Poverty Reduction Strategy Papers – Challenges and Responses by
WHO’s Department of Health and Development (HDE)
1. What are Poverty Reduction Strategy Papers
and what do they mean for health?
The
Highly Indebted Poor Countries (HIPC) Debt Initiative was
proposed by the World Bank and the IMF and agreed to by
governments around the world in 1996 as a coordinated approach
among official creditors to bring down debtor
countries’ external debt to sustainable levels. However, the
challenge to reduce poverty has obliged the whole
development community to rethink how to better support
countries’ own efforts in poverty reduction. A broad range of
actors, including global civil society movements have become
increasingly active in re-examining and influencing development
and debt strategies. Partly as a result of this, the World Bank
Group and IMF, agreed in 1999, to strengthen the Heavily
Indebted Poor Countries (HIPC) initiative to provide broader,
deeper and faster debt relief to the 41 Heavily Indebted Poor
Countries. The enhanced HIPC offers a real opportunity for
freeing up government resources for poverty eradication efforts
and to focus these on a broad range of interventions that improve health outcomes of
poor people.
The
expectation was thus made explicit that in return for debt
relief, beneficiary countries would commit themselves to
policies toward sound economic management as well as poverty
reduction. The Initiative puts emphasis on structural and social
policy reforms, particularly to enhance the provision of basic
health care and education services for the poor, facilitated
where needed with additional financing under the HIPC
Initiative. Further, governments benefiting from the debt relief
are expected to make their plans for poverty reduction explicit
through the preparation of a Poverty Reduction Strategy Paper
(PRSP).
These
should be based on the following core principles:
- country-driven,
involving broad-based participation by civil society and the
private sector in all operational steps
- results-oriented,
and focused on outcomes that would benefit the poor;
- comprehensive
in recognizing the
multidimensional nature of poverty, but also
- prioritized
so that implementation is feasible, in both fiscal and
institutional terms;
- partnership-oriented,
involving coordinated participation of development partners
(bilateral, multilateral, and non-governmental);
- based on a long-term perspective for poverty
reduction
As
such, the PRSPs are intended to be the national blueprint for
social and economic development, focused on progress towards the
International Development Goals, especially the commitment to
halving the population living in poverty by 2015. They are also
intended to be the basis on which external development
assistance will be conceptualized and provided.
PRSPs
are comprehensive in scope, covering all sectors of the economy
and cross-cutting development issues such as governance,
security and participation.
However, they are intimately related to the health
sector, both because of a developing appreciation of the role of
ill health in poverty creation, and the corresponding potential
of health improvement to support poverty reduction, and
consequently the increased willingness of funders to support
health improving expenditures. It is expected that a significant
share of the proceeds of debt relief will be devoted to the
social sectors, including health.
2.
The challenge of PRSPs for WHO
The
advent of PRSPs presents WHO with both an opportunity and a
challenge. The opportunity is to push health up the development
agenda. The challenge is to develop the capacity within WHO to
render a meaningful service to its member states, showing how
they can make health a mainspring of development, and make
health services more productive for poor people. This will
entail overcoming a historic legacy, by which the health sector
has focused on the maximisation of health gain, without regard
to its distributional impact, and by which WHO has focused on
providing technically sound advice on the control of diseases
rather than development policy for the health sector. This
analysis argues for two lines of approach:
- Developing the conceptual basis
for health's contribution to development, identifying
interventions in the health sector and related sectors
- Developing the capacity in WHO
to provide policy relevant advice to member states in
formulating and implementing poverty reduction strategies, and
specifically their health components
3. The role of HSD in PRSPs
One
of the objectives of HSD is to support countries in the
development of health components of comprehensive long term
poverty reduction strategies including formulating PRSPs.
Within
this, the main focus will be to build capacity both within and
outside the Organization in the regions, to:
- define and analyse key health
elements in a poverty reduction strategy
- discuss and negotiate health
components in the PRSP process with key leaders and stakeholders
- eveloping the capacity in WHO
to provide policy relevant advice to
HSD
will work closely with Regional Offices to develop a strategic
approach to capacity building. This means that, while having the
flexibility for ‘ad hoc’ responses to urgent needs/demands,
HSD will take a long-term view and encourage the designing,
resourcing and implementation of poverty reduction strategies in
such a way as to allow participating stakeholders to develop
critical capacities ‘while doing’. Such a ‘learning while
doing’ approach means that a capacity building plan must
accompany, and be interwoven into, the entire process of
developing and implementing poverty reduction strategies,
helping to anticipate problems and challenges and providing
appropriate solutions.
4. What will HSD do in 2001 ?
- Given the large number of HIPC
countries in the Africa Region, HSD is currently developing a
programme jointly with the Department of Healthy Environments
and Sustainable Development (DES/AFRO) to assist countries in
the preparations of poverty reduction strategies papers. Three
sub-regional workshops, one francophone, one anglophone, one
lusophone are being organized in close collaboration with World
Bank Africa Technical department and UNICEF, to assist country
teams in preparing analytical documents to be fed into the PRSP.
Participants will include government officials from the
Ministries of Health and Finance, WHO country staff including
WRs, country health economists and national management
professionals, UNICEF staff, and civil society organizations.
Close partnership will be sought with other development partners
such as the EU and bilateral agencies (DFID, FAC, GTZ). It is
hoped that similar joint activities could also be developed with
other Regional Offices shortly.
HSD will produce technical guidelines to assist countries
writing their PRSPs on health sector issues (in collaboration
with the World Bank), and on health related issues aimed at
reducing poverty and improving the health of the poor. This will
be done in consultation with other WHO departments.
- Participate
in World Bank missions to countries, mostly in AFRO, preparing
health components of poverty reduction strategies
- Review
with other regional offices, especially SEARO and WPRO, the
prospects for joint work on poverty reduction strategies.
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For
more information on HSD activities in relation to Poverty
Reduction Strategy Papers, or for an information kit regarding
PRSPs please contact :
Eugenio
Villar, coordinator Poverty and Health Policies (POV), HSD
villare@who.int
or
Margareta
Skold, Technical Officer (POV), HSD
skoldm@who.int
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