Dear Colleagues,

The Democratic convention stole the limelight this week, and not just in the US. The fact that the Democrats invited a few gorgeous young women on the stage obviously had nothing to do with it. Clearly, this is still the party of John F. Kennedy and Bill Clinton. We would have loved to see a desperate housewife  and an elderly (but no longer desperate) statesman together on stage, though.

Enough about the US political circus. Let’s focus on global health now. In this week’s guest editorial, Yibeltal Assefa, civil servant from Ethiopia and ITM phd-student, dwells on the importance of Monitoring & Evaluation Systems Strengthening (MESS). In spite of the acronym, it’s hugely important, and not just in Ethiopia.  

Enjoy your reading.

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




Strengthening the Health Information System: Is it (a) MESS?


Yibeltal Assefa  (MD, MSc, Federal HIV/AIDS Prevention and Control Office, Addis Ababa, Ethiopia)


Monitoring and Evaluation (M&E) of health programs and systems is crucial for program and policy design, program management, resource mobilization and accountability. In spite of these benefits, M&E Systems Strengthening (MESS) has not got adequate attention from countries and even Global Health Initiatives (GHIs). Many M&E efforts by donors have been directed towards narrow M&E of their own programs, and this has led to parallel systems, often undermining the overall M&E effort in countries. However, the situation is slowly changing now. Different stakeholders, both at global and local levels, are increasingly advocating for MESS. GHIs are doing so because of the limited resources available and the need for value for money: doing more with the same money. Efforts are increasingly being undertaken to link M&E of HIV programs with overall Health Information Systems.  Towards that end, the Global Fund Technical evaluation Reference Group (TERG) has brought together PEPFAR, UNAIDS, WHO, GAVI and others around MESS.

Read the rest of the editorial here



Lancet Themed issue on UHC


1.    Lancet (Editorial ) – The struggle for universal health coverage

This Lancet themed issue offers a collection of papers that make the ethical, political, economic, and health arguments in favour of UHC. The collection will be presented in New York on Sept 26, to coincide with the UN General Assembly. The Series was facilitated by the Rockefeller Foundation and led by David de Ferranti of the Results for Development Institute in Washington, DC.

The first of three Lancet Series papers explores the evidence on the links between expansions in coverage and population health outcomes. The second paper looks at the political and economic dimensions of the transition to universal health coverage, and the third examines nine LMICs in Africa and Asia that have implemented national health insurance reforms. Also, a Viewpoint  (by Jeffrey Sachs, the man who doesn’t seem to sleep in this Millenium) calls for continued progress and argues for a large public sector role in health systems reform.

Check out also the following Lancet viewpoints: a Comment in which Judith Rodin and David de Ferranti argue that UHC amounts to the third global health transition, another one in which Julio Frenk (and again de Ferranti) argue that 4 (EPIC) aspects should be clear in the drive towards UHC, and a final comment by David Evans and others on the fact that UHC needs to be part and parcel of sustainable development. Also, don’t forget the Lancet letter by civil society (Action for Global Health).

Excellent theme issue. However, it seems weird that UHC is put forward as a core global health goal somewhat in a vacuum. Although writers emphasize that UHC is a core element of sustainable development, they don’t point out the planetary tragedy (climate change, biodiversity loss, …) we’re about to witness if we don’t get our act together soon, i.e. if the opposite of sustainable development would happen. Let’s hope UHC will be more than damage control in three, four decades from now. (To see what I mean, read this CGD blog post by Michele de Nevers on the terrifiying new global warming math and old politics, based on a Rolling Stone article from last month.)

For people who want to read more on Universal Health Coverage, MMI provides an online thematic guide to UHC.


Global Fund


2.    Lancet editorial – The future of the Global Fund

Last week, the Global Fund announced that its Board had approved 45 new two year grants, from 37 countries, totalling US$419·2 million. The approved projects were part of the Fund’s Transitional Funding Mechanism. Good news, but the organisation is still in a period of transition. It needs to enter a phase of stabilisation. Two issues must be addressed for this to happen, this Lancet editorial argues.


3.    GFO – new issue

As a lot is happening at the Global Fund these days, it’s probably good to read the new GFO issue in full (and have a regular look at their website). Meanwhile, Kate Macintyre replaced Bernard Rivers on the first of September. She’s the new Executive Director of Aidspan.

You can find some other GF related blog posts and articles on Science Speaks  (in a an article reporting on a survey done by the Global Fund Board delegation representing Ngos in developing countries on the obstacles in the field that have hindered  the best use of GF grants, as well as recommendations to overcome them), on the BMJ blog (a blog post by Daniele Dionysio on the GF overhaul) and CGD  (a wonkcast with Amanda Glassman on the GF transitions and value for money).  Not directly related to the GF, but also a nice video to watch is an Al Jazeera interview with Bill and Melinda Gates on their philanthropic work (25 mins).

(by the way, Interrogating scarcity (by Ted Schrecker) is an essential read whenever we start talking about the austere budget climate and value for money to the powers that be and the public).




4.    BMJ (news) – Republicans call for changes in US healthcare and gun laws

Janice Hopkins Tanne;

The Republican party platform, adopted on 29 August, proposes changes that would affect healthcare, public safety, and other social issues for millions of US citizens. This BMJ news article give a nice overview. (Meanwhile, Paul Ryan has been caught silently requesting Obamacare money for a clinic in his district. Oops).


5.    Lancet – The shock of the new—cigarette pack warnings

Dawei Wu;

Following the Australian Government’s landmark victory against the tobacco industry on the issue of plain cigarette packaging, the cause of global public health has been dealt a blow by the US Court of Appeals. Legislation by the US Food and Drug Administration mandating graphic health warnings to be printed on all cigarette packages sold in the USA has been deemed unconstitutional. Dawei Wu comments.

Peter Singer also ponders the Court decision, in a Project Syndicate article.


6.    AJTMH – The Importance of the Global Health Strategy from the U.S. Department of Health and Human Services

Nils Daulaire;

At the beginning of 2012, the US Office of Global Affairs unveiled the Global Health Strategy (GHS) for the US department of Health and Human Services (HHS). The strategy is the product of several months spent exploring the range of global health work being done within all of HHS; examining the rationale behind that work; identifying top priorities; and synchronizing the role of HHS in a comprehensive, cohesive strategy. The strategy identifies 10 global health objectives.




7.    Lancet (World Report) – Free drugs for India’s poor

Amelia Shepherd-Smith;

The Indian Government has vowed to make drugs free for all ahead of the next election but this is not a new pledge, just its latest attempt to realise an old one. Amelia Shepherd-Smith reports.


8.    BMJ news – Bayer challenges India’s first compulsory licence for generic version of cancer drug

Sophie Arie;

Arie sketches what is at stake in two upcoming court decisions in India.


9.    Nature (online) – The time for pharmaceutical compulsory licensing has expired

Randall Kuhn & Reed F. Beal;

In related news (though not confined to India), the authors of this Nature viewpoint argue the compulsory license mechanism is broken and will not bring drug access to the world’s poorest nations. It’s time to consider another option—a tax levied on patents—to fund drugs for developing countries, rather than the erratic compulsory licensing mechanism.


Health Policy & Financing


10. BMJ (Analysis) – No more disease silos for sub-Saharan Africa

Patricio Marquez & Jill Farrington;

Countries in sub-Saharan Africa are facing a double burden of communicable and non-communicable disease. Patricio Marquez and Jill Farrington argue that knowledge of their common determinants and the links between diseases should be used to spur development of coordinated programmes to prevent and treat both.


11. Health Planning & Management – Barriers to implementing WHO’s exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions

Gwendolen G. Eamer et al.;

This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of the 2010 WHO Guidelines on HIV and infant feeding, by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers


12. CGD – What the Pre-Post Evaluation of AMFm Can Tell Us

Victoria Fan;

In a very nuanced blog post, Fan comments on the near-final draft of the independent evaluation of the Affordable Medicines Facility – Malaria (AMFm) released in July.


13. Plos – Point-of-Care Testing for Infectious Diseases: Diversity, Complexity, and Barriers in Low- And Middle-Income Countries

Madhukar Pai et al.;

Madhukar Pai and colleagues discuss a framework for envisioning how point-of-care testing can be applied to infectious diseases in low- and middle-income countries.


14. NEJM (review article)– Tuberculosis, Drug Resistance, and the History of Modern Medicine

Salmaan Keshavjee and Paul E. Farmer;

The authors comment on TB policy over the last century and a half, including the current MDR-TB policy challenge.


HSR Journal research articles, issues & supplements


15. Globalization & Health (editorial) – Understanding health systems, health economies and globalization: the need for social science perspectives

Susan F. Murray et al;

The complex relationship between globalization and health calls for research from many disciplinary and methodological perspectives. This editorial gives an overview of the content trajectory of the interdisciplinary journal ‘Globalization and Health’ over the first six years of production, 2005 to 2010. The findings show that bio-medical and population health perspectives have been dominant but that social science perspectives have become more evident in recent years. A special issue on ‘Health systems, health economies and globalization: social science perspectives’ is introduced, a collection of contributions written from the vantage points of economics, political science, psychology, sociology, business studies, social policy and research policy.


16. WHO Bulletin (new issue)

The September issue of the WHO Bulletin features an editorial on bridging the gap from knowledge to delivery in the control of childhood diarrhoea, a systematic review of strategies for delivering insecticide-treated nets at scale for malaria control, among other articles. For the Emerging Voices 2012 who already want to find out more about the Chinese health system, we also want to recommend the article on the policy implications of Universal health insurance in China.

Speaking of health insurance, next week Rwanda will host a regional conference with a focus on health insurance. The Conference on Social Health Protection in the East African Community will consider various approaches to providing universal health coverage in Rwanda, Uganda, Kenya, Tanzania and Burundi. (By then, many of the participants might have scanned the East African Bribery Index 2012, published by Transparancy international. The publication offers a survey of key sectors of medical services, education, water utilities, judiciary, police and registry and licences, tax services and the local Government. Rwanda outperforms the others.)


17. HP&P (Editorial) – Changes at Health Policy and Planning

Sara Bennett et al.;

Last year HP&P commissioned a strategic review of the journal to better position the journal in an increasingly complex publishing landscape and enhance its relevance and impact. In this Editorial, Sara Bennett and co-authors dwell on the key findings of the review, and how the journal will take them into account.

Apart from the September issue (which features plenty of interesting articles, most of whom already appeared online before), HP&P also offers a special supplement on Policy making for new vaccines in low- and middle-income countries.


18. BJOG – Who can provide effective and safe termination of pregnancy care? A systematic review

R-M Renner et al.;

Improving maternal health is one of the eight MDGs, and unsafe termination of pregnancy is a major contributor to maternal morbidity and mortality. This systematic review explored whether task sharing termination of pregnancy services between physicians and mid-level providers (a heterogeneous group of trained healthcare providers, such as nurses, midwives and physician assistants), now a key strategy to increase access to safe pregnancy termination care, has been successful and efficient.  (Limited) evidence indicates that trained mid-level providers may effectively and safely provide first-trimester surgical and medical termination of pregnancy services.


19. Health and Human Rights (early online) – Integrating interventions on maternal mortality and morbidity and HIV: A human rights-based framework and approach

Susana Fried et al.;

Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes, magnifying their respective impacts and producing related consequences. Accordingly, an integrated response will lead to the most effective approach for both, Fried et al. argue.


20. BMC Public Health (Debate) – Health and demographic surveillance systems: a step towards full civil registration and vital statistics system in sub-Sahara Africa?

Yazoume Ye et al.;

This paper argues that, in the absence of an adequate national Civil Registration and Vital Statistics system, Health and Demographic surveillance systems should be more effectively utilised to generate relevant public health data, and also to create local capacity for longitudinal data collection and management systems in SSA.


Global Health bits & pieces


  • WHO released a dengue strategy report that sets a goal of cutting deaths in half and reducing cases by 25 percent over the next eight years. The report, titled ‘Global Strategy for Dengue Prevention and Control,’ also sets a goal of estimating the true burden of dengue disease by 2015.
  • The Economist has an article on increasing AIDS activism in Henan province, China – rather unwelcome in the run-up to the power shift later this year.
  • Activism by MPs then, in Africa: some members of the Uganda parliament say they will block the passage of Uganda’s budget unless there is a substantial increase in funding for health care.
  • We want to draw your attention to a new series of blog posts on “25 years Bamako”, on the Health Financing in Africa Blog. This week, the first of the blog posts appeared on the blog, an interview with Lucy Gilson by Emerging Voice Vincent Okungu.


Development & Aid


DFID: Mitchell gone, Greening in


David Cameron reshuffled his cabinet. Andrew Mitchell was one of the people who left for another job; he was replaced at DFID’s helm by Justine Greening. The Guardian has some excellent coverage on Mitchell’s legacy, and on what can (and perhaps should) be expected from his successor. (see here, here, and here). Among the points made: Mitchell depoliticized aid (Jonathan Glennie obviously regrets this) & Greening should start to contemplate exit strategies for aid and focus more on global tax justice which would allow more domestic revenue in developing countries).




  • Foreign Policy has a nice article on 10 things you don’t know about the African economy. As Bill Clinton would put it: it’s all about jobs, stupid.
  • David Dickson from SciDev  (which has been an open access journal since its start in 2001) argues in this article that while a momentum has clearly been building up for publicly-funded research to go more and more open access, difficulties still exist for developing countries. The World Bank, the Wellcome Trust, the EC and also DFID recently adopted open access policies for their research outputs. However, one big challenge for developing countries is that the author fees required can be very pricey (1500 GBP on average). One solution could be that these fees are made components of the research grants, but we are still a long way from that – until then, let’s hope that publishers will be willing to waive their fees.
  • ODI authors published a new paper on common constraints and incentive problems in service delivery in three sectors, including health.
  • Last week, a short Economist article sketched ‘the geography of poverty’ brilliantly, or rather the current academic debate around it (with Sumners/Kenny on one side and  Kharas & Rogerson on the other side – they differ quite a lot, for example with respect to their predictions of where the poor will be situated by 2025-2030).
  • The same journal focuses on “Asia’s next revolution” this week: many Asian countries are re-thinking the welfare state at this moment.  See also the Economist editorial.
  • Finally, Britain has resumed some of its budget support to Rwanda. DRC officials are not amused.

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