The Power of Protest
Critics Explain How People Can
Affect the IMF and World Bank

Multinational Monitor: Why has Results become interested in IMF and World Bank policies?
Joanne Carter: Results is a cross-section of people interested in addressing poverty-related issues in developing countries. Most of us haven’t been involved in global justice issues in other parts of our work, but it has become clear to us that you can’t address poverty issues such as access to healthcare and education unless you address World Bank and IMF policies. That’s how we began to focus upon the World Bank and IMF — because of the scope and influence of these two institutions.

We’ve done a lot of work over the years to increase the access poor people have to basic education and healthcare services. When we talked to people on the ground, they said that we have to address the impacts of World Bank policies, particularly the impact of user fees.

Within this larger framework, we took up the issue of user fees — fees for primary healthcare and education — because we heard repeatedly from Africa and Latin America that those were among the biggest barriers to people being able to obtain those services. Just putting more money into those areas was not resulting in more people having access to those services. In a lot of cases it was resulting in fewer people having access because of the policies associated with World Bank loans.

We started to gather information about the policies and began using the most powerful tools we have in the United States — grassroots pressure — to send a message to the Bank and the Fund and our representatives there from the U.S. Treasury about addressing those policies. We began to work with our grassroots network to educate members of Congress about these issues. We found that once people understood the impacts of user fees, they very much wanted to be involved in seeing these policies change.

MM: What exactly are user fees?
Carter: User fees are fees that are imposed for services. We’ve focused on fees for primary healthcare and primary education, because those are the most basic vital services and often are ones that poor people struggle most to access. They are often fees for services that previously were free or provided at nominal cost, such as fees to attend schools or health clinics, or fees for medications that used to be free.

The whole policy of imposing user fees was strongly promoted in the last decade and a half by the World Bank in particular, in conjunction with the IMF. In reducing overall budgetary spending in poor countries, one of the areas that was most heavily impacted was basic healthcare and basic educational services. IMF belt-tightening forces cutbacks in overall spending, and the areas that get cut first are those with the least political support, such as healthcare and education for the poor. As a result, you have policies which are supposed to substitute — people themselves having to struggle to find the dollars to pay for what once was publicly supported healthcare or education.

MM: What was done in the U.S. Congress on user fees?
Carter: We worked with members on a key committee in Congress that oversees the annual foreign aid budget to include language that would address user fees. Last year, language was included in the foreign aid bill for 2001 that requires the U.S. representatives to the Bank and IMF — meaning our representatives at the Treasury Department — to oppose any loan or other kind of agreement, such as a broader structural adjustment agreement or debt relief agreement, that would include user fees for primary school or primary health care services.

Now we’re struggling to see that language implemented. There have been struggles with both the U.S. Treasury in terms of the implementation, and with the Bank itself. Treasury has tried to evade actual implementation of the law by using a technicality in the language.

MM: That language was passed in a Congress controlled by the Republican Party?
Carter: Our experience has been that this is not a partisan issue. When you talk very broadly about structural adjustment, it’s difficult for people on the Hill and in the media to understand, but when you talk about how much of a disaster these specific policies have been for people on the ground, we’ve gotten support from both parties. They say they don’t think these policies should be continued; they don’t want to see more kids out of school or more people dying from a lack of access to health care. They also think these institutions have overreached in terms of telling countries what to do, controlling both the budgets and the social policies of poorer countries. We’ve found that if you get specific and explain the actual policies to people, there ends up being bipartisan support to change them.

MM: You’ve also done work on debt cancellation?
Carter: In the past, when we worked on debt cancellation, we were very concerned that the existing debt initiative was linked to these structural adjustment policies. One of the reasons that we began to work forcefully on the user fees issue was to begin to address some of those policies, which in some cases were linked to debt relief agreements. We work to ensure that debt relief is not linked to those kind of harmful policies. We also continue to work more broadly on the issue of debt cancellation.

We’ve been calling for the cancellation of impoverished countries’ debts by the World Bank and the IMF, using the institutions’ own resources. The resources are available in these institutions, particularly at the IMF, to cancel a broad swath of debts.

MM: How has that message been received in the U.S. Congress?
Carter: It’s been an educational process, because there has been a debt relief initiative put forward by the Bank. So a lot of people thought the issue had been dealt with. But less than a third of the debts have actually been addressed for these poor countries. Even the countries that have so far qualified have had less than 30 percent of their debts cancelled.

When they understand that the U.S. and some of the other G-7 countries have committed to cancelling the debts of a certain subset of the poorest countries owed directly to them, and that the World Bank and IMF haven’t even done that much, Members of Congress are often ready to act. When they understand that the IMF has a range of resources that are potentially available to cancel these debts, then they’re interested. It’s going to take some kind of political demand and grassroots call to action to get this higher on the radar screen of the Bush administration. But we feel that Members of Congress are potentially interested in the issue, it’s just a matter of moving it politically, which will require more public outcry and public demand.

MM: How has this kind of work in Congress affected the actual policies of the institutions?
Carter: It’s been a bit of a shock to the institutions and our representatives at the Treasury Department that some of these issues have become the political priorities that they are. It’s been extremely useful to raise the political profile of issues like user fees. There have been Congressional hearings where members of Congress are asking questions of representatives of the U.S. Treasury, where letters are going to the institutions both from non-governmental organizations as well as from the Hill.

I know for a fact that people at the very highest levels of the World Bank and IMF are aware of the Congressional interest that exists and the U.S. public support for addressing issues like user fees, multilateral debt cancellation and related issues. My sense is that we have to keep the pressure on and go further. Congress has to not just pass a law and raise the questions, but demand oversight. They have to go farther and demand a response from the Bank and the Fund.

I had an opportunity to meet with the managing director of the IMF. The fact that he was aware of the user fees issue shows the fact that the involvement of Congress and other organizations is having a political impact.