Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 9, May 2004

Health for Socioeconomic Development

The concept of “health-for-all” signifies the request for social justice and health equity, as expressed in the constitution of the World Health Organization. The Alma-Ata Declaration of 1978 continues to inspire the world community because it places people at the centre of health and development. Due to this single factor, the goal and aspirations enunciated 27 years ago will always remain central to WHO’s work. WHO is committed to assist member states in framing an enabling policy and institutional settings for the health sector, thereby promoting an effective health dimension to social, economic, environmental and development policy. Therefore, for over a decade, the WHO Regional Office for the Eastern Mediterranean has been pursuing public health approaches based on the principle that good health is linked to poverty reduction and human development. This belief is reflected in the promotion of community-based initiatives, such as Basic Development Needs (BDN), Healthy Cities, Healthy Villages and Women for Health and Development (WHD), which all countries in the region are currently implementing in collaboration with WHO. These community-led activities, which place health in the broader context of socio-economic development, have been seen to be very relevant and sustainable.

Macroeconomics and Health (MH) work in countries builds on this holistic approach, helping to advocate for more investments in health and for creation of a single, comprehensive health sector strategy with a focus on the poor. In June 2003, at a "Meeting to Facilitate the Implementation of CMH in the Eastern Mediterranean Region", countries of the region came together in Fez, Morocco to draft national MH plans and a regional MH strategy. Participants agreed on the critical need for strong political commitment to support cross-sectoral collaboration and increase internal resources for health. A Task Force for the region has been set up to support countries with advocacy, analyses, implementation of the MH strategy and tracking outcomes.

Later in 2003, at the Regional Committee for the Eastern Mediterranean, Ministers of Health and other delegates approved the "Regional Strategy for Sustainable Health Development and Poverty Reduction," which advocates for a greater focus on the health needs of the poor and vulnerable in development agendas. This strategy is in line with MH work and efforts to meet the health-related Millennium Development Goals, all of which build on previous sustainable development initiatives.

Following participation at the 2nd Consultation on Macroeconomics and Health in October 2003 held in Geneva, countries continue to work towards development of national Health Investment Plans. Several of them have now established or are in the process of establishing national MH commissions to take forward analytical work and plan health investment among multiple ministries and partners. MH work aims to insert a strong health component into various development strategies, including the Poverty Reduction Strategy Papers (PRSPs) where applicable, and also to develop better technical tools to clarify the linkages needed among various initiatives and national policies.

Dr Hussein A. Gezairy
WHO Regional Director for the Eastern Mediterranean Region

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Partnering with Civil Society at Asian Macroeconomics and Health Conference

Strengthening the call for equitable access to primary health care was the overarching goal of the first inter-regional civil society conference on Macroeconomics and Health, organized by the World Health Organization on 27 and 28 April in Colombo, Sri Lanka. The conference brought together some 60 representatives of local and international non-governmental organizations (NGOs) with activities in WHO's South-East Asia and the Western Pacific regions. The governments of 12 countries engaged in carrying forward the recommendations of the Commission on Macroeconomics and Health (CMH) were also represented in the conference, which examined how civil society organizations could contribute to improving the health of the poor in their respective countries within a macroeconomics framework.

While there is wide knowledge of the value of a primary health care movement, the technical interventions, the public health measures, the system requirements, and the cost for scaling up access, there has still not been real change for the world's poor. Towards addressing this situation, participants considered the findings of the CMH and the ongoing follow-up approaches in countries of the regions. It was noted that civil society has contributed greatly toward moving health and poverty reduction higher on the international agenda. It has also supported national efforts in expanding primary health care. In the unanimous consensus statement discussed at the closing session, participants committed themselves to participate in national Macroeconomics and Health processes and asked their governments to ensure full involvement of civil society and NGOs.

Working Group discussions centred around the potential contribution of NGOs in four areas: the policy debate and decision-making; increasing access to essential health services for the rural and urban poor; giving relief to households that experience catastrophic health costs; and analysis and strategic planning of Macroeconomics and Health issues through research.

Participants concluded that civil society plays a critical role towards strengthening political will by building awareness of the importance of health and of pro-poor health system reform in economic development and poverty reduction. Governments, for their part, should facilitate the participation of civil society in national Macroeconomics and Health mechanisms and involve them in the preparation of Health Investment Plans. Civil society organizations working internationally should also lobby for increased and better donor assistance to developing countries, while urging the acceleration of debt relief and ensuring that a major share of resources so released are used for increased spending on the health of the poor.

Civil society organizations, with their knowledge of the deficiencies in the functioning of health delivery systems, should enter into partnerships with governments to assist in providing health services for the rural and urban poor. Civil society organizations, with financial support from public funds and government incentives, can often fill gaps in health delivery systems efficiently and cost-effectively.

Civil society organizations can help avert catastrophic health costs by monitoring the functioning of public health institutions to see that public health care is being effectively and efficiently delivered to the poor. They should also advocate for the provision of universal health insurance schemes and collaborate with governments toward preventing the occurrence of catastrophic expenses, for example through health education. Finally, governments should set up special funds to address households' catastrophic expenses and empower communities to make the services affordable for the poor.

The research capabilities of civil society organizations can contribute to health policy and strategic planning efforts, including by identifying reasons for inadequate access to public health services and evaluating the impact of health sector reforms. Civil society organizations should also contribute to setting a participatory, pro-poor international research agenda, and governments should support them as they aim to increase the health research capacity of low- and middle-income countries.

For more information, please see the Conference web page at