IMF "not always to blame"

... It has been easy for critics to lay developing world deaths at the door of the World Bank, but time and again we found the story is not nearly so simple.

In Ghana, we went to find out about a health system that charges for treatment and drugs and which is blamed by some for the death of Ghana's poorest when they cannot pay the bills.


"No money, you die," we were told.


The policy of user charges - "cash-and-carry" as they call it - is often blamed on the World Bank.


We didn't have to scratch far below the surface to find a more complicated story.


It turned out that many hospitals and doctors liked and had supported the system because it gave them direct control of the money from fees paid by patients.

In asking critics of the system for alternatives at the time when it was introduced in the 1980s, no-one could suggest any.


The health service was so broke it struggled to provide drugs at all.


Direct charging seemed the only way of having any health service to speak of.