Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 10, August 2004

Enhanced Investments in Health & Stronger Health Systems Based on Primary Care

The countries of WHO's South-East Asia Region have seen significant improvements in health in recent decades. Unfortunately, many of these health gains have bypassed the poor and the vulnerable. Economic development has not resulted in achievement of national and global health goals. Pressing health challenges include drug-resistant malaria, which threatens an estimated 500 million people in the Region, which also reports 40% of all tuberculosis cases worldwide. The increasing incidence of non-communicable diseases, together with communicable diseases, impose a double burden of diseases. The rapidly increasing threat of HIV/AIDS has affected nearly 6 million people. Among other issues, public health expenditure per capita in the Region is very low. High out-of-pocket and catastrophic health spending often pushes people into poverty.

On assuming office in March this year, I outlined my vision for health development. This included the need to address health inequities; to ensure basic services for all, especially the poor; and to place health at the centre of development. Achieving these and meeting the Millennium Development Goals (MDGs) depends on building stronger health systems. Increased health investment is required, as recommended by the Commission on Macroeconomics and Health (CMH), for scaling up essential health interventions.

A number of countries in the Region are pursuing WHO's Macroeconomics and Health (MH) approach. This has helped to focus high-level attention on the role of health in socioeconomic development and supports the development of pro-poor health policies. The process contributes to strengthening national health planning, improving equitable access to quality health care and promoting more effective partnerships. The Regional Office will continue to provide requested support to countries as they work towards development of national Health Investment Plans.

In April 2004, the WHO Asian Civil Society Conference on Macroeconomics and Health in Sri Lanka brought together about 60 representatives of national and international NGOs active in WHO's South-East Asia and the Western Pacific regions. The governments of the countries concerned were also represented. It examined how civil society organizations could contribute to improving the health of the poor.

The challenges are indeed daunting. But, together – WHO, Member States, development partners and other stakeholders, including NGOs, have the requisite will and resources to convert challenges into opportunities. At the 9th meeting of the Health Secretaries of the countries of our Region held in New Delhi in July 2004, I stated: “The Commission on Macroeconomics and Health has provided us with evidence that increased investment in health leads effectively to social and economic development. It is, therefore, our task to persuade our political leaders to increase resource allocation for health development, since this is a highly productive investment for any country.”

I am confident that Member States of our Region will redouble their efforts to enhance investments in health to ensure a healthy future for their citizens. We look forward to inter-regional collaboration in this important area.

Samlee Plianbangchang, M.D., Dr.P.H.
WHO Regional Director for the South-East Asian Region


India pledges to increase domestic investment in health

The Indian government is planning to raise its public health allocation from 0.9% of GDP to over two percent over the next five years, announced India's president A.P.J. Abdul Kalam in June 2004. He said that increased spending would be directed towards primary health care. This announcement is consistent with other early signs of strong commitment by the newly-formed Indian government, led by Prime Minister Manmohan Singh, to invest in the health of the poor. In a speech given as Prime Minister-designate, Dr Singh included the fight against poverty as one of his government's priorities and said he would ensure that the needs of the poor are addressed in the economic reform agenda.

As one of the original members of the Commission on Macroeconomics and Health, Dr Singh was instrumental in development of the recommendations of the 2001 CMH Report. The Commission emphasized the central role of health in economic development and urged developing and developed countries to increase financial resources for health, particularly for poor people. As finance minister of India from 1991 to 1996, Dr Singh paved the way for rapid economic growth by undertaking a restructuring of the role of the government. His vision involves a mix of reforms conducive to business while at the same time retaining a strong role for government in areas like basic education and basic health care. His government's pledge is especially important given the current low level of government spending on health in India and the high ratio of private spending on health care.

Macroeconomics and Health work in India is moving forward with determination. In 2003, the Government of India decided to establish a Temporary National Commission on Macroeconomics and Health (NCMH). The technical sub-Commission of this body plans to identify key issues for India, including an assessment of the current health financing mechanisms and options for mobilizing additional resources, determining the cost of an essential health services package, and the role of the public and private sector in delivery of this package. This work will result in a report that will input into India's Health Investment Plan.