MINISTERIAL ROUND TABLE MEETING ON HEALTH AND POVERTY RCM 51, 20 September 2000
(Summary by Dr Phua Kai Hong, Moderator
The Ministerial Round Table focused on the subject of health and poverty. Participation in the Round Table included 32 Member States, and comments and country experiences were provided by 22 Ministers or their representatives. These experiences reflected the concern with the topic and the commitment to health and poverty reduction. The meeting served to raise awareness about the linkages between health and poverty, resulting in a sharing of experiences and recommendations as to WHO's role. Several comments reflected important general concerns. Health leaders have long known that much of the burden of disease lies in poverty and improvements in health can lead to economic gains. This admission is significant, implying the recognition that health policymakers need to do better in obtaining the support needed from political leaders. At the same time, it was suggested that the health sector could take the lead in placing health in the centre of both development and poverty reduction efforts. Differences in culture and levels of economic development have enhanced the difficulties in defining and measuring poverty across the region. It is important to take into account how different communities perceive their own poverty or well being. A positive outlook and strong social support structures, despite an obvious lack of material wealth, as in the Pacific Islands, should also be recognized as assets for development. The following statements summarize comments related to the discussion of policy options. First, it was noted that even countries that are relatively wealthy would still need a national policy on social and economic development with appropriate safety nets. One aim of the policy would be to shift from giving handouts to giving empowerment to the poor. A positive approach should be followed and care should be taken to avoid negative connotations and stigmatizing the poor. This can be done through more acceptable means of addressing inequalities. Countries experiences show that with the increase in the activities of the private health sector, governments need to be more proactive in regulating this sector to protect the poor. It was noted that high health care expenses could lead families into poverty. Several countries emphasized the importance of a multi sectoral approach. The health sector can take the lead in identifying issues and getting partners on board for intersectoral collaboration. All levels of government - national, provincial and local - have to be involved in poverty reduction, in a consistent manner, from policy formulation to implementation. Greater integration is desired from all levels and sectors concerned with health and poverty. The interagency partnership is also required at the international level. At the same time, a prime guiding principle in the efforts of the international development community in
promoting health for poverty reduction should be based on the priorities of the specific country. Development programs should be planned and implemented as country-led efforts rather than being donor-led. The role ofNGOs was recognized, as these organizations are often closer to the poor than govemments. This goes with the importance of mobilizing the people to participate in and take ownership of health and poverty reduction programs. Schemes that include provision of credit with support of other social services have proved to be an effective community-based strategy for poverty reduction. With regard to access to health care, the goal of universal coverage has been reached in some countries in the region. Clearly, in these countries, a mix of financing mechanisms, including tax-based and social insurance systems, has removed financial barriers to access and given the necessary protection to all population groups, including the poor. It was reiterated that user charges for health care at the time of illness may deter the sick from seeking care. In such situations, there is a case for social assistance to target the vulnerable individuals and groups. The responsibility to assure this lies with government. The very low level of government spending on health in many countries in the region was acknowledged. There were requests for WHO to develop standards for the appropriate level of health care expenditure. However, comments from the Pacific Island Countries, with relatively high proportions of the national budget allocated to health, highlighted the need for a countryspecific approach. This analysis should consider the true costs of health care in the country. It should also aim to ensure more equity and efficiency in resource allocation and utilization. This would need to emphasize the allocation of resources for more intensive efforts to combat diseases that disproportionately affect the poor. Following the endorsement of WHO's initiative in selecting the topic for the Round Table discussion, several suggestions were made for the future work of WHO in the area of health and poverty. It was requested that WPRO should develop a framework for action in poverty reduction that also identifies the non-health components and essential social services. The framework should allow the formulation of criteria on how to implement strategies in the country-specific context and include the monitoring of implementation. It was also proposed that NGOs and other partners should be included in the framework. Several countries requested WHO support in developing alternative health care fmancing mechanisms. WHO's advocacy role was seen as critical, both in assisting Ministries of Health to obtain the broad political support needed, and in achieving inter-sectoral cooperation required to achieve better health outcomes for all population groups. WHO's advocacy-related work could include a focus on inequalities. With WHO's initiative, the integrated approach to poverty reduction including health, education and income-generating activities, could be a useful and practical model, involving new partners and strategies. In concluding the meeting, participants recognized that people are the most valuable resource, and health is a critical asset in achieving development goals.