MACROECONOMICS AND HEALTH: AN UPDATE Icreasig Ivestmets i Health Outcomes for the Poor Secod Cosultatio o Macroecoomics ad Health October 2003 World Health Orgaizatio
Macroecoomics ad Health A Summary There is growig iteratioal acceptace that effective ivestmets i health are vital to huma developmet ad ecoomic growth I this supportive global eviromet, developig coutry govermets are committig resources towards the achievemet of the Milleium Developmet Goals WHO s Macroecoomics ad Health approach supports coutries as they accelerate these efforts The focus of the coutry-led macroecoomics ad health work based o the fidigs of the 2001 Report of the Commissio o Macroecoomics ad Health is to raise high-level political awareess ad commitmet to icreasig ivestmet i health ad to tacklig systemic ad istitutioal costraits to eable the effective delivery of health services to the poor The work is carried out i lie with three themes: Achieve better health for the poor Icrease ivestmets i health Progressively elimiate o-fiacial costraits The work is take forward by atioal-level groups uder the directio of a highlevel body or social commissio composed of represetatives from differet sectors This atioal body coordiates efforts to egage political commitmet, pursues strategic aalyses, ad guides the developmet of plas that reflect atioal priorities High level political commitmet is ecessary to stregthe istitutioal ad systemic processes, sustai parterships, ad develop pro-poor policies ad actio plas i health The work idetifies optios for icreasig ad improvig efficiecy i use of domestic resources, ad ehaces coordiatio with doors to improve predictability of resources The examiatio of optios for mobilizig resources i health receives guidace from WHO ad its parters, who help coutries to embark o aalytical work ad to pla activities i ways that reflect atioal cotexts, itetios ad macroecoomic realities I takig forward this work, seior officials from the miistries of fiace, health ad plaig examie optios ad agree o log-term multisectoral health ivestmet plas It is expected that macroecoomics ad health work will evetually lead to much greater log-term fiacig ad techical support for health The impact of welldeveloped ad -applied plas will iclude better-focused govermet spedig ad actio o health ad improved predictability of resources This i tur, will stregthe disease prevetio ad cotrol efforts which are idispesable to achievig atioal ad iteratioal health-related goals 1
Backgroud There is growig iteratioal acceptace that effective ivestmets i health are vital to huma developmet ad ecoomic growth Health is receivig heighteed attetio withi poverty reductio strategies, ad sector wide approaches focus icreasigly o health outcomes New fudig mechaisms for health have bee set up (the Global Alliace for Vaccies ad Immuizatio ad the Global Fud agaist AIDS, TB ad Malaria) drawig o ew alliaces for health like Stop TB ad Roll Back Malaria Global ad atioal dedicatio to promotig better health for the poor is best reflected by the widespread edorsemet of the UN Milleium Developmet Goals (MDGs) ad the New Partership for Africa s Developmet (NEPAD) targets I this supportive global eviromet, may developig coutry govermets are committig resources to improvig the health of the poor as they accelerate efforts towards the achievemet of atioal, regioal ad iteratioal health targets The 2001 Report of the Commissio o Macroecoomics ad Health (CMH) offers recommedatios o how to achieve these goals ad proposes that developig coutries, i partership with door coutries, sigificatly icrease ivestmet i health ad scale up access to essetial health services for the world s poor The CMH Report cofirmed the critical importace of good health for achievig poverty reductio ad socioecoomic developmet Aalyses detailed i the Report showed that a relatively modest fiacial ivestmet i health would yield substatial ecoomic returs The fidigs of the Report were edorsed by Member States durig the World Health Assembly 2002, ad the Report s Actio Pla was described as a useful approach to the achievemet of the Milleium Developmet Goals ad other iteratioally agreed developmet goals I the wake of the CMH Report, icreasig umbers of coutries are explorig the extet to which the Report s cocepts ca guide resposes for addressig their health ad ecoomic eeds Durig the Natioal Resposes to the CMH Report Cosultatio i Jue 2002, represetatives from miistries of health, fiace ad plaig from 20 coutries, with the participatio of door agecies, debated how to traslate the CMH recommedatios ito cocrete actios at coutry level The meetig cosidered what could be doe to icrease ivestmets for achievig the health-related MDGs, ad proposed steps that coutries could take to iitiate a macroecoomics ad health process A year later, at a May 2003 World Health Assembly Briefig, miisters of health, represetatives from govermets ad developmet agecies, ad NGOs oted that cosesus aroud macroecoomics ad health cocepts was broadeig, ad that issues related to costraits ad health systems were becomig cetral i atioal developmet strategies 2
The Macroecoomics ad Health process Ways to support atioal efforts to place health cetrally withi coutries macroecoomic agedas are beig developed by WHO ad its parters through a strategic combiatio of advocacy, ecoomics ad public health expertise The focus of this work is to raise high-level political awareess ad commitmet for developig coutry-led plas that are carried out i lie with three themes: Achieve better health for the poor Icrease ivestmets i health Progressively elimiate o-fiacial costraits Macroecoomics ad health work is take forward by atioal-level groups uder the directio of a high-level body or social commissio composed of represetatives from differet sectors This atioal body coordiates efforts to egage political commitmet, pursues strategic aalyses, ad guides the developmet of health plas that reflect atioal priorities Macroecoomics ad health work ultimately aims to support coutries as they place health cetrally withi their developmet ageda It examies alterative approaches withi ad outside the health sector for supportig atioal efforts to icrease ivestmet i health ad takes a log-term look at how to build atioal capacity to effectively, efficietly ad equitably utilize icreased fudig It also idetifies optios for icreasig ad improvig domestic resources ad stregthes door mechaisms to ecourage predictability of exteral fudig The work builds upo existig efforts ad parterships sharig the same visio ad liks with atioal iitiatives, processes ad mechaisms established for improvig the health of the poor Macroecoomics ad health support, which is provided to coutries upo their request, is flexible ad o-prescriptive, recogizig the diversity of coutry health ad ecoomic situatios ad takig ito accout health priorities, opportuities ad obstacles uique to each coutry The process at the coutry level is ot solely the resposibility of the miistry of health but is shared by the miistries of fiace ad plaig ad also by other public ad private sectors whose policies ad actios impact health, icludig educatio, agriculture, saitatio, ad the eviromet Govermet cabiets play a critical role i improvig health, as they are resposible for fiacig decisios ad for maiteace of effective systems ad istitutios It is for this reaso that the macroecoomics ad health process first targets high-level decisio-makers by widely dissemiatig ad promotig the cetral role 3
of health i socioecoomic developmet High level political will ad commitmet are ecessary to stregthe istitutioal ad systemic processes, sustai health parterships, ad develop policies ad actio plas to mobilize fiacial resources Political will ad commitmet are also ecessary to tackle costraits ad iefficiecies i health systems ad istitutios, eablig the more efficiet use of resources ad securig their effective operatio Coutries itedig to udertake a systemic examiatio of optios for mobilizig resources i health receive guidace from WHO ad its parters, which helps them to embark o aalytical work ad to create, debate ad pla activities i ways that reflect atioal cotexts, itetios ad macroecoomic realities I takig forward this work, seior officials from the miistries of fiace, health ad plaig examie optios for expadig health ivestmet ad agree o log-term multisectoral health ivestmet plas It is expected that implemetatio of health ivestmet plas will evetually lead to much greater log-term fiacig ad techical support for health The impact of well-developed ad -applied plas will iclude better-focused govermet spedig o health ad improved door coordiatio ad predictability of resources This i tur, will stregthe disease prevetio ad cotrol efforts idispesable to achievig atioal, regioal ad iteratioal health-related goals Substatial progress has already bee achieved i may coutries that have iitiated macroecoomics ad health work, icludig: raisig high level awareess ad commitmet through advocacy buildig ad maitaiig alliaces ad experts etworks to support plaig ad implemetatio of work coductig strategic aalyses o policy-developmet ad o systemic, ecoomic, ad epidemiological aspects Presetly, over 40 coutries worldwide are drawig o the macroecoomics ad health approach, with over 20 egaged i developig atioal health ivestmet plas that address both the scalig up of cost-effective health itervetios ad the multisectoral determiats of health Overview of the Macroecoomics ad Health process at coutry level The macroecoomics ad health process is iitiated ad led by coutries Based o the experieces of coutries that adopted this approach early, three phases have bee idetified which outlie the mai activities of macroecoomics ad health work: Phases 1, 2 ad 3 4
Durig Phase 1, high-level awareess ad support is attaied through wide dissemiatio of macroecoomic ad health cocepts ad through atioal workshops with key stakeholders These workshops serve to assess the uique health situatio withi the coutry ad the impact of a macroecoomics ad health approach o atioal developmet strategies Sice the Summer of 2002, high-level political support for this work has bee demostrated i several coutries WHO ad its parters offer techical ad fiacial assistace with atioal advocacy ad evets ad cotiue to promote cocepts ad messages through publicatios, a ewsletter ad the macroecoomics ad health website Oce egaged, govermets, i collaboratio with their parters ad WHO, establish atioal techical groups ad cross-sectoral mechaisms to take forward the macroecoomics ad health process These mechaisms are composed of represetatives from miistries of health, fiace, ad plaig, as well as door ad UN agecies The, coutries develop outcome-orieted work plas liked to a budget ad timelie ad uique to each coutry s strategic pla WHO, upo coutry request, mobilizes techical ad fiacial resources ad helps idetify techical experts to assist i plaig of the health ivestmet strategy The followig 24 coutries, icludig the Caribbea Commuity which is composed of 15 member states, are ivolved with Phase 1 work thus far: The Africa regio: Agola, Botswaa, Cogo, Keya, Malawi, Mozambique, Nigeria, Rwada, Seegal, Uited Republic of Tazaia, ad Ugada The Americas: Caribbea Commuity The Easter Mediterraea regio: Djibouti, Jorda, Ira, Pakista, Suda ad Yeme The Europea regio: Estoia The South East Asia regio: Bagladesh, Idia, Nepal ad Thailad The West Pacific regio: Cambodia Phase 2 starts whe coutries coduct a i-depth assessmet of their health situatio ad aalysis of health ifrastructure The work icludes epidemiological surveys, a aalysis of the capacity of health systems to absorb additioal fudig, ad assessmet of fudig gaps for scalig up health services to the poor Most importatly, this assessmet provides a basis for sequecig ad prioritizig targeted health ivestmets Techical experts are recruited to assist coutries with the aalyses, ad WHO co-ordiates techical support ad maitais relatioships with academic ad developmet parters to assist i the work Six coutries Chia, Idoesia, Ghaa, Ethiopia, Mexico, ad Sri Laka have already etered this phase 5
At the ed of Phase 2, coutries will develop ivestmet plas based o the idetificatio of high-priority, cost-effective itervetio optios Coutries will work to sustai cross-sectoral support for the health ivestmet pla ad develop a iteral mechaism for maagemet ad trackig of key outcomes WHO will cotiue to collaborate with coutries i idetifyig key ecoomic ad health idicators ad will assist coutries i buildig likages with a variety of developmet parters Twety coutries are expected to complete this phase by the ed of 2004 Phase 3 starts with implemetatio of the health ivestmet pla ad developmet of a mechaism to moitor the process ad the log-term impact of macroecoomics ad health work o health ad the ecoomy This phase should see a overall icrease i iteral ivestmet i health ad improved fudig by exteral parters Buildig a cosesus aroud icreased ivestmet also ivolves the establishmet of systems to track the impact of ivestmets ad improved effectiveess The coutryled macroecoomics ad health process provides a opportuity for coutries to establish their ow trackig mechaisms WHO ad its parters support coutries as they develop their ow idicators for measurig progress i implemetig the health ivestmet plas I particular, these idicators track the achievemet of health outcomes ad expediture to achieve these outcomes at atioal ad sub-atioal levels I additio, MDG idicators provide broad bechmarks to assess progress of poverty alleviatio efforts WHO efforts at coutry level to support Macroecoomics ad Health work WHO helps catalyse the atioal-level processes, offerig kowledge ad expertise i order to secure the ivestmet of icreased resources to improve capacity ad effectiveess of health systems ad atioal istitutios This process is more robust whe it ivolves key atioal ad iteratioal stakeholders for reviewig the issues, establishig cosesus o the macroecoomics ad health approach, ad committig to implemetig the health ivestmet plas Coutry-led work is sustaied by egagig a broad rage of iterested parters developmet baks, bilateral agecies, cosultats, academic ad civil groups to support the work The Orgaizatio plays a itegrative role by drawig o its decetralized structure ad its established coutry-level parter relatioships to serve as a broker amog recipiet coutries, developmet agecies ad civil groups 6
WHO Regioal ad Coutry Offices have bee cotributig greatly with techical iput ad by guidig coutries through the strategic preparatio ad plaig process of macroecoomics ad health work Several WHO Regioal Offices have icorporated macroecoomics ad health cocepts ito the health ad ecoomic strategy of the regio For example, a regioal cocept paper developed by the WHO Regioal Office for Africa outlies the relevace ad impact of macroecoomics ad health to the regio ad provides a framework for collaborative opportuities Durig the Summer of 2003, more tha thirty coutries participated i regioal meetigs i the Africa, Easter Mediterraea, ad South-East Asia Regios to share experieces i iitiatig, plaig, ad implemetig macroecoomics ad health work Expected outcomes Ehaced political will to place health withi atioal developmet strategies ad the macroecoomic eviromet Strog govermet commitmet to ivestig i the health of the poor ad to tacklig the costraits ad iefficiecies i health systems ad istitutios This icludes commitmet to mobilizig resources to improve access ad provisio of health care for the poor It is also marked by govermet efforts to stregthe istitutioal processes ad sustai health parterships Better coordiatio with atioal parters ad improved predictability of aid by harmoizig parter objectives ad capacities to support coutry-level priorities Developmet of log-term, multisectoral health ivestmet plas that attract sigificatly greater fudig for health from domestic ad exteral sources 7
ANNEX 1: Update o Macroecoomics ad Health activities at coutry level The Africa Regio WHO Regioal Office for Africa Fourtee coutries atteded a WHO Africa Regioal Office iter-coutry workshop from August 4-8 2003 i Addis Ababa, Ethiopia A cosesus o the importace of macroecoomics ad health i the coutries was established, ad coutries developed draft plas of actio to take forward the process I early September, a macroecoomics ad health sessio was held durig the 53 rd Regioal Committee of Miisters of Health i South Africa Agola The PRSP ad the Medium Term Developmet Pla are curretly beig drafted, providig a good etry poit for macroecoomics ad health work Agola aims to elaborate a structured framework ecompassig the macroecoomics ad health cocepts ad existig public expediture mechaisms for health This will help itegrate the macroecoomics ad health process ito the mai atioal developmet plas ad iitiatives Botswaa Botswaa has outlied importat steps for implemetig macroecoomics ad health work that iclude the establishmet of a atioal coordiatig mechaism ad the commissioig of techical papers o areas of scalig up A cosultat has bee hired to support Botswaa as it pursues macroecoomics ad health work The Republic of the Cogo Poverty reductio is a key objective of the Cogo s socio-ecoomic program The coutry has just preseted a coutry work pla ad budget for Phase 1, which will receive fudig A major part of the macroecoomics ad health work will be to support efforts to icrease public health spedig to 20% of total public sector spedig by 2008, to develop huma resources, ad to support the mobilizatio of iteral ad exteral fiacial resources Ethiopia Ethiopia, egaged i phase 2 activities, has established a Techical Workig Group uder the Miistry of Health ad the coutry s Cetral Joit Steerig Committee of the Health Sector Developmet Programme A Macroecoomics ad Health Coutry Coordiator has bee hired to direct research ad evaluate existig health care frame- 8
works ad the costs of icreased health care expeditures I May 2003, Ethiopia s macroecoomic ad health Pla of Actio was approved ad edorsed by the Miister of Health A local road map is beig istituted to stregthe the Health Sector Developmet Programme (HSDP) ad assess how the macroecoomics ad health approach ca be itegrated ito the existig PRSP Ethiopia hosted the August 2003 iter-coutry workshop o macroecoomics ad health Ghaa Ghaa is also ow i Phase 2, developig a log-term pla for atioal health ivestmets The Ghaa Macroecoomics ad Health Iitiative s priority is to aalyse the atioal poverty reductio strategy i light of the CMH Report s fidigs Ghaa is supportig atioal policies to prepare the health system to optimize uptake of resources ad health ivestmets It is also developig a log-term pla for atioal health ivestmets Keya Keya has outlied its Phase 1 work pla ad iitiated commitmet to Phase 1 activities The Miistry of Health ad the Natioal AIDS Cotrol Coucil ad door groups have requested techical assistace to evaluate the fiacial eeds for scaligup health expeditures The work pla aims to lik the macroecoomics ad health process to the coutry s ecoomic recovery strategy, the atioal budgetary process, ad the UN Developmet Assistace Framework group work pla The Republic of Malawi Malawi is still decidig how to best move forward with macroecoomics ad health work but has set several objectives, icludig orgaizig a workshop to build highlevel support The process will be located i the Miistry of Ecoomic Plaig ad Developmet Mozambique A 1999 Actio Pla for the Reductio of Absolute Poverty (PARPA) led to implemetatio of the coutry s PRSP Macroecoomics ad health aims to cosolidate this developmet paradigm, icludig buildig owership amog seior govermet officials, pursuig advocacy ad establishig a solid basis for the desig of a log-term health ivestmet strategy Nigeria Macroecoomics ad health i Nigeria is curretly located i the Departmet of Health Plaig ad Research of the Federal Miistry of Health Phase 1 objectives focus o buildig widespread govermet cosesus o the relevace of the CMH 9
Report fidigs at all levels of govermet ad settig up a appropriate istitutioal mechaism for implemetig macroecoomics ad health work Plas iclude the developmet of a cocept paper o CMH ad a operatioal strategy for itegratig macroecoomics ad health cocepts ito the log-term health ivestmet strategies of the coutry Rwada The Miisters of Fiace ad Health both expressed great commitmet to the goals of the macroecoomics ad health process ad are workig with WHO s Regioal Office to begi coutry-level macroecoomics ad health work Focal poits have bee selected by both miistries to spearhead this work Rwada s Phase 1 work pla will focus o defiig ad dissemiatig messages ad creatig effective istitutioal mechaisms to support macroecoomics ad health Seegal I April 2003 the IMF approved a agreemet uder the Poverty Reductio ad Growth Facility mechaism to support Seegal s ecoomic reform program for 2003-2005 Articulated withi the I-PRSP framework, this agreemet is heavily reliat o wide-ragig structural reforms Macroecoomics ad health ca provide a strog aalytical ad evidece-based argumet for sigificatly icreased health ivestmets Uited Republic of Tazaia Tazaia ad Zazibar have proposed a framework for a Pla of Actio coverig November 2003 to March 2004 Pricipal objectives are to build cosesus o the relevace of the CMH Report fidigs ad to establish a appropriate istitutioal mechaism for takig them forward Tazaia will place the CMH Report fidigs i the aual health sector review ageda Ugada Ugada has idetified several core o-goig processes to which macroecoomics ad health could be liked A techical task force will be commissioed to desig a comprehesive paper puttig all the iitiatives together uder the health ad developmet framework This comprehesive approach will be discussed durig the upcomig PRSP review The macroecoomics ad health process will be located i the Prime Miister s office to facilitate coordiatio across all relevat miistries The Americas Regio WHO Regioal Office for the Americas A pael will be orgaized with colleagues from Mexico s Natioal Commissio, 10
ad participats from the regio who are iterested i learig more about health, macroecoomics ad ecoomic growth will be ivited The Caribbea Commissio o Health ad Developmet was lauched i Washigto i September 2003 Caribbea Commuity The recetly-established ad -lauched Caribbea Commissio for Health ad Developmet has developed a 18-moth timelie to create a policy framework for providig guidace o establishig priorities for health fiacig i the 15 coutries of the Caribbea Commuity It has submitted a budget for Phase 1 ad Phase 2 activities, for which it has already obtaied exteral door support Mexico Sice its iauguratio i July 2002, the Mexica Commissio o Macroecoomics ad Health has scheduled meetigs, set up a web site to dissemiate the CMH Report fidigs ad has outlied plas for forward movemet of a macroecoomics ad health process The represetative from WHO s Regioal office of the Americas is coordiatig preparatio of this proposal Coutries iterested i the macroecoomics ad health approach Argetia, Brazil, Nicaragua ad Peru are explorig the impact ad relevace of macroecoomics ad health for their atioal cotext The Miistry of Health of Argetia is orgaizig a ew Health Ecoomics ad Fiacig Uit, which may be a good etry poit for macroecoomics ad health work Followig widespread dissemiatio of the CMH Report i Peru, the Regioal Office is commuicatig with coutry represetatives to reivigorate its iterest i pursuig macroecoomics ad health The Easter Mediterraea Regio WHO Regioal Office for the Easter Mediterraea I Jue 2003, the WHO Regioal Office for the Easter Mediterraea held a meetig to discuss how to take forward macroecoomics ad health work i the coutries of the regio A Regioal Cocept Paper o sustaiable developmet has bee drafted ad will highlight regioal support for coutries wishig to implemet the CMH Report s fidigs Djibouti Djibouti has show strog commitmet to beig ivolved with the process ad has outlied some specific steps to create the ecessary parter alliaces of miistries, agecies ad civil society The Phase 1 coutry pla calls for a Natioal 11
Macroecoomics Steerig Committee ad a CMH techical group to be directed by the Miistry of Health Aother key objective is to map out a strategic pla for icreasig itersectoral collaboratio to ivest i all the key determiats of health, icludig water, saitatio, ad educatio The Islamic Republic of Ira Ira is establishig a Natioal Commissio o Macroecoomics ad Health comprised of represetatives from differet departmets ad agecies The CMH recommedatios have bee debated at the highest levels of the Miistries of Health, Plaig ad Budget The Phase 1 coutry work pla calls for raisig awareess amog the highest levels of govermet o the cetrality of health to sustaiable developmet strategies Jorda Jorda has established a Natioal Commissio o Macroecoomics ad Health chaired by the Miister of Health ad icludig the Miister of Plaig ad the Secretary Geeral of the High Health Coucil Jorda will preset a revised workpla, icludig assessig available data o Burde of Disease ad idetifyig the focus of a Cost-Effectiveess Aalysis to assess gaps ad idetify research eeded Pakista Sice Pakista s PRSP is already fialized, the coutry s objective will be to dissemiate the key messages of the CMH Report, traslate them ito the local macroecoomic cotext, ad use them to defie research to costruct a evidece base for placig health more cetrally i the PRSP Suda Suda has fialized its pla for iitiatig a macroecoomics ad health process It is aticipated that the CMH focus o buildig existig etworks ad stregtheig parter etworks will lead to a real cross-sectoral dialogue ad participatio i poverty reductio efforts Yeme Yemei participats to the regioal meetig idetified the HS reform iitiative as a etry poit for macroecoomics ad health, ad the PRSP will be the vehicle for puttig the process ito operatio Yeme has appoited a coordiator of the Macroecoomics ad Health Program ad has set up a iter-sectoral Natioal Commissio o Macroecoomics ad Health 12
Oma While ot curretly pursuig macroecoomics ad health, represetatives from Oma atteded the regioal meetig ad shared thoughts o how the coutry is settig priorities for developig log-term ivestmet strategies The Europea Regio WHO Regioal Office for Europe Followig the decisio by the Regioal Director to establish a Task Force to explore ways of esurig follow-up to the macroecoomics ad health approach, the work i the Europea Regio has so far focused o the preparatio of a Europea Report o Macroecoomics ad Health that aalyzes the applicability of the Report i the coutries of the regio Estoia Upo request of the govermet, WHO preseted i March 2003 its work o the macroecoomics ad health approach to a group of decisio-makers ad officials from the Miistries of Social Affairs, Foreig Affairs, Fiace, as well as to academic represetatives ad iteratioal agecies Estoia is ow cosiderig ways to follow up the recommedatios of the CMH Report The South-East Asia Regio WHO Regioal Office for South-East Asia The Regioal Office has bee proactive i promotig the relevace of the CMH Report to the coutries of the regio ad has established a dedicated Workig Group to egage i dissemiatig the Report s fidigs The Regioal Office fialized Coutry Guidelies for CMH Follow-up ad a related documet, Outlie for a Strategic Framework ad Ivestmet Pla The Regioal Cosultatio o Macroecoomics ad Health, orgaized by the Regioal Office i Idia i August 2003, idetified several cosideratios ad challeges associated with plaig ad implemetig macroecoomics ad health Bagladesh Bagladesh has take several steps i respose to the CMH recommedatios I July 2003, the govermet decided that the existig Advisory Committee o Health ad Poverty Reductio Strategy would be reorgaized ad etrusted with macroecoomics ad health strategic plaig Formatio of a Natioal Commissio o Macroecoomics ad Health is uder cosideratio 13
Idia Terms of referece for a Temporary Natioal Commissio o Macroecoomics ad Health (NCMH) have bee established, ad a sub-commissio is beig selected This sub-commissio will be the techical ad operatioal arm of the NCMH, coductig meetigs ad hirig cosultats to carry forth the objectives of the NCMH Idoesia Idoesia has established mechaisms to guide the macroecoomics ad health process Commitmet to implemetig a macroecoomics ad health approach has led to health s icreased promiece o the ageda of the Cosultative Group of Idoesia (GCI) The govermet of Idoesia will itegrate its health ad developmet iitiatives uder a overall macroecoomics ad health policy framework Focus is ow o advocacy, developig broad parterships, ad supportig istitutioal ad capacity developmet withi decetralizatio Sri Laka Sri Laka has established mechaisms to guide the macroecoomics ad health process The ewly appoited Commissio o Macroecoomics ad Health icludes represetatives from various miistries, the private sector, academia ad UN agecies Sri Laka has submitted a detailed pla of actio for Phase 2 activities Icluded are advocacy ad preparatory studies that will form the basis for a 10-year ivestmet pla Thailad The Workig Group o Macroecoomics ad Health, set up by the Miistry of Public Health of Thailad, has developed a proposal to set up a Natioal Commissio o Macroecoomics ad Health The Workig Group has also defied a macroecoomics ad health process for Thailad Coutries iterested i the macroecoomics ad health approach I Bhuta, may of the CMH Report recommedatios are already a part of the govermet s health ad developmet ageda Maldives supports the fidigs of the CMH Report ad is dedicated to icreasig fudig of the social sector through iteral ad exteral fuds I Myamar, the Natioal Committee will guide the macroecoomics ad health process A draft work pla has bee developed for 2003-2004 outliig the tasks of the workig group o CMH I Nepal, a sub-commissio o Macroecoomics ad Health has bee formed ad is chaired by the Miisters of Health ad Fiace The Sub-Commissio has idetified key activities ad areas of research The Wester Pacific Regio WHO Regioal Office for the Wester Pacific Despite the challeges posed by the recet outbreak of Severe Acute Respiratory 14
Sydrome, the Regioal Office cotiues to support dissemiatio of the macroecoomic ad health cocepts ad ecourages their icorporatio ito atioal health policy developmet ad poverty reductio mechaisms Cambodia The Govermet of Cambodia is committed to pursuig the macroecoomics ad health recommedatios ad with the WHO coutry office joitly drafted a Proposal o Macro-Ecoomics, Poverty ad Health The Health Strategic Pla of 2002 provides a framework for cohesio amog other importat efforts A Natioal Commissio of Macroecoomics ad Health has bee established ad is chaired by the Miisters of Health ad Fiace Chia Chia s lauch of the CMH follow-up process i December 2002 evoked wide iterest withi govermet, further heighteed by the urget public health crisis created by the SARS outbreak i early 2003 The serious ecoomic, fiacial ad health cosequeces for may sectors of the ecoomy as a result of SARS caused dramatic review of the adequacy of fudig for public health eeds, for itesified medical worker traiig, ad for improved regulatios ad surveillace Successful cotaimet of the SARS epidemic i mid-2003 provided a eviromet for itermiisterial cosultatios to sharply review the adequacy ad purposes of govermet fudig, the role of isurace ad social security arragemets, ad public health versus medical care fuctios of the health system ad of health educatio Resultig chages i health budgets, resposibilities ad practices are establishig a ew basis from which Chia ca further pursue improvemets cosistet with the themes from macroecoomics ad health work 15
Macroecoomics ad Health: A Update Coordiatio of Macroecoomics ad Health: Dr Sergio Spiaci, Executive Secretary Writte ad Produced: Techical Cotributors: Productio Assistat: Ages Leotsakos, Tom O Coell, Valerie Crowell Silvia Ferazzi, Padma Shetty Zarita Khamkoeva World Health Orgaizatio 20 Aveue Appia CH-1211 Geeva 27 Switzerlad Tel: +41 22 791 2111 www who it/macrohealth/