Dear Colleagues,


Many people are coming back from holidays these days. Our colleague David Hercot is no exception. So we capitalized on this, and allowed him to get back in the groove by writing an editorial on his recent stay in South Africa. David was there for research purposes, but he also had plenty of opportunities to discuss the National Health Insurance reform with public health colleagues.
Enjoy your reading.
Kristof Decoster, David Hercot, Ildikó Bokros, Basile Keugoung &Wim Van Damme




South Africa‘s health system financing at a crossroads


by David Hercot (ITM)


Earlier this month I had the chance to pay a visit to Cape Town’s marvelous floristic kingdom, the tiniest of the six floral kingdoms that divide plant species across the world. It is impressive how different the plants are in that tiny far end of Africa. Now, that was not the first reason of my trip, obviously. Our team is involved in research on Global Health Initiatives’ impact on health systems, with colleagues at University of Western Cape and the South African Medical Research Council. As we advertised recently, the findings have been compiled on a websiteand we hope this will make it easy for you to find out the interesting results.


Read the rest of the editorial here.



Global Fund Transitional Funding Mechanism decisions


1.    GFO (issue 193)

Earlier this week, Aidspan published Issue 193 of its “Global Fund Observer.” The whole site has been revamped, it’s definitely worth to check it out. The new issue features an article announcing the GF’s Transitional Funding Mechanism decisions, an article on the results of the TFM decisions by country, and an article about a new report from the GF Board on challenges in grant implementation.
In addition to the almost weekly GFO, Aidspan now also publishes new content immediately on their website. A brand new Comment by David Garmaise dwells on a position paper by a number of CSOs on the development of a new funding model for the Global Fund.
Science Speaks interviewed Bernard Rivers, who is leaving Aidspan, after 10 years.


Child mortality


2.    Plos Collection – Child Mortality Estimation Methods

MDG 4 calls for a reduction of two-thirds in the under-5 mortality rate between 1990 and 2015. Reliable estimates of child mortality are critical to the monitoring of progress toward this important goal. The UN Inter-agency Group for Child Mortality Estimation (IGME) annually reports on country, regional and global trends in child mortality. In this Collection of five research articles and two reviews the independent Technical Advisory Group to the UN IGME introduces the group’s methodological innovations in estimating child mortality.
You can find summaries of the key findings of the collection in a BMJ news article  and a Plos ‘Speaking of Medicine’ interview with one of the main authors.
Earlier this week, a UNICEF expert said that an intense focus on countries with the highest levels of child mortality combined with the availability of cheaper vaccines and medicines can lead to a development breakthrough. We could even achieve a ‘man on the moon’ moment, he declared. (perhaps we can then also plant the US flag?)


US elections & domestic/global health


3.    Lancet – Class, health and the American elections;

Laurie Garrett;

Laurie Garrett reviews the complex social, political, and financial issues at play ahead of the November 6 US presidential election and their implications for domestic and global health programmes. Excellent article, as usual.
In case you need some more arguments to attack the Romney/Ryan clan, check out this blog post by Robert Reich: “Finding Private Ryan: Pushing back the Republican tide.  (by the way, anybody who can give us one solid argument why a Romney/Ryan administration would be good for just one aspect/sector of American or global health, gets a prize: the next guest editorial is totally yours)


4.    Politico – on GOP & global abortion

The Republican Party is calling for forbidding abortion under all circumstances in its draft platform, but this is not a great surprise: the party has advocated this position for many years now. There is no other Western nation that restricts abortion so severely (as the GOP platform would like), in fact, only the predominantly Roman Catholic countries Nicaragua, Chile, Salvador and Dominican Republic forbid abortion in any circumstance. But what happens in nations where abortions are not allowed? Illegal, underground abortions become quite common. According to the UN, it’s estimated that 47,000 women lose their lives each year from the complications from unsafe abortions… Is this the Brave New World R & R have in mind for US women?


Still on the topic of women’s health, a blogpost appeared in Science Speaks about rural women in Kenya who avoid health care settings for childbirth to avoid the perception that they have HIV, a status that would stigmatize them as being ‘promiscuous’ which leads to discrimination.


5.    Guardian – The Pacific free trade deal that’s anything but free

Dean Baker;

In case you’d wonder: the Obama Administration also has its flaws, in fact, it has many. Check out this critique of the Trans-Pacific Partnership Agreement (TPP) negotiations by Dean Baker.


Public Health & the Big Picture


6.    BMJ (editorial) – Public Health: What’s the big idea?

Trevor Jackson;

This BMJ editorial comes back on the essay by Tim Lang and Geof Rayner on ‘ecological public health’ we covered in last week’s newsletter. They argue that public health thinking needs an overhaul and a new model that is fit for the 21st century. In other words, they offer a ‘Grand Vision’ and try to see the Big Picture. (that sounds almost like the Republican Convention, we admit, but they’re dead right, we shouldn’t leave this just to politicians and economists.)
Related to this, a Lancet Letter dwells on the concept of ‘One health’. “The concept of “one health” recognises that all animal species (including human beings) provide a shared reservoir for pathogen gene exchange and spread. The expanded “one world, one health” concept, … , recognises that the health of people and societies is intimately linked and ultimately dependent on the resilience of the world’s life-supporting ecosystems. However, the concept has not been operationalised. One world, one health captures a single integrated global priority, which should encourage the identification of sustainable health solutions that respect the rights of current and future generations.”  (but too bad the concept sounds like the Beijing Olympics slogan ‘One world, one dream’)
Still focusing on the big picture, Foreign Affairs just published a discussion on the limits of growth. “The warnings of The Limits to Growth were far more prescient than Bjørn Lomborg suggests, argue several critics, including two of the book’s authors. No they weren’t, Lomborg insists.” (unfortunately, the articles are gated)


7.    Foreign Policy blog – West Nile, Ebola, and Cholera: Lessons from Three Epidemics

Julia Robinson;

In the past month, the US witnessed an outbreak of West Nile Virus, Ebola hit  Uganda and the DRC, and cholera popped up in Sierra Leone that’s spread to its West African neighbors. What lessons can be learned from these three epidemics, according to Julia Robinson?  “No single health issue can exist in a vacuum–it is interconnected with development, sustainability, economics, and so on. These diseases require more than a vaccine, treatment, or epidemic control. Education overall as well as health education and awareness, reduction of our carbon emissions, and a renewed focus on infrastructural and economic development are all required. We must take more holistic approaches to global health–otherwise, we’re merely treating the symptoms of the problem.”


8.    WHO (Regional Office for Europe) – Draft Twelfth General Programme of Work: draft for discussion by the regional committees in 2012 (pdf)

This first draft of the twelfth general programme of work for the period 2014–2019 represents work in progress. It is presented for discussion by the regional committees in 2012 and builds on the outline framework presented in May 2012 to the Sixty-fifth WHA and the Executive Board at its 131st session. In this draft, Chapter 1 provides a short review of the changing global context in which WHO is working. Chapter 2 looks at some of the broad implications of this context, particularly their influence

on the direction of reform. Chapter 3 covers the programme and priority-setting aspects of reform. It discusses the scope of each category; describes how cross-cutting issues will be handled; and reviews each of the agreed priorities in turn. Chapter 4 deals with corporate services and enabling functions.  (although this is work in progress, it’s definitely worth a thorough look).
CFR produced an update of its excellent ‘Global Health Regime’ issue brief.


Health Policy & Financing


9.    Lancet (Comment) – Unexpected high levels of multidrug-resistant tuberculosis present new challenges for tuberculosis control

Sven Hoffner;

In a Lancet article, Tracy Dalton and colleagues reveal alarming levels of tuberculosis that are resistant to both first-line and second-line drugs. The findings show high prevalence of resistance to at least one second-line drug among multidrug-resistant tuberculosis patients. Worse still, the study found higher than expected overall levels of extensively drug-resistant tuberculosis. Sven Hoffner discusses the new challenges these findings present for future tuberculosis control in this accompanying Comment.
Sarah Boseley summarized the findings (somewhat less technically) in the Guardian.


10. Performance Based Financing – PBF: the pitfall of relying on a single sponsor

Bruno Meessen;

Bruno Meessen reflects on the lessons from a recent regional workshop organized by the World Bank on results-based financing for Anglophone African countries. In a previous blog post, he identified several positive developments. In this second contribution, he shares a point of concern: so far, PBF seems like a story of one single sponsor per country.


11. Washington Post – Guinea worm is poised to become the second human disease to be eradicated

Alyssa A. Botelho;

“Guinea worm disease is reaching the end of its days. The parasitic infection, which has sickened millions, mostly in Asia and Africa, is on the verge of being done in not by sophisticated medicine but by aggressive public health efforts in some of the poorest and most remote parts of the world.”


12. Results for Development institute – Post-2015 health MDGs

Julian Schweitzer et al.; (pdf)

This report has been prepared by the Results for Development Institute (R4D) with the purpose of reviewing and contributing to the evidence base concerning progress on the health MDGs to 2015 and beyond. For this purpose, the evidence base comprises experience with the MDGs to date, current debates and policy developments, the aim of a post-2015 global agreement similar to the MDGs, how a global agreement might add value to national efforts, and the type of agreement that might be made, including targets and indicators. The report was already published in July, but we somehow overlooked it.


13. Center for Global Health R&D Policy assessment – India’s Role in Global Health R&D

Paul Wilson & Aarthi Rao;

What is India’s current capacity for new health technology development and how is this capacity likely to evolve? Do the government’s policies support innovation that is important to public health? And as Indian firms gain access to markets in the US and Europe, will they still invest in products for neglected infectious diseases? This Center for Global Health R&D Policy report, “India’s Role in Global Health R&D”, sets out to answer these questions.


14. Insider Monkey – Billionaire Bill & Melinda Gates’ Foundation Trust’s Top Stock Picks

The Gates Foundation manages much of its assets in a trust to ensure that it will be able to continue its charitable work in the future. The trust’s second and third largest holdings are shares of Coca-Cola and McDonald’s (11.7 and 9.9. million shares of these, respectively). So what does this mean? That the Gates Foundation is funding the fight against malaria and other infectious diseases from profits of two global beverage and fast food giants, companies which sell products that do everything but keeping us healthy.  (Having said that, the Tampa Republican convention didn’t feature any sushi or healthy food-stalls either  – apparently, that’s for “Liberals”).


15. Capacity Plus – Task Sharing, Not Task Shifting: Team Approach Is Best Bet for HIV Care

David J. Olson;

By developing a more rational division of labor among HIV/AIDS health workers in developing countries, we can go a long way in “Overcoming the Last Barrier to Universal Access.” Team-based approaches seem the way forward, although they are not possible in all HR constrained settings.

Nurses have a significant role to play in that effort and should thus be represented in global health decision making fora, Olson argues.


16. Malaria Journal – Trends in availability and prices of subsidized ACT over the first year of the AMFm: evidence from remote regions of Tanzania

Prashant Yadav, Jessica L Cohen, Sarah Alphs, Jean Arkedis, Pete Larson, Julius Massaga and Oliver Sabot;

“This study is the first to rigorously examine the availability and price of subsidized ACT during the first year of the AMFm, measured through retail audits in remote regions of Tanzania. The AMFm led to large increases in availability of low priced ACT in Tanzania”.


17. International Health – Feasibility and benefits of scaling up antiretroviral treatment provision with the 2010 WHO antiretroviral therapy guidelines in rural Lesotho

Helen Bygrave, Peter Saranchuk, Lipontso Makakole,Nathan Ford;

This article shows some promise in terms of the possibility to integrate global recommendations on ART in low resource settings.


18. Social Science & Medicine – A typology of structural approaches to HIV prevention: A commentary on Roberts and Matthews

Alexander C. Tsai;

Renewed enthusiasm for biomedical HIV prevention strategies has followed the recent publication of several high-profile HIV antiretroviral therapy-based HIV prevention trials. In a recent article, Roberts and Matthews accurately note some of the shortcomings of these individually targeted approaches to HIV prevention and advocate for increased emphasis on structural interventions that have more fundamental effects on the population distribution of HIV. In response, Tsai offers a typology of structural approaches to HIV prevention.


Development & Aid


19. ODI (report) – Security: the missing bottom of the Millennium Development Goals?

Lisa Denney;

This paper examines the arguments and proposals for including a security-related target in the post-MDG framework. (we agree that’s a sensible thing to do, and Romney & Ryan will no doubt finance it)


20.  Localising aid: can using local actors strengthen them?

Jonathan Glennie et al.; (pdf)

This paper sets out a research programme to address whether the ‘Paris-style’ approach to using systems in order to strengthen them is working, and whether an analogous approach might also be appropriate for non-state sectors (i.e. the private sector and civil society).
Finally, we also want to draw your attention to Owen Barder’s blog post on complexity and Cameron’s “golden thread” approach.

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