A large portion of Kenya’s youth work as “Boda-Bodas,” or motorbike taxis. It’s a dangerous job that earns them around $1 a day. This was how Patrick Maina used to earn a living before his accident in 2021, when he broke his spine. Five years later, Patrick has the potential to walk again, but can’t afford the physiotherapy and other medical costs he needs to make that a reality.

Much like other African countries, Kenya has taken on massive amounts of debt and is regarded as in “debt distress” by the International Monetary Fund (IMF), the same institution that Kenya owes a portion of its debt to. Unfortunately, this gives the IMF and the World Bank, known together as the Bretton Woods institutions, substantial leverage over domestic policy.

The institutions push neoliberal policies, requiring governments to enforce harsh austerity measures that hurt the working class. Although there is little evidence that the Bretton Woods institutions directly ask governments to cut health care spending, these cuts usually are an outcome of IMF and World Bank lending. This is because the conditions attached to loans require African governments to make cuts to the public sector, or to privatize public assets, so they can allocate more money to paying off their creditors. Yet their conditions are rarely successful and typically result in more debt and poverty.