Dear Colleagues,


The  Second Global Symposium on Health Systems Research: Inclusion and Innovation Towards Universal Health Coverage is only four months away now. Preliminary information about plenary speakers, concurrent sessions and poster presentations in Beijing is now available on the programme web site. Early-bird registration closes 30 June!

This week’s guest editorial is written by Seye Abimbola, one of the more prolific Emerging Voices. He wonders how the quality of primary health care can be improved in Nigeria. His editorial provides some interesting ideas that are no doubt also food for thought for other federalized low-and middle income countries. As of today, BMJ blog also features his post.


Enjoy your reading.

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




How to improve the quality of primary health care in Nigeria


by Seye Abimbola (Emerging Voice, former BMJ Clegg Scholar and now a research fellow at the National Primary Health Care Development Agency, Abuja, Nigeria)


Health services in Nigeria mirror political organisation. The federal government is responsible for tertiary care, state governments for secondary care, and the local governments (LGs) run primary care. The financing of (but not the responsibility for) public health is tied to the flow of funds from the federation account. Funds are shared between levels of government according to an allocation formula that keeps about half at the federal level, allocates a quarter to the 36 states, and gives the other quarter to 774 LGs.

Read the rest of the editorial here





The general assessment of Rio+20 (ending today) is covered below in the Development & Aid section. Here we cover the global health related bits.

1. WHO news – The future we want: a healthier planet

Before the Rio+20 conference, WHO released this statement: “The United Nations Conference on Sustainable Development (Rio+20) offers the world an important opportunity to both acknowledge, and benefit from the inextricable links between human health and sustainable development.” WHO has three key messages related to health and sustainable development: achieve universal health access, enhance health gains from sustainable development investments and decisions, and adopt health indicators to measure progress /achievements in sustainable development.
On this website, you can find some (background) documents on health and Rio+20, and information on some of the key side events on health & sustainable development in Rio+20 – by now, most of the events are finished though.


2. RH reality check – Rio+20 Agreement Fails Women, and the World

Zonibel Woods;

There is an explicit mention of family planning in Rio’s outcome document: paragraph 145 reads: “We emphasise the need for the provision of universal access to reproductive health, including family planning and sexual health and the integration of reproductive health, in national strategies and programmes.” The text includes a re-affirmation of both the Cairo and Beijing agreements, Woods agrees, but it falls short by failing to recognize that reproductive rights are also critical to the achievement of sustainable development.


3. IHP – Occupy Science: Time for more activist tools to bridge the gap between science and decision making?

Kristof Decoster;

Rio+20 isn’t finished yet, but the picture looks bleak, at least from a distance. The outcome document is disappointing. I wonder whether scientists shouldn’t start using activist tactics to bridge the evidence-global decision making gap. (and yes, this might sound like a very naïve idea.)


Family planning summit


4. BMJ (Editorial) – Meeting an unmet need for family planning

Gavin Yamey et al.;

On 11 July 2012, the Gates Foundation and the UK government will co-host an international summit in London to shine a spotlight on the world’s massive unmet need for family planning. The summit hopes to catalyse a global movement to provide 120 million women in low income countries access to family planning by 2020. The summit will tackle questions of funding, service delivery, and monitoring.
In a related blog post, Sarah Boseley discusses the amount of money that is needed, what it should pay for and whether the fundamentally important issues of women’s reproductive rights will be addressed at the summit.


5. Guttmacher Institute/UNFPA – Adding it up: Costs and benefits of contraceptive services – Estimates for 2012

A new study by the Guttmacher Institute and the United Nations Population Fund finds that the number of women in developing countries who want to avoid pregnancy but are not using modern contraception declined only slightly between 2008 and 2012, from 226 to 222 million. However, in the 69 poorest countries—where 73% of all women with unmet need for modern contraceptives reside—the number actually increased, from 153 to 162 million women.


Health Policy & Financing


6. KFF –  Governments, Private Sector Partners Come Together At Child Survival Call To Action In Washington

KFF provides a neat short summary of the two-day child survival summit (Washington DC)  including many links to related commitments and declarations. A new global health initiative called ‘Survive and thrive’ was announced by Hilary Clinton. It links up professional associations in the US,  private companies, civil society organizations and the US government in an effort to bring high impact high efficiency interventions to scale. Weird they didn’t give the money to  existing initiatives/organisations like PMNCH or UNICEF, to just name two. Is this progress or needless fragmentation? In a related blog post, CGD’s Victoria Fan comments on the long term chances of survival of the current child survival momentum.
In the Huffington Post, Robert Steinglass rightly calls on the global health community to pay enough attention to implementation issues amid this enthusiasm for investment in innovations to save children.
Sarah Boseley illustrates this well in her blog post on a new report of the polio eradication monitoring group. We have the technical fixes to eradicate polio but currently 2,7 million children in the world have never seen a vaccine. We have to face that reality.
The polio eradication campaign for 2012-13 has a budget of $2.2bn, but is $945m short, which has led to the cancellation of some vaccination programmes, according to the report.


7. Lancet (Comment) – The changing global face of suicide

Michael R. Phillips et al.;

On the basis of WHO estimates for 2004, India and China account for 49% of global suicides, and all low-income and middle-income countries (LMICs) combined account for 84% of all suicides. As better information about suicide in LMICs emerges it is starting to challenge conventional beliefs about suicide that, up until the past decade, have been almost completely based on research from high-income countries. Demographic, social, and psychological factors that have been assumed to be universal risk factors for suicide can, in fact, vary greatly between cultures and over time.
A blog post by Paul Southworth from a few weeks ago also ponders suicide as a global health issue. He lists four priorities to reduce suicides globally.


8. BMJ (Analysis) – Global threat from drug resistant HIV in sub-Saharan Africa

Raph L. Hamers et al.;

Roll-out of antiretroviral treatment for HIV in sub-Saharan Africa has been accompanied by rising rates of drug resistance. Raph Hamers and colleagues call for improved patient management and the integration of population based drug resistance surveillance into national treatment programmes.


9. GFO – Analysis: restrictions on access to funding by middle-income countries

The debate concerning what proportion of Global Fund money should go to low-income countries has been going on for years. This article provides some background information and describes the arguments being advanced by civil society organisations opposed to placing too many restrictions on the ability of middle-income countries to access funding.


The Global Fund also published a new ‘Governance handbook’ this week.


10. Plos Medicine – Big food, food systems and global health

David Stuckler & Marion Nestle;

In an article that forms part of the PLoS Medicine series on Big Food, guest editors David Stuckler and Marion Nestle lay out why more examination of the food industry is necessary, and offer three competing views on how public health professionals might engage with Big Food.

In another article in the series, Andrew Cheyne and colleagues compare soda companies’ CSR campaigns – which are designed to bolster the image and popularity of their products and to prevent regulation – with the tobacco industry’s CSR campaigning.


11.   Plos Medicine – Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

Sanjay Basu et al.;

In a systematic review Sanjay Basu and colleagues reevaluate the evidence about comparative performance of public versus private sector healthcare delivery in low- and middle-income countries.


12.   JAMA – Cuts in Malaria Financing

M.J. Friedrich;

Friedrich comments on the recent malaria funding study in Malaria Journal (April 2012).  Funding cuts to malaria control programs might be associated with almost all the documented resurgences that have occurred worldwide over the past 80 years.


13.   UHC forward – International Labour Organisation recommends that countries aim for universal coverage including social health protection coverage

On June 14, the 101st International Labour Conference adopted its Recommendation R. 202 on national floors for social protection. The Recommendation aims at universal coverage including social health protection coverage and income support for those in need.

An MMI newsletter editorial  (by Thomas Schwarz) also emphasizes UHC is the ultimate expression of fairness.


14.   TMIH (Editorial) – Health research in Africa: getting priorities right

Ole F. Olesen et al.;

Due to international donor priorities, private and public funding for health research in Africa remains disproportionately focused on the three major infectious diseases, whereas only smaller amounts have been allocated to confront other diseases.


15.   Health diplomacy monitor (June issue)


This special issue of the Monitor covers the 65th session of the World Health

Assembly, but features also plenty of other interesting articles, for example an editorial on the changing dynamics of AIDS funding.




16.   HP&P – ten best resources for… evidence-informed policy making

Kaelan A. Moat & John N. Lavis;

This new article in the HP&P series ‘Ten best resources for …’ focuses on evidence-informed policy making.


Development & Aid



Rio+20 finishes today. No doubt in the coming days in-depth analyses will be published in all media. The Guardian dedicated this webpage to the three-day event, as it unfolded. Unsurprisingly, most articles are rather negative. There’s some encouraging news, though, for example on development banks’ support for public transport.

You might also want to read the following articles, published before or during the conference:

  • Jeffrey Sachs wrote a piece on Rio+20  (the opposite would have surprised) (on the Project Syndicate website)
  • So did Bjorn Lomborg (in Foreign Affairs).
  • The Economist assessed the conference outcomes: many ‘mays’, few ‘musts’…
  • CFR’s J. Baghwati  reckons a lot of the debate in Rio+20 amounts to sheer nonsense – in his opinion, there’s a crucial difference between political human rights and economic ones, for example (Project Syndicate)
  • Alertnet alerted us to the fact that some progress is happening, outside the negotiation rooms – global business (that is, part of it) wants to change its ways, it appears.
  • An ODI blog post also assesses  what sustainable development progress would look like.


Post 2015

  • Claire Melamed wrote a short blog post on health and education post-2015.
  • A new ODI paper explores the role for business in a new post-MDG development framework.
  • A Global Dashboard post wonders  whether there will be two parallel processes for brainstorming on the post-2015 Framework: the High-Level Panel, and one linked to the General Assembly.


Other D&A stuff

  • A White House fact sheet lists Obama’s accomplishments in Sub Saharan Africa
  • Last but not least, the OECD criticizes Canada for aid budget cuts and lack of transparency. In Canada, aid has a lot to do with mining companies, nowadays …

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