Tag Archives public health

What the war in Ukraine and the COVID-19 crisis teach us about our global interconnectedness and its implications for inequality

By Posted on

Due to the war in Ukraine not only the country’s inhabitants have come under fire, but also the granary of much of the world. If the war is not stopped, grain prices will rise. This will have severe effects on many countries and vulnerable countries in Africa are likely to bear the brunt. The war, like the corona pandemic, illustrates how closely we are interconnected as nations on a global scale. What effects do such crises have on existing inequality? In this blog, a number of researchers of global development and social justice share their thoughts.

On 17 March, the Institute of Social Studies (ISS) at Erasmus University launched the book ‘COVID-19 and International Development’ (Springer, 2021). During the recent book launch in Amsterdam, ISS researchers have shed light on the unseen faces of the corona pandemic in low-income countries. We spoke with some of the authors of the book about the impact of COVID-19 on the Global South, and their expectations for the future.

What are the main socioeconomic impacts of the COVID-19 pandemic in the Global South? 

Rolph van der Hoeven and Rob Vos: ‘Developing countries have suffered severe economic fallouts due to the pandemic. Between 100 and 160 million more people in low-income countries have fallen into poverty and hunger. The recovery has been bumpy and developing countries have had little fiscal and monetary capacity to respond. Many countries now face severe debt distress. Some progress has been made towards realizing two of four reforms we proposed in the book: international tax coordination and issuance of new SDRs. However, these still need to be tailored to serve the interests of the Global South. Worldwide, we are unprepared for future pandemics and major global crises. Just look at last year’s events: many of the world’s poor also had to cope with a surge in food prices. The current Russian invasion of Ukraine will further increase food prices, while the capacity of the government to protect the vulnerable has eroded. We should expect poverty and hunger to rise even further.’

Natascha Wagner: ‘We still have very little fact-based evidence on the indirect health consequences in the Global South where health information systems are weak. We have observed severe disruptions in the provision of routine health care services, preventive care, and treatment schemes. Foregone health care potentially results in more severe complications, co-infections and uncurable conditions, in particular among the poorest. The combination of ad hoc lockdowns without a social assistance system that just as rapidly reaches the poorest has severely affected the already sluggish progress towards the SDGs.’

Farhad Mukhtarov: ‘The pandemic has made it clear that the global water crisis is not so much about scarcity or affordability of water. These can be resolved in most cases by temporarily augmenting supply and providing subsidies. Rather, it is about societal inequality, racial and class-based patterns of violence and exploitation. Many things are needed: fairer wealth re-distribution, more equal practices of taxation, greater investment in the public sector, as well as greater social provision of marginalized groups. They are all necessary to treat various ailments of contemporary global societies.’

Matthias Rieger: ‘The global nature of the pandemic and insufficient data often render it hard to precisely quantify “impacts”. During the pandemic I noticed confused public and policy discourse around the world on “impacts” without proper counterfactual thinking. I think the pandemic has highlighted the need to use natural experiment approaches in global health research and to routinely collect reliable health data.’

Sylvanus Kwaku Afesorgbor: ‘We are getting more and more confident that our optimism about the quick recovery from the COVID-19 trade shock was justified. Although the omicron is more contagious, it has less health consequences and the impact of the pandemic is weaning off – also amongst the non-vaccinated’.

 

Have you become more (or less) optimistic about the COVID-19 -related impacts since your chapter was written?

Peter A.G. van Bergeijk: Globalization encountered another setback with the Russian invasion of Ukraine. The revival of a Cold War setting is on the verge. This will tend to reduce the world’s openness by another 1.5% points (indication of the increase in the share number): Mr. Putin may have effectively killed the era of globalization.’

 

Binyam Afewerk Demena: NEW The major (COVID-19) implication is that the feasibility of export-oriented growth strategies decreases. In addition, the workings of international organizations will be further frustrated. That is bad news for developing countries. The Global South still has to deal with many challenges posed by the COVID-19 pandemic, due to weak health systems, low socio-economic conditions, extreme poverty rates, and limited access to sanitation to contain impacts.’

Agni Kalfagianni: ‘The COVID-19 pandemic has put further strain on poor health care systems and has reduced even more access to food for the most vulnerable. Not much has changed really to give reason for either optimism or pessimism in that respect. The lack of solidarity towards vaccine access from the Global North to the Global South exacerbated existing problems. Regarding future pandemics; we may react more quickly, given the experience that we gained. But until major changes in the health care systems and global cooperation take place, we will fail again.’


Are we now better prepared to protect vulnerable individuals and communities from future pandemics? 

Zemzem Shigute: ‘The corona virus has proven to be a conundrum that even the most economically powerful nations were not able to control. The virus itself does not discriminate between rich and poor people or nations. However, marginalized groups, including migrants, continue to bear its plight. They face intersecting layers of struggle based on various factors including gender, marital status, education, language, employment, and duration of stay in the country.’

Syed Mansoob Murshed: ‘The COVID-19 pandemic’s initial impact on inequality was negative. However, there are signs that the world’s inequality tolerance may be diminishing. Secondly, the labour supply surge – engendered when China and the former Eastern bloc embraced capitalism – is now also ending. That may be good news for workers and the poor in developing countries but has to be counterbalanced with the bad news about trade disruptions and rising energy prices.’

Opinions expressed in Bliss posts reflect solely the views of the author of the post in question.

Are you looking for more content about Global Development and Social Justice? Subscribe to Bliss, the official blog of the International Institute of Social Studies, and stay updated about interesting topics our researchers are working on.

COVID-19 | How Kerala’s response to the COVID-19 pandemic is highlighting inadequate responses elsewhere in India by Sreerekha Sathi

By Posted on

The Indian state of Kerala seems to have addressed the COVID-19 pandemic remarkably well, limiting the amount of virus-related infections and deaths through its assertive approach. Kerala’s outlier position in India is well known, and its development model that differs from those of other Indian states might well be the cause of its successes in responding to COVID-19. Central to this development model—and the state’s response—is a well-functioning public healthcare system rooted in the state’s left-wing government. The rest of India and other countries can learn several lessons from Kerala’s government and its people, if they are willing to listen.

By the end of April, India’s coronavirus infections exceeded 40,000 cases, while around 1,300 people have died from the virus. India has been under a severe lockdown since 25 March, which due to the country’s socio-economic dynamics has caused many problems for working-class and unemployed people, especially for the large body of internal migrant labourers and marginalized communities, many without the resources to self-quarantine. Millions of Indians will face starvation due to a sudden loss of income as the lockdown has made it impossible for them to engage in economic activity. More than 90 percent of India’s population of 1.3 billion people work in the informal sector, while two-thirds of the population moreover have to get by on less than US$2 a day.

Kerala, a small state on India’s southern tip, was hit first and hardest. The state reported its first case of coronavirus (COVID-19) on January 29th, and by May counted 500 infections, however had only three virus-related deaths with a recovery rate above 90 percent. It is evident that the state with its population of 33 million people has had significant successes thus far in staving off the virus. Here, for example, there is no shortage of medical masks for health professionals, no lack of hand sanitizers, and people living in the state have not been running around trying to hoard basic necessities as has happened in rich countries like the United States. The story of the state’s success in controlling the pandemic has attracted global attention, particularly because this state in India, one of the poorest countries in the Global South, has managed to do what many others with vastly more resources have not been able to.

So how has Kerala been doing this?

The coronavirus epidemic hit the state as it was in the process of recovering from two majors disasters that occurred in 2018—severe floods and the spread of the deadly Nipah virus. These disasters shaped responses to COVID-19 by creating a readiness to respond to future disasters, so that when the coronavirus emerged, the state and local communities were dedicated toward collectively fighting the COVID-19 pandemic, knowing what was at stake.

When the number of coronavirus cases reached around 100, the state government’s popular health minister declared a campaign called ‘Break the Chain’ to fight the further spread of the virus. The campaign that reached deep into Kerala’s densely populated cities and villages was focused on sharing information about the virus and how to fight it by educating people on maintaining personal hygiene. The state government in a short time installed water taps in all important public transportation hubs and public offices and provided free hand sanitizers. It also informed people about the importance of social distancing and self-quarantining. Students from colleges and universities along with volunteers from different sectors were entrusted with the duty of producing facial masks and hand soap and distributing them through community institutions. This engaged public response is world away from the policies elsewhere in India and many other parts of the world that consigned people to their houses, leaving them to fend for themselves without providing adequate support.

As in other countries, while health professionals remain at the center of the fight against the virus, it is important to point out just how central the community healthcare workers in Kerala have been. The backbone of the fight have been women called Accredited Social Health Activists (ASHAs) and Anganwadi workers (Sreerekha, 2017) who are employed in the state’s social welfare schemes and who were able to reach every nook and cranny of the state’s numerous cities, villages, and towns to trace contacts effectively. Alongside these women workers have been the state police and fire departments as well as other emergency services who have helped the state fulfill services such as distributing essential medicines to non-corona patients.

Most importantly, state-backed community kitchens have been a lifeline for many hungry residents. For the first time in history, by the third week of March, Kerala opened community kitchens in every village and municipality of the state, providing free cooked food so that no-one would go hungry during the lockdown. This contrasts very sharply with the experience of poor people in many other parts of India, where they are left mostly at the mercy of NGO or volunteer help.

How Kerala does it differently

A well-functioning public healthcare system is at the core of the state’s response, the foundation for which goes back to the much popular, well-debated and critiqued Kerala development model (Ravi Raman, 2010). The state is led by the Communist Party of India (Marxist) (CPIM), well known for its experiments with projects related to the grassroots decentralization of government and community-driven developmental planning in the 1990s. The Kerala development model does have its limitations, especially in addressing issues of gender and caste hierarchies and discrimination, and its successes have been achieved even alongside the pressures and compromises with liberal modernity. The state’s successes in fighting the pandemic though have been possible due to relevant steps taken on time and owing to the functional state mechanisms supplemented by the support and commitment of local community networks and an educated population.

With a very high number of expatriates and a big tourism industry the state needed to quickly implement restrictive measures. This has not been an easy path for Kerala, especially considering the fact that its officials are in a constant battle with the right-wing BJP central government. Time and again, the BJP central government has tried ‘to teach Kerala a lesson’ by cutting its funds or even halting the arrival of aid during emergencies. The right-wing party has until now failed to ever win any elections in the state.

Amidst all these dynamics, Kerala presents a useful lesson to the world as a state that even in the face of extreme adversity through sensitive and practical programs and with the support of a politically educated community has been able to take major steps to protect the interests of its residents, particularly marginalized and working class populations. Although the COVID-19 threat remains, Kerala has collectively mobilized to confront it. Kerala’s public healthcare system functions through effective local development measures and community and state networks to make it possible not only to tackle the COVID-19 threat, but also to protect the well-being of its people in so doing.

This article is part of a series about the coronavirus crisis. Find more articles of this series here.

About the author:IMG_4882

Sreerekha Sathi is Assistant Professor of Gender and Political Economy at at the International Institute of Social Studies of the Erasmus University in The Hague. Her research interests span theories of women’s work, feminist critiques of development, feminist research methodologies and social movements in the global south, specifically South Asia.

COVID-19 | A political ecology of epidemics: why human and other-than-human diseases should push us to rethink our global development model by Fabio Gatti

By Posted on

The recent COVID-19 outbreak has generated an incredible interest around public health in particular and other social issues in general. However, most commentaries have failed to look at the crisis from an environmental and ecological perspective. We need to look at the links between COVID-19 and the global environmental crisis in order to identify and address the structural causes leading to the emergence of the pandemic: increasing urbanization, an exodus from rural areas and the abandonment of peasant farming, the intensification of natural resource extraction, and the industrialization of agriculture.

Different epidemic, similar responses

I started getting familiar with diseases and epidemics last summer when I was looking at an agricultural pest outbreak in Apulia, southern Italy. At that time it was not humans who were considered at risk, but a different species: olive trees. The bacteria Xylella fastidiosa that arrived in Europe for the first time in 2013 endangered the survival of thousands of centuries-old olive trees. These plants in Apulia not only are an important agricultural asset on which many depend for their livelihoods, but also have a strong cultural value that relates to the history, the identity, and the landscape of a whole region.

In my research, with the risk of simplifying a bit, two different interpretations of the bacteria’s role in the desiccation of the trees were apparent on the ground: on the one side, a reductionist position considering the new pathogen as the one and only cause of the disease, and therefore concentrating efforts on ‘eradicating’ the bacteria from the countryside; on the other, a more holistic view stressing the fact that the bacteria was only one of the factors contributing to the trees’ pathology, and thus calling for a much deeper reflection on the structural causes of the outbreak.

For example, the abuse of pesticides and herbicides during the last decades, desertification due to climate change, depletion of water resources linked to the intensification of monoculture plantations, and the lack of traditional mantainance practices (e.g. pruning of ploughing) due to the rural exodus might have all together contributed to the weakening of the immune system of the olive trees and the contamination of the environment they are embedded in. Thus, addressing the wider social, economical and environmental factors which made olive trees especially vulnerable to the spread of the bacteria would have been another strategy to tackle the emergency.

What happened then strongly reminds me of the recent COVID-19 crisis: the Italian government declared a ‘state of emergency’ and the crisis was managed by creating an “infected area” in order to try to isolate the bacteria. Infected trees, after being isolated, had to be eradicated in order to avoid the contagion of neighbouring plants. Pesticides were employed in order to get rid of the insect responsible for carrying the bacteria from one tree to the other. The reductionist paradigm ended up dominating.

Spillover

“The real danger of each new outbreak is the failure—or better put—the expedient refusal to grasp that each new Covid-19 is no isolated incident. The increased occurrence of viruses is closely linked to food production and the profitability of multinational corporations”

(Rob Wallace, from this interview)

The current COVID-19 pandemic thus raises some important questions: is this pandemic just the effect of a random event, i.e. the accidental incursion of coronavirus SARS-CoV-2 into human bodies, or are there some structural reasons which we are failing to consider? Is this only a public health crisis, for which the goal should be to make sure that we can eradicate the virus in order to ‘go back to normal’ (e.g. developing a vaccine that makes us immune to it), or is this part of a global socio-ecological crisis that should push us to reconsider our global development model?

Some studies support the latter position. In his book Spillover: Animal Infections and the Next Human Pandemic, David Quammen claims that, while zoonotic diseases (infections caused by pathogens who jump from animals to humans—the so-called spillover) are not something new to humankind, what is relatively new is the frequency of such events. In the last 30 years, spillovers have happened at an unprecedented pace due to primarily deforestation and land use change caused by the expansion of agribusinesses, together with uncontrolled and explosive urbanization processes that have greatly increased the occasions of encounters between humans and wild species.

Intensification of animal farming also plays a role. In Big Farms make Big Flu, evolutionary epidemiologist Robert Wallace claims that intensive animal farming is responsible for the recent increase in new pathogens’ creation. More than that, the production of diseases is itself part of companies’ business models. Rather than just an unintended consequence of a genuine effort to ‘feed the world’ or achieve ‘food security’, the logic of agrifood corporations implies the externalization of health and environmental costs (such as the accidental generation of a new pathogen) to the public (animals, humans, local ecosystems, governments) while privatizing the profits resulting from their activity, in the most pure capitalist economic rationality.

And a recent position paper analyzing the spread of the infection in northern Italy claims that atmospheric particulate matter might have played a non-negligible role in the long-range transmission of SARS-CoV-2 virus in the area, and therefore adds another aspect to the relationship between COVID-19 and environmental degradation, in this case air pollution.

We cannot go back to normal, because normality was the problem

What can we do, then? The attempt of this post was to make clear that the biggest mistake we can make is to consider the COVID-19 pandemic as an isolated event unrelated with the global environmental crisis and to miss the connection with global capitalism, the expansion of commodity frontiers, and the intensification in the industrial mode of food production. COVID-19 and climate change are two sides of the same ecological crisis and should be addressed as such[1].

If we realize this, the crisis will open a great space for radical social change to be put in place. In a recent intervention on the Spanish newspaper El País, South Korean philosopher Byung-Chul Han reminds us that “the virus will not defeat capitalism, there will be no viral revolution: no virus is capable of doing the revolution”. It should therefore be us—civil society, progressive governments, development professionals, environmental activists—who gather momentum to foster radical change in what we believe development is, and making it what we want it to be.

[1] In a recent blog post, Murat Arsel looks at some similarities and differences between the COVID-19 crisis and the climate crisis, with the goal of learning something useful for climate change politics. He acknowledges that “the astonishing spread of COVID-19 could not have been possible without the incredible powers of global capitalism”, and calls for a different system “not so fundamentally focused on maximizing profits over all other concerns”. Still, he talks of the pandemic and climate change as two separate crises. My claim here is that, from a structural point of view, COVID-19 and climate change are in fact two sides of the same coin.

The author thanks Oane Visser and Fizza Batool for their comments on an earlier version of the post. This article is part of a series about the coronavirus crisis. Find more articles of this series here.

photo_cv

About the author:

Fabio Gatti is a graduate from the Agrarian, Food and Environmental Studies (AFES) major at the International Institute for Social Studies (ISS) in The Hague. His current research interests speak to the fields of political ecology, science and technology studies (STS), environmental humanities, and post-development studies.

COVID-19 | Ecuador, COVID-19 and the IMF: how austerity exacerbated the crisis by Ana Lucía Badillo Salgado and Andrew M. Fischer

By Posted on

Ecuador is currently (as of 8 April) the South American country worst affected by COVID-19 in terms of the number of confirmed cases and fatalities per capita. While even the universal health systems of Northern European countries are becoming severely frayed by the nature of this pandemic, Ecuador serves as a powerful example of how much worse the situation is for many low- and middle-income countries, particularly those whose public health systems have already been undermined by financial assistance programmes with international financial institutions (IFIs). The IMF and other IFIs such as the World Bank must acknowledge the role they have played and continue to play in undermining public health systems in ways that exacerbate the effects of the pandemic in many developing countries.

The recent IMF Extended Fund Facility (EFF) Arrangement, signed in March 2019 with the Government of Ecuador, was already the subject of massive protests in October 2019 given the austerity and ‘structural reforms’ imposed on the country (aka structural adjustment). It has also directly contributed to the severity of the pandemic in this country given that health and social security systems were among the first casualties of the austerity and reforms. In particular, the government’s COVID-19 response has been severely hindered by dramatic reductions of public health investment and by large layoffs of public health workers preceding the outbreak of the virus.

From this perspective, even though the IMF has recently moved to offer finance and debt relief to developing countries hit by the COVID-19 pandemic, a much more serious change of course is needed. For this, it is vital to understand its own role ­– and that of other IFIs such as the World Bank – in undermining health systems before the emergence of the pandemic in various developing countries, lest similar policy recipes are again repeated.

The baseline

It is clear that the pre-existing national healthcare system in Ecuador has been replete with problems even in ‘normal’ times. As in most of Latin America, the weaknesses of the healthcare system in Ecuador stem from its segmented and stratified character, with a distinct segregation between three main subsectors – the public, social security, and private sectors. The Ecuadorian Ministry of Health has a weak coordinating and regulatory role over these three subsectors, each of which caters to different beneficiary populations and with clearly distinct quality of services. The public system is the lowest quality and the one accessed by most poor people. Despite claims of universal health, the national system is a far cry from anything approaching genuine universalism.

Moreover, there has been a progressive privatization and commodification of healthcare since 2008. For instance, the building of capacity within the social security system has been undermined by the channelling of health funding via contracts to the private sector, where pricing is also mostly unregulated [1]. More generally, Ecuador has consistently exhibited one the highest out-of-pocket (OOP) health expenditure shares in South America, despite a government discourse and constitutional mandate to deliver free, high quality, public healthcare for all citizens. OOP payments – or direct payments by users at the point of service – reached 41.4% per total health spending in 2016 [2]. They include, for instance, payments for medicine or medical supplies by poor people in public hospitals, as well as payments by middle- and upper-class people for consultations and surgeries. The COVID-19 crisis puts pressure on precisely these aspects of healthcare provisioning, rendering the system prone to systemic failure for the majority of the population, especially in times of economic crisis when the ability of users to pay is severely curtailed.

Crisis and IFIs

These problems in the healthcare system have been exacerbated by the austerity measures of the current government of Lenín Moreno. The measures were introduced in the context of the protracted economic crisis that started in 2014 and have been endorsed by the IMF and other IFIs. Public health expenditure plateaued at 2.7% of GDP in 2017 and 2018, and then fell slightly to 2.6% in 2019, when GDP also slightly contracted (see figure). This was despite the constitutional goal that established an increase of at least 0.5% of GDP per year until 4% was to be reached, which is still far below the 6% of GDP recommended by the Pan American Health Organization [3].

pic

Source: elaborated from the Fiscal Policy Observatory data (last accessed 7 April 2020 at https://www.observatoriofiscal.org/publicaciones/transparencia-fiscal/file/221-transparencia-fiscal-no-163-marzo-2020.html)
* The main component of this expenditure is on non-contributory social protection (social cash transfers).
** It excludes health expenditure of the social security system.

However, the collapse in public investment in the health sector has been far more dramatic, falling by 64% from 2017 to 2019, or from USD 306 million in 2017 to USD 110 million in 2019 [4]. Such reductions would have been largely borne by the public health system and constitute expenditures that are vital for a COVID-19 response, such as the construction of hospitals and the purchase of medical equipment.

It was in this context that the IMF Extended Fund Facility (EFF) was agreed and signed in March 2019. Within the framework of this programme, the government implemented a large layoff of public healthcare workers (including doctors, nurses, auxiliary nurses, stretcher-bearers, social workers, and other healthcare workers). The layoffs continued throughout 2019, despite protests by the National Syndicate of Healthcare Workers of the Ministry of Health [5], [6], [7]. It is difficult to know the exact number of layoffs because of the fragmented functioning of the health system, although within the Ministry of Public Health alone, 3,680 public health workers were laid off in 2019, representing 4.5% of total employment in this Ministry and 29% of total central government layoffs in that year [calculated from 8]. Similar reductions in the social security sector were announced in 2019 for 2020, although we have not yet been able to find any data on these reductions.

Thus, it is not a surprise that Ecuador is currently doing so poorly in handling the COVID 19 crisis. The retrenchment of the public health system together with an already weak and retrenched social protection system coupled for the perfect storm. But even more worrying is that, in the face of the pandemic, the government paid 324 million USD on the capital and interest of its sovereign ‘2020 bonds’ on 24 March instead of prioritizing the management of the health crisis. This decision was taken despite a petition on 22 March by the Ecuadorean assembly to suspend such payments, along with a chorus of civil society organizations lobbying for the same [9] [10]. The government nonetheless justified the payment as a trigger for further loans from the IMF, World Bank, Inter-American Development Bank, and Andean Financial Corporation [11]. This is especially problematic given that Ecuador has been hard hit by the collapse of oil prices and, as a dollarized economy, its only control over money supply and hence hope for economic stimulus rests on preventing monetary outflows from the economy (and encouraging inflows).

The payment is also paradoxical given that the IMF and the World Bank are currently calling for the prioritization of health expenditure and social protection and for a standstill of debt service, and have announced initiatives for debt relief and emergency financing [12] [13]. Nonetheless, despite such noble rhetoric, it appears that the precondition for such measures continues to be the protection of private creditors over urgent health financing needs.

Atoning for past and present sins on the path to universalism

The COVID-19 pandemic undoubtedly exposes the inadequacies of existing social policy systems in developing countries and the urgent need of moving towards more genuinely universalistic systems. Ecuador is exemplary given that it has until recently been celebrated as a New Left social model even while its national health system has remained deeply segregated and increasingly commodified.

However, while the IMF and other IFIs have emphasised the importance of placing health expenditures in developing countries at the top of the priority list in the context of the COVID-19 pandemic [12], they have not acknowledged their own continuing roles in undermining these priorities. Indeed, their messaging is often contradictory, given that both the IMF and the World Bank have also repeatedly insisted that developing countries must persist with ‘structural reforms’ during and after the pandemic [13] [14]. In other words, there is no evidence that the course has been reset. As one way to induce a reset, it is important that they acknowledge the roles they have played and continue to play in undermining public health systems and universalistic social policy more generally, lest they continue to repeat them despite the switch to more noble rhetoric.

Sources:
[1] http://cdes.org.ec/web/wp-content/uploads/2016/01/privatizaci%C3%B3n-salud.pdf
[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30841-4/fulltext
[3] https://www.cepal.org/es/publicaciones/45337-america-latina-caribe-la-pandemia-covid-19-efectos-economicos-sociales
[4] https://coyunturaisip.wordpress.com/2020/03/28/los-recortes-cobran-factura-al-ecuador-la-inversion-en-salud-se-redujo-un-36-en-2019/
[5] https://www.eluniverso.com/noticias/2019/03/06/nota/7219694/trabajadores-publicos-salud-denuncian-despidos-masivos
[6] https://www.elcomercio.com/actualidad/recorte-personal-contratos-ocasionales-ecuador.html
[7] https://www.elcomercio.com/actualidad/despidos-trabajadores-ministerio-salud-evaluacion.html
[8] https://www.observatoriofiscal.org/publicaciones/estudios-y-an%C3%A1lisis/file/220-n%C3%BAmero-de-servidores-p%C3%BAblicos-del-presupuesto-2018-2019.html
[9] https://www.elcomercio.com/actualidad/asamblea-suspender-pago-deuda-coronavirus.html
[10] https://ww2.elmercurio.com.ec/2020/03/24/la-conaie-pide-al-gobierno-suspender-el-pago-de-la-deuda-externa/
[11] https://www.bourse.lu/issuer/Ecuador/34619 (first link under the notices section)
[12] https://www.imf.org/en/News/Articles/2020/04/03/vs-some-say-there-is-a-trade-off-save-lives-or-save-jobs-this-is-a-false-dilemma
[13] https://www.worldbank.org/en/news/speech/2020/03/04/joint-press-conference-on-covid-19-by-imf-managing-director-and-world-bank-group-president
[14] https://www.worldbank.org/en/news/speech/2020/03/23/remarks-by-world-bank-group-president-david-malpass-on-g20-finance-ministers-conference-call-on-covid-19

This article is part of a series about the coronavirus crisis. Read all articles of this series here.

About the authors:

Ana LucíaAna Lucía Badillo Salgado is a PhD researcher at the ISS focusing on the political economy of social protection reforms in Ecuador and Paraguay, in particular the role of external actors in influencing social policymaking. She is also a Lecturer at Leiden University College. mug shot 2

Andrew M. Fischer is Associate Professor of Social Policy and Development Studies at the ISS and the Scientific Director of CERES, The Dutch Research School for International Development. His latest book, Poverty as Ideology (Zed, 2018), was awarded the International Studies in Poverty Prize by the Comparative Research Programme on Poverty (CROP) and Zed Books and, as part of the award, is now fully open access (http://bora.uib.no/handle/1956/20614). Since 2015, he has been leading a European Research Council Starting Grant on the political economy of externally financing social policy in developing countries. He has been known to tweet @AndrewM_Fischer