Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 6 October 2003

African countries discuss Macroeconomics and Health

The August 2003 WHO inter-country workshop in Addis Ababa, Ethiopia brought together fourteen African countries to debate macroeconomics and health concepts. Enhancing political commitment for health and planning country actions to improve effectiveness of health delivery systems were the focus of discussions during the workshop, which was organized by WHO Regional Office for Africa with the dynamic support of the WHO Ethiopia Office and Headquarters.

This meeting was timely, as the need for stronger political commitment and increased funds for health could hardly be more pressing. According to the Minister of Health of the host country, sub-Saharan African countries will face a tremendous challenge to mobilize resources for health both from domestic and external sources, but this should not discourage countries to the point of inaction. The Minister stressed the importance of health in development and the need for all sectors to pull together to address the burden of disease. The macroeconomics and health approach, as discussed in the meeting, can be used as a tool to examine health priorities within the broader development agenda of each country. Also, it can help with resource mobilization by identifying new approaches and options for financing health and improving efficiency of health care. These efforts will be indispensable for achieving the Millennium Development Goals (MDGs) and targets set by the New Partnership for Africa’s Development —NEPAD.

From the meeting emerged critical issues of macroeconomics and health content and relevance in countries. Participants emphasized the need for strong advocacy within the government and across sectors to raise political will and commitment for health. Then, it will be necessary to strengthen institutional and health system capacities in order to target health investment to the needs of the poor, who thus far have been marginalized. Macroeconomics and health work must be linked with ongoing processes, such as health sector reforms and poverty reduction strategies, existing health programmes, and other ongoing country initiatives. Finally, good coordination between governments, development partners, banks, and agencies, including WHO, will serve to increase predictability of resources and accelerate health development work in countries.

The meeting in Ethiopia demonstrated African countries' high level of interest and commitment to placing health more prominently in their political agendas. The upcoming Global Consultation in October will offer a further opportunity to consolidate the role of health in development and to start planning macroeconomics and health work. The ball has been set in motion.

Dr Luis G. Sambo
Director of Programme Management
WHO Regional Office for Africa

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Macroeconomics and Health meeting in Eastern Mediterranean Region

CMH event in Fez, Morocco

During the last year, WHO’s Eastern Mediterranean Regional Office has been providing support to the countries of the region as they examine new approaches to investing in health for tackling their health and development needs. To further strengthen these efforts, the Regional Office convened two consecutive meetings in Fez, Morocco in June 2003. The first meeting aimed to formulate a Regional Strategy on Sustainable Health Development and Poverty Reduction, which could be a sound basis for taking forward macroeconomics and health work in the region. The development of this Regional Strategy is an attempt to build on the region’s experiences of Community Based Initiatives like Basic Development Needs, moving from micro-level to macro-level initiatives by creating wider partnerships. Drawing on themes expressed in the first meeting, the second planned to examine the concepts of the CMH Report as they apply to countries’ health and economic circumstances.

Over 35 senior officials from the Ministries of Health, Finance, and Planning and WHO Country Offices from Djibouti, Islamic Republic of Iran, Jordan, Pakistan, Sudan, Yemen and Oman participated in the second meeting to discuss how macroeconomics and health concepts can apply in their countries, and to plan specific steps to move the work forward. Country plans of action were prepared focusing on how to mobilize high-level political support and develop long-term multisectoral health investment plans. Among the many conclusions drawn, participants noted that lessons from previous sustainable development efforts should be incorporated into the health investment plan. Macroeconomics and health work should focus on the strategic dimensions of health policy and identify a number of priority areas to bring to the attention of senior policy makers. Other conclusions drawn were related to technical points, WHO’s role in macroeconomics and health work, and the next steps for action.
For more information on the meeting, visit: http://www.who.int/macrohealth/events/emro_cmhplan/en/.

Countries in South-East Asia review progress

The WHO Regional Office for South-East Asia organized the third and final of a series of regional meetings on macroeconomics and health in 2003. The meeting was held in New Delhi in late August and brought together representatives from the Ministries of Health, Finance and Planning and WHO Country Offices from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. The aim was to review progress on macroeconomics and health work in these countries and to identify actions needed, including WHO support, to move the process forward. In addition, participants discussed their contribution to the Global Consultation in October 2003.

Dr. Uton Muchtar Rafei, Regional Director of the WHO Office for South-East Asia, inaugurated the meeting by highlighting the importance of national political commitment and multisectoral efforts to improve health, particularly of the poor. Participants agreed that the macroeconomics and health process will be country-driven and linked to existing structures, mechanisms and processes. Advocacy of the concepts must be sustained in order to develop a national consensus on the centrality of health in development and the importance of a multi-sectoral approach to investing in health. Technical expertise provided by WHO and its partners needs to support countries in building national capacity and strengthening institutions.

Countries discuss Macroeconomics and Health at Regional Committee meeting

The August inter-country workshop in Ethiopia (see foreword) prepared the ground for further promoting macroeconomics and health concepts during the 53rd session of WHO’s Regional Committee meeting held in Johannesburg in September 2003. A “Macroeconomics and health: the way forward in the African Region” presentation was delivered during the session, with Ministers of Health unanimously affirming the importance of these concepts and adopting a Resolution on Macroeconomics and Health. It was agreed that progress reports on national work achieved will be presented at every Regional Committee session each year. The Ministers noted that macroeconomics and health work should be country-owned and driven, and consensus on concepts should be built within the ministry of health before other ministries become involved.

During the session, it was emphasized that countries must accelerate efforts to allocate 15% of government budgets to health, as put forward in the 2001 Abuja Declaration. To do so, participants recommended that studies be conducted to provide the evidence for increasing investment in health. Also, they noted that as there is an urgent need for more resources, the private sector must be involved more closely in the financing and provision of health services, and debt relief must be seriously addressed. There is also the need for a clear agreement between UN Agencies, the World Bank, and the International Monetary Fund to ensure that structural adjustment does not hinder efforts to expand health services.

WHO’s role in these efforts will include helping to articulate the relationship between poverty reduction strategies and macroeconomics and health work. WHO will provide technical and financial backing in this area, and support with advocacy and the dissemination of concepts and messages.

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