PHA-Exchange> The commission on macroeconomics and health.

[Claudio]

From: "Ipshita" <ipsita at bol.net.in>
(Prof. D Banerji)
 New Delhi

This is the abstract of something sent out in Apri. it is good to resend as
the anniversary of Alma Ata is here. The full paper cn be requested from Dr
Baneji at the address above.
Claudio

THE MACROECONOMIC COMMISSION ON HEALTH



A Critique



Debabar Banerji,




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. The 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 parts of
the Report. The experience of application of this method in other countries
from as early as 1951were simply ignored. This of attitude 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
subject.


Close to Client (CTC) institutions, a 100-bedded with a single doctor and
some paramedical staff, 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 brisling 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
revealed a shocking state of affairs within the organisation. `Cruelty and
inflexibility of senior managers and policymakers' and `a range of
high-profile actions and interventions that are clearly not sustainable' and
`short-term results are justifiable at any cost to satisfy external
stakeholders', are some the indictments made by the consultants. These
indictment also apply to the MCH.