PHA-Exchange> Critique on Macroeconomic Commissiom on Health

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From: Prof D Banerji <nhpp at bol.net.in>
April  14, 2002

                         THE MACROECONOMIC COMMISSION ON HEALTH

                                                          A Critique

Debabar Banerji,
Professor Emeritus,
Centre of Social Medicine and Community Health
Jawaharlal Nehru University,
B-43 Panchsheel Enclave,
New Delhi 110017


                                                       Abstract

WHO has been able to interest some of the top economists of the world to
join the MCH to study macroeconomics of health services for the poor people
of the world, who account for more than two-thirds of the population. The
approach followed by the CMH is disturbing. They have been ahistorical,
apolitical and atheoretical.  They have not succeeded in making
contributions from economics to enrich the interdisciplinary method of
health service development to ensure optimal use of the very scarce
resources. They have adopted a selective approach to conform to a
preconceived ideology. They have ignored the earlier work done in this
field. They have pointedly ignored such major developments in the health
services as the Alma Ata Declaration, failure of the Universal Programme of
Immunization and the numerous WHO Resolutions, promising Health for All by
AD2000, using the approach of Primary Health Care. They have made frequent
references to the relevance of what they call `operational research', but
they made different interpretations of this approach in different patrs of
the Report. The experience of application of this method in other countries
from as early as 1951 were simply ignored. This attitude of developing
massive blindspots in their vision has brought the quality scholastic work
to almost the rock-bottom level. It is not surprising that the CMH has
developed a tube vision in making recommendations on so important a sublect.
Close to Client (CTC) institutions, a 100-bedded with a single doctor and
some paramedical staff institution, undertaking a wide range of
responsibilities to attend to the requirements of the patients, putting in
place organisational and management superstructure to lend support to the
CTC-Hospital complex, are the major recommendations for action. The lack of
understanding in conceptualising such a plan of action is startling. Even
more starling is the emphatic assertion by the CMH to perpetuate vertical or
categorical programmes against major communicable diseases like
Tuberculosis, AIDS and Malaria. That the CMH justifies such already
discredited approaches on the grounds that vertical programmes have proved
to be convenient in a number of ways to the `donors' lets out the real
motivations for undertaking such an
almost openly ideological driven agenda. This is a serious danger signal for
scholars of the world who would like to have a scientific attitude towards
programme formulations for the poor to get the maximum returns from the
limited resources. The concept of DALYs is rife with gross infirmities. The
WHO generated data used for DALY calculation and convert them into dollars
terms are patently invalid, unreliable and not comparable between and even
within countries. The figures churned out from the patently defective models
and mathematical discourses are obviously meaningless.
There appears to be a nexus between WHO and the type of scholars represented
in the MCH. A hint of this link up emerged when the WHO was impelled to ask
for consultative advice to examine the managerial process through which the
organisation has planned and monitored its performance. The consultants
evealed a shocking state of affairs within the organisation. `Cruelty and
nflexibility of senior managers and policymakers' and `a range of
igh-profile actions and interventions that are clearly not sustainable' and
short-term results are justifiable at any cost to satisfy external
takeholders', are some the indictments made by the consultants. These
idictmentsalso apply to the MCH.


If you want a full copy of this 18 pp document order it directly from Prof
Banerji at email adress above.