Third World Debt: It'll take more than this to beat poverty

Agnes Chibile of Lusaka, Zambia, had eaten nothing the day before we met last month. She stood wringing her hands, wondering where to get food for her eight children, aged 12 to 21.

The family is struggling to survive. Mrs Chibile's husband died after losing his job in one of the rounds of "retrenchment" intended to reform the economy. Her two eldest boys are disabled and cannot work. None of the others go to school, because she cannot afford the fees. One was sick with malnutrition. "At most, in a week, we eat once or twice," she said.

The rent on her run-down home in the Chunga district is about pounds 1.40 a month, but she can't afford it. She faces being made homeless on New Year's Eve, because the government is selling its council houses to raise money and there is no way she can take up the offer to buy the one she lives in.

Debt relief is a question of life or death for Mrs Chibile who lives in a country that spends more on servicing debts than on its healthcare and education services combined.

When Gordon Brown announced this weekend that he would write off hundreds of millions of pounds owed to Britain by the world's poorest nations, Mrs Chibile was the human face of the misery that pressure groups have been campaigning to alleviate.

What Mr Brown promised was that at least two-thirds of the world's 41 poorest nations will receive help with their debt burdens during the next year.

The aim, the Chancellor said, was to get the ball rolling. "We have got to get the debt relief process moving," he said. "I have reason to believe that our action will be followed by other countries. We have an enormous opportunity here."

The campaigners' delight was genuine. Sir Bob Geldof, organiser of the Live Aid concert for the Ethiopian famines, said: "I think future generations will remember a very simple and confident gesture like this."

For Christian Aid, it was the millennium gesture they wanted, a kickstart to the process. Yet it is only the start.

The debt to individual governments - known as bilateral debt - is only part of the overall debt burden faced by the poorest countries. Some of the wealthiest nations of the world, including Germany and Japan, have resisted moves to co-operate on cancelling the multilateral debt owed to international institutions such as the World Bank and the International Monetary Fund.

They will be the focus of the next stage of the debt relief campaign, spearheaded by the Jubilee 2000 coalition of aid agencies, churches and development movements, in the run-up to the G8 summit in Japan in July.

Promises have been made for the last 30 years. Robert McNamara, president of the World Bank, said he would provide assistance where it would contribute most to "removing the roadblocks to development". That was in 1969.

Besides, the devil remains in the detail. Gordon Brown has said that the money will be freed up only when money saved on the forgiven debt is used "productively", on education and health and anti-poverty programmes.

To qualify, it is understood that the poor countries will still have to meet conditions laid down by the World Bank and the International Monetary Fund (IMF) under the "Poverty Reduction and Growth Facility".

"Conditionality" has been a principle of debt relief for years. But the effect of conditions laid down in the past can be seen clearly in the plight of people such as Agnes Chibile.

The West, through the auspices of the World Bank and IMF, has promoted neo-liberal policies in the Third World. For nations to qualify for debt relief, we have demanded civil service reform in the form of massive job cuts, wage freezes, privatisation of services and tight economic control. The combination has squeezed the social sector in countries such as Mali and Zambia to devastating effect.

In Uganda, for example, Dr Bakera of the Ministry of Health admitted that immunisation rates fell because they did not have the staff on the ground to carry them out.

Wage freezes and appalling working conditions have led to almost half of Zambia's physicians working abroad. One who stayed told me of his alarm at their lack of drugs and equipment: "We have seen things go from being fairly acceptable, where we could admit virtually anybody and be happy to look after them, to being actually scared to look after a patient, because you can't even do the very basic things."

In most countries, we have encouraged American models of healthcare where the people pay a "user fee", a charge for medical treatment. The sums are, to Western eyes, tiny. But the effect, as even the World Bank's internal assessments acknowledge, has been a deterrent to people seeking help.

In households living on less than a dollar a day, user fees are an insuperable obstacle to accessing healthcare. George Alberti, president of the UK's Royal College of Physicians, who has worked in Africa, says: "User fees have been a catastrophe."

For the first time in generations, the life chances of children being born in many countries in Africa are worse than for their parents. Infant mortality rates have stopped declining and, in some nations, are actually beginning to rise.

The policies the West has promoted have contributed. It is arguable we are culpable to a degree that those laying down the rules for the poorest governments have failed to acknowledge.

There are problems with corruption and bad governance in a number of the poorest nations, but many campaigners believe denying them help - or delaying it until conditions are met - is not the answer. In the words of one Unicef official, the scale of the suffering is too great for that. Thirteen children are dying every minute, many from preventable conditions, including diarrhoea and malnutrition.

The Chancellor stressed that debt relief was only a start to eradicating poverty in the Third World. "It's not about debt relief for its own sake, it's about poverty reduction as a result of debt relief, and then it's about ... getting economic development so that these countries are able to grow themselves."

But as Gary Streeter, the shadow spokesman on international development, adds: "The most important thing now is to cut through the red tape." Actions speak louder than words.

Louise Jury is the co-author with Matthew Lockwood of `Millennium Lottery: Who lives, who dies, in an age of Third World debt?' published tomorrow by Christian Aid.