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� The pearl of theIndian ocean
� Trails blazed� Challenges� Response - NCMH
2001 – 18.7 million soulsPop density – 299 / sq.km.85% rural(DS 94)Dependency 54(DS 94)Literacy 90.1(94)Per capita GNP US$ 856(2000)
Source - Annual Health Bulletin 2001Source - Annual Health Bulletin 2001
� Health unit 1926� Alma Ata 1978� Essential drugs list
1958 (WHO - 1977� GFATM
� Health unit 1926� Alma Ata 1978� Essential drugs list
1958 (WHO - 1977� GFATM
Triple burden ofdiseaseCommunicable tonon communicablediseasesDiseases ofcommunication
Triple burden ofdiseaseCommunicable tonon communicablediseasesDiseases ofcommunication
High cost ofmaintenance of existingfacilitiesPressure to expandservices / facilitiesPressure to keepabreast of technologicaladvancesDemand for all servicesat door step
0
0.5
1
1.5
2
2.5
1940 1943 1946 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000
Year
% S
hare
of G
DP
MOH Health Share o f GDP Nominal (R+C) Exp .
0.00
1.00
2.00
3.00
4.00
5.00
6.00
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
Y e a rHealth Share o f No minal GDP Ed ucat io n Share o f No minal GDPDefense Share o f No minal GDP
� Development of Health Finance Policyfor Equity, Efficiency andSustainability
� Strengthening of the Health FinancialManagement System
� Development of Health Finance Policyfor Equity, Efficiency andSustainability
� Strengthening of the Health FinancialManagement System
� Objective:To improve the equilibrium among equity,efficiency and sustainability of Health Finance
� Development of a health financial policy for national,provincial and district levels
� Development of a plan to reorient procedures andformats towards performance based planning andbudgeting
� Cost effectiveness studies…..� Community involvement ……� More Autonomy …….
� Objective:To improve the equilibrium among equity,efficiency and sustainability of Health Finance
� Development of a health financial policy for national,provincial and district levels
� Development of a plan to reorient procedures andformats towards performance based planning andbudgeting
� Cost effectiveness studies…..� Community involvement ……� More Autonomy …….
� Objective: To improve transparency andaccountability of the health system
� Strengthening and reorganizing the DDGFinance Office and DDG (Planning) forhealth service delivery and inter-sectoralhealth issues within the context of healtheconomic reality and with total accountability
� Strengthening and reorganizing the financialsystem and capacity of the PDHS Office
� Strengthening and reorganizing the DPDHSOffice
� Objective: To improve transparency andaccountability of the health system
� Strengthening and reorganizing the DDGFinance Office and DDG (Planning) forhealth service delivery and inter-sectoralhealth issues within the context of healtheconomic reality and with total accountability
� Strengthening and reorganizing the financialsystem and capacity of the PDHS Office
� Strengthening and reorganizing the DPDHSOffice
NationalNationalCommission onCommission on
�June 2002 - A Sri Lanka delegationparticipated at the Consultation onNational responses to the CMH Report
� Aug. 2002- National Health Councildecision to set up the National Commission
on Macroeconomics & Health
� Nov. 2002 - Appointment of the NCMH
�June 2002 - A Sri Lanka delegationparticipated at the Consultation onNational responses to the CMH Report
� Aug. 2002- National Health Councildecision to set up the National Commission
on Macroeconomics & Health
� Nov. 2002 - Appointment of the NCMH
1. To advise the Government and the Ministerof Health on all broad policy issues, policy
options and directions in relation to investmentsin health, both in the public and private sectors
so that health could make an optimalcontribution to development of the country.
2. To recommend new approaches and strategiesfor scaling up health interventions, particularly
those aimed at the poor, and increasing theinvestments in health for human development.
1. 1. To advise the Government and the MinisterTo advise the Government and the Ministerof Health on all broad policy issues, policyof Health on all broad policy issues, policy
options and directions in relation to investmentsoptions and directions in relation to investmentsin health, both in the public and private sectorsin health, both in the public and private sectors
so that health could make an optimalso that health could make an optimalcontribution to development of the country.contribution to development of the country.
2. To recommend new approaches and strategies2. To recommend new approaches and strategiesfor scaling up health interventions, particularlyfor scaling up health interventions, particularly
those aimed at the poor, and increasing thethose aimed at the poor, and increasing theinvestments in health for human development.investments in health for human development.
Contd….>
3. 3. To commission appropriate studies, inTo commission appropriate studies, indifferent aspects of macroeconomics anddifferent aspects of macroeconomics andhealth that will support the work of thehealth that will support the work of the
Commission.Commission.
4. 4. To recommend modalities for mobilizingTo recommend modalities for mobilizingincreased external resources for healthincreased external resources for health
development and to advise on broad policiesdevelopment and to advise on broad policiesand strategies for their optimal utilization.and strategies for their optimal utilization.
5. To advise the Minister of Health on all5. To advise the Minister of Health on allaspects related to economics and health foraspects related to economics and health for
overall health and human development in Srioverall health and human development in SriLanka.Lanka.
Contd..
Co-ChairmanHon.Minister of Health
Hon.Dep.Minister of Finance
Co-ChairmanHon.Minister of Health
Hon.Dep.Minister of Finance
NCMHNCMH
Planning CommitteePlanning Committee
SecretariatSecretariat
WG1Budgeting Issues
WG1Budgeting Issues
WG2Financing Issues
WG2Financing Issues
�Advocacy for healthinputs
�MDGs, Vision 2020,�PRSP, Master plan�Commitment by
Finance to increaseresources by 0.1%GDP annually
�Outcome of two complementary activities
�JICA assisted HMP development 2002,2003
�PHRD activity 2000 & 2002,2003
�Strategic Framework for MoH developed inApril 2003
�Outcome of two complementary activities
�JICA assisted HMP development 2002,2003
�PHRD activity 2000 & 2002,2003
�Strategic Framework for MoH developed inApril 2003
Improve Health Services Delivery and Health Actions
Strengthen Stewardship
& Management
Functions
Improve Human
Resource Development
& Management
Improve Health Financing,Resource Allocation
and Utilization
Strengthen individual, household and community actions for health
povertyreductionpoverty
reduction
health
� Master plan – SWAP� Implicit commitment� WB US $ 50 mlns� Performance based
budget – resources topoor
� Rehabilitation NE� Social marketing –
individual’s role inhealth,
� Family & societysupport
o Advocacy – privatesector
o Studieso Review of cost studieso Evaluation of taxation
and fiscal intensiveso Financing of provincial
health service
o Advocacy – privatesector
o Studieso Review of cost studieso Evaluation of taxation
and fiscal intensiveso Financing of provincial
health service
� calling for expressions ofinterests in undertakingMacroeconomics andHealth studies (34 /16 s-listed)
� seminar on policy issuesin health financing
� web site� TOR for working group
on financing
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