How countries are moving forward
Achievements to date
1) Fostering high-level political support
Copies of the report and background papers, translated into multiple languages, have been widely distributed for country review. Many countries (e.g. Ghana, India, and China) held national workshops with essential stakeholders to assess how to incorporate CMH findings into national development strategies. Several countries initiated the MH process through a national launch event, allowing important government officials and other high-profile participants to express publicly their support of the MH process. For example, in India, the Indian National CMH was launched in January 2003 with a keynote address by Dr Jeffrey Sachs of Columbia University. In Sri Lanka, a Macroeconomics and Health event led by the National Health Council and chaired by the Prime Minister resulted in the establishment of a National Commission on Macroeconomics and Health (NCMH).
WHO products
- Technical support for advocacy tools, national workshops, and consultations to secure commitment from politicians and policy-makers. IEC (Information, Education, Communication) products include an "Investing In Health" information booklet, an electronic newsletter and the MH website (http://www.who.int/macrohealth). These maintain support, help disseminate experiences to date and inform additional stakeholders (e.g., development partners, donors, etc.) of progress.
- Seed funds to catalyse and promote a national launch and other activities aimed at securing broad-based support and national commitment.
2) Establishment of high-level national MH mechanism
National cross-sectoral mechanisms support the MH process, usually by expanding the scope of existing coordinating bodies. Occasionally, a national MH commission is established if no better mechanism exists (e.g. Ghana, India and Nepal). Comprised of representatives from multiple ministries including health and finance, the structure of the mechanism is country-dependant. For example, Sri Lanka’s NCMH includes representatives from various ministries, the WHO Country Office, UNDP, the private sector and academia. The Commission is co-chaired by the Minister of Health, Nutrition and Welfare and the Minister of Rural Economy and Deputy Minister of Finance. A different structure exists in Ethiopia. Their MH coordination is provided by a newly hired Macroeconomics and Health Country Coordinator (an Ethiopian economist) and by a Technical Working Group operating under the Ministry of Health.
WHO products
- Technical guidelines to design Terms of Reference (ToRs) for domestic MH coordinating mechanisms, with provision of case examples of other countries' coordinating efforts.
- Support to identify and place an in-country focal point, when requested by the country.
- Seed funding to establish the national MH mechanism.
3) Development of outcome-oriented workplans
Linked to a budget and timeline, this plan outlines the activities, outputs, and objectives unique to a country’s strategic plan. It includes the identification of resources and support needed to carry out the described activities. These preparatory work plans pave the way for development of the Health Investment Plan.
WHO products
- Mobilize technical and financial resources necessary for the development and implementation of a realistic and outcome-oriented work plan, budget and timeline.
- Guidelines, templates and outlines to help countries assess gaps in technical expertise they will need for policy development and planning.
- WHO, especially regional focal points, identifies and places local experts by collaborating with universities and regional and national NGOs, and by the selected use of international consultants. Over 21 countries have participated in regional technical meetings, with many also receiving in-country follow-up visits by technical experts.
- Regional workshops to assist country progression, share country experiences and lessons learnt, and develop specific strategies to create and fully implement a plan for investing in health.
4) Assessment of health situation and analysis of health infrastructure
Several countries, including Indonesia and Sri Lanka, have produced country concept papers to adapt the findings to local health, economic and political situations. These concept papers are an initial assessment of the health and health delivery structures of the country.
Countries, in this phase, execute an in-depth epidemiological survey of the causes and risks associated with morbidity and mortality, disaggregated by income level, ensuring that the conditions most impacting the poor will be targeted. Also, an analysis of the capacity of current health systems to absorb additional funding and assessment of funding gaps for scaling-up of the current health infrastructure and services to the poor is finalized. This provides a basis for sequencing and prioritization of targeted health investments. Indonesia, for example, received funds to prepare an assessment of public health expenditures aimed at assessing the poverty reduction impact of current and proposed spending patterns. In this planning stage, countries are identifying the need for experts and institutional technical support to perform such analyses. Technical experts are recruited to assist countries in planning and executing the necessary assessments and analyses. Technical experts will also assist countries in developing important linkages with local and regional partners, such as representatives from the World Bank and NGOs.
WHO products
- Mobilise and coordinate technical support for environmental scanning and the identification of key stakeholders and socioeconomic factors.
- Fund selected research, as well as aid countries to create ToRs for technical and research groups.
- Develop and maintain relationships with academic and development partners to assist in analyses and evaluation at the country level.
- The Earth Institute at Columbia University and the Royal Tropical Institute (KIT) are supporting specific assessment activities in several countries, as well as helping define ways countries can strengthen institutional research and analytical capacity.
5) Development of a Health Investment Plan
Countries will develop investment strategies based on the assessment of options and determine a package of high-priority, cost-effective interventions. A costing analysis of the selected interventions will ensure a sound evidence base on which to develop a long-term Health Investment Plan. Governments are working to foster and sustain cross-sectoral support for the Health Investment Plan. An important management element will be putting into place an internal mechanism for tracking of key outcomes.
WHO products
- Continue to develop and access a pool of experts who can address countries’ research needs (e.g., economics, epidemiology, health services research, etc.)
- Will collaborate with countries to identify key economic and health indicators, including health-related MDGs and country-specific health goals (i.e. Healthy Indonesia 2010), by which to track the effectiveness and impact of the investment plan.
- Assist countries in building linkages with development partners, NGOs, donors, and academic institutions to sustain support and integration with ongoing poverty reduction plans and public health projects.
The next section will give some examples of the varied paths to the MDGs being built by countries employing a Macroeconomics and Health Strategy.