The work thus far
In June 2002, the 1st Consultation on National Responses to the Report of the Commission on Macroeconomics and Health (CMH) was convened in Geneva. Representatives from ministries of health, finance and planning from 20 countries came together to translate the recommendations of the CMH Report into concrete actions at the country level towards achieving the Millennium Development Goals (MDGs). The Consultation positioned WHO, inter alia, to support these efforts in countries and to provide opportunities for periodic consultations on the impact of the Macroeconomics and Health (MH) process.
WHO has responded by establishing a Coordination of Macroeconomics and Health (CMH) Support Unit that assists interested countries to analyse their health policies and create fiscally sound strategies. The Support Unit works with WHO and its partners to:
- help align macroeconomic growth goals towards reducing poverty and improving the health outcomes of vulnerable groups; and
- support the aims of sustainable growth and development by integrating MH into PRSPs, achievement of MDGs and other national development agendas.
A series of Consultations at the regional level provided countries the forum to share approaches and successes in the MH process. The 2nd Consultation on Macroeconomics and Health, "Increasing Investments in Health Outcomes for the Poor" (October 2003, Geneva), furthered the momentum of the countries. Discussion among ministers of health, planning, and finance, bilateral and multilateral partners, and financing institutions contributed to further focus MH work on improving access to health care and on innovative solutions to address the obstacles that hinder efficient use of financial resources. As expressed in the meeting declaration (see Annex 2), countries identified resource mobilization options, human resource constraints, and the harmonization of donor funding as key issues.
In the two years since the CMH Report was published, approximately 40 countries have taken steps to act on its recommendations with ongoing support by all levels of WHO. The work has been driven by three overarching themes:
- Develop a multisectoral investment plan to improve health outcomes, especially among poor people;
- Strengthen commitments to increased financial investments in the health plan to achieve MDGs and other national goals; and
- Determine how to minimize non-financial constraints to the absorption of greater investments by increasing efficiency and effectiveness.
Given the diversity of health, economic and social situations, efforts to place health in the macroeconomics context must accommodate the health priorities, opportunities and obstacles unique to each country. Specifically, governments are assessing their health priorities and evaluating the cost of providing necessary interventions to the poor, in light of the financing mechanisms available internally and externally and the constraints experienced within the system. Substantial progress is being achieved in many countries that have initiated the CMH follow-up work, which includes advocating for the central role of health in sustainable development, establishing alliances and developing focused economic analyses. The work has demanded a multi-sectoral approach. Implementation must take into account the cross-sectoral interaction of risk factors for disease. Without the complementary improvement of other sectors such as education, water and sanitation, and environment, countries will be unable to optimize investments in health or achieve national health objectives.
In summary, countries have built on existing mechanisms for health investment and policy and systems reform and have used the macroeconomics process to make these activities more central to poverty reduction and economic growth. During the process of developing a long-term Health Investment Plan, several key opportunities and outcomes have emerged within the countries:
- A process to identify and promote country health priorities and health-related MDGs
- The establishment of a cross-sectoral mechanism to further promote priorities and to negotiate and collaborate with bilateral and multilateral partners and donors
- A move to directed evaluations of health financing and resource mobilization options specific to the country social and economic context
- A vehicle to insert health more strongly into PRSPs and other poverty reduction instruments.