This week saw the prestigious World Health Summit in Berlin, featuring high profile keynote speakers, panellists and international health politicians (opening statement ‘the hope is bigger than the fear’ – not sure common citizens around the world share this assessment), World Polio Day, and the last US presidential debate, which revealed anything but opinions about foreign aid since ‘it’s time to do some nation-building at home’ according to Obama (It’s time to ‘win the hearts and minds’ of American citizens – no, he didn’t say that). The debate reflected an inward-looking America, although Romney called for foreign aid for the Muslim world. Furthermore, jailing the ‘seismic seven’ has caused worldwide debate over the pros and cons of scientific communication (or knowledge translation?), while fears are mounting about pending EU and US budget cuts for development aid in general.
Over to Beijing then. The Emerging voices training is in full swing now, here in the Chinese capital, so this week we offer an IHP newsletter with Chinese characteristics – as we speak, one of our editors is actually flying over the ocean to join us. Next week the global symposium in Beijing will obviously require most of our attention, so the IHP newsletter might look slightly different then. We hope you don’t mind.
In this week’s guest editorial, our colleague Bruno Meessen reflects on a recent conference in Amsterdam on health systems strengthening in fragile states.
Enjoy your reading,
Kristof Decoster, Peter Delobelle, David Hercot, Ildikó Bokros, Basile Keugoung & Wim Van Damme
Health systems strengthening and conflict transformation in fragile states: catching two birds with one stone?
by Bruno Meessen (ITM)
On October 11th, I attended a one-day expert meeting organized by Medicus Mundi International at the Royal Tropical Institute (KIT) of Amsterdam to discuss the theme ‘Health Systems Strengthening and Conflict Transformation in Fragile States’. Cordaid hosted the meeting. Since this issue is attracting growing attention, events like this may point to the fact that health related NGOs and academics working in fragile states have started to take ownership of the New Deal for Engagement in Fragile States, which was presented and endorsed by a number of governments and multilateral donors at the Fourth High-Level Forum on Aid Effectiveness in Busan, South-Korea. Or perhaps the continental European actors are trying to catch up with UK dynamism, as evidenced by DFID’s current research efforts in this domain?
Global Health Policy & Financing
1. Lancet (early online) – Innovative financing for health: what is truly innovative?
Rifat Atun et al.;
In this early online article, Rifat Atun et al. argue that, although resources mobilised from international innovative financing sources – including GAVI, Global Fund, and UNITAID – are relatively modest compared with donor assistance from traditional sources, the real innovation has been the establishment of new organisational forms as integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate and channel financial resources to LMICs.
2. BMJ (Analysis) – Future of WHO hangs in the balance
WHO is in crisis. Unless member states can be persuaded to “untie” their donations and give the organisation leeway to control its budget and set priorities WHO will slide further into irrelevance with disastrous consequences for global health, warns David Legge.
3. Lancet (Offline) – Can WHO survive?
Horton reports on a recent debate on the WHO held at the London School of Hygiene and Tropical Medicine. After listing some of the opinions articulated there, Horton wraps up: “First, … after an interval of uncertainty, WHO does now have a technical vision, it is clear about what it wants to achieve. Universal health coverage is the agency’s unifying mission. Second, to deliver this mission will require decisive leadership, prioritising of functions, and unprecedented attention to quality and performance. And third, WHO needs to realise the potential of its staff.” So Horton is not that gloomy, it seems, about the future of WHO.
4. Lancet – New voices in global health and sustainable development
Sabine Kleinert et al.;
In partnership with the World Health Summit and the M8 Alliance, The Lancet issued a call for abstracts under the title New Voices in Global Health to report important research, policy, and advocacy initiatives in global health. 169 abstracts were submitted from 46 countries in six continents. Through a peer review and selection process, eight abstracts were chosen for oral presentation and 12 for poster presentation at the Summit. This webpage contains those 20 abstracts. Topics range from the role of international health laws, the use of scientific evidence for policy in the Haiti cholera epidemic, and universal health coverage in Rwanda, to the perception of health by adolescents in cities.
Some more news from the World Health Summit then:
One of the biggest issues according to Laurie Garrett (CFR) is the financial situation for global health, relying heavily on the US Government and the Gates Foundation for the moment. The first will unavoidably cut some of its funding in the next months; the latter is not transparent at all. “The house of cards is about to collapse” she concluded, if measures are not taken immediately. Another call for action was voiced by Judith Mackay (Senior Advisor, World Lung Foundation), speaking in the same keynote lecture as Laurie Garrett. She stated that the tobacco epidemic is not declining but will rise due to the increasing population – with a special worry about women from LMICs who are now targeted by the tobacco industry. Combined with other approaches, improvement might follow from education, if for example states realize the loss of tobacco taxes will be balanced by tax returns from other sectors like restaurants being more frequently visited after a smoking ban, and more importantly by a reduction of health care costs.
Richard Horton also attended the meeting – you might want to check his tweets. We can’t, over here 🙂
Global burden of disease
World Polio Day was celebrated on October 24. The Global Polio Eradication Initiative has published a special issue of its “Polio News” bulletin in recognition of World Polio Day. The issue includes several articles examining global eradication efforts and calls for readers to become a part of the day by joining “the world’s biggest commercial” or by downloading an action pack.
UNICEF on Wednesday called for continued dedication in ‘finishing the job’ in eradicating polio, while also applauding India for being ‘declared polio free’ for the first time in history. UNICEF Executive Director Anthony Lake said in a statement released on World Polio Day, that ‘fewer children than ever before suffer the debilitating effects of this cruel disease.’ He added that the world must concentrate its efforts in reaching children that are most at risk: children with disabilities, living in extreme poverty and in conflict zones in remote areas. Rotary International on Tuesday cautioned India that a $700 million funding gap in the polio program can undermine all progress achieved against the disease so far.
5. TM&IH (online) – Dose reduction of antiretrovirals: a feasible and testable approach to expand HIV treatment in developing countries
Sanda Vento et al.;
In this TMIH editorial, Sandra Vento and colleagues advocate for dose reduction of different antiretrovirals to be urgently explored as one possible option to help sustain ART roll-out in developing countries, based on previous examples of dose reduction, as well as the estimated reduction in cost. In addition, dose reduction could decrease the number of adverse events, improve tolerability and favour adherence to treatment.
Some more news on HIV/AIDS:
- “Finding a safe, effective AIDS vaccine has, thus far, proved elusive even after some $8 billion invested from 2001-2011 into vaccine research and development,” PlusNews reports in an article examining ongoing HIV vaccine research efforts. However, some encouraging vaccine research news came this week from South-African researchers (check out their paper in Nature medicine).
- Indonesia plans to include HIV Treatment in UHC.
6. Sarah Boseley (Guardian) – Buying antimalarials at the local store – too high a price to pay?
As the Global Fund Board prepares to decide whether it will continue to host the Affordable Medicines Facility–malaria, the outcome is hard to predict. ACTs financed by the Affordable Medicines Facility—malaria (AMFm) can be used by primary care providers in all sectors. The AMFm has both supporters and critics, and provokes intense passions because it ‘is about the belief on one side that the private sector is the most effective way to get medicines to those who need them – and the certainty on the other side that bolstering the public sector to diagnose and treat people is a fairer and safer way to go,’ reports Sarah Boseley in a new global health blog post.
You might also want to read a short article in the Lancet Infectious Diseases (by David Reddy et al.) on counterfeit antimalarial drugs. The authors argue that production and distribution of counterfeit antimalarial drugs (or indeed any drug), should be deemed a crime against humanity.
An interesting World Bank blog post discusses the health costs and benefits of DDT use in malaria control and prevention.
- MSH’s “Global Health Impact” blog provides a Storify summary of a Washington Post Live panel discussion on non-communicable diseases (NCDs) that took place last week, one year after the UN summit on NCDs.
- Meanwhile, Amanda Glassman (CGD) says the World Bank and the regional development banks should be considered as an alternative to public-private partnerships to tackle NCDs.
- To fight chronic “diseases in Mexico, the nation with the world’s highest rate of obese and overweight adults, a Reuters investigation found that WHO’s regional office (PAHO) has turned to the very companies whose sugary drinks and salty foods are linked to many of the maladies it’s trying to prevent. However, PAHO strongly disagrees with the allegations in the article, (see their press release on Saturday). The release states: ‘Private companies are not involved in health policies formulation or in decision-making processes of the Organization.’
- As for the EU, we have our own NCD issues, as Martin McKee et al. point out in The Lancet, commenting on the recent tobacco turmoil around Commissioner John Dalli.
Regulation & access to quality medicine
7. PLOS-Medicine – Strengthening medical product regulation in Low- and Middle-Income countries
Charles Preston et al.;
In a Policy Forum, Charles Preston et al. propose that strengthening regulatory systems in LMICs must become a global health priority, based on the globalization and rapid scale-up of medicines to the developing world, and as shown by case studies from key regulatory domains such as product supply chains, clinical trials, pre-market approval, post-market surveillance, and regulatory science, where several ways of strengthening these systems can contribute to global health.
In an interesting blog post on the World Bank End Poverty blog, Patricio V. Marquez digs into the issue of medicine access and pricing. As the implementation of the universal health coverage agenda evolves across African countries, proper attention needs to be placed to ensure timely access to essential medicines taking into account international experiences and ongoing innovative efforts in the countries.
Check out also this Lancet Infectious Disease correspondence on universal access to quality medicines. The authors (including our colleagues M. Boelaert and R. Ravinetto) stress that sustainable actions are urgently needed to address the scourge of poor-quality medicines, which disproportionally hits developing countries, where drug regulation is often inadequate or insufficiently enforced—even in middle-income countries.
UHC and post-2015
8. Salud Por Derecho – Universal Health Coverage on the International Agenda
Trinidad García and Vanessa López;
Some international organizations such as the WHO and the ILO (but also many other stakeholders, as you know) and some countries like France or Brazil are pushing for a reviewed concept of Universal Health Coverage. Garcia & Lopez emphasize that much of what is at stake will depend on the definition that will eventually be given to UHC, as well as the political will that each countries decides take in relation to health as a universal human right.
9. Ecohealth – Towards a Better Integration of Global Health and Biodiversity in the New Sustainable Development Goals Beyond Rio+20
Etienne V. Langlois et al.;
The authors argue that discussions beyond Rio+20 and toward the adoption of SDGs offer a critical opportunity to re-assess the major challenges for global health and sustainable development. There is an urgent need to translate the general aspirations put forth by Rio+20 into concrete health outcomes and greater health equity. The way toward the post-2015 SDGs will likely be more effective if it highlights the full gamut of linkages between ecosystem processes, anthropogenic environmental changes (climate change, biodiversity loss, and land use), socio-economic changes, and global health. Negotiations beyond Rio+20 should strongly acknowledge the global health benefits of biodiversity protection and climate change mitigation and adaptation strategies, which reduce diseases of poverty and protect the health of the most vulnerable. They argue that health and ecosystems are inextricably linked to all development sectors and that health should remain a critical priority for the upcoming SDGs in the context of global environmental change.
- The UN panel on post-2015 development goals, co-chaired by Britain’s prime minister David Cameron, has set an ambitious timetable, The Guardian reports. The panel is expected to hand in its first draft around March and submit its final report in May. (we hope Cameron reads the abovementioned Ecohealth paper)
- Dr Jim Kim, WB President, spoke at the post-MDGs session in Tokyo, highlighting his vision of the World Bank’s role in the post-2015 process and what the Bank can do to assist its member countries. You find his speech here.
Global Health Initiatives
- CGD recently established a Global Fund Forum with opinions by several high-profile speakers about how resources should be allocated in a growing austerity climate. Prominent thinkers and practitioners are asked what reforms the Global Fund should prioritize and how it should best fulfill its mandate of improving the way development aid is managed in addition to advancing the fight against the three diseases as its Board considers new policies and its new Executive Director prepares to takes office.
- Aidspan published Issue 199 of its Global Fund Observer. The issue features an article on a diagnostic review of GF grants in Peru; a commentary by Aidspan’s David Garmaise on language used in the GF’s Office of the Inspector General reports; an article looking at GF grants to Nigeria, etc.
10. KFF report – The Women, Girls, and Gender Equality Principle of the U.S. Global Health Initiative: How Have USG Programs Responded?
This report examines how countries are responding to and implementing the women, girls, and gender equality principle of the U.S. Global Health Initiative (GHI). This principle, one of seven core principles of the GHI, aims to sharpen the focus on women and girls across U.S. government global health efforts. Based on interviews with representatives from 15 GHI country teams, this report identifies nine key themes and trends that could help inform U.S. policy
In her ‘Politics’ blog on the Huffington Post, Serra Sippel, President of the Center for Health and Gender Equity, writes that the three agencies (USAID, CDC and PEPFAR) will be responsible for ensuring that there is an ongoing focus on the GHI principles – especially the principles of health sector integration, equal rights for women and girls, country ownership, and health systems strengthening. A focus on these principles is necessary to ensure US global health programs are effective.
Health Policy & financing
11. Lancet (editorial) – Promoting research integrity: a new global effort
A new global effort is being made to promote research integrity. Various initiatives, including regional ones, are ongoing to ensure ethical standards.
12. Lancet (editorial) – Sex workers, HIV and the law in Asia Pacific
Only giving condoms to sex workers will not curb the HIV epidemic in Asia Pacific. However, giving them legal protection and respecting their rights will help, this Lancet editorial argues. It is imperative to review and reform the current laws, ensuring that sex workers and sex worker organisations are fully and centrally engaged in improving legal environments to safeguard their human rights.
13. CGD – Opening Up Microdata Access in Africa
In this post, Gabriel Demombynes, Senior Economist in the Nairobi office of the World Bank, describes some of the issues raised at the Center for Global Development and the African Population & Health Research Center’s first meeting of the Data for African Development Working Group meeting last month. The key data problem in Africa is data access, he says. As a broad principle, publicly funded data should be freely available to the public, he continues.
14. Jama (viewpoint) – The health policy election
Aaron E. Carroll;
If you don’t know which election this author is talking about, you probably are an alien (not the aliens the Chinese government is referring to though, as soon as you arrive at Beijing airport). Carroll dwells on Romney & Obama’s different plans with private insurance, Medicaid and Medicare. “Even though their visions for private and public coverage differ in many ways, the overarching distinction between the candidates is how they prioritize coverage expansion vs reduced federal spending on health care.”
Global health bits & pieces
- Massachusetts Senator John Kerry may head the US State Department next year, but his daughter Vanessa has already launched a new era of global health realpolitik: Claire Panosian Dunavan reflects in GlobalPost’s “Global Pulse” blog on the Global Health Service Partnership, a new public-private partnership launched by Vanessa Kerry to boost the education of doctors and nurses in sub-Saharan Africa.
- Tobacco companies may be prohibited from some advertising, but there are no regulations against advertising via apps, reports TIME Magazine.
- In Ethiopia, construction began on a PEPFAR-funded National Public Health Training Center, a state-of-the-art facility which will act as training and support hub for Ethiopia’s national public health monitoring, research and laboratory network.
- Pollution might be a more important health problem than malaria or TB, according to the World’s worst pollution problems report published by the Blacksmith Institute in partnership with Green Cross Switzerland. The report documents, for the first time, the public health impact of industrial pollutants – lead, mercury, chromium, radionuclides and pesticides – in the air, water and soil of developing countries. (China is still a ‘developing country’, we hear from our interlocutors here in Beijing. We don’t really agree, but in terms of air pollution they probably are – just ask our boss, Wim Van Damme: after a few laps of walking(!) in the stadium here at Peking University, enjoying the pristine air, he felt really ill).
15. BMC International Health and Human Rights – Combating healthcare corruption and fraud with improved global health governance
Tim K Mackey and Bryan A Liang;
Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, the authors propose a global health governance framework calling for international recognition of “global health corruption” and development of a treaty protocol to combat this crucial issue.
16. BMJ Open – Childhood mortality in SSA: insight into small-scale geographical inequalities
Lawrence Kazembe et al.;
In this study, Lawrence Kazembe et al. provide clear evidence of considerable geographical inequalities of under-five mortality that is unexplained by socio-economic factors, indicating that planning and intervention measures could have different outcomes in terms of effectiveness in areas with a high degree of variation. Homogenous policy intervention strategies may hence not give the required outcomes as suggested by large significant inequalities in the under-five mortality within and between countries.
Department of Error
IHP#191 contained some errors regarding Item 5 (Positioning Health in the Post-2015 Development Agenda), as an alert reader kindly pointed out:
- The document hyper-linked as a call for proposals by the UN was actually a paper of ‘issues to consider’, sent to NGOs who were about to participate in the WHO consultation on NGO engagement, an event held last week at WHO HQ in Geneva. This call was unrelated to the post-2015 development agenda, but part of the WHO reform process (as indicated under Item 7 in IHP#191)
- The webpage hyper-linked as ‘thematic consultations’ is a civil society and not a UN website. The official website (a joint initiative between the UN and civil society) can be found @ http://www.worldwewant2015.org/
- The main thematic consultations on health are not led by MMI, but by WHO, UNICEF and the Government of Sweden. The WHO webpage related to this is http://www.who.int/topics/millennium_development_goals/post2015/en/index.html
- Unfortunately, it appears substantial EU aid budget cuts are very well possible.
- According to David Dominic in a Huffington Post article, “it seems that the U.K. aid system, with regards to sub-Saharan Africa, is carefully designed to control and exploit the region, with scant regard for the impacts upon the poor. That is, aid seems to be used as a tool of modern imperialism.”
- Open Access Week, a global event now entering its sixth year, is an opportunity for the academic and research community to continue to learn about the potential benefits of Open Access, to share what they’ve learned with colleagues, and to help inspire wider participation in helping to make Open Access a new norm in scholarship and research.