio-economic milieu to further neoliberalization processes. We found that the MDBs adopted an inadequate business-as-usual approach that is intensifying the financialization of healthcare in projects using interventions at the micro through to the macro level. This path dependent approach emphasizing multi-scalar financialization has long-term implications for human well-being. Further, we contend that MDB lending is deepening ‘debtfare’ through its healthcare and other support, a term Susanne Soederberg (Citation2014, p. 3) conceived to describe the way neoliberal states ‘mediate, normalise and discipline the monetised relations that inhabit the poverty industry.’
Acknowledgements
We would like to thank Public Service International for funding Susan’s earlier research that contributed to this paper. Thanks also to Adam David Morton for his suggestion on the title and the reviewers for their useful comments.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1 Countries with better performing systems spend around 7% of GDP on healthcare.
2 There are significant differences between states. For example, Kerala invests strongly in its public health system, Maharashtra with a large private healthcare sector, less so. To mid-July 2021, the fatality rate for Kerala from COVID-19 was 0.48%, while that for Maharashtra was 2.04%, four times higher (Shukla, Citation2021).
3 All figures are in USD.
4 Some private sector services may be of better quality than public ones, but this varies between providers and regions.
5 Most hospitals, particularly private ones, persistently discriminate against Dalits and Other Backward Castes (Dhara, Citation2020). There is also a large disparity in healthcare expenditure and insurance between men and women across the country. For example, in Mizoram only ‘17 percent of women against 44 percent of men ages 15–49 years… are covered by any health scheme or health insurance’ (World Bank, Citation2021a, 12).
6 Williams et al. (Citation2021) found that most reports on private hospitals refusing to admit COVID patients came from India. While data is limited, it is likely that many of those refused treatment were Dalits and OBCs.
7 The bill for a two-week hospital stay in Delhi is over what 94% of the Indian population earn in one year.
8 All the data on the IFC is derived from the IFC (Citation2021), Project Information & Data Portal, correct as of 22 June 2021.
9 ADB PSOD data is from ADB (Citation2021).
10 The ADB promised a $300m loan for MSMEs in their CARES loan documents that was not finalized during the timeframe examined. They approved a TA in December 2020 for an MSME Ecosystem project (54367-002) with similar goals to the World Bank loans that aimed to improve MSME access to enterprise development services and promote strategic cluster development.
Additional information
Funding
Notes on contributors
Susan Engel
Susan Engel is an Associate Professor in Politics and International Studies at the University of Wollongong. She is a co-editor of the 2022 Routledge Handbook of Global Development and co-author of The Global Architecture of Multilateral Development Banks: A System of Debt or Development? With AR Bazbauers (2021, Routledge). She is a scholar-activist who works with a range of NGOs.
David Pedersen
David Pedersen is completing his PhD at the University of Wollongong. His thesis is: “Pandemic in Paradise: A Critical Political Economy Analysis of Crisis Management in Bali’s Tourism Sector.” He has published papers on emotions in microfinance and international relations teaching.