Special Issue No. 7: Consultation on Macroeconomics and Health: December 2003
London School of Hygiene and Tropical Medicine on improving the effectiveness of the health delivery system
Professor Anne Mills reviewed evidence that coverage levels for basic interventions within the health sector are still too low, especially among the poor. She also highlighted main constraints to scaling up interventions and emphasized that it is essential to increase the quantity, quality, and motivation of human resources in developing countries, including identifying training needs and using financial and non-financial incentives to recruit and retain skilled health workers. Please see: http://www.who.int/macrohealth/events/health_for_poor/en/2mills.pdf [pdf 146kb].
IMF, OECD and World Bank views
Dr Peter Heller of the International Monetary Fund proposed first examining whether current expenditure on health is effective, and said that increased taxation should be used cautiously as a way to mobilize resources. Recognizing that increased external resources are critical for poor countries, the IMF representative recommended better coordination between donors and recipient countries and increased predictability of funds. He warned, however, that countries may need to strengthen capacity to manage and budget for increased resources before they can be absorbed. Please see: http://www.who.int/macrohealth/events/health_for_poor/en/6heller.pdf [pdf 91kb].
Mr George Schieber provided the World Bank perspective, urging focusing on cost-effective interventions targeted to the poor provided through an efficient health care delivery system. He also said that investments must be made across sectors, domestic resources mobilized, and countries should aim to gain increased donor support and debt forgiveness through effective macroeconomic and health sector strategies, like PRSP and SWAPs. Finally, Schieber noted that donors? responsibilities include harmonizing procedures, increasing predictability of funding, and allowing an assessment of their performance. Please see: http://www.who.int/macrohealth/infocentre/presentations/en/7cmh_schieber.pdf [pdf 848kb].
Mr Paul Isenman, of the Organisation for Co-operation and Development (OECD), said that the OECD's Development Assistance Committee (DAC) is working to tackle problems related to donor-driven priorities, uncoordinated donor practices, and delays in disbursements. He stressed the efforts made following the "Rome Declaration" of February 2002 to harmonize donor procedures, share information, untie aid, respect national priorities, and strengthen local capacity. Please see http://www.who.int/macrohealth/events/health_for_poor/en/1isenman.pdf [pdf 530kb].
Canada's vision of the health pact of poor and rich countries
The country has a lonhttp://webit/workflow/profile/story/container/edit.html# http://webit/workflow/profile/story/container/edit.html#g history of working in partnership with other stakeholders, and this reflects Canada's view that multilateral initiatives are increasingly becoming the cornerstone of health and development, said Dr Montasser Kamal of the Canadian International Development Agency. Canada also strongly believes that the effectiveness of current partnerships should be measured, in part, by their impact on strengthening health systems. Strong systems assure the rich countries that their investment is sustainable and the developing countries can guarantee that their hard-won gains will continue to be enjoyed by future generations. Please see: http://www.who.int/macrohealth/infocentre/speeches/canada_oct2003/en/.
Gates Foundation focuses on innovative approaches
Dr Sally Stansfield presented the Gates Foundation?s program areas. She highlighted that now is a time to build innovative solutions to important health problems affecting the developing world in order to address emerging infections, implement global initiatives and aim towards the achievement of the Millennium Development Goals. Although there are a number of donor constraints and many implementation challenges in developing countries, new resources must become available ?through individuals, civil society organizations, corporations, pharmaceutical companies and foundations? and promising innovations should be put in place. Please see: http://www.who.int/macrohealth/infocentre/presentations/en/2stansfield.pdf [pdf 315kb].