No. 13, April/May 2005
A recently-completed Public Expenditure Review of the Health Sector and an estimate of the costs of reaching the MDGs in Yemen, both supported by the work of M&H and development partners, have contributed to momentum towards reformulation of Yemen's 1998 Health Sector Reform Strategy.
Towards a review of Yemen's Health Sector Reform Strategy
A recently-completed Public Expenditure Review of the Health Sector in Yemen for 1999-2003 identifies the need for a comprehensive plan for the health sector with more effective donor support, to which work by the Millennium Project, M&H work, and other health and development initiatives are contributing.
The Public Expenditure Review found that in recent years, progress has been achieved towards improving both population health and the health care delivery system in Yemen, however there are a number of continuing challenges related to health sector planning, budgeting and implementation.
In 1998, the Ministry of Public Health and Population initiated the Health Sector Reform Strategy, which included decentralization plans, redefinition of the role of the public sector, an essential drugs policy and encouragement of responsible participation by the private sector and NGOs. However, there was not a sufficient consensus among stakeholders on how to implement this strategy, nor was it incorporated into the Five-Year Health Development Plans.
Based on the available health data in Yemen, in March 2005 a health economist from the Royal Tropical Institute (KIT), with technical support from WHO and the United Nations Population Fund, provided an initial estimate of the cost of reaching the health MDGs of US$ 52 per capita. However, since this estimate does not include the full cost of health systems development, it seems that the estimate of US$ 60 per capita, provided by the Evidence and Information for Policy department at WHO, is closer to real needs. The costing exercise, which will continue using the lower cost scenario, will be more closely linked to the five-year health sector planning and with development of health financing strategies.
The process in Yemen has shown that before estimating costs, it is crucial to prioritize and reach consensus on health strategies, select interventions and investments in health systems, and set targets and scenarios. This process can be guided by the WHO country office in the absence of institutional capacity in the Ministry of Health. In addition, discussions are needed with national health sector programmes to collect useful data on the costs of various interventions and investments in health systems and to link it with the national budgeting process.
Given the need for increased focus on health systems issues, the WHO country office supported the formation of a sub-working group on health systems within the Ministry of Public Health and Population of Yemen, and discussions on health sector reform and planning have been re-launched on the political agenda. The Ministry of Public Health and Population envisage a reformulation of the 1998 Health Sector Reform strategy by June 2005. The revised Health Sector Reform strategy should result in a Five- Year Health Plan (2006-2010) and will be aligned with national development plans.