Academic journal article Bulletin of the World Health Organization

Macroeconomics and Health Commission Findings Become Reality

Academic journal article Bulletin of the World Health Organization

Macroeconomics and Health Commission Findings Become Reality

Article excerpt

Developing countries have embraced the recommendations of the WHO Commission on Macroeconomics and Health, an expert panel which has called on governments to increase health spending and make their health systems more efficient. Many accept that following this advice would benefit their economies and development agendas but some say they are struggling to increase health spending under the terms of debt repayment with global lending institutions.

Developing countries have taken their cue from the findings of a WHO commission that called on governments in 2001 to scale up investment in health care as an integral part of long-term economic development programmes.

More than 40 countries have taken steps to translate this and other findings of the Commission on Macroeconomics and Health into national policy and 20 of those are working closely with WHO experts on this.

The new approach is based on the Commission's philosophy: to provide more equitable access to scaled-up and more efficient basic health services in developing countries. Some countries are implementing this in conjunction with efforts to achieve the Millennium Development Goals for improving health in developing countries.

A WHO team has been advising 20 countries on how to increase their health budgets and implement other recommendations of the Commission. Ghana, India, Indonesia, Mexico and Sri Lanka have been among the most active.

Three years after the Commission on Macroeconomics and Health report was published in December 2001, these five countries have established their own national commissions and other bodies on macroeconomics and health which are in the process of drawing up their own Health Investment Plans to implement the report's findings.

Progress on increasing health budgets has been slow and it could be years before the beneficial effects on the economy are felt, according to Dr Sergio Spinaci, Executive Secretary of the Coordination of Macroeconomics and Health Support Unit.

Spinaci said the Commission's work had resulted in a far better understanding that good health can help to increase gross domestic product (GDP) but that this was coupled with frustration in many developing countries that macroeconomic policies endorsed by global lending institutions can undermine their ability to implement the Commission's recommendations.

"It is not easy within present budgetary constraints to invest more in health, especially if you have a large proportion of the budget invested in debt repayments and a macroeconomic policy focused on containing even minor inflation and setting rigid spending ceilings for the social sectors," Spinaci told the Bulletin.

Still, there are some encouraging signs. Under the leadership of its new prime minister, Manmohan Singh--one of the original Commission members--the Indian Government plans to increase its public health allocation from 0.9% of GDP to over 2% over the next five years, with particular emphasis on primary health care. Public health experts see this pledge as especially important given that public spending currently represents only 17.8% of total health expenditure.

A technical panel is finalizing a report for India's National Commission for Macroeconomics and Health to demonstrate the impact of increased investments in the health sector on poverty reduction and to outline reforms necessary to improve health service delivery.

The Sri Lankan Government said last month it would increase health expenditure by 10 113 million Sri Lankan Rupees or US$ 96 million--nearly a 30% increase--to 40 408 million Sri Lankan Rupees, or US$ 385 million, in its annual budget.

That will bring health spending from a current level of 1.3% of GDP to nearly 1.7% and, even despite about 5% inflation, marks a substantial increase.

In a newly published study on Sri Lanka, Louis J. Currat, the former executive secretary of the Global Forum for Health Research, said the National Commission on Macroeconomics and Health needed to address organizational issues such as overcrowded hospitals due to the absence of a referral system, the decrease in preventive services, over-centralization and a lack of resources. …

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