No. 14, February 2006
India NCMH: Supporting an effective strategy for health sector reform
The India National Commission on Macroeconomics and Health (NCMH) developed a list of priority health conditions and interventions based on specific criteria and recommended that public health spending be increased from the current level of approximately 1.2% to 3% of GDP within the next ten years. These are part of the Report of the National Commission on Macroeconomics and Health, which undertook a critical appraisal of the health system, including links between health, development and poverty; burden of disease; and financing and delivery of health care services. In order to reduce household expenditures of the poor, which are estimated to raise the proportion of people living below the poverty line in India by as much as 3.3% per year, the report recommends that a core package of services be made universally accessible at public costs. It also outlines ways to finance a comprehensive package of services to ensure access by the poor, including social health insurance. The NCMH took an intersectoral approach to health, calculating the cost of nutrition and other health inputs in addition to health services.
The India NCMH focused on the significant disparities in health status and access to care among population subgroups. It also described weaknesses in the public health system, such as lack of capacity to plan and implement an effective health sector strategy, and suggested ways to address them. The report's recommendations include increased involvement of civil society and communities in decision making and a strengthened regulatory function by the government on the contribution of the private sector.
For more information, see http://www.who.int/macrohealth/action/Report%20of%20the%20National%20Commission.pdf.
Macroeconomics and Health in Mexico: Reducing wide disparities in health
The work of the Mexico National Commission on Macroeconomics and Health (CMMS) has focused on the analysis of health financing and social protection, creating an inventory of public goods, adapting the Millennium Development Goals (MDGs) to the national context and describing the relationship among health, development and poverty reduction. The health situation in Mexico, a middle-income country, is characterized by wide disparities in health indicators among regions and socio-economic groups. Accordingly, the CMMS report, Investing in health for economic development, suggests moving up the timeframe for specific MDGs targets, establishing targets at the subnational level, and including additional goals, such as those related to chronic illnesses. The report cites the Government's human development program Oportunidades as a successful example of how public expenditures on health can be a tool for fairer health financing, more equitable access to health services and greater efficiency of allocations in the sector.
The report is to be used as a dynamic document towards creating a social consensus in terms of health and development goals, processes and outcomes. The goal is to encourage social involvement in these issues and promote government accountability in equitable access to health and education services.
For more information, see the report executive summary at http://www.who.int/macrohealth/action/sintesis15novingles.pdf
Sri Lanka: Planning for maintaining achievements and addressing new challenges
The report of the Sri Lanka National Commission on Macroeconomics and Health (NCMH), Economy and health: taking Sri Lanka towards the global best, recommends that the public sector invest at least 2.5-3.0% of GDP in health and that steps be initiated to develop a health insurance system to decrease the inequities linked to high out-of-pocket expenditures. The recommended investment would help enable Sri Lanka to maintain and build on its health system achievements and face impending health challenges. The report identified overcrowded tertiary hospitals and neglected primary facilities and prevention as major challenges (73% of actual health care expenditures in 2004 were for hospitals, while public health services accounted for only 4%). Lack of coordination between central and district levels and insufficient planning of human resources are two additional issues addressed by the report.
For more information, see http://www.who.int/entity/macrohealth/action/sri_lanka_report.pdf.
A Strategic framework and investment plan for Thailand
Thailand's health investment plan, prepared by the working group on macroeconomics and health, estimates that 1,854,405 million baht (US$ 47.5 billion) will be needed by the health sector over 2006-2015. This estimate is based on projections of the financing required to improve infrastructure and human resources for health; expand and sustain health insurance coverage; and provide cost-effective interventions to reduce major health risks. The health investment plan is part of the report, Macroeconomics and health framework for investing in health - Thailand. The report also reviews current situations and trends in health outcomes, health care financing and coverage (in particular Thailand's Universal Coverage Scheme, introduced in 2001) and resources for health. It then discusses various options under a strategic framework for investing in health development that could potentially be incorporated into long-term health sector plans.
Thailand's working group on macroeconomics and health was set up by the Ministry of Public Health of Thailand in July 2002. Participants in the working group include various experts and high level health administrators, health planners, economists, and representatives from the National Economic and Social Development Board, the Ministry of Finance, and WHO Thailand, together with the Bureau of Policy and Strategy in the Ministry of Public Health as the secretariat.
For more information, see http://www.who.int/macrohealth/action/thailand_report.pdf.