No. 14, February 2006
This issue highlights just some of the work in macroeconomics and health that is ongoing in a number of countries in all WHO regions. More information from other countries can be found on the macroeconomics and health website at www.who.int/macrohealth.
NATIONAL MACROECONOMICS AND HEALTH REPORTS
In recent months, a number of countries released national macroeconomics and health reports, the culmination of CMH follow-up work since 2001. The focus of these reports, and how they will be used, vary from country to country. In countries such as Ghana and India, the result has been a costed health plan that takes into account selected health-related sectors. In others, such as the 15 member states of the Caribbean Community, China, Mexico, and Sri Lanka, a targeted research agenda has been commissioned that is building the evidence for national priority-setting, advocating with policy-makers and future planning.
Technical Advisory Group in Cambodia examines how to increase and improve health resources
The Cambodian follow-up to the Commission on Macroeconomics and Health has been a process of collaboration between key ministries in the Royal Government of Cambodia, civil society organisations, and international partners. A Macroeconomics and Health Technical Advisory Group (TAG) was formed drawing on staff from the Ministry of Health, Ministry of Economy and Finance and Ministry of Planning. This group has led a series of activities examining the quality and quantity of financing for the public health sector, including a National Research Symposium that brought together civil society organisations, international partners and management from the three ministries. Through this process, the TAG has authored a joint discussion paper, Financing the Cambodian public health sector. As Cambodia already devotes a large percentage of its national budget to health, this paper brings the institutional and technical expertise of the three ministries to bear upon the question of how the public health sector may better benefit from resources that are currently available, while at the same time examining possibilities for increased resource flows.
For more information, see http://www.who.int/macrohealth/action/cambodia_tag_report.pdf.
The Caribbean Commission on Health and Development: Building evidence and proposing solutions
The aim of the Report of the Caribbean Commission on Health and Development (CCHD) is to analyse different dimensions of the health situation in the Caribbean, present the nature of the problems faced and offer some possible solutions for consideration. The work of the CCHD, a sub-regional initiative, is placed within the context of increasing integration in the 15 countries of the Caribbean Community (CARICOM) due to changing political arrangements, especially the Caribbean Single Market and Economy. The report considers in detail the burden of noncommunicable diseases, noting that in the latter part of the 1990s, cardiovascular disease, diabetes mellitus and cancer accounted for 51% of deaths in the Caribbean. It presents evidence of the economic returns to health, through health's impact on foreign direct investment and tourism. The CCHD also devotes considerable space to the critical shortage of nurses due to migration. In order to reduce user fees, the report recommends that public health services should be fully funded from public funds, and broaches the possibility of instituting a Caribbean-wide social health insurance.
The CCHD report was presented to the 26th meeting of the CARICOM Heads of Government, who have asked that the report be distributed to all stakeholders and an implementation agenda be developed.
For more information, see http://www.who.int/macrohealth/action/PAHO_Report.pdf.
China: Towards alleviating poverty pockets and sustaining long-term economic growth
The focus of the macroeconomics and health work in China has been on presenting evidence to promote the need for a greater Government role in ensuring affordable, quality health care for the population. The China macroeconomics and health report, China: health, poverty and economic development, highlights significant barriers in financial access to medical services, with 70% of people failing to take inpatient care citing financial difficulty as the reason. There is a growing gap in the health system, as well as soaring costs of health care. At the same time, evidence suggests that poor health may have an significant impact on total factor productivity, which will play an increasingly important role to sustain high economic growth in China in the coming years. The report reviews the strategies currently followed by the Government to deal with these issues, as well as strategies being planned.
For more information, see http://www.who.int/macrohealth/action/CMH_China.pdf .
Towards achieving health targets: A health investment plan for Ghana
The report of the Ghana Macroeconomics and Health Initiative (GMHI), Scaling-up health investments for better health, economic growth and accelerated poverty reduction, establishes a multi-year strategy to scale up a priority health package to improve health outcomes and expand access for the poor. This package consists of essential health interventions, health systems development, close-to-client services, and improved access to water and sanitation. The report's investment plan details resource requirements, financing gaps and resource allocation in line with policy priorities. The GMHI found that an additional US$ 5 billion will be needed over 2002-2015 to achieve national health priorities. The report also presents evidence of the links between health and development in Ghana; for example, it is estimated that Ghana's low life expectancy of 57 years deprives the country of about US$ 620 million in annual output.
The GMHI report is aligned with completed and ongoing planning activities, such as the Ghana poverty reduction strategy, the medium-term expenditure framework and the Ministry of Health Programme of Work. Its findings are being used by the United Nations system to inform the assessment of the health component of the Millennium Project in Ghana, and as a reference in preparing the proposal for the United States Millennium Challenge Account. It will also be employed in discussions with donors on financing options for the health investment plan, including health's share of the recent US$ 4 billion debt relief to Ghana.
For more information, see http://www.who.int/macrohealth/action/GMHIFinalReport-web.pdf.