2. Delegación de funciones
2.6. Ejemplos: nuevos modelos organizativos sanitarios
2.6.1. Los referentes del cambio
Encouraged by high prices for agricultural commodities in the 1960s and 1970s, Côte d’Ivoire became heavily indebted in the 1980s to both public and private borrowers. The capacity to repay these debts was dependent on income from agricultural exports, which dropped vertiginously in the 1980s. By mid-decade, Côte d’Ivoire had one of
287 On the political role of educated unemployed youth, who have since September 2002 been involved in
organising anti-French demonstrations, see Konaté, Yacouba, ‘Les Enfants de la Balle, de la Fesci aux mouvements de Patriotes’, Politique Africaine, 89, 2003.
Africa’s highest debt burdens, while its income was falling.288 In 1987 it defaulted on service payments on external debt.
The immediate domestic consequence of this financial crisis was that less money was available for the government to buy off contending social and economic groups. In the boom times, Houphouët-Boigny had used the country’s wealth to fund a successful patronage system and purchase loyalty to his vision of national integration. As the cake, including available agricultural land, became smaller, the conflicts over its distribution became more acute.289
In the 1990s these problems took on political dimensions. Allasane Ouattara, from the north of Côte d’Ivoire and then deputy director of the IMF, became prime minister in 1990. His nomination followed pressure from the IMF, which regarded him as a highly competent technocrat. However, in the context of the growing social divisions in the country, he came to be seen as the representative of the north. Henri Konan Bedié, Houphouët-Boigny’s heir apparent, regarded him as a serious rival for the succession to the presidency. At Houphouët-Boigny’s death in 1993, Bedié became President after a tense standoff. Ouattara left the PDCI to join the breakaway Rassemblement des Republicains (the RDR).
The importance of this political split is that newly introduced political competition in the form of multi-party democracy, which was introduced at donor insistence and very much against Houphouët-Boigny’s will, began to mirror increasing social divisions. Under the guise of the concept of national purity (“Ivoirité”), Bedié excluded Ouattara from running for political office at the 1995 elections because he could not prove he was an Ivorian national. His exclusion came to represent the plight of the millions of vulnerable or excluded northerners and foreigners. In this way, the social crisis of dwindling resources intertwined with a factional political struggle with nasty xenophobic undertones.290
The financial crisis changed Côte d’Ivoire’s relationship with donors. Maintaining the lending relationship with the IFIs became the most urgent issue for the
288 Côte d’Ivoire’s ratio of total external debt to export earnings rose steadily from the late 1970s to reach
a peak of nearly 800% in 1993/4. For further details see World Bank, ‘Aid and Reform in Africa …’, Figure 7.10.
289 Chauveau, ‘La Question foncière …’.
290 For the general political developments of the 1990s, see N’Guessan, Koumé, ‘Le Coup d’Etat de
Décembre 1999, espoirs et désenchantements’, in Le Pape, Marc and Vidal, Claudine, (eds) Côte d’Ivoire l’Année terrible 1999–2000, Paris, Karthala, 2002; and Dembele, Ousmane, ‘Côte d’Ivoire la fracture communautaire’, Politique africaine, 89, 2003. On “Ivoirité”, see Dozon, Jean-Pierre, ‘La Côte d’Ivoire au Péril de l’Ivoirité’, Afrique Contemporaine, 193, 2000.
Ivorian government, leading for example to the creation in 1991 of an interministerial committee dedicated solely to this issue – the COMFESIP291 IFI lending overtook bilateral development aid for the first time in 1982 after a major loan from the IMF, agreed in 1981. From 1986 disbursements of development aid from the IFIs were higher than bilateral funds, with the exception of the early 1990s when the French poured money into Côte d’Ivoire while the IFIs declined due to unpaid arrears and blockages in the structural adjustment programme. Around half of bilateral funds have come from France.
Table 4.1 Bilateral and Multilateral disbursements to Côte d’Ivoire for selected years, in Millions of dollars current292
Year Bilateral Multilateral Year Bilateral Multilateral
1970 53 23 1990 554 621 1975 102 66 1991 439 594 1980 210 148 1992 462 512 1982 183 301 1993 768 198 1986 164 200 1994 982 734 1988 138 448 1995 829 416
The loans from the IFIs were attached to demands for reforms (conditionalities). The reforms concerned the internal and external liberalisation of the Ivorian economy and reduction of state expenditure in line with the New Political Economy of Development (NPED, see chapter 2). The specific measures demanded of Côte d’Ivoire were summed up by the World Bank in 1998 as “further fiscal consolidation to reduce the dependence on external assistance and increase public saving, with a more efficient use of scarce public resources … deepening of structural reform to promote private sector development and investment … the pursuit of an ambitious social development agenda designed to reduce poverty”.293 These generic features of the NPED merged in the IFI conditionalities with elements specific to the Ivorian economy, including for example pressure to formalise land ownership in order for farmers to use land as collateral for loans. The IFIs also pressured the Côte d’Ivoire government to dismantle CAISTAB and liberalise the whole cocoa sector. This was highly contentious, as CAISTAB constituted the principal source of money for the state patronage that greased
291 The Comité de mobilisation des financements extérieurs et de suivi des investissements publics. 292 Adapted from World Bank, ‘Aid and Reform in Africa …’, Table 7.10. Note that this table is based on
total disbursements, not all of which were concessional enough to be counted as development aid under OECD/DAC criteria. Total net flows, which would subtract loan repayments, would show a greater proportion of bilateral aid, as this consists of more grants.
the wheels of the Ivorian political system.294
This process of reform under pressure from the IFIs was, in the words of the World Bank review of 2001, “a bruising experience”, in which reforms were made only under “extreme Bank pressure”.295 The IFIs saw resistance to the reforms as “vested interests” related to links between politicians and businesses that stood to lose out. While the IFIs enjoyed the considerable leverage given them by Côte d’Ivoire’s financing needs, the Ivorian side remained convinced of the virtues of its mixed economy model, and suspected the IFIs of ideological dogmatism. This confrontation became acute over the issue of the devaluation of the CFA Franc, which the IFIs considered necessary for the success of all the other reforms. Although a change in the value of the CFA Franc was not a decision for Côte d’Ivoire alone, Houphouët- Boigny’s opposition was well known. Such was his influence in the Franco–African community that the devaluation, which was supported by many in Paris, was delayed until January 1994, a fortnight after his death.296
The devaluation of the CFA Franc was followed by massive development aid transfers, both from the IFIs and, especially, from France (Table 4.1), to alleviate the country’s immediate balance of payments and debt problems. The massive rise in disbursements by the IFIs, which had withheld funds in 1993, was regarded as a “reward” for the devaluation. The years 1994 and 1995 saw a series of new loan agreements, including a three-year Enhanced Structural Adjustment Facility (ESAF) loan agreed by the IMF in 1994, which acted as an important trigger for other donors. The growth of the Ivorian economy in 1995–1998 was impressive, although the debt burden remained massive.297
The French were of course aware in the early 1990s not only that the scale of the financial crisis of Côte d’Ivoire was beyond their means, but also that the political and social model they had helped set up was fracturing. Although increasingly worried by the emergence of a xenophobic political discourse after Houphouët-Boigny’s death in
294 See World Bank, ‘Aid and Reform in Africa …’, pp. 382–3; and Conte, Bernard and Sindzingre, Alice,
‘Les Réformes comme processus international et domestique: liberalisation et industrie en Côte d’Ivoire’, unpublished paper, Centre d’études d’Afrique noire, Bordeaux, 1999, pp. 10–13. The World Bank’s view on the reform of CAISTAB can be found in McIntire, John, and Varangis, Panos, ‘Reforming Côte d’Ivoire’s Cocoa Marketing and Pricing System’, Policy Research Working Paper, World Bank, Abidjan Resident Mission, March 1999. See also Losch, ‘Le Complexe café cacao …’, Chapter 6, ‘Ruptures et recompositions: le complexe révélé’.
295 World Bank ‘Aid and Reform in Africa … ’, pp. 446 and 435. See also the potted history of relations
with the IFIs in Jeune Afrique/L’Intelligent, 11–17 février 2002.
296 See supra chapter 1, section 3ii.
297 See Conte and Sindzingre, ‘Les Réformes comme processus …’, pp. 15–17. Note that the IFI approach
1993, and especially surrounding the elections of 1995, the French in fact had little option but to support Bedié and try to use behind the scenes influence to moderate the political dialogue. The French were also intimately involved in Côte d’Ivoire’s crisis through their multidimensional presence in Côte d’Ivoire, in the commercial and banking sector in particular. During this period the Ivorians habitually came to the French for financial help and, through the Elysée and the Cooperation Ministry, tried to use historical and personal influence to persuade the French to bail them out before going to the IFIs. This practice was stopped, or at least seriously curtailed, by the Abidjan doctrine of 1993.
In terms of the IFI-led reform agenda, France played an ambivalent role. Their considerable interests in the country and the region meant that both French officials and the business community were divided over reform issues.298 Given the fact that the model of mixed economy was in large part inherited from the French, it is no surprise that they were generally supportive of the Ivorian resistance to liberal reform, for example of the cocoa sector. However, faced with the scale of the financial crisis and mismanagement by the Ivorian state, the French were also aware of the need for reform, and supported the principle of privatisation of productive sectors, in contrast to disputes with the IFIs over privatisation in francophone Africa in the past. Equally, the French largely agreed on the need to take steps to expand Côte d’Ivoire’s tax base and public service efficiency. For some French officials reform was needed in order to keep the IFIs on side and keep the lending coming (burden sharing). For others the reforms were necessary regardless of relations with the IFIs, as Côte d’Ivoire’s problems were due to a fundamental divergence from the discipline of market principles.299 The result was that the French tried during this period to cajole the Ivorian government into implementing reforms, in order for Côte d’Ivoire to avoid having to accept all the details of direct IFI conditionalities, while using IFI leverage as the “bad cop” when this failed. This ambivalent relationship with the IFIs was played out in the growing numbers of donor coordination fora, both at the general level (the donor round tables) and the sector wide donor coordination meetings. In the words of Conte and Sindzingre:
“les Français critiquent volontiers la Banque et les Ivoiriens, éduqués à la française, ne font pas confiance aux forces de
298 While the World Bank study of 2001 takes the position that French interests made them generally
reform averse, Conte and Sindzingre, ‘Les Réformes comme processus …’, pp. 17–20, convincingly argue that different French actors had very different positions on the range of reform issues.
marché, notamment en matière de politique de prix agricoles … [mais] … en 1993, la France n’a plus les moyens de verser des sommes de plus en plus importantes qui ne servent pas au développement mais à rembourser les bailleurs multilatéraux. Emerge une ‘division de travail’ entre les IBWs [IFIs] (crédibilité économique, liage des mains des gouvernments par des arrangements multilateraux) et l’ex-puissance coloniale (influence politique).”300