Dear Colleagues,

No doubt many of you are kept in the loop on the upcoming Beijing HSR symposium by the Symposium organizers. When registering for the Symposium, most of you probably joined Health Systems Global, the new membership-based society on performance and health systems research.  And if you have not yet joined, you can still join here.  Members of Health Systems Global will soon be receiving nomination forms for Board elections, perhaps already today. Details about the application process including deadlines will be included in that communication. There are eleven Board positions that need to be filled.  (Although far more transparent, that sounds almost like elections for the new Chinese Politburo top positions J, given the timing.   Hopefully, board members will not disappear mysteriously for a few days during the Symposium. )

In this week’s guest editorial, Emerging Voice 2012 and pediatrician Eleanor Namusoke Magonge from Uganda ponders the media distortion of health systems research in her country and elsewhere.

Enjoy your reading.

Kristof Decoster, David Hercot, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme




Media distortion of Health Systems Research: A Ugandan experience


by Eleanor Namusoke Magongo, MBchB, MMED Pediatrics, Pediatrics Advisor-Management Sciences for Health, STAR-E (Strengthening TB/HIV/AIDS Response in Eastern Uganda) project


In Uganda, there is a growing interest in Health Systems Research (HSR). About 5 years ago, the oldest university, Makerere University, introduced HSR as one of the courses offered at the university. However, despite this growing interest in HSR, there is disappointingly little media attention for HSR.  Researchers in Uganda have had a problem trusting the media because on many occasions, the research findings have been misrepresented by the media.

Read the rest of the editorial here 


Calls to Action in journals


1.    Epianalysis – Blah, blah, blah: a jaded calculation of the rhetoric-to-results ratio in public health

Sanjay Basu;

Just read this blog post for yourself, and you will understand why we start this week’s newsletter with it. Very incisive piece and a blunt message. And yes, we plead guilty tooJ.


US elections & health


2.    Lancet (Editorial) – Americans’ choice for health

The issue of health in the upcoming US election is central to the major parties’ campaigns (see for example also the comparisons of the two party platforms in this blog post or on Devex, including the very different climate change positions, unlike in 2008). Barack Obama’s Patient Protection and Affordable Care Act (ACA) is set against the Republicans’ push for competition between providers with each state given the power to craft its own plan. The Lancet will capture the debate over the weeks leading up to the Nov 6 election. Some of the articles were already published in July (after the Supreme Court decision) or August (for example Laurie Garrett’s analysis), and more updates will follow in the coming weeks.

A BMJ news article elaborates on the Democrat platform with respect to Medicare, Medicaid and women’s health rights.

Check out also this week’s Lancet World Report on how women are set to benefit from Obama’s health reform, and contrast with the GOP “war on women” (article in the Daily Beast). (but just ask Marleen Temmerman or some Togolese women how women can deal with political bigots)

Meanwhile, a short Science Speaks article explains what the “continuing resolution”, a bill to fund federal government programs for 6 months (until March 27, 2013)   might imply for global health programs. Not bad for PEPFAR in the short run, but not so good news for the Global Fund.

You might also want to read this Chatham House article on the foreign policy instincts of Obama and Romney (and their foreign policies’ intellectual sources). They aren’t that different, argues David Milne. ( anyhow, in the current circumstances, this is more stuff for Las Vegas casinos)

Still on the US, Peter J. Hotez wrote a BMJ editorial on how to fight neglected tropical diseases in the South of the United States.




3.    Lancet (Editorial) – Europe: the great divide

Europe is in the midst of a crisis, a human one, this Lancet editorial argues. And we all know why. Many people in and outside the eurozone are struggling.

“A Review by Michael Marmot and colleagues published in The Lancet today also offers a reality check for policy makers. It shows that health inequities are increasing in many European countries and the 2008 economic meltdown—and the response to it—has exacerbated the health divide.”  Also in the Lancet, Zsuzsanna Jakab, WHO regional director for Europe, comments on this European review of social determinants of health and the health divide


4.    WHO Regional office for Europe – Governance for health in the 21st century

Ilona Kickbusch & David Gleicher;

This study on governance for health in the 21st century tracks governance innovations that have been introduced to address priority determinants of health and summarizes them as five strategic approaches to smart governance for health. The study relates the emergence of joint action of the health sector and non-health sectors, of public and private actors and of citizens to achieve seminal changes in 21st-century societies. They include a new understanding of health and well-being as key features of what constitutes a successful society and vibrant economy and the higher value placed on equity and participation.




5.    Lancet – India’s patent laws under pressure

Peter Roderick & Allyson M. Pollock;

Pending cases against India’s patent laws threaten public health and misinterpret international intellectual property agreements, say Peter Roderick and Allyson M Pollock. The effect of the international harmonisation of patent laws is in the spotlight this month as global pharmaceutical giants Bayer and Novartis’ legal challenges to key provisions of India’s Patents Act come to a head.

In last week’s Economist print issue, reporting on the India court cases, it was argued that Big Pharma and governments will need to find a compromise. And they argue the Bayer case is actually the more dangerous one of the two.

In other news, reported in Nature, India is trying to tackle antibiotic resistance through better regulation of over-the-counter sales.


Global Fund & HIV/AIDS


6.    Aidspan (Commentary) – The Global Fund Needs to Manage the Relationship Between the Secretariat, the PR and the CCM

David Garmaise;

David Garmaise calls the relationship among the Global Fund Secretariat, the Country Coordinating Mechanism and the Principal Recipient the “tricky triangle.” Up to now, the Global Fund has not done a very good job of managing this tricky triangle, he argues. He gives some suggestions to improve the situation.

The Global Fund also published a 10 page information note for civil society, on how they need to engage with the GF in light of the recent structural changes  (see ‘Featured Content’).

Still on the GF, a Science Speaks article reports on a letter by TB advocates. The latter have signed a response to a GF funding proposal they say will foster a divisive “disease against disease” approach to funding, and seriously undermine efforts to roll out cost-effective diagnostic and treatment approaches. Instead of the ‘historical disease allocation model’, they suggest other funding models.


7.    CGD – Ethiopia’s AIDS spending cliff

Amanda Glassman & Kate McQueston;

There’s an AIDS spending cliff in Ethiopia and the government is already in free fall. Next year, Ethiopia will experience a 79% reduction in US HIV financing from PEPFAR. Amanda Glassman considers the implications, and wonders whether it will be possible to do more with less, even more so now that there might be some political instability after the death of Meles Zenawi.


8. – HIV vaccine ‘still a decade away’, say researchers

Luisa Massarani;

An effective HIV vaccine may not be ready for another decade despite ongoing efforts by scientists around the world, the AIDS Vaccine 2012 conference heard this week (9–12 September). (and yes, we agree with Tom Paulson and others that we’ve heard this before – let’s ask Sanjay Basu to write a blog post on ‘pie in the sky’ predictions).


9.    Medicus Mundi – Global advocacy in an era of resource constraints and shifting global priorities

Von Eduard Grebe;

The success of the global AIDS activist movement bringing about change in the global AIDS response has been impressive. However, its time of greatest influence seems to be behind it, this author argues. Yet, the task ahead is still vast. It is critical that AIDS and global health activists revitalise their own movements and organisations. Von Eduard Grebe thinks the proposal by Mark Dybul, Peter Piot and Julio Frenk is a sound one and perhaps the way forward.

Check out also Thomas Schwarz’s piece on ‘UHC as a shared vision beyond 2015’ in the same MMI bulletin. “The existing fragmentation of the global health advocacy community is worrying. To overcome this situation people of the health community should agree on an overall understanding on what they want. Universal Health Coverage could work as a common, holistic concept for integrating the global movement for health”, writes the author.


Health Policy & Financing


10. Lancet (Comment) – Dengue vaccine development: a 75% solution?

Scott B. Halsteadt;

Halsteadt comments on the first-ever results from a dengue virus vaccine trial aimed a showing effectiveness.

The New York Times also dedicated an article to the results, in plain English even, reporting that “The leading candidate to become the world’s first vaccine against dengue fever was only 30 percent effective in its first large clinical trial, dealing at least a temporary setback to efforts to control a disease that threatens half the world’s population.”

In the Huffington Post, Orin Levine (who just became head of “vaccine delivery” at the Gates Foundation), pointed out that the trial results “provide signals rather than definite answers, and a mixture of both promise and unresolved challenges.” … “To date, these represent the most promising indications that a safe, effective vaccine to prevent dengue is technically feasible.” … “At the same time, the results on protection were inconclusive, somewhat inconsistent with the measured immune responses and uneven across the four strains included in the vaccine.”


11. BMJ (news) – Uganda launches HPV vaccination programme to fight its commonest cancer

Anne Gulland;

Experts on cervical cancer have welcomed the launch of a vaccination programme in Uganda but have called for investment in screening to run in parallel. (This kind of programme raises obvious questions on priority setting in resource-constrained environments. Under pressure of Big Pharma (?), the government implements a new programme that will vaccinate children in schools. Equity is also a concern, as children who attend the school regularly enough to be present on the day of vaccinations are probably not the poorest in the country).


12. UNICEF, WHO, the World Bank and UN Population Division  – Accelerating progress on child survival since 2000, UN says

The pace of reducing child deaths has accelerated sharply since 2000, according to new data released earlier this week by UNICEF, WHO, the World Bank and the UN Population Division. Read also this Guardian article by Sarah Boseley on the good news. Yet, in spite of the (huge and accelerating) progress, the world is not on track to meet the child mortality MDG, UNICEF spokespeople emphasize.

Other encouraging child health news came from the EU this week: “The European Union will continue to prioritise funding for children in humanitarian emergencies, despite the economic challenges”, the EU Commissioner for International Cooperation, Humanitarian Aid and Crisis Response, Kristalina Georgieva, assured UNICEF’s Executive Board this week. (Could it be that in spite of the economic crisis, child survival commitments are being held, unlike the AIDS commitments…?)


13. PSI impact – Celebrating Global Female Condom day

August 12th marked the first ever Global Female Condom Day. (yes, tell Republicans the happy news).

Why are we celebrating this, even with fashions shows, like in Seattle? Female condoms offer women—and men —dual protection from unintended pregnancy and sexually transmitted infections, including HIV, so this is a tool that can empower women to protect themselves from disease and exert control over their reproductive health. According to USAID however, they are not yet wide-spread (or well-known), which means the Female Condom Day’s primary role was to raise awareness.

Another piece of news related to reproductive rights (or at least, to sexual behavior) came from Togo, where the Gnassingbé family has been in power since 1963, making Togo a republic only by name. A few weeks ago, the Let’s Save Togo’s women’s collective called for the women of Togo to go on a week-long sex strike in order to press for Gnassingbe’s resignation. How will this help? After exhausting all other imaginable peaceful remedies, the women hope to mobilize people to solve the current (political) crisis. A means of last resort perhaps, but if nothing else, they have already received worldwide media coverage.


14. Lancet Correspondence – Doubts about the evidence that foreign aid for health is displaced into non-health uses

The Lancet features a Letter by David Roodman in which he expresses his methodological doubts about the Lu et al. crowding out findings of 2010. Chris Murray responds, unfazed, basically saying that the findings are surprisingly robust “both to new data and the testing of an extremely wide range of models”.


15. Lancet Correspondence – Health at the Rio+20 negotiations

Sudvir Singh et al.;

This letter summarises health-related discussions during the Rio+20 negotiations and analyses the strategic position of health in the final outcome text “The Future We Want”.


16. Allafrica – East Africa: Regional Council Calls for Universal Health Insurance

The East African Community (EAC) is pushing for a social health protection programme across all member states, as a way to improve universal access to health services. At the opening of a three-day regional conference on social health protection in the regional bloc (in Kigali), Ambassador Richard Sezibera, the Secretary General for the EAC, said that there was urgent need for regional collaboration on the harmonisation of social health protection mechanisms as the region aims to become a middle-income economy.


17. Lancet (World Report) – The Central African Republic’s silent health crisis

Andrew Green;

The health crisis in the Central African Republic, not exactly a middle-income country, has long been neglected by the government and international donors alike. What will change the status quo? Andrew Green reports from Bangui.




18. HP&P – 10 best resources on … pay for performance in low- and middle-income countries

Ayoko Honda;

This paper aims to share some of the current resources on the application of P4P in LMIC, highlighting concept papers, systematic reviews, recent empirical studies and debate that are considered to provide a holistic view of P4P schemes.


Development & Aid


  • Owen Barder posted the third article in his series on complexity and development, a post on complexity and the results agenda.  Great blog post.
  • ODI published a working paper on key governance constraints on service delivery. How can aid best contribute to improving the delivery of public services in developing countries?
  • CGD’s Charles Kenny argues for a new global initiative to add transparency to government financial transactions worldwide (in the Guardian). See also his Working paper. His buddy Andy Sumner published an update on global poverty and the new bottom billion.
  • The global carbon trading system is close to collapse, and the Kyoto protocol may end by the end of the year. Let’s see what CoP 18 will bring in Qatar in December.
  • Dani Rodrik ponders the MDGs and what should come after them (on Project Syndicate).
  • A new UNDP publication (consisting of 12 essays) aims to accelerate the achievements of the MDGs through economic and social rights.
  • Sanoussi Bilal wrote a nice paper on what South-South cooperation is about, and Emma Mawdsley even wrote a book on ‘Emerging powers and the changing development landscape’.
  • The Global Post zooms in on Africa as the new playground for Al Qaeda.
  • Finally, you might want to read a bit more about the ‘Alliance for a Green revolution’ in Africa (Agra), supported by the Gates & Rockefeller foundations, and opposition against it, for instance by the watchdog Agra Watch.

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