WHO/OMS Improving and increasing investments in the health outcomes of the poor Macroeconomics and Health in context 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 2

WHO/OMS 3 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

WHO/OMS 4 Health Spending in selected countries Source: Human Development Report, 2004.

WHO/OMS 5 Poor Suffer Disproportionately from Disease Source: The Millennium Development Goals: Rising to the Challenges. World Bank, 2004.

WHO/OMS 6 Catastrophic Health Expenditures Number of people with catastrophic expenditure and impoverishment due to health spending Source: Evidence and Information for Policy, WHO

WHO/OMS MH: Participating countries and regions Africa: 11 countries West Pacific: 6 countries Europe: 3 countries The Americas : 2 countries, 3 sub- regions ( Andean Region, MERCOSUR, Caribbean Community ) South East Asia: 7 countries Eastern Mediterranean: 6 countries Countries :  Engaged in macroeconomics and health work  Developing health and development plans     Sub-regional Initiatives 7

WHO/OMS 8 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

WHO/OMS  In this setting, WHO and its partners support the linking of national health priorities with PRSPs, achievement of MDGs, SWAps and other development agendas. MH: Responses by WHO 9

WHO/OMS Capacity-building at country level  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 Macroeconomics and Health supports countries to: 10

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 11

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

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 13

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. 14

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 15

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 16

WHO/OMS Impact 17  Integrate health system, poverty reduction and disease- specific 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