Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 13, April/May 2005

Implementing Macroeconomics and Health principles in Senegal

In Senegal, efforts towards implementation of Macroeconomics and Health (M&H) work have aimed to strengthen ongoing processes, such as the Poverty Reduction Strategy Paper (PRSP) and the sector-wide approach (SWAp) of the programme for health development, towards improved management of health sector resources.

M&H follow-up has supported efforts to draw attention to the relationship between ill health and poverty and to advocate for increased investment to scale up primary health care interventions. An M&H mechanism, co-chaired by the Ministers of Health and Finance, was set up in 2002 to facilitate a policy dialogue on health investment among ministries that deliver inputs for health.

During 2004, following a request from national authorities, WHO engaged a consultant from the Royal Tropical Institute (KIT) in Amsterdam, who conducted a detailed analysis on the relationship between poverty and health, as well as health financing. It examined how the national health plan could be strengthened, taking into account linkages with other programmes and initiatives such as the Millennium Development Goals (MDGs), the New Partnership for Africa's Development (NEPAD), the PRSP and the SWAp. The objective of the analysis was to identify gaps in information, which will be continued by a national consultant towards completing the institutional diagnostic. A more detailed analysis at the district level, based on data on disease burden, poverty and resources for the health sector, will support improved planning of health care delivery in the context of the SWAp.

The analysis showed that poverty and health problems follow a similar geographical pattern, indicating that health should appear more prominently in the PRSP. In addition, the position of health in the current government budget suggests a need for enhanced ability of the Ministry of Health to advocate for more resources. Furthermore, a number of constraints to absorption capacity of the health sector were recognized, including human resource issues, management procedures, donor project-based support, information management and monitoring. Opportunities were identified to mobilize increased funding for health and reach poverty pockets more effectively, including public-private partnerships and insurance schemes.

This initial work has shown that inter-sectoral collaboration offers an important opportunity. Building on these efforts, the Ministry of Health is now working towards implementation of a process for multi-sectoral planning at the district level. Attention to cross-sectoral determinants of health, including nutrition, hygiene, and water and sanitation, are needed to increase the capacity of the health sector to improve health and social outcomes. In addition, the private sector provides health services and plays a growing role in health care delivery.

WHO technical support aims to create a synergy between various approaches around health, poverty reduction and economic development, ensuring that integrated activities by all partners serve to strengthen the current national plan for health development. Given the pressing need for better information about health spending, support is planned to develop the National Health Accounts. This support aims to enhance the efforts of the Ministry of Health to improve management of health investments at all levels, including better integration of external aid into the national priorities towards poverty reduction and achievement of the MDGs.

Issa Mbaye SAMB
Minister of Health and Medical Prevention, Republic of Senegal