Yet Rowden succeeds impressively in carefully guiding the reader to the point of agreeing (if you didn’t already) with the judgement of S N Muchiri, Kenya’s chief economist in the Ministry of Health, on IMF-dictated spending cuts: ‘The only difference from what happened in Rwanda is that here they don’t use pangas [machetes], they use policies.’

Rowden starts with an erudite and concise summary of the AIDS pandemic and key current health debates, all of which are now ‘hitting the wall’ of insufficient public health finance as a result of neoliberal economic policy. He then leads you through a very accessible tour of development economics from the 1940s to the Reagan and Thatcher-initiated neoliberalism of the 1980s. This is followed with a detailed, but essential, explanation of how each promise of neoliberal policy reform was ‘debunked by the actual outcomes … a significantly lower rate of progress on social indicators for the vast majority of low- and middle-income countries.’

The final third of the book draws the first two parts together to explain how the neoliberal paradigm drew the emphasis away from the community-level primary healthcare focus of the 1970s towards privatisation and a massive and devastating under-resourcing of public health, contributed to and maintained by IMF policy. In the past ten years, there has finally been a consensus on the need for a dramatic scale up of funding for health and a renewed focus on primary healthcare. However, even the inspiring AIDS activists who secured treatment for half of those in need have hit a wall of neoliberal and IMF policy. It is a wall that must be climbed in order to realise universal access to HIV and health services.

This book is a welcome and timely rallying call, especially to health activists and development NGOs, to confront and challenge the IMF and question ‘its specific definition of macro-economic stability’.

Mike Podmore