The Work of the Commission on Macroeconomics and Health. (Round Table)

Bulletin of the World Health Organization, February 2002 | Go to article overview

The Work of the Commission on Macroeconomics and Health. (Round Table)


More funds for health: the challenge facing recipient countries

The Report of the Commission on Macroeconomics and Health makes a strong case for a substantial increase in investments in health sector development. However, as the Report recognizes, we should not ignore the challenges of ensuring that any additional funds are spent effectively. This will require new ways of working on both sides of the donor-recipient country partnership. Here, I want to focus on the challenges that recipient countries will face. This focus should not be interpreted as implying that there are no difficulties associated with the aid instruments -- clearly there are -- but I will leave others to address them.

A major area of emphasis in the thinking adopted by Working Group 5 of the Commission on Macroeconomics and Health was directed towards achieving a better understanding of the "constraints" to improving health outcomes and how such constraints might be overcome. Constraints were conceived to be conditions that hamper efforts to scale up the provision of effective interventions. Following this reasoning, we developed a typology of constraints (1) and examined evidence for strategies that can "buy out" or otherwise ameliorate constraints (2). In addition, case studies were prepared on Chad (3), the Indian states of Kamataka and Tamil Nadu (4), and the United Republic of Tanzania (5). We classified factors that constrain the expansion of services into the following categories, according to the area in which they operate: community and household; health services delivery; health sector policy and strategic management; overall public policy; and environmental characteristics. Subsequently, we examined the extent to which the constraints could be bought out by additional funds.

Lack of money is often a governing constraint, especially at the peripheral level, and any attempt to scale up will require significant increases in expenditure. However, the fact that progress is not possible without money does not mean that it is assured if money becomes available. Without a health system that can use money well, spending will not merely be inefficient -- it may be useless, or conceivably counterproductive. Most of the world's poorest people lack access to an adequate health system, and this limits all efforts to scale up the provision of effective interventions. In many cases these systemic problems will become governing restraints if spending is quickly increased, driving the marginal benefit of spending on materials or staff to zero.

The removal of structural constraints and the building of new management and service delivery capacity are thus necessary precursors to the scaling up of health interventions. But this does not mean that the need for a commitment to greatly increased funding is deferred or lessened. Instead, money must be used immediately to remove constraints as quickly as possible. There must be system-wide spending in order to make progress, with a deliberate focus on careful phasing of investments that will increase absorptive capacity.

Historically, one way of avoiding the problems of limited capacity has been to adopt a "vertical" approach to a particular intervention or family of interventions. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • A full archive of books and articles related to this one
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The Work of the Commission on Macroeconomics and Health. (Round Table)
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

    Already a member? Log in now.