Achievements through September 2004
The European Region (EURO)
Following the release of the CMH Report, the Regional Director of the WHO European Region decided to set up a special Task Force to assess the relevance of the Report's findings to the Region and propose specific interventions. The Task Force work plan is in line with the implementation of RC52 Resolution on Poverty and Health (EUR/RC52/R7). The first meeting of the EURO Task Force was held at the end of January 2003, in videoconference link with WHO Geneva and the European Observatory on Health Care Systems in Brussels. A strategy was outlined for follow-up and for the assessment of available resources.
Preliminary analytical work of the Task Force has highlighted that:
- EURO countries, even at the lowest income level, have a health system in place, a tradition of public health, a work force with a higher level of skills and a better developed infrastructure than countries at a comparable level of economic attainment elsewhere;
- Health data show relatively lower levels of infant, child and maternal mortality and high levels of adult mortality;
- Predominant health challenges are more complex than in developing countries from other Regions, and include chronic non-communicable diseases, such as cardiovascular disease and injuries, or more difficult infectious diseases, such as multi-drug resistant tuberculosis.
EURO participated in the 2nd Macroeconomics and Health Consultation, "Increasing Investments in the Health Outcomes of the Poor", 28-30 October 2003, in Geneva. EURO is actively pursuing the development of a Macroeconomics and Health Report for Eastern Europe and central Asia to show the relevance of the CMH recommendations to this region especially in light of the different epidemiologic and economic profiles in these countries compared to the majority of developing countries that were cited in the CMH report.
Macroeconomics and Health country work in EURO has focused on three countries, Azerbaijan, Estonia and Kyrgyzstan.
A European Report on Macroeconomics and Health: issues and first results - October 2003
The European Region: Macroeconomics and Health work
A Country-Wide National Workshop on "Poverty and Health" was held in Baku on 19-21 November 2003. The workshop was a joint collaboration between the Ministry of Health of Azerbaijan, the European Regional Office of the World Health Organization (EURO) and WHO Headquarters. The objectives were to:
- Familiarise participants with the notions of investing in health for development;
- Provide an overview of the challenges and successes of integrating health in the PRSP;
- Provide an overview of how different health system functions and technical programmes are changing to better tackle the problems of the poor in Azerbaijan;
- Explore concrete examples of integrating social and economic determinants of population health into policy development.
The workshop blended theoretical and scientific input with practical tools useful for participants involved in decision-making at different levels of policy development in Azerbaijan. Practical experiences and case-studies were utilized.
This occurred within the context of the new Biennial Collaborative Agreement between the Ministry of Health of Azerbaijan and EURO for 2004 to 2005. One priority element of this agreement is the participation of a country representative in a "knowledge forum on pro-poor health action", with the purpose of supporting policy-makers to exchange experience on managing progress towards placing health in the context of poverty reduction strategies and MDGs.
At this time (January 2004) WHO/HQ are collaborating with the WHO country office and Ministry of Health of Azerbaijan to determine the best ways to move forward. One possibility, dependant on funding, is the placement of a short term consultant in Azerbaijan to help with efforts to integrate health into the broader development agenda.
Kyrgyzstan is working to sustain the health achievements that it has made in such areas as child health and control of communicable diseases while adequately addressing the rising burden of non-communicable diseases and micro-nutrient deficiencies. These health issues have to be considered in the context of the relatively low public spending on health in the country and that informal payments account for the largest share of health spending in Kyrgyzstan (51.3 percent in 2001).
In recent years the Government has shown a commitment to health system reform and building national capacity for a comprehensive approach towards health and development. In 2002, the Parliament adopted a paper on Population Health Promotion. The proposed macroeconomics and health work would aid in providing a strategic framework for identifying national health priorities and for making allocative decisions for tackling the priority diseases and health system reforms. Initial efforts have concentrated on meeting and mobilising support with government stakeholders to make the economic case for health investments and to promote the development of a coordinated health strategic framework linked to development exercises such as the PRSP. Further more, there is initial agreement with MOH and the Office of the Vice Prime-Minister to establish an inter-sectoral working group that links directly to the existing mechanisms to do with the Comprehensive Development Framework (CDF) in Kyrgyzstan.
The macroeconomics and health follow-up in Kyrgyzstan is planned to focus on the following activities to aid the government in more closely linking national health planning with development goals:
- Advocacy to leverage the profile of health and the health system vis-à-vis other stakeholders in government
- Development of a comprehensive epidemiological assessment (epidemiological baseline determination)
- Development of a comprehensive population and development strategy
- Prioritising diseases and health interventions that affect poor and marginalized population
- Ensuring greater resources and priority for health through strengthening the link between national development strategies and MDG and improving donor coordination in the health sector
- Promoting pro-poor health care financing mechanism
- Strengthening financial management including management of recurrent costs
- Costing exercise with a focus on economic costs and benefits of MDG targets
- Developing sustainable NHA
Estonia is a middle-income country in transition, a new member of the World Trade Organization steadily moving toward a market economy with increasing ties to the West, including the pegging of its currency to the euro. A major goal is accession to the EU, possibly by 2004. The overall health status of the Estonian population has been found to be poor as compared to EU and Nordic countries, for some problems lower than the reference countries of Central Europe. Infant mortality rate is 12.32 deaths/1,000 live births. Among the main health problems affecting Estonia are cardiovascular diseases, chronic liver disease and cirrhosis, alcohol abuse, occupational health and violence-related problems. Tuberculosis and HIV/AIDS are raising particular concern and have contributed to most of the 50% increase in infectious disease mortality since the late 1980s. Lack of estimates of poverty (as well as homelessness) is an obstacle to in-depth analysis of the links between poverty and health problems, but a 2002 study commissioned by the World Bank and Ministry of Social Affairs of Estonia reached the conclusion that wide inequalities exist and are worsening.
In March 2003, WHO presented its work on the MH approach to a group of decision-makers and officials from the Estonian Ministries of Social Affairs, Foreign Affairs and Finance, academic representatives and international agencies. The Government has expressed an interest in the CMH approach, and a member of the Secretariat gave a presentation on MH strategies entitled, "Investing in Health to Reduce Poverty and Spur Development." Good interactions and dialogue followed the meeting, and Estonia is considering ways to follow up.