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Mauricio Soto, Geremia Palomba, Carolina Bloch, Nick Carroll, Tohid Atashbar, Deeksha Kale, Baoping Shang, Kiichi Tokuoka, Ruud de Mooij, and Guillaume Chabert
IMF country teams have become increasingly engaged on health spending issues in surveillance and program work, and more so since the COVID-19 pandemic. The primary objectives of health spending are to improve health outcomes and provide protection to households against high financial costs of health care. The Fund’s engagement on health spending issues is guided by an assessment of its macro-criticality, with the scope and purpose of engagement varying across countries and depending on whether it occurs in surveillance or program contexts. This technical note discusses how to assess the macro-criticality of health spending and reviews appropriate policy responses. The design and implementation of macro-critical health reforms often require specific sectoral knowledge and experience. Thus, this note emphasizes the importance of collaborating with development partners on health policy issues.
Samah Mazraani
The paper examines Madagascar's education, health, and social assistance spending and outcomes. Government spending on education is relatively low compared to peers, and the quality of education has deteriorated. The paper recommends allocating more resources to the sector, ensuring transparent and merit-based teacher recruitment mechanisms, and strengthening teacher training and incentives. Health spending is also low, and the health system faces challenges in malnutrition, immunization, and service delivery. Additional domestic resources and large-scale structural reforms are needed. Social safety net programs have limited coverage and low spending, and expanding them should be a top priority to reduce poverty and support vulnerable populations.