Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 13, April/May 2005


A number of high-profile health and development events took place in March. Senior officials from donor agencies and partner countries came together in Paris to begin the process of adding targets and indicators to their efforts to improve aid effectiveness. Later in the month, the Commission for Africa released its report calling for a comprehensive package and a new kind of partnership for Africa, while the WHO Commission on Social Determinants of Health was launched and has embarked on its three year mandate to address the "causes behind the causes" of ill health. The release of the UN Secretary General's progress report on implementation of the Millennium Declaration also made headlines in March. Finally, the CMH Executive Secretary participated in a donor seminar where he discussed options towards improved management of health resources, based on M&H experiences in countries. In publications news, the report of the April 2004 Asian Civil Society Conference on Macroeconomics and Health is now available in French and Chinese, on the M&H website.

High-Level Forum establishes targets and indicators for aid effectiveness

From 28 February to 2 March 2005, senior officials from donor agencies and developed and developing countries came together in Paris at the High Level Forum on Joint Progress towards Enhanced Aid Effectiveness. They committed to a practical blueprint towards greater country ownership of development plans, donor harmonization and alignment, managing resources and improved decision-making for results and mutual accountability.

This plan, contained in the Paris Declaration on Aid Effectiveness, establishes a number of Partnership Commitments, 12 specific indicators that will be used to measure progress, and five preliminary targets to track progress, including that by 2010: 75% of aid disbursed according to agreed schedules is released on time; 85% of aid is reported on budgets; and at least 25% of aid is provided in the form of programme-based approaches. For their part, developing countries agreed to articulate national development strategies that have clear strategic priorities and are linked to medium-term expenditure frameworks and reflected in annual budgets, and to develop results-oriented monitoring frameworks (75% of partner countries to have these in place by 2010). Targets relating to seven other indicators are being developed during 2005, and will be finalized and completed at the United Nations General Assembly Summit in September 2005, which will review progress towards the MDGs since the 2000 Millennium Declaration. These cover issues including the percentage of untied aid, use of country systems, and reductions in the use of parallel implementation structures such as Project Implementation Units.

The meeting in Paris follows on from the February 2003 High-Level Forum on Harmonisation in Rome. For more information, please see

Commission Report calls for a comprehensive package to tackle poverty in Africa

The Commission for Africa released its final report entitled "Our Common Interest" in March 2005, calling for a comprehensive package to tackle poverty in Africa with responsibilities for both African countries and the developed world. The report argues that capacity and accountability are two critical areas of weakness. Developed countries must invest in building national capacity and can support improved governance, for example by helping build accountable budgetary processes and imposing penalties for bribery by foreign firms. The report emphasizes that its recommendations cannot be achieved in isolation; a "big push" is needed on many fronts at once, such as peace and security, economic growth, and trade. In order to finance this package, the Commission proposed that an additional US$ 75 billion per year is needed, with African countries providing about one-third and donors about two-thirds of this amount.

In the health sector, the report suggests that governments should increase resources and donors should provide massive increases in funding to support one nationally owned strategy in each country, towards easing constraints related to harmonization, predictability of funding, and respect for country priorities. The report aims to demonstrate that if the recommendations are followed, African countries have the capacity to absorb the suggested increase in resources and will be able to accelerate progress towards achievement of the MDGs.

The Commission recommends that African governments should invest in rebuilding systems to deliver public health services, and that donors should provide an additional US$ 7 billion over five years for this, behind the Health Strategy and Initial Programme of Action of the African Union's NEPAD programme. In addition, donors and African governments should invest in training and retention to ensure there are an additional one million health workers by 2015. The report recommends that African governments should meet their commitment, contained in the 2000 Abuja Declaration, to allocate 15% of annual budgets to health, while donors make up the shortfall by providing US$ 20 billion per year to support Africa's health services and an extra US$ 10 billion per year for HIV/AIDS, provided predominantly through national budgets.

The Commission for Africa was launched by the British Prime Minister Tony Blair in February 2004 and was charged with producing clear recommendations on development in Africa for the G8, European Union and other wealthy countries as well as for African countries. For more information, please see

WHO Commission on Social Determinants of Health launched in Chile

On 18 March 2005, the President of Chile His Excellency Mr Ricardo Lagos Escobar and the WHO Director-General Dr LEE Jong-wook launched the Commission on Social Determinants of Health in Santiago, Chile. The Commission is charged with recommending interventions and policies to improve health and narrow health inequalities through action on social determinants. The Commission will work over a period of three years from March 2005 to identify, evaluate, adapt and distribute effective strategies to address social determinants, with the aim of supporting governments to scale up interventions. Social determinants of health have been defined to include poverty, social exclusion, and unsafe employment conditions, as well as lack of quality health systems. The Commission, chaired by Sir Michael Marmot, is composed of 17 global experts on health, education, housing and economics.

Linkages between the Commission on Social Determinants and Macroeconomics and Health follow-up work were highlighted in the January 2005 issue of the MacroHealth Newsletter. The CSDH will build on existing efforts towards better health and greater health equity, and will work with national authorities to incorporate social determinants approaches into efforts to meet the MDGs. For more information please see

UN Secretary-General's report calls for action at September Summit

In March 2005, the United Nations Secretary-General Kofi Annan presented his report, "In Larger Freedom: Towards Development, Security and Human Rights for All" to the UN General Assembly, calling on leaders to adopt a package of specific, concrete decisions this year to tackle the challenges of development, security and human rights. This report assesses progress on implementation of the Millennium Declaration five years after its adoption and is intended to lay the groundwork for decisions at the upcoming summit of world leaders at the UN in September 2005.

In the area of development, key proposals include that developing countries should adopt a comprehensive national strategy to reach the MDGs by 2015 and provide necessary domestic resources. In addition, developing countries are asked to strengthen governance, combat corruption, and promote private sector-led growth. Developed countries are asked to support these efforts through increased development assistance, a new development-oriented trade round and debt relief. The report also includes recommendations for changes within the UN to enable it to better respond to the challenges outlined in the report.

For more information, please see

Financing global public goods and the CMH experience

The CMH Executive Secretary, Sergio Spinaci, addressed policy-makers and development experts at a seminar organized by the French Minister for Economic Affairs, Finance and Industry and the French Minister-delegate for Cooperation, Development and the French-Speaking Countries in late March 2005. The seminar, entitled "Development and global public goods: which resources?", was intended to clarify issues related to increased and more effective financing for development, including proposals for international taxation and the International Finance Facility (IFF), in preparation for several important events in 2005, a critical year for the MDGs. The CMH presentation, which was very well received as being complementary to the discussion on financing mechanisms, focused on the necessity of scaling up to the district level and on allocation of aid through national budgets.

French, Chinese versions of WHO Asian Civil Society Conference on MH Report

French and Chinese versions of the Report of the April 2004 WHO Asian Civil Society Conference on Macroeconomics and Health are available on the Macroeconomics and Health website at The Asian Civil Society Conference on Macroeconomics and Health brought together local and international non-governmental organizations (NGOs) with activities in WHO's South-East Asia and the Western Pacific regions. In the unanimous consensus statement, included in the report, participants committed themselves to participate in national MH processes and asked their governments to ensure full involvement of civil society and NGOs.