A new study suggests that lending conditions imposed by the International Monetary Fund in West Africa squeeze “fiscal space” in nations such as Sierra Leone – preventing government investment in health systems and, in some cases, contributing to an exodus of medical talent from countries that need it most. Researchers from the Universities of Cambridge, Oxford and the London School of Hygiene & Tropical Medicine analysed the IMF’s own primary documents to evaluate the relationship between IMF-mandated policy reforms – the conditions of loans – and government health spending in West African countries.