Abstract Background The link between health and the economy is well known. However, economic growth as measured in SDG8, continues to leave people behind and the funding gap for realizing SDG3 for good health and well-being remains vast. International financial institutions, i.e. the IMF, influence national policies in ways that may undermine the SDGs. We examine incoherencies between economic growth and health goals in Malawi, Uganda, and Tanzania. Methods We conducted qualitative research based on policy analysis. To analyse IMF policy advice in the three countries we reviewed relevant program documents, article IV consultation reports (2016-18) and literature on structural adjustment. We accessed health information from WHO and World Bank databases, and national policies. Results In all three countries, some indicators, e.g. infant and child mortality, improved, but others lag behind. Underfunding is a major cause for poor health and inequities. GDP increases (as a measure of economic growth) do not automatically translate to increases in health spending. Health expenditure from domestic public resources remains much lower than international thresholds. To achieve this level of spending domestically, GDP in these countries would require an unrealistic manifold increase. IMF policy advice and loan conditionality that focus on GDP growth and tight monetary and fiscal targets impair social spending, while suggested taxation measures are generally regressive. Conclusions The GDP-focused SDG8 can delay efforts towards the SDG3 if governments opt to focus on GDP growth without measures to equally distribute wealth and invest in social sectors, often under IMF's influence. Although the IMF has acknowledged the importance of social development, its policy advice still adheres to austerity, harming population health. To realize the SDGs everywhere, governments should abandon GDP growth as a policy objective, strive for equitable economic development and emphasise global co-operation. Key messages GDP increases do not automatically translate to an increase of health spending, partly a result of IMF structural adjustment programs and policy advice. To realize the SDGs everywhere, governments should abandon GDP growth as a policy objective and place more emphasis on SDG17 on global co-operation.
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