Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 8, March 2004

NEWS ..... NEWS ..... NEWS ..... NEWS ..... NEWS

Partnering with students: CMH and the World Bank at the University of Manchester

Participants to the December 2003 Compact Seminar on International Development focused on the role of multilateral institutions in international development and how they can tackle issues like poverty, trade, debt reduction, access to services, and efforts to meet the Millennium Development Goals. Responding to several presentations, including one on Macroeconomics and Health, participants went into a lively debate on globalization and poverty. Included among the many issues raised were the importance of ensuring all forms of assistance in the social sector, including the health sector, as grants, not loans; the limits of economic growth and the need to provide social safety nets for poor people; the problem of brain drain and how this phenomenon can be eased in the health sector; and how the CMH approach links with disease-specific programs and policies.

The two-day seminar was organized by the World Bank and held in the Institute of Development Policy and Management (IDPM) at the University of Manchester. It was a very positive experience, strengthening understanding of the CMH approach and links to the academic community. Participants included graduate students involved in development studies and representatives from the European Vice-presidency of the World Bank and the IDPM.

Macroeconomics and Health session at Forum 7

Forum 7, the annual meeting of the Global Forum for Health Research, was held on 2-5 December 2003 in Geneva, Switzerland, and included a session on “Country-level responses to the Commission on Macroeconomics and Health.” Chaired by Sir George Alleyne, Emeritus Director of the WHO Regional Office for the Americas/Pan American Health Organization (PAHO), the session heard presentations by country representatives on how research carried out as part of a Macroeconomics and Health process can provide evidence for increased health investments and is central to the development of a health investment plan.

Dr Sergio Spinaci, Executive Secretary of the CMH Support Unit, opened the session by outlining the CMH process and highlighting country needs for access to reliable, country-specific data for making allocative and policy decisions. This includes information on the disease burden of the poor, data on cost-effectiveness and the cost of scaling up a pro-poor package of health services. Data on the flow of resources, both external and internal to health, are also needed. In Ghana, a report has been produced, based on local research and evidence, that will be used to advocate among the highest political levels for increased investment in health. A representative from Indonesia noted that under Indonesia’s decentralization reform, epidemiological and economic research is being used to provide evidence for increasing the health budget given competition from other sectors. It is also an important tool for guiding the allocation of health resources.

The Global Forum for Health Research was set up in 1998 to help correct the 10/90 gap in health research (only about 10% of annual spending on health research worldwide is used for research into 90% of global health problems) and focus research on the health problems of the poor. The Forum’s annual meeting brings together decision-makers, policy-makers, and researchers to discuss health problems and priorities. For more information on the meeting, please visit

High-level Forum on the Health MDGs

Senior officials from seventeen developing countries and a number of development partners, at the first meeting of the High-Level Forum (HLF) on the Health MDGs on 8 and 9 January 2004 in Geneva, noted that progress on the health MDGs is slow and agreed on steps to accelerate action. Increased resources for health are needed, and to this end, donor commitments made at the 2002 Monterrey Conference should be accelerated. Participants concluded that large inflows of grant aid are unlikely to have destabilizing macroeconomic effects, so developing country absorptive capacity need not be a barrier to expanding health investment.

Participants recommended practical steps to ensure that strategies to reach the MDGs are more prominent in Poverty Reduction Strategy Papers (PRSP), and agreed that countries should have a single PRSP process. With respect to donor harmonization, developing countries should take the lead in addressing this issue by raising the issue with donors. Human resource constraints in the health sector are a major challenge, and the HLF supported plans to set up a Working Group on Human Resources in Health to address this issue. It was also recommended that a link be established between the HLF Secretariat and the Global Commission on International Migration to explore the impact of migration on health. Developed countries were urged to end active recruitment of health workers from countries with staff shortages, while developing countries should implement measures to reduce migration of health staff. Finally, participants agreed that health information systems need to be strengthened, better-coordinated and more reflective of country needs and priorities. They endorsed plans to establish the Health Metrics Network.

The HLF provides an informal opportunity to build and strengthen partnerships among senior policy-makers to accelerate action towards achievement of the health-related MDGs. The HLF was established in May 2003 by the Canadian International Development Agency (CIDA), the UK Department for International Development (DFID), and the World Bank. It is proposed that the next HLF meeting be held in Nigeria in late 2004. It will review progress on the recommendations made at the January meeting and will include a focus on poor performers and countries in crisis.

Discussions on health and poverty at WHO’s EB Session

A paper entitled “Influence of poverty on health” was prepared for the 113th Session of the WHO Executive Board, held from 19 to 24 January 2004 in Geneva. The paper presented WHO’s work on poverty and health, highlighting the importance of the CMH Report and follow-up work. By providing evidence of the economic benefits of health investment and supporting the development of health investment plans, WHO’s Macroeconomics and Health approach is helping to focus attention on the health of the poor, in accordance with the Declaration of Alma-Ata and WHO’s contribution to achievement of the MDGs.

There is still a need, however, to tackle more effectively the health needs of poor people. It will be essential to disaggregate health data by income and design policies and systems to ensure access for poor people. When developing poverty reduction strategies, attention needs to be paid to constraints which have hampered the health components of these strategies in the past. WHO aims to provide support to Member States to shape their health agendas with a pro-poor focus and implement them in the context of poverty and development.

WHO’s Executive Board meets twice a year. The main functions of the Board are to give effect to the decisions and policies of the World Health Assembly (WHO’s supreme decision-making body), to advise it and generally to facilitate its work.