WASHINGTON - Alpha Conde, the president of Guinea, was stunned.
In front of him, Christine Lagarde, the Managing Director of the International Monetary Fund, had just called for an increase in the country's budget deficit so that it could battle Ebola - a complete reversal from the Fund's orthodox view that deficits must be closed.
"The IMF doesn't say that very often," Lagarde admitted later.
"It is good to increase the fiscal deficit when it's a matter of curing the people." Conde, whose country is one of three in West Africa hit hard by the epidemic, called it "quite a change from the usual narrative."
That exchange, at the beginning of October in Washington, represented both the evolution and longstanding ambiguities in how the IMF and the World Bank help the world's poorest countries.
The two powerful development institutions have loosened their purse strings to help fight Ebola, which has killed more than 5,100 people mainly in Liberia, Guinea and Sierra Leone since early this year.
But at the same time they are accused of having weakened public health services in West Africa as they imposed rigorous controls on borrower country budgets.
The IMF's responsibility "is obvious" said Olivier Bouchard, a specialist in infectious disease at Avicenne hospital near Paris.
"Though that must be tempered with the knowledge that the leaders of the countries themselves always had the choice to emphasise one expenditure or another... and waste less," he added.
The accusation arises from the IMF's "structural adjustment" programs of the 1980s and 1990s, which tied loans to strict budget regimes, and might have resulted in cuts to health spending.
"These arrangements tied the hands of governments so that when there were disease outbreaks, they didn't have the resources in place to control them," said David Stuckler, Professor of Political Economy at Oxford.
According to his research covering 1996-2006, expenditures on health care in countries under IMF programs grew at about half the speed of those not beholden to the Fund.
As for the World Bank, health expert Mohga Kamal-Yanni of the anti-poverty group Oxfam pointed at the way its promotion of health care user fees diminished the role of the state in delivering services.
The result in the countries hit by Ebola, she said, is "no health workers, no health units, no available medicine."
"Our systems were left worse off by the difficulty to invest in social services and particularly in health," Dede Ahoefa Ekoue, Togo's Minister of Social Action, told AFP. Togo is responsible for coordinating the anti-Ebola fight in West Africa.