WHO/OMS
Macroeconomics and Health in
context
Improving and increasing investments
in the health outcomes of the poor
Dr. Sergio Spinaci, WHO
Senegal, February 2005
WHO/OMS
Presentation profile
 Towards achieving the MDGs
 Overview of Health Spending
 Overview of national MH process
 Macroeconomics & Health:Responses by WHO
 Capacity-building at country level
 Achievements in Ghana, India, Mexico and the

Caribbean
Conclusions
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WHO/OMS
The CMH Report : Towards achieving the MDGs
 CMH recommendations support scaling up of
systems, financing and outcomes, essential
for achieving MDGs. Acknowledging that the
poor:
•
•
•
Suffer disproportionately from preventable disease
Are in danger of catastrophic out-of-pocket health
expenditures
Are subject to geographic, economic, and social factors
that limit access to care
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WHO/OMS
Health Spending in selected countries
Priorities in public spending for selected countries
Total debt service (% of GDP)
in 2002
12
Public expenditure on health
(% of GDP) in 2001
10
8
(% )
6
Military expenditure (% of
GDP) in 2002
4
2
0
In d
Eth
Ch
In d
Me
S
Gh
Se
i
n
on
ia
n
a
i
xi c ri La
o
e
na
a
pi a
es
ga
nk
o
ia
l
a
Source: Human Development Report, 2004.
Public expenditure on
education (% of GDP) in 2001
(or most recent year available
during period 1999-2001)
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WHO/OMS
Poor Suffer Disproportionately from Disease
TB deaths/100,000 pop
AIDS deaths/100,000 pop
Maternal deaths/10,000 live births
Under-Five deaths/1,000 live
births
Underweight children (percent)
0
50
100
150
200
Richest 25% of world population
2nd richest 25% of world population
Rate/Ratio
2nd poorest 25% of world population
Source: The Millennium Development Goals: Rising to the
Poorest 25% of world population
Challenges. World Bank, 2004.
5
WHO/OMS
Catastrophic Health Expenditures
Number of people with catastrophic expenditure and
impoverishment due to health spending
EMR
impoverishment
AFR
catastrophic
EUR
SEA
AMR
WPR
-
30
60
90
Number of people (million)
Source: Evidence and Information for Policy, WHO
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WHO/OMS
MH: Participating countries and regions
Europe: 3 countries
n
Eastern
Mediterranean:
n
The Americas :
2 countries, 3 subregions (Andean
Region, MERCOSUR,
Caribbean Community)
Countries :
n
n
.
n
nn n
n
n nn
n n
n
n
n
n n
6 countries
n nn nn
n nn n n
n n
n
n n
n
n n
West Pacific:
6 countries
.
.
Africa:
South East Asia:
11 countries
7 countries
Engaged in macroeconomics and health work
Developing health and development plans
. Sub-regional
Initiatives 7
WHO/OMS
Overview of national MH process
 Advocacy:
• Disseminate CMH findings and raise political commitment to health
• Establish multi-sectoral technical groups and mechanisms to
implement the MH process
 Research and planning:
• Assess health situation and infrastructure (epidemiology, health system

capacity, funding gaps, cost analyses of investment options)
Establish health investment plans for prioritizing investment
Define implementation strategy
•
•
Implementation:
• Implementation of health investment plan
• Monitor MH process and long term impact
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WHO/OMS
MH: Responses by WHO
 In this setting, WHO and its partners support the
linking of national health priorities with PRSPs,
achievement of MDGs, SWAps and other
development agendas.
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WHO/OMS
Capacity-building at country level
Macroeconomics and Health supports countries to:
 Foster sustained political support for long-term
investment in health
 Improve coordination among stakeholders for more
effective policy dialogue (SWAps, cross-sectoral support,
etc)
 Support MoH to produce a comprehensive health sector
strategy, linked to the MDGs, costed and budgeted in
line with MTEF
 Ensure health is strongly reflected in PRSPs
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WHO/OMS
Capacity-building at country level
 Focus on financing health systems that can deliver
essential health services for the poor and vulnerable
 Strengthen institutions to manage increased
resources
 Improve local capacity for country-relevant research
that inputs into national policy making
 Strengthen monitoring and evaluation mechanisms,
including tracking resource flows for health
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WHO/OMS
Case Study - Ghana



The Ghana Macroeconomics and Health Initiative (GMHI) - pro-poor
approach to expand essential health services and close to client
facilities.
The investment plan - collection and analysis of data on disease
burden, non-financial constraints, health expenditure and poverty at the
district level.
Revision of the Ghana Poverty Reduction Strategy (GPRS) - A step
towards operationalising the health and health related MDGs. The plan
is a key input into the revised Ghana Poverty Reduction Strategy and
the Ministry of Health programme of work for 2007-2011.
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WHO/OMS
Case Study - Ghana

The GMHI has had several key objectives:
• Disseminate and discuss the findings and recommendations of the
CMH report
• Develop a long-term health investment plan
• Provide strategic options for scaling-up investments in sectors that
influence the health status of Ghanaians
• Mobilize political support and advocacy at the local and international
levels
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WHO/OMS
Case Study - India



In January 2003, the Indian government set up a National Commission
for Macroeconomics and Health (NCMH), co-chaired by the Minister of
Health and Family Welfare and the Minister of Finance.
The objectives are to assess the impact of increased investments in the
health sector on poverty reduction and the overall economic
development of India and to establish an evidence base for long-term
scaling up of essential health interventions.
Report of the commission will present to the GoI the cost of providing
and options for financing package of interventions.
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WHO/OMS
Case Study - Mexico


Mexican national commission (CMMS) set up July 2002 by Minister
of Health to study health – economic development relationship and
identify priority actions to link health and economic policies
Working Groups:
• diagnosis of health status of Mexican population and public health
•
•
•
•


system vis a vis MDGs
health, economic development and poverty reduction
intra- and inter-sectoral health-related public policies
health insurance and social protection
global and regional public goods for health in Mexico
CMMS Report presented November 2004, circulated to key
stakeholders
Strong support by key MoH officials provides momentum
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WHO/OMS
Case Study - Caribbean sub-regional initiative




Caribbean Commission for Health and Development formed and
charged with the responsibility of providing guidelines to action
for the 15 members of Caribbean Community. The Secretary
General of the Caribbean Community (CARICOM) chairs the
Commission
Planned activities: promote essential operational research on
health and poverty priorities, policy roundtables, advocacy in
CARICOM major events, estimates of investments needed
Final report to be presented to the Caribbean Community's
Council on Human and Social Development and to Heads of
Government in 2005
MDGs are explicit targets
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WHO/OMS
Impact
 Integrate health system, poverty reduction and diseasespecific initiatives to maximise outcomes towards achieving
health and development goals
 Addressing the overarching issues including the role of the
civil society and private sector, effective financing schemes
and safety nets for the poor, better monitoring of the flow,
etc.
 Coordinate collaborations/partnerships between recipient
countries and development community
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