More debtfare than healthcare: business as usual in the Multilateral Development Banks’ COVID-19 response in India

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 (2014, p. 3) conceived to describe the way neoliberal states ‘mediate, normalise and discipline the monetised relations that inhabit the poverty industry.’