Macroeconomics and Health (CMH)

Achievements through September 2004

The Americas Region (PAHO/AMRO)

PAHO/WHO has suggested opening a dialogue on the implications of the CMH Report for the Americas, initially with a few key sub-regional stakeholders such as the Central American Integration System (SICA), the Andean Health Agency (ORAS), and MERCOSUR.

PAHO's success in the HIV/AIDS strategy to mobilize health investments for anti-retroviral packages has been noted. The importance of having a macroeconomic foundation for managing the health sector has been stressed. At the country level, PAHO/WHO is interested in incorporating National Health Accounts into the local MH process as basic tools. They also feel that the MH-triggered research will contribute to the epidemiological database to assess the burden of disease of the poor and options for cost-effective interventions.

The Americas region supports the Commission's report emphasis on the close relationship between health conditions, poverty reduction and social development--"This vision emphasizes the values and objectives of health for all and Primary Health Care, laying the groundwork to achieve the development objectives of the millennium and restoring the values and principles of the equity and the social justice in distributing resources allocated to health". Based on the existence of the subregional initiatives of economic and social integration, such as the Andean Health Agency (ORAS) and the Caribbean Community, this region promotes the development of Subregional Commissions of Macroeconomics and Health.

Subregional Commissions can respond to the similarity of problems of health and its determinants among adjacent countries and to the presence of subregional institutions that could support the Commissions' development and aim to integrate the countries economically and socially.

The regional office participated in the 2nd Macroeconomics and Health Consultation, "Increasing Investments in Health Outcomes for the Poor", 28-30 October 2003. Subsequently, two new sub-regional macroeconomics and health proposals were submitted as described below.

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Caribbean Community

The 15 member states that make up the Caribbean Community (CARICOM) have set up a Caribbean Commission for Health and Development. CARICOM includes Antigua and Barbuda, The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Montserrat, St. Kitts and Nevis, Saint Lucia, St. Vincent and the Grenadines, Suriname, and Trinidad and Tobago. On 22 September 2003, the official launch of the CARICOM CHD announced the plan of action and objectives for the Commission. Chaired by the former head of PAHO/WHO, Sir George A. O. Alleyne, this Commission is patterned after the WHO CMH, and is charged with the responsibility of providing guidelines for action to the 15 member states. The overall goal is to "give substance to the Nassau declaration that the health of the region is the wealth of the region and respond to Millennium Development Goals in which health and development are priorities."

A policy framework is being developed to assist the CARICOM member countries in structuring their health and development agendas. This will be accomplished by a clear assessment of all determinants of health, coupled with selected studies on burden of disease and cost-effectiveness analysis. A macroeconomic framework will assess the aggregate returns for areas such as direct foreign investment, tourism and trade that can be expected by a coherent long-term strategy towards investments in health. Research proposed includes papers on the labour market returns to health and inequalities in health and income. Such research will convince senior government leaders of the necessity for increased health investments that are pro-poor.

An 18-month timeline guides the creation of a framework establishing priorities for health financing, including public/private partnerships and the sharing of services. The framework, plus locally developed evidence, will help member states structure their health and development agendas in an interrelated manner, while focusing on provision of pro-poor health services. An important outcome for the Community is partnership building, catalysed by multi-sectoral workshops to be sponsored in the various member states.

The Caribbean Community has obtained donor support for a significant part of their work plan, showing the value of engaging all local stakeholders into the earliest stages of developing a work plan for implementing a MH strategy. PAHO/WHO will be the executing agency and will provided needed technical support in concert with WHO-HQ, using local and regional technical experts when possible.

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The Mexican Commission of Macroeconomics and Health (CMMS) was inaugurated in July 2002. Since then, the Commission has scheduled periodic meetings, set up a web site to disseminate the Report findings widely, and outlined plans for forward movement of the process. The WHO/PAHO representative is coordinating the preparation of the proposal. Based on the consensus reached on the priorities and activities for the joint work plan, WHO/PAHO will also work with the Secretariat to assess funding sources. The CMMS continues moving forward towards the completion of a report on the different aspects of the relationship between health and economics in Mexico.

In order to better organize this challenging research project the CMMS was divided into five working groups, each of them coordinated by one of its members. The groups were established based on a careful process in which policy needs were prioritized. Each group will generate a report that would feed the CMMS's final product. The five working groups are the following: (1) Diagnosis of the health status of the Mexican population and of the public health system vis- à-vis the achievement of the MDGs, (2) Health, economic development and poverty reduction, (3) Intra and inter sectoral health related public policies, (4) Health insurance and social protection and (5) Global and regional public goods for health in Mexico.

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Andean Commission of Investment in Health

The Andean subregion includes the countries of Bolivia, Colombia, Ecuador, Peru and Venezuela. The subregional approach in these countries aims to strengthening the individual and collective capability to improve health and reduce poverty and social exclusion. The Andean Presidential Council established among its directives to welcome the creation of an Andean Commission of Investment in Health in order to advance in a joint strategy for the development of the health sector.

The Andean Commission is expected to focus on the social sectors and health as a crucial determinant to address poverty reduction and sustainable development. The sub-regional framework will allow sharing of experiences, mutual support and pooling and effective use of resources for national plans. This initiative is strongly supported by the WHO Regional Office for the Americas and highly welcomed not only by the ministers oh health and health sector authorities, but also, in a very significant way, by the heads of state of the Andean Community of Nations.

The Andean Commission, once established, is expected to overall address the following issues:

  • Development of an Andean MH framework, including issues such as health care of migrants and cross-border health and employment issues;
  • Building of the institutional network between participating countries to support countries in generating strategic health investment plans;
  • Organization of debates about the Agenda to socialize findings on the impact of social and health conditions on economic development and promote positive approaches;
  • Provision of technical support to the countries in developing investment plans and sharing experiences.

Subregional Commission of Health and Development for the MERCOSUR

The proposed MERCOSUR Health and Development Commission would represent the countries of Argentina, Brazil, Paraguay and Uruguay. These countries have already experienced commercial integration initiated in 1991 with the signing of the Treaty of Asuncion by these countries.

The objective of the MERCOSUR Commission of Health and Development would be to "incorporate and emphasize the social and health dimensions on the agenda of the commercial, political and economic integration of the MERCOSUR countries, and as one of the determinants to address poverty reduction and sustainable development of these countries." The focus would be on increased and more equitable distribution of health investments, incorporating specific aspects of every country, realizing that there are common determinants of health shared by countries requiring a coordinated effort.

The MERCOSUR Commission of Health and Development, once established, plans in particular to address the following issues:

  • Development of a sub-regional MERCOSUR MH framework with a focus on the health of migrants and in the border areas;
  • Building of the institutional network between the health, finance and economic planning decisions makers in the participating countries;
  • Organization of discussion fora about the Agenda to involve the civil society in the approach and promote widespread consensus and support;
  • Provision of technical support to the MERCOSUR countries to help them develop sound investment plans and share experiences with the other MERCOSUR members.