Macroeconomics and Health: an update - July 2003
Country achievements: a summary of progress
Since the global launch of the CMH Report, WHO and its Regional and country offices have worked closely with governments to promote the Report's findings and to support country efforts to bridge the gap between national macroeconomic and health policies. The CMH follow-up process in countries has been providing opportunities to national groups - from a range of ministries to academic groups, civil groups, and the private sector - to debate their vision of health and to strategize on how to incorporate health into national development plans.
Many countries have already started to mobilize their knowledge, experiences, and resources to formulate long-term programmes for scaling up essential health services - usually as part of a national poverty reduction strategy - and are expressing interest in the CMH Report findings. Not all of these countries are planning to establish a National Commission on Macroeconomics and Health (NCMH) as recommended by the CMH Report, but nearly all are placing the CMH follow-up work in the context of their national development agendas. The international community, including WHO, will support promising national mechanisms in efforts to develop an approach to macroeconomics and health. WHO's own approach will be refined and adapted to different country situations through a process of consultations with countries and development agencies.
Below is an overview of technical progress within countries, mechanisms to support country follow-up and ways to strengthen collaborative partnerships.
Catalysing action: MHS work at country level
The objective of the Macroeconomics and Health Strategy (MHS) process is to support governments and other interested parties in developing countries as they decide whether and how to follow up on the recommendations of the CMH report. MHS work seeks to place health at the centre of the development agenda by mobilising high-level commitment on the part of policy-makers, donors and other interested parties. Adopting a MHS is not a linear process, but a diverse set of linked processes and products.
The implementation of MHS work in countries is carried out in three phases to produce impact-oriented and sustainable results. Each phase can last from a few months to several years.
During Phase 1, the CMH Report is widely disseminated and the relevance of its recommendations to the individual country is analysed. The main expected outcome of this phase is the establishment of an inter-ministerial mechanism committed to planning increased health investments, especially for the poor.
Phase 2 starts with the establishment of national mechanisms to follow up on a macroeconomics and health approach. During this phase, countries formulate investment plans indicating priority health interventions and analysing resource needs. Based on the established priorities, the MHS facilitates resource mobilisation from national budgets and global funding mechanisms.
During Phase 3, investment plans are implemented and the process is monitored by a country-led coordination mechanism. MHS provides technical support through the WHO and other technical programs.
As of July 2003, about 40 countries have expressed interest in pursuing the Macroeconomics and health approach. Ethiopia, Ghana, Kenya, Rwanda, the Caribbean Community, Mexico, Jordan, Yemen, Estonia, Bangladesh, India, Indonesia, Sri Lanka, Thailand, Cambodia and China are fully engaged in Phase 1 activities or are entering Phase 2. An additional 22 countries are in preparations to enter Phase 1: Angola, Azerbaijan, Bhutan, Botswana, Congo, Djibouti, the Islamic Republic of Iran, Lao, Malawi, Mozambique, Myanmar, Nepal, Nigeria, Pakistan, Philippines, Peru, Senegal, South Africa, Sudan, Tanzania, Uganda and Vietnam.
The evidence to date has shown that:
- The country-level process of developing an MHS (Phase 1) can successfully insert health into the broader development agenda, as in the cases of Jordan, India and Rwanda.
- Once developed (Phase 2), a MHS can effectively lead to products and outcomes on the critical pathway to instituting a long-term plan of health investments. The experiences of Ghana, Sri Lanka and Mexico have all shown this.