No. 10, August 2004
COUNTRY ACTION ..... COUNTRY ACTION
Assessing the Macroeconomics and Health situation in Senegal
A consultant from the Royal Tropical Institute (KIT) in Amsterdam has conducted a Macroeconomics and Health situation analysis to support the work towards development of a Health Investment Plan in Senegal. The analysis looked at the poverty and health situation, including how Senegal's National Health Plan (PDIS) could be strengthened. Despite the lack of health data disaggregated by income, it was found that poverty and health problems follow a similar geographical pattern. The analysis also examined financing for health and found that health is underrepresented in the PRSP and government budget. In recent years, health's share of the government budget has declined relative to other areas. Absorption capacity of the health sector was identified as an important challenge. The main constraints to more effectively and efficiently use funds include human resource issues, including insufficient numbers, urban concentration, and motivation, management procedures, donor procedures, information management and monitoring. Another challenge highlighted was weak inter-sectoral collaboration. Opportunities were identified to mobilize increased funding for health and reach poverty pockets more effectively, including public-private partnerships and insurance schemes.
Discussions about future work found that Macroeconomics and Health is a strong advocacy tool for increased investment in health for the poor and improving health financing. Country-specific assessments and recommendations on how to improve overall health financing and targeting the poor to improve health outcomes should be conducted. MH also provides the opportunity to strengthen dialogue between ministries. The results of the analysis supported by KIT will feed into Senegal's Health Investment Plan.
Macroeconomics and Health work progresses in the Caribbean
The MH mechanism in the Caribbean, the Caribbean Commission on Health and Development, has commissioned nine technical Working Papers examining health and macroeconomic issues in the countries of the region, including a health situation analysis and an economic situation analysis. Other papers address poverty and health; health as an asset for returns to foreign direct investment, tourism, trade, and trade in health services; health as a regional public good; capacity of health services; and HIV/AIDS. There are also two papers on external causes, including injuries, and chronic non-communicable diseases and mental health, areas in which the Commission has expressed strong interest. These Working Papers will input into the final Report of the Commission, to be presented to the CARICOM Council on Human and Social Development (COHSOD) and the Heads of Government.
On 3-4 June 2004, drafts of these Working Papers were presented at a Technical Consultation chaired by Sir George Alleyne, Chairman of the Commission. To date, the focus of MH work has been building partnerships and linkages with experts and planning analytical work. Following this meeting, the Commission intends to step up efforts to increase national involvement in the MH process, beginning with a planned series of Policy Round Tables.
The Caribbean Commission on Health and Development was launched in September 2003, with the responsibility of providing guidelines for action to increase investment in health in the 15 countries of the Caribbean Community.
Pakistan pursues Macroeconomics and Health work
Pakistan's national MH mechanism is pursuing analytical and advocacy work to provide evidence and momentum for developing pro-poor national health policies. The national Commission is studying the effect on health services delivery of the Devolution Plan, which the government of Pakistan has undertaken as part of its efforts to decentralize and delegate more authority to the district level. In April 2004, a national training course on Macroeconomics and Health was held for policy-makers. Participants included officials of the federal Ministries of Health, Finance, and Planning, as well as representatives from provincial governments. In addition, a national report on Macroeconomics and Health has been commissioned to examine the health and macroeconomic situation in Pakistan. It examines key issues that need to be addressed, such as human resource constraints, intersectoral action, and clarifying provincial and district responsibilities under the new decentralized system. It also looks at ways to increase funding for the health sector.
Pakistan's national Commission is disseminating CMH documents to advocate for increased high-level attention to health. Plans are underway to translate several documents into the Urdu language for distribution at the district level.
Joint work moves ahead in Sudan
The CMH Support Unit is coordinating its efforts with WHO's MDGs, Health and Development Policy department in Sudan. In early 2004, a joint mission from the two departments met with stakeholders to discuss how health planning in post-conflict Sudan can integrate with the Interim PRSP and map a route to achievement of the health-related MDGs, and how MH work can support this process.
A recent report entitled "A Status Report on Macroeconomics and Health Sector in Sudan", commissioned from consultant Abusaleh Shariff as part of MH work, says that as peace returns to Sudan and stable economic growth continues, the government can expect a high return from well-planned investments in the health sector. The report emphasizes the importance of addressing cross-sectoral risk factors for poor health, including water and sanitation, nutrition, and education. There is a need for a defined package of priority services to be provided through a network of grassroots health workers across Sudan. Possible sources of funding are examined, and the proper formula for spending between the federal and state governments and donors and among sub-sectors of the health sector is proposed. In particular, there is a strong imperative for public spending to be directed primarily toward primary care for rural populations, with particular emphasis on preventive health. Finally, the report identifies ways to increase absorption capacity of the health system over a period of six years.
The report also outlines issues to consider when designing the PRSP, including ensuring community participation, particularly of women; improved incentives for health workers; linking strategic objectives with available funding; appropriate decentralization, considering the different realities between the North and South of the country ; economic growth and governance, including developing a prudent policy for the use and export of oil; and strategies and principles for sharing oil revenues between the federal and state governments.
More Country Updates in the next issue of the MacroHealth Newsletter...
57th Annual DPI/NGO Conference: Millennium Development Goals: Civil Society Takes Action: New York, NY, 8 – 10 September 2004. Annual conference of all the NGOs accredited to the United Nations. For more information please visit:
Regional Conference on Cost-Effective Healthcare 2004: Singapore, 21 – 23 October 2004. Organized by Singapore General Hospital Post-Graduate Medical Institute, the event will include pre-conference workshops on Pharmacoeconomics and Cost-effectiveness Analysis. For more information please visit:
Global Forum for Health Research Annual Meeting: Forum 8: Mexico City, 6 –10 November 2004. This year's programme will focus on global efforts to expand health research in neglected areas to support achievement of the Millennium Development Goals. Attention will also be given to health priorities not covered by the Goals. For more information please visit :
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