Macroeconomics and Health (CMH)

Increasing Investments in Health Outcomes for the Poor: Second Consultation on Macroeconomics and Health

Statement by Mrs Sushma Swaraj, Minister of Health & Family Welfare and Parliamentary Affairs, Government of India, and chairperson of the morning session

29 October 2003

Dr J.W. Lee, Director-General, WHO, Honourable Ministers, Excellencies, Ladies and Gentlemen,

I thank you for nominating me as the chairperson of this session. It is indeed a privilege to preside over this meeting, and to participate in discussions, that can have a far reaching implication for the health of the poor, a concern that is close to my heart. Besides, as so clearly brought out by the Commission on Macroeconomics and Health, a healthy population is a prerequisite for economic growth, poverty reduction and a stable social system.

Over the years, there has been a sea of change in the development thinking. Increasingly we are realizing, that obtaining increases in GDP, is not enough: it is perhaps equally important to ensure its equitable distribution and quality of life. Similarly, merely increasing health spending is not enough, more important is how to spend, for whom to spend and on what to spend. These are legitimate concerns for all countries, whether rich or poor. In most countries, the public spending is characterized by limited resources coupled with unlimited and competing demands. The challenge is to locate resources and utilize these in an efficient and effective manner. Measuring efficiencies in spending is a difficult task. This will require that we develop a comprehensive and an all inclusive definition of health systems, identify parameters and performance indicators, and monitor them rigorously against the predetermined objectives.

Globalisation and Technology advancement pose both a threat and an opportunity for the health system. While technology has lengthened lifespans, it has also enabled movement of persons, on a scale never seen before. So if we have gained from such advances in technology, we are also now more vulnerable to the rapid spread of diseases as we saw in SARS. Due to the demographic and epidemiological shifts, as a result of the development process, most developing countries also face a double burden of communicable and non communicable diseases, aggravated in no small measure, by widespread poverty, malnutrition, illiteracy, gender discrimination and environmental degradation. These conditions, if left unaddressed, will increase inequity and sharpen disparities. It is here, that the CMH report assumes more importance, as it clearly brings out forcefully two ideas – one that the principal objectives of all development is the well being of the people and two, that such well being can be ensured through good health.

The Millennium Development Goals as also the subsequent Monterrey Conference, and World Summit on Sustainable Development recognize the crucial place of health in development. We must therefore now resolve to undertake the macro economic measures, necessary to achieve our objectives.

I would like to compliment, the vision and leadership of WHO, in carrying forward the mission of growth and social justice through investing in health. The need is for a manifold increase in investment in health focusing on expanding access to primary health care, infant and maternal mortality reduction, controlling communicable diseases and preventing the increase in lifestyle diseases. It is in this context, that we need to integrate traditional systems of medicine with our modern systems and have a holistic approach towards health care. Likewise, motivating doctors and other health personnel with the right compensation packages and a sound personnel policy is a critical challenge that we have to address comprehensively as it is their functioning that will have a direct impact on the quality of the health delivery system. The developing countries will have to increase the allocation of their budgetary and other domestic resources for health in addition to mobilizing external resources for assuring health security for the poor. We will have to ensure that the underprivileged sections of the society have affordable access to medicines and Medicare. Only then will the health delivery systems be meaningful and effective.

I am happy to see that this Consultation has brought together the developing countries, development partners, donor agencies and foundations and all other stakeholders.

Friends, I seek your cooperation in conducting this session so that we can successfully complete the agenda within the allotted time.

I now invite Professor Lincoln Chen of the Kennedy School of Government, Harvard University, to set the ball rolling by his keynote address on Health Economics, Growth and Poverty Reduction.