PHM comment on CMH

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People’s Health Movement Response to Commission on Macro-economics and Health The People’s Health Movement (PHM) welcomes this opportunity to comment on some central 1issues related to the Report of the Commission on Macro-economics and Health . This summary outlines some of the key points from the Report, and then raises some issues for discussion. Resources for health We welcome the report’s strong advocacy for greater funds for tackling ill-health in developing countries. It is also good to see the Commission acknowledge that domestic governments in low-income countries are unable themselves to mobilize anywhere near this level of resources, and so the emphasis has to be on donor support. We also welcome the strong critique of user charges as a means of financing health care and the rebuke to economists who place a higher priority on controlling fiscal deficits than promoting of human development. Issues • The Commission should examine more thoroughly the effects of World Bank and IMF inspired adjustment programmes. Adjustment programmes are not substantially increasing economic growth in low-income countries, undermining prospects of large increases in health expenditure. • Given the greater reliance on donor support, what methods will be used to ensure greater local control over all health system resources – an important determinant of the ultimate sustainability of systems? How will the Commission’s proposals (and now the work of ...

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• Publié par: Zaun
• Nombre de lectures: 14
• Langue: English

Extrait

People’s Health Movement Response to Commission on Macro-

economics and Health

The People’s Health Movement (PHM) welcomes this opportunity to comment on some central

issues related to the Report of the Commission on Macro-economics and Health

1

. This summary

outlines some of the key points from the Report, and then raises some issues for discussion.

Resources for health

We welcome the report’s strong advocacy for greater funds for tackling ill-health in developing

countries. It is also good to see the Commission acknowledge that domestic governments in low-

income countries are unable themselves to mobilize anywhere near this level of resources, and

so the emphasis has to be on donor support. We also welcome the strong critique of user

charges as a means of financing health care and the rebuke to economists who place a higher

priority on controlling fiscal deficits than promoting of human development.

Issues

•

The Commission should examine more thoroughly the effects of World Bank and IMF

inspired adjustment programmes. Adjustment programmes are not substantially

increasing economic growth in low-income countries, undermining prospects of large

increases in health expenditure.

•

Given the greater reliance on donor support, what methods will be used to ensure greater

local control over all health system resources – an important determinant of the ultimate

sustainability of systems? How will the Commission’s proposals (and now the work of

National Commissions on Macro-economics and Health) link with sector wide

approaches and the Poverty Reduction Strategy Paper process?

•

Greater clarification on costing is required. The estimates of financial support needed by

developing countries is based on summing up the estimated costs of highly selective

health interventions (see below), and so therefore may not be such a useful estimate of

the financial needs of poor countries.

Health systems versus health interventions

The Report raises some important points about the need to develop health systems: especially

welcome is its recognition of the need to boost pay and conditions for health service workers to

prevent the spiral of decline in the health sector in many poor countries.

However, more substantially, the Report takes a highly selective line on the provision of health

services. The Commission lists a bundle of priority, cost-effective interventions that are a priority

for receipt of public funding – the list includes communicable diseases, malnutrition and maternal

and perinatal mortality. While the list also includes tobacco related diseases, additional resources

for these are not recommended.

Issues

•

Given the high and growing burden of non-communicable disease, it appears unrealistic

to suggest that public services can leave the treatment of conditions in this category to

the market.

•

Some of the scaling-up of actions on communicable disease is meant to take place very

rapidly, and could probably only be implemented through vertical disease control

programmes. However, these programmes can distort and damage health systems

development by diverting scarce financial and human resources from other necessary

services. Greater attention is needed to ensuring that disease control initiatives do not

harm health systems. Some commentators

2

have recently suggested that donors and

governments should sign-up to a code of practice which would, amongst other measures,

ensure that disease control programmes are compatible with primary care priorities even

if this comes at the expense of slower coverage build up.

Determinants of health

Related to the issue of health system interventions is the need to tackle the causes of ill-health

outside the direct control of the health sector which, as the Report notes, are highly significant.

Issues

•

The Report does not specify how greater intersectoral collaboration will be achieved. It

would be very useful for follow-up work to focus on successful examples of how services

as important as education, water and sanitation can be co-ordinated with attempts within

the health sector to achieve better health.

•

Poverty and Social Impact Analysis of important development policies should also be

higher on the agenda of international agencies, given the failures of adjustment

programmes over the last two decades. WHO could play an important role in promoting

analysis of World Bank and IMF programmes, and supporting countries in designing

healthier development policies.

Global public private partnerships

The report recommends a series of measures at the international level to complement its vision of

healthy development; including full-financing of the Global Fund for AIDS, TB and Malaria and the

development of more public-private partnerships focused on tackling disease.

Issues

•

Given the reservations we have raised about disease specific measures and the lack of

evidence to show that these global public private partnerships contribute to longer-term

system sustainability, WHO and national governments should be wary about supporting

their further development.

Conclusions: the Role of the

World Health Organisation

The World Health Organisation should see health as end in itself, not as a means to the end of

economic growth as promoted by the Report of the Commission on Macro-economics and Health.

There are great dangers in the latter approach, in terms of skewing priorities towards

interventions with greatest impact on productivity and income, not on health and well-being. The

Organisation should increase its emphasis on the determinants of health, and show the critical

influence of national and international economic systems/policies on these determinants. This

requires active and, where necessary critical, engagement with other international institutions,

which in turn requires much greater political courage. WHO's timidity towards other international

organisations, coupled with its narrow, disease specific approach (in contrast with WHO's broad

definition of health) leaves a political vacuum where there should be a key advocate for health in

the international system, and a resultant neglect of health in international policy-making.

Increasing funding for selective disease control programmes is no substitute for effective action to

steer the world towards a system which promotes health.

We call upon the WHO to strengthen its approaches to health policies which are in line with the

consistently-endorsed Health for All principles, based on values of equity, social justice and

respect for human dignity, and health as an end in itself. WHO should strengthen its work on

assisting countries in taking stands on health-related international matters, such as trade

negotiations, and implementing agreements in the best interest of health. It should also continue

the longstanding partnerships with its Member states and assist them in building up sustainable

and comprehensive health systems. The WHO should take the voices of its Member states

seriously and move cautiously on the issue of public-private partnerships.

1

Based on an earlier paper by Medact “The Commission on Macro-economics and Health –

Medact’s Response” (London: December 2001)

http://www.medact.org/tbx/docs/CMH%20-

%20Medact%20response.doc

2

Unger, JP et al. 2003. “A code of best practice for disease control programmes to avoid

damaging health care services in developing countries”.

International Journal of Health Planning

and Management

2003; 18: S27-S39