Macroeconomics and Health (CMH)

MacroHealth Newsletter

Special Issue No. 7: Consultation on Macroeconomics and Health: December 2003

The Need for Worldwide Increase in Health Investment

Ministers of Health, Finance and Planning from 40 developing countries came together with development partners at WHO headquarters in Geneva from 29 to 30 October to address the need to significantly increase investments in health. This was the first time that the World Health Organization hosted a meeting of this magnitude so widely attended by non-health officials, underlining the urgency of building national capacity to absorb increased health funding.

The meeting provided an opportunity for discussion of issues related to improving the effectiveness of health delivery systems and increasing domestic and external resources to health. It came nearly two years after the launch of the 2001 Report of the Commission on Macroeconomics and Health (CMH), which recommends that by 2007, donors should increase assistance for health from the current levels of about US$6 billion per year to US$27 billion.

Two years on, the world still has not shown determination to increase investment in health to the levels needed to measurably impact major diseases that affect the world’s poor. A recent study has shown that the total development assistance for health from major selected sources increased by US$1.7 billion, from an average of US$6.4 billion (1997-1999) to US$8.1 billion (2002). Most of the increase in funding was allocated to fighting HIV/AIDS in sub-Saharan Africa. These recent increases in assistance for health are encouraging, but they still fall short of meeting real needs.

The combined work of countries, WHO, and partners during the meeting resulted in a draft Declaration outlining partners' and countries' roles and actions. Continued global leadership and follow-up from the development community combined with inter-ministerial collaboration will be urgently needed: first, to increase resources for health from domestic sources, debt relief and development assistance for health, and second to eliminate health system and institutional constraints, enabling greater absorption of increased resources. This will be critical for pursuing country action to reach the WHO's '3 by 5' goal – to have 3 million people with AIDS in developing countries on treatment with antiretrovirals by the end of 2005 – and other health targets.

Country Macroeconomics and Health activities, which were made possible with funding from the Bill & Melinda Gates Foundation and other development partners, are ongoing in the countries participating in the Consultation. WHO has been supporting national efforts in these countries for raising political commitment to increase investments and action in health. Presently, more than 40 countries worldwide are drawing on a macroeconomics and health approach. Over 20 are setting health and investment priorities and are engaged in assessing health financing gaps.

The consultation

The Second Consultation on Macroeconomics and Health, held at WHO in Geneva, brought together over 350 participants. These included representatives from 27 low-income and 13 middle-income countries as well as 18 major donors, of which 14 donor countries and four donor foundations and international banks.

Participants included country representatives from all six WHO regions. From the countries invited, 31 Ministers of Health and 18 Ministers of Finance or Planning participated. Additional participants included 197 high-level officials from the ministries of health, finance and planning. There were senior representatives from the International Monetary Fund (IMF), the Organisation for Economic Co-operation and Development (OECD), and the World Bank. Regional entities such as NEPAD, the Andean Health Organization (ORAS) and the Commission of African Union, as well as ten UN organizations, eleven academic institutions and six NGOs were represented at the Consultation.

The Consultation began with a one-day preparatory meeting on 28 October, with high-level health, finance, and planning officials from participating countries coming together to discuss key operational policy issues in their ongoing macroeconomics and health work. The debate of the preparatory day fed the political discussions held during the Ministerial Consultation.

Three themes were addressed during the Consultation through presentations by country delegates, expert speakers, and representatives of development agencies. These were:

  • how to improve the effectiveness of health delivery systems and monitor outcomes;
  • how to make health central in the country macroeconomic framework and increase internal allocation of resources to health;
  • how to make external funding more predictable and increase coordination with partners.

Please visit: for more information.

Preparatory meeting: Discussion of selected policy issues

The 28 October preparatory meeting, in which participants broke up into three thematic Working Groups, provided an opportunity for discussion of issues related to improving the effectiveness of health delivery systems and increasing domestic and external resources to health.

Professor Anne Mills of the London School of Hygiene and Tropical Medicine was chair of Working Group 1, which discussed country experiences in improving the effectiveness and efficiency of health delivery systems, and in monitoring outcomes. The session heard that three main issues are key to well-functioning health systems: setting realistic health priorities; building institutional and organizational components of health delivery systems; and setting up effective mechanisms for tracking management and health outcomes.

Dr Peter Heller from the IMF and Mr Alexander Preker and Mr Pablo Gottret from the World Bank co-chaired Working Group 2 and introduced the session by emphasizing the extraordinary opportunity that this Consultation has offered for enabling dialogue between ministries of finance, planning and health and the international community. Participants discussed how to make health central to the macroeconomic policy framework and increase internal resources to health. Discussions took place around three main areas: reviewing multisectoral coordinating mechanisms that can best integrate pro-poor health investments into development plans; identifying options for re-allocating internal resources; and building on private, public and external partnerships in order to improve the health of the poor.

Working Group 3, co-chaired by Mr Paul Isenman from OECD and Ms Carin Norberg, Executive Director of Transparency International, discussed how to make external funding more effective, predictable, and coordinated. The session heard that recent development assistance trends and data must be analysed and ways to increase funding must be assessed. Some of the key issues debated during the session were:

  • better availability of data to countries and building of national capacity to use those data;
  • prompter translation of donor commitments into grants;
  • stronger focus of development assistance on health systems, other sectors impacting health and health MDGs;
  • better coordination between national priorities and policies and external assistance;
  • the crucial role of multilateral international organizations, including WHO.

Please visit: for more information on the preparatory meeting.