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

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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

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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)

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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.

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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

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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

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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:

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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

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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.

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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

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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.

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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

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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

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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