You expose the devastating condition of Zimbabwe's health care system (front page, Feb. 5), but with one glaring flaw: you offer no apparent cause, and therefore no solution.

According to the International Monetary Fund itself, spending per head on health care in Zimbabwe fell by a third from 1990 to 1996 when an I.M.F.-imposed structural adjustment program was introduced.

Unicef reported that in just three years under the program, the quality of health services had declined by 30 percent; twice as many women were dying in childbirth in Harare hospitals; and fewer people were visiting clinics and hospitals because they could not afford user fees.

Such structural adjustment programs require nations to drastically cut budgets — particularly in social services — and to increase fees on impoverished users as conditions of receipt of loans or reductions in debt.

Zimbabwe's health care crisis is no mystery. The mystery is that the solution — canceling its debts, canceling all I.M.F. (and World Bank) conditions on spending priorities, and channeling the necessary funds from the international community directly into health care — has not happened sooner and in more countries.

ANTONIA JUHASZ

Project Director, International Forum on Globalization

San Francisco, Feb. 5, 2004