India has announced the formation of its own national commission on macroeconomics and health. The commission, to be co-chaired by India's health and finance ministers, will look into areas needing attention and try to find ways of increasing investment in health.
Its formation was prompted by the report of the World Health Organization's Commission on Macroeconomics and Health, set up in 2000, which concluded that development would not automatically occur in the developing world without increased investment in health. Its report, published in December 2001, called for both increased budgetary allocations by the developing world and greater donor assistance (BMJ 2002;324:7).
“India is spending less than 1% of its gross national product on its healthcare budget and can never achieve the 8% economic growth that it aspires to without a significant increase in its budget for health, nutrition, and education,” said Jeffery Sachs, chairman of the WHO's commission. Professor Sachs, who is currently director of the Earth Institute at Columbia University, New York, will be an adviser to India's national commission.
“If you don't do anything about the AIDS pandemic, for instance, and … let it spread from 3–4 million HIV infected [people] and wait for 10 years, then all the hope we now have for growth will be dashed in an epidemic of a scale we cannot even imagine,” warned Sachs.
The cost of fighting AIDS was beyond the reach of developing countries, said India's health minister, Shatrughan Sinha. He explained: “With an estimated four million HIV positive cases in India and with 10% of those progressing to AIDS, even at the minimum cost of $365 [£227; €346] per annum per patient we shall require about $150 million annually, which is more than half of the annual central health budget.”
Sinha was equally blunt in criticising the Global Fund to Fight AIDS, Tuberculosis and Malaria, a public-private partnership that was established in 2002 to attract new resources into fighting these diseases. “Though India had submitted proposals for assistance of $112m for combating all the three diseases, only the TB component was approved, and the total assistance sanctioned was only $8.8m during the first round,” he said.
“Just at the moment, finance ministries are a bit wary of putting more money into health, because they are not sure it delivers,” David Nabarro, executive director of WHO told the BMJ.
“Increased investment in health will mean more money but will also mean that people who work in health will have to be prepared to indicate what they are achieving with their spending,” cautioned Nabarro. And that would no longer mean business as usual, he added.