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WHO/OMS
Improving and increasing investments in the health outcomes of the poor
Macroeconomics and Health in context
Dr. Sergio Spinaci, WHOSenegal, February 2005
WHO/OMS
Presentation profile
Towards achieving the MDGs
Overview of Health Spending
Overview of national MH process
Macroeconomics & Health:Responses by WHO
Capacity-building at country level
Achievements in Ghana, India, Mexico and the Caribbean
Conclusions
2
WHO/OMS
3
The CMH Report : Towards achieving the MDGs
CMH recommendations support scaling up of systems, financing and outcomes, essential for achieving MDGs. Acknowledging that the poor:
• Suffer disproportionately from preventable disease
• Are in danger of catastrophic out-of-pocket health expenditures
• Are subject to geographic, economic, and social factors that limit access to care
WHO/OMS
4
Health Spending in selected countries
Source: Human Development Report, 2004.
Priorities in public spending for selected countries
0
2
4
6
8
10
12
MexicoSri Lanka
Indonesia
GhanaEthiopia
ChinaSenegal
India
(%)
Total debt service (% of GDP)in 2002
Public expenditure on health(% of GDP) in 2001
Military expenditure (% ofGDP) in 2002
Public expenditure oneducation (% of GDP) in 2001(or most recent year availableduring period 1999-2001)
WHO/OMS
5
Poor Suffer Disproportionately from Disease
0 50 100 150 200
Underweight children (percent)
Under-Five deaths/1,000 livebirths
Maternal deaths/10,000 live births
AIDS deaths/100,000 pop
TB deaths/100,000 pop
Rate/RatioRichest 25% of world population2nd richest 25% of world population2nd poorest 25% of world populationPoorest 25% of world population Source: The Millennium Development Goals: Rising to the
Challenges. World Bank, 2004.
WHO/OMS
6
Catastrophic Health Expenditures
- 30 60 90
WPR
AMR
SEA
EUR
AFR
EMR
Number of people (million)
impoverishment
catastrophic
Number of people with catastrophic expenditure and impoverishment due to health spending
Source: Evidence and Information for Policy, WHO
WHO/OMS
MH: Participating countries and regions
Africa:
11 countries
West Pacific:6 countries
Europe: 3 countries
The Americas :
2 countries, 3 sub-regions (Andean Region, MERCOSUR,
Caribbean Community)
South East Asia: 7 countries
Eastern
Mediterranean: 6 countries
Countries : Engaged in macroeconomics and health work Developing health and development plans
Sub-regional Initiatives 7
WHO/OMS
8
Overview of national MH process
Advocacy: • Disseminate CMH findings and raise political commitment to health
• Establish multi-sectoral technical groups and mechanisms to implement the MH process
Research and planning: • Assess health situation and infrastructure (epidemiology, health
system capacity, funding gaps, cost analyses of investment options)
• Establish health investment plans for prioritizing investment
• Define implementation strategy
Implementation: • Implementation of health investment plan
• Monitor MH process and long term impact
WHO/OMS
In this setting, WHO and its partners support the linking of national health priorities with PRSPs, achievement of MDGs, SWAps and other development agendas.
MH: Responses by WHO
9
WHO/OMS
Capacity-building at country level
Foster sustained political support for long-term investment in health
Improve coordination among stakeholders for more effective policy dialogue (SWAps, cross-sectoral support, etc)
Support MoH to produce a comprehensive health sector strategy, linked to the MDGs, costed and budgeted in line with MTEF
Ensure health is strongly reflected in PRSPs
Macroeconomics and Health supports countries to:
10
WHO/OMS
Capacity-building at country level
Focus on financing health systems that can deliver essential health services for the poor and vulnerable
Strengthen institutions to manage increased resources
Improve local capacity for country-relevant research that inputs into national policy making
Strengthen monitoring and evaluation mechanisms, including tracking resource flows for health
11
WHO/OMS
Case Study - Ghana
The Ghana Macroeconomics and Health Initiative (GMHI) - pro-poor approach to expand essential health services and close to client facilities.
The investment plan - collection and analysis of data on disease burden, non-financial constraints, health expenditure and poverty at the district level.
Revision of the Ghana Poverty Reduction Strategy (GPRS) - A step towards operationalising the health and health related MDGs. The plan is a key input into the revised Ghana Poverty Reduction Strategy and the Ministry of Health programme of work for 2007-2011.
12
WHO/OMS
Case Study - Ghana
The GMHI has had several key objectives: • Disseminate and discuss the findings and recommendations of the
CMH report• Develop a long-term health investment plan• Provide strategic options for scaling-up investments in sectors that
influence the health status of Ghanaians• Mobilize political support and advocacy at the local and international
levels
13
WHO/OMS
Case Study - India
In January 2003, the Indian government set up a National Commission for Macroeconomics and Health (NCMH), co-chaired by the Minister of Health and Family Welfare and the Minister of Finance.
The objectives are to assess the impact of increased investments in the health sector on poverty reduction and the overall economic development of India and to establish an evidence base for long-term scaling up of essential health interventions.
Report of the commission will present to the GoI the cost of providing and options for financing package of interventions.
14
WHO/OMS
Case Study - Mexico Mexican national commission (CMMS) set up July 2002 by Minister
of Health to study health – economic development relationship and identify priority actions to link health and economic policies
Working Groups: • diagnosis of health status of Mexican population and public health
system vis a vis MDGs • health, economic development and poverty reduction • intra- and inter-sectoral health-related public policies • health insurance and social protection• global and regional public goods for health in Mexico
CMMS Report presented November 2004, circulated to key stakeholders
Strong support by key MoH officials provides momentum
15
WHO/OMS
Case Study - Caribbean sub-regional initiative
Caribbean Commission for Health and Development formed and charged with the responsibility of providing guidelines to action for the 15 members of Caribbean Community. The Secretary General of the Caribbean Community (CARICOM) chairs the Commission
Planned activities: promote essential operational research on health and poverty priorities, policy roundtables, advocacy in CARICOM major events, estimates of investments needed
Final report to be presented to the Caribbean Community's Council on Human and Social Development and to Heads of Government in 2005
MDGs are explicit targets16
WHO/OMS
Impact
17
Integrate health system, poverty reduction and disease-specific initiatives to maximise outcomes towards achieving health and development goals
Addressing the overarching issues including the role of the civil society and private sector, effective financing schemes and safety nets for the poor, better monitoring of the flow, etc.
Coordinate collaborations/partnerships between recipient countries and development community