A/HRC/28/60 28. In the decade before the Ebola outbreak, Guinea, Liberia and Sierra Leone experienced, according to recent GFI estimates, an annual average of US$ 1.37 billion illicit financial outflows, while, according to the World Health Organization (WHO), during the same period the three countries spent on average only US$ 140 million per year on public health (see fig. IV).22 All three countries were under International Monetary Fund (IMF) programmes, failed to meet targets for social spending before the outbreak and saw a further decrease in the number of community health workers from 0.11 per 1,000 population in 2004 to 0.02 per 1,000 population in 2010.23 Some health experts claimed that IMF programmes contributed to the weaknesses of the public health systems in the countries, an assessment that has been questioned.24 29. In addition to illicit financial flows, the three countries paid on average US$ 205 million in debt service per annum on public or publicly guaranteed external debt during the decade before the Ebola outbreak, and continued to spend US$ 81.6 million in 2013.25 In Sierra Leone, where the estimate for illicit financial outflows is lower, legal tax incentives and tax breaks for extractive industries have weakened domestic resource mobilization. Christian Aid has estimated that the Government of Sierra Leone will lose revenues of US$ 131 million in the three years 2014–16 alone as the result of corporate income tax incentives granted to five mining companies – an average of US$ 43.7 million a year. All tax incentives combined amounted in 2012 to eight times the health budget and seven times the education budget.26 While the roots of the weakness of the public health system in the Ebola-affected countries are varied, tax evasion, legal tax breaks and external debt services have been contributing factors to the weak state of public health institutions and services. The above examples demonstrate that debt relief, improved tax regimes and a reduction in illicit financial flows would allow those and many other least developed countries to improve their public health and education systems. 22 23 24 25 26 Kar and Spanjers, “Illicit financial flows from developing countries: 2003–2012” (see footnote 5), pp. 28–29 ; WHO, Global health expenditure database, General Government expenditure on health 2012 in US$, available from http://apps.who.int/nha/database/Home/Index/en. Alexander Kentikelenis and others, “The International Monetary Fund and the Ebola outbreak”, The Lancet Global Health (2015), available from http://dx.doi.org/10.1016/S2214-109X(14)70377-8. See Sanjeev Gupta, “Response to ‘The International Monetary Fund and the Ebola outbreak’”, The Lancet Global Health, available from http://dx.doi.org/10.1016/S2214-109X(14)70345-6. World Bank, International Debt Statistics, Debt service on external debt, public and publicly guaranteed, available from http://databank.worldbank.org/data/views/variableselection/selectvariables.aspx?source= international-debt-statistics. Christian Aid, “Losing out. Sierra Leone’s massive revenue losses from tax incentives” (London, Christian Aid, April 2014), pp. 5–6, available from www.christianaid.org.uk/images/Sierra-LeoneReport-tax-incentives-080414.pdf. 11