INCREASING INVESTMENTS IN HEALTH OUTCOMES FORTHE POOR
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IN HEALTH OUTCOMES FORTHE POOR - extracted text
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INCREASING INVESTMENTS
IN HEALTH OUTCOMES FORTHE POOR
2nd CONSULTATION ON MACROECONOMICS AND HEALTH
October 2003 • Geneva, Switzerland
World Health Organization
INCREASING INVESTMENTS
IN HEALTH OUTCOMES FORTHE POOR
2nd CONSULTATION ON MACROECONOMICS AND HEALTH
October 2003 • Geneva, Switzerland
World Health Organization
2nd
MACROECONOMICS AND
HEALTH
CONSULTATION
Abbreviations
CMH:
Commission on Macroeconomics and Health
DAH:
Development Assistance for Health
HIPC:
Heavily Indebted Poor Countries Initiative
IMF:
International Monetary Fund
MDG:
Millennium Development Goals
MH:
Macroeconomics and Health
NEPAD:
The New Partnership for Africa's Development
OECD:
Organisation for Economic Co-operation and Development
ODA:
Official Development Assistance
ORAS:
Andean Health Organization
PRSP:
Poverty Reduction Strategy Papers
SWAp:
Sector Wide Approach
Concept and Production:
Writers:
Editorial Contributors:
Executive Secretary CMH Support Unit
Art and Design:
Printed by:
Agnds Leotsakos
Valerie Crowell, Agnes Leotsakos
Tom O'Connell. Silvia Ferazzi. Padma Shetty
Sergio Spinaci
IMAGIC SARL
World Health Organization - CMH Support Unit
20 Avenue Appia - CH-1211 Geneva 27 - Switzerland - www.who.lnt/macrohealth
FOREWORD
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'I
A ca!8 for better health among the poor
he last few years have seen the emergence of an international consensus in global
T
public health: socio-economic development can be achieved only by rigorously
promoting the implementation of pro-poor policies within a viable development
strategy, financed through a significant increase in health investments. We have witnessed
important achievements, including heightened attention among policy-makers to the health
of the poor and recent increases in assistance for health. But more determination and
resources are needed to meet the real health needs of the poor. Failure to act promptly and
decisively will result in countless additional deaths and illness from preventable causes,
trapping individuals and families in poverty and hindering economic growth and development
WHO’s Macroeconomics and Health approach is a response to developing countries’
requests for support in analysing their health situations, policies and options for mobilizing
additional re'sources for health and using existing resources more efficiently.The'work
supports the development of Health Investment Plans that address health priorities within
the overall macroeconomic framework.The work brings together ministers of health,
finance, and planning with development partners to take forward a shared agenda to increase
investments in health and eliminate health system and institutional constraints, enabling
greater absorption of additional resources.These efforts support achievement of major
WHO priorities, the Millennium Development Goals and national development targets.
In this spirit of global partnership, WHO has convened a series of Consultations at the
regional and global level, providing fora for exchange of experiences and lessons learned in
implementing and advancing country-level Macroeconomics and Health processes. June 2002
saw the gathering of representatives from ministries of health, finance, and planning from 20
countries at the 1st Consultation on National Responses to the Report of the Commission
on Macroeconomics and Health. The 2nd Consultation on Macroeconomics and Health,
"Increasing Investments in Health Outcomes for the Poor", held in October 2003, was the
culmination and furtherance of over a year’s efforts to translate the recommendations of the
CMH Report into concrete actions at the country level.
Participation at the October meeting by high-level representatives from 40 developing
countries, the International Monetary Fund, the World Bank and other development
partners signified real commitment and resulted in a Declaration that was unanimously
endorsed by the countries. Participants identified several particularly pressing issues to be
addressed, including resource mobilization options, human resource constraints, and
harmonization of donor funding. Following three days of productive discussion, countries
reaffirmed their will to create Health Investment Plans that address these and other issues
and pay particular attention to the health needs of the poor.
There is now much work to be done, and this Consultation is but one step in a vital process
that must lead to action and results.This report presents key materials and outcomes from the
2nd Consultation. I hope it stimulates thought and carries forward the tremendous momentum
that will be necessary to achieve the goals we have set for ourselves and for the world.
Dr Kerstin Leitner
Assistant Director-General
Sustainable Development & Healthy Environments
CONTENTS
Page
Foreword......................................................................................................................................... iii
Introduction: Macroeconomics and Health................................................................................... I
A time for action..............................................................................................................................3
Preparatory meeting sets the stage for Consultation discussions.............................................4
Improving the effectiveness and efficiency of health delivery systems and monitoring
outcomes.................................................................................................................................... 4
Making health central in the macroeconomic framework and increasing internal
allocation of resources to health............................................................................................5
Making external funding more predictable and increasing coordination with partners . . 6
»
i
Summary ofWorking Group recommendations................................................................... 7
The Consultation on Macroeconomics and Health.................................................................10
Next steps for Macroeconomics and Health activities............................................................ 12
Sustaining political commitment: the central place of health in sustainable
development............................................................................................................................. 12
Mobilising increased domestic resources............................................................................ 12
Improving coordination with partners................................................................................ 13
Extracts from speeches................................................................................................................ 13
Consultation papers....................................................................................................................... 17
World media coverage of the Consultation ............................................................................ 17
Press conference........................................................................................................................... 18
Conclusion: Forging a path to increased health investments and stronger,
more equitable health systems..................................................................................................... '9
Declaration.................................................................................................................................... ^1
All Annexes are accessible in the attached CD-ROM
ealth is a priority goal in its own right as well as a central input to
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development. Good health is critical for poverty reduction and the
achievement of the Millennium Development Goals. Although the global
environment for health is dynamic —with more energy, public awareness, more political
engagement and increased financial resources — still, major diseases continue to cause high
morbidity and mortality and overwhelm public health systems around the world. Unless the
world commits to steady, long-term investments in health, poor communities and countries
will continue to suffer disproportionately from the “double crises" of devastating diseases
overwhelming failing health systems.
The result is a vicious cycle of ill health, poverty, and economic stagnation or recession.
People that are ill and dying cannot lift themselves out of poverty. Sick, malnourished
children cannot attend school and reach their full potential. And populations that are
burdened by major diseases cannot contribute to their country’s socio-economic growth.
The two-way causal links between health and economic growth, first publicized by the 2001
Report of the Commission on Macroeconomics and Health, are now widely recognized.
Responding to the CMH Report's findings and to the urgent need for action,WHO’s
Macroeconomics and Health Strategy mobilizes support for countries as they place health
centrally within their development agenda.The work examines alternative approaches within
and outside the health sector for supporting efforts to increase resources and investment
for health, and imputs into long-term plans to build national capacity to effectively, efficiently
and equitably utilize increased funding.A Macroeconomics and Health process complements
other development instruments, such as Poverty Reduction Strategy Papers (PRSPs) and
Sector-Wide Approaches (SWAps), by ensuring that health system constraints and equity
issues are given proper attention and analysis. Since 2001, many countries have chosen to
follow-up on the Commission’s recommendations by initiating Macroeconomics and Health
activities, which are now being pursued in over thirty countries worldwide.
An important event in the ongoing efforts to highlight the importance of health for poverty
reduction and development took place from 28 to 30 October 2003, when ministers of
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health, finance and planning from 40 developing countries gathered with development
partners at WHO Headquarters in Geneva.The 2nd Consultation on Macroeconomics and
Health,"Increasing Investments in Health Outcomes for the Poor", discussed necessary next
steps for achieving more investment in health and building national capacity to absorb
increased funding.
The WHO-hosted meeting was widely attended by non-health officials, evidence that there is
cross-sectoral recognition of the urgent need for worldwide increase in health investment.
The meeting provided an opportunity for dialogue
among ministers of health, finance and planning
together with development partners. Delegates
demonstrated political commitment to bringing
about lasting strengthening of health systems and
were keen to develop a common understanding of
how countries and their partners can transform
global and national pledges into action, as
documented in the ensuing Consultation
Declaration.
Over the past years, there has been a heightening
focus on improving health as a co-requisite for
poverty alleviation, as developing country governments are committing more resources
towards the achievement of the MDGs.
The country-led Macroeconomics and Health process offers suggestions on how to realize
these goals and helps raise high-level political commitment for more resources to health.The
CMH Report has been instrumental in calling for greatly expanded financial resources to
health, from internal reallocation of resources and from donor funding to fill the financing
gaps.The Macroeconomics and Health process assists countries in tackling their institutional
and systemic constraints and making optimum use of scarce health resources. At the same
time, this process improves coordination with international partners and provides increased
predictability of donor investment.
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A time for action
The 2nd Consultation on Macroeconomics and Health,“Increasing Investments in Health
Outcomes for the Poor”, was held two years after the launch of the 2001 Report of the
Commission on Macroeconomics and
Health (CMH) which recommended that by
2007, donors should increase assistance for
health from the current levels of about
US$ 6 billion per year to US$ 27 billion.
The Commission also called for more
budgetary resources for public health from
developing countries, and more political
and organizational effort than has been
seen in the past decades to achieve real
improvements in health.
The 2nd Consultation followed the 1st
Consultation on Macroeconomics and
Health, held in June 2002, at which several
developing countries agreed to follow-up
on the recommendations of the CMH Report and approved a broad action plan at country
level.
The CMH Report estimated that the
However, a year and half after the June meeting, the world
minimum expenditure for scaling up
still has not increased investment in health to the levels
a set of essential interventions is on
needed to measurably impact major diseases that affect the
average US$ 34 per person per year.
worlds poor. The 2nd Consultation offered an
In many of the world’s poorest countries,
unprecedented opportunity to focus debate and come to a
average total spending for health is about
consensus on the urgent actions needed to improve health
US$ 11 per person per year.
sector performance and provide an enabling environment
through more and better financing.
Over 350 participants attended the Consultation.These included representatives from 27
low-income and 13 middle-income countries as well as 18 major donors, of which 14 were
donor countries and four donor foundations and international banks. Participants included
country representatives from all six regions - Africa, the Americas, Eastern Mediterranean,
Europe, South-East Asia, and the Western Pacific. 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 The New Partnership for Africa’s Development (NEPAD), the
Andean Health Organization (ORAS) and the Commission of African Union, as well as ten
n
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UN organizations, eleven academic institutions and six NGOs, were represented at the
Consultation. See Annex I for the List of Participants.
The Consultation began with a one-day preparatory meeting on 28 October, with high-level
health, finance, and planning policy-makers 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 discussions held during the Ministerial Consultation.
Please see Annex 2 for a detailed Consultation Agenda.
Preparatory meeting sets the stage for
Consultation discussions
In order to prepare the groundwork for the Ministerial Consultation, technical sessions were
held on 28 October, for which participants broke up into the three thematic Working
Groups.The preparatory meeting provided an opportunity
for discussion of issues related to the Consultation's three
main themes:
• How to improve the effectiveness of health delivery
systems and monitor outcomes (Working Group I);
• How to make health central in the country
macroeconomic framework and increase internal
allocation of resources to health (Working Group 2);
• How to make external funding more predictable and
increase coordination with partners (Working Group 3).
These themes were discussed during the Consultation
through presentations and debate between country delegates, expert speakers, and
representatives of development agencies.
Improving the effectiveness and efficiency of health delivery
systems and monitoring outcomes
Working Group I, chaired by Professor Ann Mills of the London School of Hygiene and
Tropical Medicine, provided the opportunity for discussion of how to improve the
effectiveness and efficiency of health delivery systems and monitor 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.
Priority-setting in countries begins with a consensus among major stakeholders to develop a
comprehensive development framework, with agreed upon objectives and sufficient
resources to finance efforts. Political commitment is raised through consistent involvement
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CONSU LTAT ION'
of government and its partners in all aspects of analytical and planning work and
implementation. Before national health priorities can be set effectively, participants felt there
Political commitment across sectors,
strong evidence to set priorities and
monitor outcomes, and a focus on easing
human resource constraints are essential
to improving the effectiveness of
health delivery systems.
must be a realistic assessment of the components of the
health delivery system based on firm evidence.
Governments can proceed by targeting the poorest groups
with priority interventions.When discussing the
components of a more effective health system, countries
agreed that governments must ensure access for the poor
to essential health services.To achieve this goal, human
resource constraints will need to be addressed, and health sector management must be
strengthened. Finally, to develop more effective monitoring mechanisms, countries should
invest in information systems and quality data. Governments will take the lead in
coordinating the development of information systems to avoid duplication, and the private
sector can make its data accessible to the public to ensure that both the public and private
sectors are held accountable for outcomes.
,
Making health central in the macroeconomic framework and
increasing internal allocation of resources to health
Working Group 2 sessions were chaired by Dr Peter Heller, Deputy Director of the Fiscal
Affairs Department at the International Monetary Fund, Mr Alexander Preker, Lead
Economist for Health, Nutrition, and Population at the World Bank, and Mr Pablo Gottret,
Senior Economist in the Human Development Program at the World Bank. Delegates
discussed how to make health central to the macroeconomic policy framework and
increase internal resources to health. Discussions took place around three main areas:
Domestic resource mobilization for health
can come about through reallocation of
expenditures, heightened efficiency in
resource use, and increased revenue
efforts, as well as enhanced public-private
partnerships. Countries need ambitious
goals based on realistic fiscal frameworks.
reviewing multisectoral coordinating mechanisms that can
best ensure the integration of pro-poor health investments
into development plans; identifying options for reallocating
internal resources; and building on private, public and
external partnerships in order to improve the health of the
poor.
To ensure that pro-poor health investments are integrated
into overall development plans, participants noted the
critical importance of involving multiple ministries and sectors in dialogue.This wide
involvement is important to decisions on how to prioritize increase in expenditure across
sectors. Countries must be the drivers of this process, whether by means of PRSPs or other
development initiatives, and they must think creatively about how to achieve ambitious
development goals while at the same time staying within realistic fiscal frameworks. When
discussing how to generate and allocate more domestic resources for health, tax reform
(particularly win-win taxes) and reallocation of expenditures within and outside the health
sector to more efficient purposes were among the ideas proposed. Macroeconomic stability
E
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is also critical to achieving
real economic growth and
thus increasing overall
domestic resources. Finally,
a clear role must be
defined for public-private
partnerships outlining how
they will complement
public sector financing and
provision of health
services. It was noted that for the poorest countries, even the most efficient use of domestic
resources will not be enough, and grants and debt relief will be important sources of
additional external funds. Countries must ensure they are following a pro-poor strategy and
that changing demographics and the rise in non-communicable diseases do not crowd out
spending on health for poor, rural populations.
.
Making external funding more predictable and increasing
coordination with partners
Working Group 3, chaired by Mr Paul Isenman. Head of the Policy Coordination Division at
the Organisation for Economic Co-operation and Development, and Ms Karin Norberg.
Executive Director ofTransparency International, heard how to make external funding more
effective, predictable, and coordinated.The session also heard that recent development
assistance trends and data must be analysed, and ways to
Harmonization of donor procedures and a
more timely translation of donors’
commitments into disbursements are
needed to increase coordination between
developing countries and their partners.
increase funding must be assessed.Total development
assistance for health increased by US$ 1.7 billion between
1999 and 2002, with the largest growth recorded in
HIV/AIDS interventions. Several participants recognized the
impact of the Macroeconomics and Health approach on
this important outcome.
Country participants felt it would be important to make data on external assistance to
developing countries more available and to build national capacity to use those data.They
called for a prompter translation of donor commitments into grants, and increased
predictability of aid flows, since budgetary decisions on use of external assistance are made
on the basis of commitments. Meanwhile, common donor criteria for reporting on health
outcomes need to be identified, and investment should be made to increase in-country
capacity to track, monitor, and evaluate data on national outcomes of investments in health
from external assistance. Countries felt that development assistance needs to focus more on
health systems, as well as on other sectors impacting health and the health-related MDGs.
Finally, participants noted the need for better coordination between national priorities and
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policies and external assistance and highlighted the crucial role that multilateral international
organizations, including WHO, can play.
The three Working Group presentations and discussions inspired extensive and lengthy
debate on the themes of the meeting. At the close of the preparatory meeting, the Chairs
prepared the summaries of the Working Group sessions for presentation to the ministers of
health, planning and finance and donor representatives at the Consultation on the following
day. For the Working Group list of participants please see Annex 3. For a more detailed
description of Working Group outcomes, please see Annex 4. For all Working Group
presentations, please see the event website at:
http://www.who.int/macrohealth/events/health_for_poor/en/ .
Summary ofWorking Group recommendations
Working Group
theme discussions
Working Group recommendations
I. Set national
health priorities
•
Assess the components of the health delivery system
•
Ensure that quality and demand for health care are
sustained
•
Set priorities across sectors that impact health
•
Ensure local delivery systems reach the poorest groups
•
Make data available through strong evidence and
information systems
•
Emphasis on district health planning and monitoring,
analyses of constraints, target vulnerable groups by
building an optimal mix of fixed and outreach services
•
Focus on improving human resources: increase number,
correct maldistribution and improve skills
•
Provide incentives and reward good performance:
promote management capabilities
•
Pursue social mobilization. Improve access and financing
of care by assessing and optimizing roles of local NGOs
•
Invest in information systems and quality data for
monitoring and evaluation
•
Ensure an integrated approach to avoid the creation of
multiple information systems
•
Make access to private sector data and monitoring
outcomes available to ensure accountability at all levels,
including private providers
Theme I
How to
improve
effectiveness of
the health
delivery system
and monitor
outcomes ?
2.
institutional and
organ
constraints and
op
rtunities
3. Monitor
outcomes
2nd
Working Group
theme discussions
MACROECONOMICS AND
HEALTH
CONSULTATION
Working Group recommendations
•
Encourage dialogue between international health
community, ministries of finance and planning, and
I.Integrate
pro-poor health
investment into
national
development
plans
ministries of health
•
Ensure multisectoral approaches (policies to improve
access to education, clean water and sanitation
infrastructure)
•
Countries are the principal drivers in choosing the mix of
government policies for improved health
•
Set ambitious goals and think innovatively on how to
solve challenges
•
Strengthen domestic resource mobilization (tax reform
and increased revenue efforts)
Theme 2
•
Domestic resource mobilization can come about through:
- Reallocation of expenditures from national budget
How to make
health central
in the country
macroeconomic
framework and
increase
internal
allocation of
resources to
health
- Reallocation of expenditures within the health
budget
- Seeking lower cost forms of interventions and
treatment
- Realizing higher efficiency in resource use
•
Promote macroeconomic stability and prevention of
financial crises
•
Ensure government spending is focused on the poor
•
SWAPs and untied budget support can facilitate
maximization of gains from external resources. Good
governance can ensure continued donor support
3. Involvement of
public and
private
partnerships
and external
•
Involve and define a role for the private sector in
financing and provision of health services. Assure that
out-of pocket expenditures maximize health outcomes
and are used for risk-pooling schemes
•
Donors must ensure sustained and predictable external
assistance to support well-formulated programs.The
strong imperative is for donors to finance through grants
/
and debt relief
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MACROECONOMICS AND
Working Group
theme discussions
HEALTH
CONSULTATION
Working Group recommendations
I .The flow of
development
assistance;
Assessing
assistance trends
and how to
increase funding
Theme 3
How to
increase
predictability of
external
funding and
increase
coordination
with partners
3. Realistic
choices for
coordination
with partners
•
Development Assistance for Health has increased since
1998 with the largest growth recorded in HIV/AIDS
interventions
•
Inform countries of both donor disbursements and
commitments. WHO to continue with OECD to put in
place a system to track and monitor the flow of
development assistance
•
Ensure timely translation of donors’ commitments into
disbursements. Identify steps to make aid flows more
predictable and emphasize multilateral assistance and
multi-year commitments
•
Identify common criteria for reporting health outcomes.
The “health metrics” approach was recognized as a
promising mechanism
•
Strengthen national capacity at all levels to track, monitor
and evaluate data on outcomes of investments in health
•
External assistance for health should include analyses of
its potential effectiveness based on existing health
systems; ensure support to build their capacity
•
External resources should not substitute domestic
investment. Macroeconomics frameworks should be
more flexible and sensitive to the need for investment in
health. External assistance for health should be in the
form of grants, less conditional, innovative and follow
government priorities
•
Recipient countries’ priorities should be pro-poor
and transparent and be innovative in promoting public
goods
•
Assistance should support health-related sectors
(education, water and sanitation)
•
Provision of technical assistance to countries by
international organizations, including WHO
•
Ensure harmonization of external assistance and internal
allocation of resources
•
CMH Consultation and similar exercises are useful
mechanisms to facilitate South-to-South information
sharing
Determine what flow of assistance is needed to help
countries meet the MDGs
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The Consultation on
Macroeconomics and Health
On 29 October 2003. Dr LEE Jong-wook, the WHO DirectorGeneral, officially opened the Ministerial Consultation.“Many
countries are implementing the
“The Macroeconomics and Health
approach is an invaluable road map
recommendations of the
Report of the Commission on
guiding national health care systems to
Macroeconomics and Health. Its message was simple: one
reaching the poor and the disadvantaged
of the most effective ways to reduce poverty is to improve
with essential health care services.”
health,” Dr Lee said.
DrTadesse Kebede, Minister of Health of Ethiopia
Delegates heard speeches by Professor Lincoln Chen of
Harvard University, who noted that the world is facing the "double crises" of devastating
diseases overwhelming failing health systems in poor communities. He said that urgent
mobilization of financial and social resources is needed and stressed the importance of
cementing a “new alliance" between public health and finance. Delegates also heard from
Professor Jeffrey Sachs of Columbia University, who stressed that while developing countries
can absorb substantial increases in development assistance, funds fall dramatically short of
meeting countries’ urgent needs. Sachs emphasized that the
“After SARS, health and investment in health
funds required — US$ 27 billion by 2007— are widely
reached the top of China’s agenda. If there is
available in rich nations, and urged developing country
no health, there is no better-off, or Xiaokang,
leaders to request increased assistance for health based on
society. This important Consultation has
provided an opportunity for China to share
experiences with other countries. It has
brought together multiple ministries and
experts and their own Macroeconomic and
Health initiatives.
China’s own strategy for investment for
health will especially address gaps in the
health system that affect its rural areas to
threatening diseases and to poor populations
whose lives must be improved as the country
a realistic assessment of their needs.
Delegates also heard presentations from seven countries
— China, Djibouti, Ethiopia. Ghana, Indonesia. Mozambique
and Sri Lanka — confirming the links between disease and
development and highlighting national efforts to mobilize
resources to reduce disease burden and build health
systems. In particular, countries described heightened high-
level political commitment and analytical work undertaken
as part of the Macroeconomics and Health process and
how these are helping to accelerate existing initiatives in
line with countries' poverty reduction strategies.
advances economically and socially.”
Professor Ann Mills of the London School of Hygiene and
Mr Gao Qiang, Executive Vice-Minister
of Public Health of China
Tropical Medicine focused on human resource constraints
as one of the major impediments to scaling up essential
health interventions. She urged identifying training needs and making health service
employment more attractive to workers in the sector. Dr Heller of the International
Monetary Fund proposed drawing on the private sector and win-win options like tobacco
taxation for mobilizing resources, noting that for the poorest countries, external resources
fFI
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will be necessary. He said, "There is a need to balance realism with ambition, taking a
pragmatic view on how to address key obstacles and bottlenecks to the scaling up of the
delivery of medical care systems."
Mr George Schieber of the World Bank presented evidence that increases in health status
accounted for 17% of increases in productivity gains in countries, underscoring the positive
economic impact of investments in health. He emphasized the need for a pro-poor approach:
"Recent studies suggest that policy makers should focus on sectors, regions and factors of
production dominated by the poor....as there is evidence that improvements in these areas,
as well as lower inflation, lead to both growth and
“Djibouti, being a poor country, is fully
committed to improving the health and
quality of life of its poor people. National
efforts can be greatly facilited through
additional external financial assistance and
progressive redistribution." The World Bank commitment
to health projects is on the rise; in Financial Year 2003 it
will likely provide US$ 1.7 billion for 32 new operations, as
compared with an average of US$ 1.3 billion per year for
22 projects over Financial Years 1998-2002.
debt relief for the social sector,
providing the needed resources for the
pro-poor health sector reform."
Dr Mahmoud All Youssouf, Minister for International
Cooperation, Ministry of Foreign Affairs of Djibouti
Speakers also tackled issues related to donor-driven
priorities and systems. Mr Paul Isenman presented efforts
by the OECD’s Development Assistance Committee to
ensure harmonization of donor procedures, untying of aid,
respect for national priorities, and strengthening of local
capacity. Representing the Bill & Melinda Gates Foundation, Dr Sally Stansfield described
constraints faced by donors and implementation challenges in developing countries, urging
the need for promising innovations. Countries need to show that they can improve health
outcomes with additional assistance, she stated. Finally, Dr Montasser Kamal from the
Canadian International Development Agency expressed support for strengthening health
systems, as this is a way for donors to ensure that investments are sustainable.
After the many presentations, the Consultation concluded with the discussion of a draft
Declaration, which was unanimously endorsed by countries attending the Consultation and
later approved by the four Chairs of the Consultation, the following Ministers:
•
Mrs Sushma Swaraj, Minister for Health and Family Welfare of India
•
Mr Mwesigwa Rukutana, Minister of State for Finance, Ministry of Finance, Planning and
Economic Development of Uganda
•
Mr M.N. Khan, Minister of Health of Pakistan
•
Prof. Eyitayo Lambo, Minister of Health of Nigeria.
By endorsing the Declaration, country leaders pledged to maintain and strengthen political
commitment and inter-ministerial cooperation for addressing macroeconomic- and healthrelated challenges.They called for urgent mobilization of domestic resources for health.
including through increased debt relief, more flexibility in macroeconomic frameworks, and
cautiously-increased taxation.They also stated the need for additional external resources for
in
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health, calling upon donors to expand financing, improve flexibility and predictability of funds,
and fulfil development assistance commitments to health.
In addition, countries concluded by reaffirming their will to continue to prepare and
implement Health Investment Plans with the support of development partners.They pledged
to establish, strengthen and operate appropriate mechanisms for carrying out these plans, as
well as to ensure that they adopt priorities that are pro-poor, to sustain significant increases
in resources allocated to health, and to give a high priority to addressing human resource
constraints.
Finally, country participants discussed presenting the Declaration at the 2004 World Health
Assembly to indicate their strong commitment to its principles and guidelines for action.
They agreed to meet again to review progress and maintain momentum for these important
tasks.
Next steps for Macroeconomic
and Health activities
The commitment and momentum generated by this important meeting must be continued,
and lessons learned must be put into practice. In particular:
Sustaining political commitment: the central place of health in
sustainable development
As countries go forward with analyses and planning for strengthening their health systems.
several key issues need to be considered. High-level
political commitment, as well as heightened collaboration
among multiple ministries, is essential to sustaining
attention to poverty-health linkages and the importance of
investing in health.To maintain this commitment and widen
the circle around health as an investment with major socio
economic returns, continued advocacy and dissemination of
the CMH messages are important.As countries develop
their Health Investment Plans, focus must be on targeting
priority interventions to the poor and achieving measurable results. Human resource
constraints should be given urgent attention.
Mobilizing increased domestic resources
In order to meet the CMH Report's recommended per capita expenditure on health of
US$ 34 on average per year, countries will have to mobilize increased domestic resources
for health.Already, studies have been undertaken in many countries to analyse the efficiency
of resource use and determine how much additional funding is needed and how resources
could be mobilized to fill the gaps. Countries should press for debt forgiveness, increase tax
2nd
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CONSULTATION
revenues and set up equitable mechanisms that reduce or eliminate out-of-pocket payments
by the poor. In particular, there is an urgent need to increase the flexibility of imposed
conditionalities and reduce conditionalities that have been shown to worsen the health of
the poor.
Improving coordination with partners
Additional external resources will be required in many countries to finance health investments.
The significant number of bilateral and multilateral development partners represented at the
Consultation are an important indication of the high level of support for the Macroeconomics
and Health process in countries.While external funding for health has increased in recent years,
more is needed, and there is still work to be done on improving coordination between and
among donors and countries. Development assistance commitments to health must be fulfilled,
procedures harmonized, and country priorities respected.
Extracts from speeches
One of the most effective ways to reduce poverty is to
improve health
“....Collaboration is just as important nationally as it is globally, and is demonstrated by this
extraordinary gathering. I cannot think of another occasion when we have hosted such a
“We will work with International Financing
diverse and influential group.
Institutions and highly-indebted countries to
Many countries are implementing the recommendations of
transfer debts to increased investments for 3
the Report of the Commission on Macroeconomics and
by 5 and other health needs. These other
Health. Its message was simple: one of the most effective
health needs include the fight against TB and
ways to reduce poverty is to improve health.The fatalistic
malaria; the completion of polio eradication;
argument that health was unaffordable for most people was
prevention of tobacco-related and other
noncommunicable diseases; and the
discredited. In robust economic terms the opposite was
shown to be true: it is the neglect of national health
reduction of maternal and child mortality.
systems that is unaffordable. In fact it ruins countries and
Poverty Reduction Strategy Papers provide
communities, probably more effectively than any other
an important opportunity to reflect these
negative force. That argues powerfully for investment in
important health priorities in intersectoral
health infrastructure, human resources and technologies on
approaches to poverty reduction.”
a far larger scale than was previously thought necessary, or
Dr LEE Jong-Wook
even possible.
The global community had already acknowledged this fact
by agreeing to the Millennium Development Goals a year earlier.The welcome increase in
official development assistance for health during the last two years is probably due in part to
this clearer understanding of what is needed. But it is still only a very small fraction of what
is required every year to reach those goals.”
Dr LEE Jong-wook, WHO Director-General
IQ
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The investments in health must be well-designed, well-financed,
and very importantly they must be very ambitious and must
happen very soon
“....The MDGs are about health through and through. One cannot think about poverty
reduction without thinking about improvements in health.That’s why a significant number of
the goals are explicitly about health: reducing the child mortality rate by two thirds by the
year 2015 compared with 1990; reducing the maternal mortality rate by three quarters by
the year 2015; controlling the great pandemic diseases of our time - AIDS, malaria, and TB;
giving access to safe drinking water and sanitation; and alleviating the scourge of hunger. All
of these goals are about improving public health. Moreover, the first MDG, to reduce by half
the proportion of the population in extreme poverty (the so-called 'dollar a day’ poverty) by
the year 2015, cannot conceivably be accomplished if the health goals are not achieved.
People that are sick and dying do not get out of poverty. Children orphaned by AIDS or
other killers do not have much prospect of getting out of poverty in the world that we are
living in.
The investments in health must be well-designed, well-financed, and very importantly, they
must be very ambitious and must happen very soon.There’s no time to lose, whether it’s in
Uganda with its life expectancy of 45 years, where 124 out of 1000 children still die before
the age of 5, or other countries in a similar position.There is no future without getting these
disease burdens under control.The MDGs are more than targets: they provide leverage for
you to use within your publics, your governments and the donor world.
In regards to the question on absorptive capacity, I can firmly tell you as a macroeconomist
that all of your countries can absorb substantial increases of assistance if directed towards
health.This increased assistance will not destabilise countries, but actually give a tremendous
boost to productivity and to the ability to achieve economic growth.”
Professor Jeffrey Sachs, Director of the Earth Institute at Colombia University, USA
A double crisis
"....First, although this is an exciting time for global health - more energy, actors, resources,
public concern, and political engagement - our health world is confronting a divisive and
historically unprecedented "double crises" of devastating
diseases overwhelming failing health systems in the world's
poorest communities. Divergence in health has intensified.
Severe disparities in health are unsustainable,
epidemiologically and morally, in our interdependent world.
Second, massive and sustained action over three decades -
one generation - will be necessary to dampen disease and
build health systems in the poorest countries. Urgent
mobilization of social and financial resources is needed to
KI
curb immediately the spiral of preventable deaths, paving the way for steady improvements
over the longer-run.
“...treating this Consultation like another
Third, success will depend in some measure on a "new
meeting will be a lost opportunity. World
alliance" between public health and public finance -
health is in crisis; both urgent as well as
ministries of finance, planning and health, international
sustained actions are needed. A new alliance
financial and health organizations, and economists and
between public health and public finance
has been stimulated by the Commission on
Macroeconomics and Health and is being
strengthened by these consultations, the only
health professionals.This is not a "love match" but a
"marriage of necessity." Economists and health
professionals live in different worlds: economists are
from Mars, health professionals are from Venus!
global forum of this kind.”
Economists believe in fiscal prudence, health in saving
Dr Lincoln Chen
lives; economists shape behaviour through incentives,
health through the ethics of service. Bridging these
divides and forging alliances among health and finance, I believe, will influence the future of
world health.
Dr Lincoln Chen, Harvard University, USA
The mission of growth and social justice through investing in
health
“...I would like to compliment the vision and leadership of WHO in carrying forward the
mission of growth and social justice through investing in health.The need is for a manifold
increase in investment in health focusing on expanding
access to primary health care, infant and maternal mortality
reduction, controlling communicable diseases and
preventing the increase in lifestyle diseases. It is in this
context that we need to integrate traditional systems of
medicine with our modern systems and have a holistic
approach towards health care. Likewise, motivating doctors
and other health personnel with the right compensation
packages and a sound personnel policy is a critical challenge
that we have to address comprehensively, as it is their functioning that will have a direct
impact on the quality of the health delivery system.The developing countries will have to
increase the allocation of their budgetary and other domestic resources for health in
addition to mobilizing external resources for assuring health security for the poor. We will
have to ensure that the underprivileged sections of the society have affordable access to
medicines and Medicare. Only then will the health delivery systems be meaningful and
effective."
Airs Sushma Swaraj, Minister of Health £ Family Welfare
and Parliamentary Affairs of India
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Bringing finance and health ministers together
"...It is a tremendous opportunity having finance and health ministers together.There are
two ways to provide health care. One is through private insurance, the other, as in Pakistan
and many developing countries, is through the State..."
Mr M.N. Khan, Minister of Health of Pakistan
Mobilizing national resources
“....This meeting is important as African countries will be
sharing views and experiences.There are many aspects to
be considered, such as mobilizing national resources. In
Botswana, we have always had national development plans
that included health. Primary health care is a priority.Today
every person is within IS km of a primary health care
center and receives free treatment. Health care centres
monitor the nutritional status of children under six and provide dietary supplements, and
primary schools provide children with one free meal a day. We are starting to provide free
anti-retroviral treatment."
Mr Baledzi Gaolathe, Minister of Finance of Botswana
Innovative financing for health
"We need to harness every resource we can find.That includes reaching out to the private
sector, trying to achieve better linkages and synergies across borders. We also need to find a
way, instead of just doing business as usual, to really enable innovation, enable people who
are taking risks, enable people who are doing what sounds a little crazy out there, in order
to get the job done. Give them the money. Give them the chance.Test it, make it work. Show
that we’re all willing to innovate. Empower new leaders...” "This chance that we have now,
with additional resources and additional political will, will be gone in just a very few
months....We need to show that we can accelerate coverage, we need to show that we can
improve health outcomes and we need to find a way to share better what works across
borders. And we need to document that development assistance for health really does
change health outcomes."
Dr Sally Stansfield, Bill <S Melinda Gates Foundation, USA
Strengthening health systems in developing countries
"Canada strongly believes that the effectiveness of current partnerships should be measured,
in part, by their impact on strengthening health systems. Strong systems assure the rich
countries that their investment is sustainable and the developing countries can guarantee
that their hard-won gains will continue to be enjoyed by future generations. Canada will
continue to work with its partners to strengthen health systems in developing countries and,
following Canada's five principles of Strengthening Aid Effectiveness, engage in Program-based
and system-wide approaches (SWAps) in the health sector.The five Principles are: local
ownership, results-based approach, improved donor coordination, strong partnership, and
greater coherence."
Dr Montasser Kamal, Chief, UN Health-related Institutions Unit, Canadian
International Development Agency
For some of the full speeches, please visit
http://www.who.int/macrohealth/events/health_for_poor/speeches/en/.
Consultation papers
Several background papers were prepared for the Consultation and distributed to
participants."Macroeconomics and Health:An Update" describes the Macroeconomics and
Health approach, process, and expected outcomes in countries and provides an update of
country Macroeconomics and Health activities.“Macroeconomics and Health in Context:
Background Summary for Participants" is a technical
document that provides information relevant to the
Consultation and the Working Groups.
"Development Assistance for Health: Recent Trends and
Resource Allocation,” by Dr Catherine Michaud of the
Harvard Centre for Population and Development Studies,
shows that the analysis of recent trends of Development
Assistance for Health (DAH) from major donors conveys
mixed messages. While DAH fared much better than other
sectors during the 1990s, at a time when Official
Development Assistance (ODA) plummeted, and political
commitment to improving health for the poor is at a high point, funds still fall short of
meeting real needs.
In "Pro-poor Health Reforms:Why,What and How”, Mr Rajiv Misra, Former Health
Secretary of the Government of India, provides a convincing argument for targeting the poor
in any effort to increase investment in health and implement systemic reforms.
"Links between Macroeconomics and Health: Relevance to the South-East Asian Region" was
prepared by Dr Abusaleh Shariff, Chief Economist and Head of the Human Development
Division at the National Council of Applied Economic Research in India. Dr Shariff analyses
the links between macroeconomics and health in ten countries in the South-East Asian
Region. He reports that health is an essential input to economic development, and that
health spending must be increased in nearly all South-East Asian countries.
Please see Annex 5 for the Consultation papers.
ia
2nd
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World media coverage of the Consultation
The Global Consultation was covered in the press worldwide, as developed and developing
country media tuned in to see the gathering of ministers of
....Countries can be too poor and too
finance, health and planning and development partners to
disadvantaged to grow, no matter how
pledge commitment to increasing investment in health.The
enlightened their policies. Without a
press was also interested in how country follow-up work
healthy population, developed harbours,
was progressing nearly two years after the highly-publicized
roads and other infrastructure, foreign
launch of the Report of the Commission on
investors will stay away. And the poor
Macroeconomics and Health.
people themselves can be too poor to save
Much work went into ensuring that consistent and well-
a dime, if all income gets spent on life's
articulated information was made available to the media
necessities. In sub-Saharan Africa, the cycle
of disease, low domestic savings, poor
infrastructure and no foreign investment
produces self- reinforcing poverty, not
growth.
The Financial Times, 9 November 2004
both before and during the Consultation.Advocacy
materials were prepared and provided, including a press kit
containing the Media Advisory, Fact Sheet, Press Release
(available in English, French and Spanish), and the
Consultation papers. In addition, a variety of advocacy
materials were made available including:The CMH Report,
“Investing in Health: a Summary of the Findings of the
Commission on Macroeconomics and Health", two issues of the MacroHealth Newsletter,
and biographies of Consultation speakers. Please see Annex 6 for the press release,“Health
and Finance Ministers to Address Need for Worldwide Increase in Health Investment.”
An event website was created (www.who.int/macrohealth/events/health_for_poor/en/) to
promote the Consultation and provide event information and documentation.
Press conference
A press conference was held on 29 October 2003. Podium speakers included LEE Jong-
Wook.WHO Director-General; Mr Baledzi Gaolathe, Minister of Finance and Development
Planning of Botswana; and Mr M.N.Khan, Minister of Health of Pakistan. Dr Lee noted the
significance of bringing together at the Global Consultation such a large number of ministers
from different sectors.
Mr Khan emphasized that countries must focus on training human resources, their most
important assets. He also stressed the critical importance of peace for any effort to improve
the health of the poor. He reiterated this at the plenary session, saying,"Peace is a
prerequisite for any kind of programs to be implemented....Where there is peace, instead of
spending billions of dollars on the war machine, we can spend that on the children, on the
women to alleviate poverty and look after their health.” Mr Khan also mentioned public
private partnerships and increased gender equity as key to scaling up essential health
services to the poor.
■ET
Mr Gaolathe stated his commitment to working together with the Minister of Health of
Botswana to address issues like HIV/AIDS. He also emphasized that countries need
additional external resources and have the capacity to absorb them. He noted that NEPAD’s
Health Strategy calls for greatly increased funding for health from both domestic and
external sources.
Articles on the Consultation and Macroeconomics and Health were featured in the Voice of
America News, Jeune Afrique, and The Press Trust of India, among others. Please see Annex 7
for complete media coverage of the Consultation.
Conclusion
Forging a path to increased health investment and stronger,
more equitable health systems
The 2nd Consultation on Macroeconomics and Health reflected high-level commitment
among ministers of finance, planning and health together with international donors,
representatives of civil society and international agencies to accelerate and intensify action in
countries to increase investment in health.They also explored how to make health more
central to the countries' macroeconomic frameworks and increase the efficiency and
effectiveness of health systems.
Country delegates unanimously endorsed the Declaration, and development partners
indicated their strong support for country Macroeconomics and Health work. Now, political
and partner support - particularly funds, policies, and commitment from all stakeholders - is
required to make certain that the principles expressed in the Declaration are integrated into
countries' policy-making processes at the highest levels. It is important to build on the
momentum generated by the Consultation to ensure recognition of the importance of
health for socio-economic development and of the urgent need for action to strengthen
health systems.
At the close of his speech, Professor Lincoln Chen commented, “Make no mistake, treating
this Consultation as just another meeting will be a lost opportunity.World health is in crisis;
both urgent as well as sustained actions are needed. A new alliance between public health
and public finance has been stimulated by the Commission on Macroeconomics and Health
and is being strengthened by these consultations, the only global forum of this kind.As
demonstrated by history, these conferences can build the political will, negotiate the
consensus, cement the trust, and forge the clarity of purpose for jump-starting urgent
action."
Dr Kirsten Leitner, Assistant Director-General for WHO Sustainable Development and
Healthy Environments cluster, emphasized the importance of sustaining the momentum and
enthusiasm engendered by the Consultation. She closed the final session; "Now we need
staying power."
2nd
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Increasing investments in health
outcomes for the poor
2nd
M AC R OEC 6 N 6 M I C S A N D
H EA LTH
CO NS U LT AT I ON
Declaration
The 2nd Macroeconomics and Health Consultation
Increasing Investments in Health Outcomes for the Poor
World Health Organization
Geneva, Switzerland - October 28-30, 2003
1 Angola. Argentina. Azerbaijan,
Preamble
‘
Bangladesh. Bhutan. Botswana. Brazil,
Cambodia. China (People's Republic of),
We, the 40 participating countries' of the 2nd Macroeconomics and Health Consultation,
Congo. Djibouti. Estonia, Ethiopia.
Ghana. Haiti. India, Indonesia. Iran
have had an important opportunity for dialogue among our Ministries of Health, Finance and
(Islamic Republic of),Jordan. Kenya.
Malawi, Mexico. Mozambique, Myanmar,
Nepal. Nicaragua, Nigeria. Pakistan. Peru,
Philippines. Rwanda. Senegal. South
agencies2. Sharing of experiences during this 2nd Consultation has been beneficial, and will be
Africa, Sri Lanka. Sudan.Thailand.
Uganda. United Republic ofTanzama.Viet
instrumental in helping us identify effective ways to address common global challenges with
Nam.Yemen
’The international agencies present at
the Consultation included: the
International Monetary Fund (IMF), the
Organisauon for Economic Co
Planning together with bilateral donors, representatives of civil society and international
regard to health, poverty reduction and economic development
Mindful of the United Nations Millennium Development Goals, the Global Strategy for
Health for All in the 21st Century, the Monterrey Consensus on Financing for Development,
operation and Development (OECD),
the United Nations Development
Programme (UNDP), the Joint United
Nauons Programme on HIV/AIDS
(UNAIDS), the United Nations
Children's Fund (UNICEF), the United
Nations Conference on Trade and
and the Johannesburg Declaration on Sustainable Development, we wish to record and
resolve the following:
Whereas we note that :
Development (UNCTAD), the United
Nations Environment Programme
(UNEP), the United Nations Population
Fund (UNFPA), the Food and Agriculture
Organization of the United Nations
(FAO), the International Labour
Organization (ILO) and the World Bank
■ establishing and strengthening peace in the world in general, and in our regions in
particular, is essential, as without peace and harmony there can be no hope of successful
implementation of the recommendations made at the Consultation;
Sub-regional Entities included: the
Andean Health Agency (ORAS). the
Asian Development Bank (ADB). the
Caribbean Community (CARICOM). the
Commission of the African Union (UA).
the Inter-European Parliamentary Forum
■ the reports of the Commission on Macroeconomics and Health and its six Working
Groups highlight the opportunity and knowledge that now enable significant
improvements in health, contributing to poverty alleviation and economic growth;
on Population and Development, the
New Partnership for Africa's
■ the UN Millennium Development Goals (MDGs) set challenging, specific targets requiring
Development (NEPAD). the United
Nations Economic Commission for
urgent action and international cooperation for their achievement;
Africa (UNECA).and the United
Nations Economic and Social
Commission for Asia and the Pacific
(UNESCAP).The participating countries.
bilateral development cooperation
agencies, international funds and
partnerships, organizations representing
civil society, and foundations are
Included in the list of participants
(www.who.int/macrohealth/events/health
_for_poor).
■ the WHO has declared a global health emergency and committed itself to the goal of "3
by 5” - to get 3 million people in developing countries on anti-retroviral treatment by
the end of 2005;
■ the Ottawa meeting further defined the work that the development community should
undertake to progress toward the MDGs and ensure their rr
£ -JOO
____
0847b
[2nd
MACROECONOMICS AND
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CONSULTATION
■ regional and sub-regional initiatives, such as those being developed by the Andean Health
Agency, the Caribbean Community and the New Partnership for Africa’s Development,
are a welcome development and are providing further impetus to country and inter
country approaches to macroeconomics and health;
■ the 2nd Consultation on Macroeconomics and Health has helped to delineate the range
of issues to be addressed to enable progress on the MDGs and to accelerate reduction
of poverty caused by and contributing to ill health;
■ the Consultation has facilitated discussion among Ministries of Planning. Finance and
Health to address the dual crises of a crushing burden of disease and failing health
systems;
■ the three themes of the meeting were reviewed by Working Groups and reports were
presented by their Chairs.The following main points were noted by country delegations
during the Consultation:
Theme k Effectiveness of Delivery Systems and Monitoring of
Outcomes
■ political commitment by all parties is fundamental to progress toward the MDGs and to
successful implementation of the CMH vision, and requires Finance, Health and Planning
Ministries to collaborate at all levels to create an environment of sustained attention to
the challenges linking macroeconomy and health;
■ the CMH Report follow-up has helped countries and sub-regions to develop their own
political, financial, economic and health strategies, and the process should be continued;
■ good governance is critical throughout and every effort needs to be made to promote
transparency, accountability and efficiency;
■ advocacy of the value of health and its importance to economic growth and
poverty
alleviation is a core part of the process;
■ a multi-sectoral approach beyond the health sector, taking into account water and
sanitation and education with due attention paid to gender issues, is necessary and
requires appropriate coordinating mechanisms;
■ the private and voluntary sectors may be critical for positive solutions in many countries,
not least for the important processes of social mobilization;
■ focus has to be on results, emphasizing improved access to health services and better
outcomes for the poor, and including greater access to essential and generic drugs,
strengthened health systems and better management;
■ improved research and analysis capabilities must provide the foundations for the national
Health Investment Plans;
■ lifting of human resource constraints is critical for improving performance of the health
system and deserves urgent attention.These constraints are linked to conditions of
service, training, and remuneration, and will fundamentally determine capacities for
sustained improvement in health services.
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Theme 2: Health in the Macroeconomic Framework and
Allocation of Resources
■ the burden of debt for some countries, including both those under the Heavily Indebted
Poor Countries Initiative (HIPC) and non-HIPC countries, disrupts the provision of
health services and must therefore be reduced with appropriate debt relief grants to
safeguard public health and protect vulnerable people;
■ domestic and international economic crises can have catastrophic health consequences
for the most vulnerable, and therefore special attention to health is required in the
negotiations to resolve the crises;
□ at the national and international level, there is an urgent need for more flexibility in
macroeconomic frameworks to respond to adverse economic shocks, including
contingent spending plans to handle possible large supplementary inflows for health from
global funds to avoid harm to the health of poor people, especially children;
■ countries must evolve appropriate strategies based on realistic assessment of how health
systems function currently and must press vigorously for additional grants for health to
the extent required for improving their performance;
□ while increased tax revenues along with reallocation of subsidies may be necessary, other
innovative approaches to mobilizing additional domestic resources for health should be
considered; however, taxation of tobacco is of high priority as a resource for health;
■ linkages and mutual accountability will be required across global initiatives and
partnerships aimed at better health for the poor, including further work on
harmonization, policy coherence and scaling up to reach the MDGs.
Theme 3: Predictability of External Funding and Increased
Coordination
■ additional investments, from both domestic resources and external grants, will be
required to finance health investments, including strengthening infrastructure and human
resources, pursuing system reforms, and scaling up of essential health interventions;
■ the international agencies and the donor community must further expand their financing
for health, and support health within the framework of national poverty reduction
strategies and as part of debt relief arrangements;
■ at the country level, urgent and continuing efforts must be made to improve absorptive
capacities for increased funding, and donors must be willing to finance associated costs to
improve both the effectiveness and efficiency of resource use;
■ the international agencies and the donor community must improve flexibility and
predictability in the provision of external resources, harmonize their procedures and
reporting requirements and respect country priorities;
■ development assistance commitments to health must be fulfilled, with monitoring of the
commitments and annual disbursements thereof by low and middle-income countries and
with the assistance of external partners such as the WHO and OECD;
2 nd
MA CR O ECO N OMI C S A N D
H E A LT H
C ONSU LT AT ION
■ in line with the CMH Report recommendations, middle-income countries will develop
approaches tailored to their specific needs; low, middle-income countries will need
additional external funding, mainly to cover the high cost of HIV/AIDS.
We have therefore concluded that:
■ countries should continue to be encouraged and supported to prepare and implement
Investment Plans to accomplish the CMH recommendations consistent with the core
themes of the Macroeconomics and Health work:
i.
Investing in the health of the poor.
ii.
Ensuring more resources for health overall, from all sources and with greater
efficiency and impact.
iii.
Lifting the non-financial and systemic constraints to effectively use additional
investments in health.
We request the WHO, working with the international and
bilateral agencies, to:
■
continue dissemination of the messages of the CMH;
■ make necessary arrangements to support countries and sub-regional partnerships that
have already established mechanisms to prepare their Investment Plans and help
countries that have not yet begun their efforts, with the support and involvement of the
international community;
■ assist countries and sub-regional partnerships in securing financing for both further
preparation and implementation of their Investment Plans;
■ continue to provide technical cooperation to countries and sub-regions for their plans in
coordination with other agencies.
And, we will:
■ establish, strengthen and operate appropriate national and sub-regional mechanisms for
development of our specific national Health Investment Plans and orient priorities
toward pro-poor approaches, including approaches within poverty reduction strategies;
■ give the highest attention within our Investment Plans to capacity building, leadership
skills and incentives for retention and utilization of skilled human resources, bearing in
mind that human resource constraints constitute the main impediment to progress.
Mindful of the serious challenges ahead and the compelling need
for rapid action, we conclude these Consultations and look to the
progress to be reported in our next meeting.
World Health Organization
20 Avenue Appia - CH-1211 Geneva 27 - Switzerland
www.who.int
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