Academic journal article Bulletin of the World Health Organization

Increased Health Investment: A Normative Path or a Mirage? (Round Table)

Academic journal article Bulletin of the World Health Organization

Increased Health Investment: A Normative Path or a Mirage? (Round Table)

Article excerpt

In my view, the Report of the Commission on Macroeconomics and Health has succeeded in presenting a coherent normative path for solving the worsening health conditions that prevail in many low-income developing countries. The logical framework adopted in the Report is strong enough to convince sceptics that, if maximum contributions are obtained from all stakeholders of low-income countries, donor countries, find international institutions, investing in health can make this world truly different from what it is today.

There is no question that the end objective of the Report's proposals is desirable. Nevertheless, translation of its vision into results is by no means certain; and some individuals might even claim that it is not realistic.

I can think of several reasons why a nationwide close-to-client (CTC) system (health centres, health posts, and outreach services from these facilities), as proposed by the Commission in its Report, could turn out to be something like a mirage. First, the enormous human resources needed, clearly a "must" for making the system operative, might not be realistically available, even in the medium term. Second, establishing a nationwide CTC system requires extraordinary dedication by the governments of low-income developing countries and presents them with a dilemma: such governments might not feel inclined to take up the challenge involved unless they are sufficiently convinced they can depend .upon secular flows of enormously scaled-up donor funding.

There are other criticisms that can be raised. For example, examining the situation from the point of view of the donors, we find that current domestic health expenditures in G7 countries are around 10% of their GDP (ranging from 6.7% in the United Kingdom to 13.0% in the USA), according to the 2001 World Development Indicators. …

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