We would first like to draw your attention to an ongoing conference in Bangalore, India (5-6 October). ITM is co-organising the National Conference on Bringing Evidence into Public Health Policy (EPHP 2012) with the Bangalore Institute of Public Health. The conference is the largest gathering recently of researchers, policymakers and public health practitioners in India to discuss UHC. Several papers selected for presentation will be presented and discussion held on how these findings could inform policy. The entire conference is being streamed live on the Internet. You can find the schedule here.
In this week’s guest editorial, our colleague Fahdi Dkhimi reflects on a recent CoP workshop in Marrakesh, Morocco. Among other issues, the event zoomed in on the Moroccan scheme RAMED, the Medical Assistance Regime for the Economically Disadvantaged. We hope you also find the time to read another account of the Marrakesh event, by Lara Brearley (UK Save the Children). Together these two posts give a fairly good overview of the workshop.
Enjoy your reading.
Kristof Decoster, David Hercot, Ildikó Bokros, Peter Delobelle, Basile Keugoung &Wim Van Damme
Ramed: the Moroccan path to UHC?
by Fahdi Dkhimi (ITM)
As highlighted by Gwatkin recently in the Lancet, the beginning of the third millennium has been marked by renewed interest in equity and poverty, usually embedded in a more broadly desired political objective: achieving Universal Health Coverage (UHC).
Read the rest of the editorial here
Health Systems Research & Health Policy
1. WHO Bulletin (Editorial) – Time for innovative dialogue on health systems research
Bruno Meessen et al.;
A forthcoming (but postponed) report by the WHO on evidence for policy is already fuelling passionate debate, especially among scientists. Opinions are divided: some scientists believe strongly in the systematic assessment of evidence on the effectiveness of health system interventions and reforms; others are sceptical. Starting from the recent Cochrane PBF debate, Bruno Meessen and others show this is more than just an academic debate. They stress that a balanced dialogue between different knowledge holders – researchers, practitioners and policy-makers – is a conditio sine qua non for successful health policies. (Rumour has it that the ‘postponement’ of the World Health report has to do something with similar issues, so no doubt this will be a key debate in Beijing too.)
2. Sarah Boseley (Guardian) – From user fees to universal healthcare – a 30-year journey
Thirty years after he advocated user fees for healthcare in developing countries, former World Bank thinker David de Ferranti, lead author of a recent Lancet series urging universal healthcare, explains his change of mind in this Guardian article. He denies his change of heart is a ‘Damascene conversion’. (Needless to say, this article was tweeted about a lot this week.)
3. People’s Health Movement – Call to action
The Cape Town PHM call to action has been finalized. (It was my first week on Twitter, so I might have missed it, but I saw very few tweets on this much needed PHM ‘call to action’.) Whether that has something to do with – what historian Anne-Emanuelle Birn would call – “the politics behind the global health agenda”, is anybody’s guess. Check out her very interesting interview with Tom Paulson, on Humanosphere.
In the interview, Birn however acknowledges that the Gates Foundation does appear, rhetorically at least, to have become less single-minded in its’ techno-fix’ approach and more willing to expand its efforts into some of the messier, more politically charged arenas such as women’s reproductive health. The (just published) 2011 annual report of the Foundation shows some evidence of this new and more holistic position of the GF (but Tom Paulson noted some other points too in this annual report).
Post-2015 and health
4. Lancet (Offline) – Offline: What kind of world do you want post-2015?
Horton wonders what will win a place on the world’s list of preeminent priorities once the MDG target year of 2015 is passed. “During the past decade, health was at the centre of human development. This frontline position was based on a macroeconomic analysis of development. … Now, however, this model of development has been superseded by a new philosophy—sustainable development. And here, although health still retains a place of importance, it is no longer the dominant idea underpinning the way we see human progress.”
That assessment is very true – just check out the new WB World development report on jobs, for example, or this blog post by CGD fellow Charles Kenny (in a first article in a series on the post-2015 goals, “the UNGA games”). Kenny says he’s a fan of (ONE’s) Ben Leo’s idea for a global survey asking people what they would like to see in the next round of MDGs. The results of (already existing) surveys so far are crystal clear: what people want, all over the world, is jobs.
5. WHO – Health in the Post-2015 Development Agenda
This document provides an outline of the proposed process for the global thematic consultation on health. Horton already mentioned the nine scheduled thematic consultations in his Offline article. For each thematic area, selected UN organizations will lead the preparation and planning of the consultations in partnership with one or two government leads that will ensure Member State leadership and involvement as well as overall steering. The governments of Botswana and Sweden have expressed interest in taking on this role, and working with WHO and UNICEF in preparing and implementing the thematic consultation on health. This concept note defines the objectives for the thematic consultation on health, describes how it could take place, and identifies the resources needed.
Check out also the MMI website, to see how you can contribute.
In a piece on the Arogyaworld website , Jeff Meer argues the social determinants of health shouldn’t be forgotten. The current draft of WHO targets (draft action plan NCDs) does not contain any direct measurement of social determinants so far, he implores.
6. Lancet (editorial) -Europeand global health: looking for a leader
What Europe could do for global health and what global health could do for Europe was the subject of a panel discussion last week at Europe House in London, UK. The aim of the meeting, Beyond the Eurozone Crisis: New Realties for Global Health, was to discuss opportunities and challenges that Europe faces in the midst of the financial crisis, and how it can reposition itself around policies for global health in the context of a longer term shift in the world economic order, where developing countries have become the engines of growth. (Leadership is lacking so far in the EU (sounds familiar), it was said; somebody even mentioned Europe needs a ‘saviour’ like the Gates foundation …)
7. Lancet (Comment) – Time for heroes: public health leadership in the 21st century
Matthew Day et al.;
As part of a project funded by the Worldwide Universities Network, the authors explored the role of leadership in tackling the public health challenges of the 21st century. Apparently, ‘level 5 leaders’ or public health ‘superheroes’ who “paradoxically blend personal humility with professional will and make the right decisions happen, are what is needed. (don’t know whether Mitt Romney qualifies)
8. Global Fund Observer (issue 197)
This issue features, among other things, an Analysis of the new GF funding model, offering the different perspectives.
Aidspan also just started a new Discussion page – The new feature provides users of the site with an opportunity to discuss Global Fund-related issues.
The first discussion topic has been posted. On the site, Aidspan provides five short extracts from a paper published in July by Andrew Harmer et al. on the impact of Global Fund support for civil society advocacy in three countries in EECA. The paper raises interesting issues that affect all regions, not just the EECA. The topics range from “Have Global Fund programmes fostered an ‘enabling environment’ for CSO advocacy?” to “Effects of dependency on Global Fund financing”, to “Impact on national policies.” (In order to comment, you need to create an account on the Aidspan site.)
We don’t want to make a habit of it, but given the ongoing conference inBangalore, we thought it would be nice to include an ‘Indiasection’ in this newsletter again.
Recent stuff you might want to read on Indian health care:
- a World Bank report on government-sponsored health insurance inIndia (September 2012)
- In a nice ‘Speaking of Medicine’ blog post, Leena Menghaney, a lawyer and the IndiaManager of the Access Campaign at Médecins Sans Frontières, explains the difference between the two court cases: “One case (Novartis) goes to the heart of what merits a patent. The other (Bayer) addresses what countries can do when patented life-saving medicines are priced out of reach for the vast majority of patients.” The Financial Times also paid attention to the two court cases this week.
- A panel of Indian ministers has proposed price controls on 348 drugs in what could be India’s first effort in 17 years to regulate the prices of drugs (BMJ news). Opinions are divided.
Health Policy & Financing
9. Lancet (World report) – What has the US Global Health Initiative achieved?
The Obama Administration’s signature global health programme established a vision, but one that remains mostly unfulfilled, say health and development experts. (sounds familiar, bis) Ted Alcorn reports.
In an Op-Ed for Global Health and Diplomacy, Hillary Clinton said the US needs to shift from providing global health aid to investing in global health. Also, it’s a shared responsibility – every nation needs to invest in health. As politicians tend to do, she explains how the US will make this shift and why it will be successful.
10. CSIS report – New approaches to Global Health cooperation – perspectives from Brazil
Katherine E. Bliss et al.;
This report summarizes key observations and conclusions that emerged at a November 2011 seminar in Rio de Janeiro.
11. BMJ (news) – Lack of money and poor security are barriers to global eradication of polio
Ban Ki-moon has called on warring parties in countries where polio is endemic to ensure that healthcare workers are given safe passage to carry out vaccination programmes. Talking at a meeting on polio eradication at the UN general assembly in New York last week, he urged all sections of the community in affected countries to come together to eradicate polio “once and for all.” The presidents of the 3 remaining polio-endemic countries ofAfghanistan,NigeriaandPakistan, representatives of donor governments and development institutions came together there at a polio solidarity event to express their determination to end polio. An innovative approach came from the Islamic Development Bank which is arranging a US$ 227 million, 3 year financing package to eradicate polio inPakistan.
12. Video Guttmacher institute on abortion
The Guttmacher institute just released a new video on the figures and facts about unsafe abortion and unintended pregnancies worldwide. (Let’s start the next presidential debate in the US with this video).
Some related news. In New York, on Monday, international luminaries, family planning experts and women’s rights activists marked the launch of a new 26-member high-level task force to galvanise support behind the goals of the International Conference on Population and Development (ICPD) that took place in Cairo almost two decades ago.
13. KFF report – theUSdepartment of Defense & global health
This report provides the first comprehensive look at the Defense department’s role in global health, examining its organizational structure, activities, strategy, policy, and budget for activities related to global health. “The department has a long history of supporting health and medical activities internationally, though it does not typically define these efforts as “global health.” “ ( probably because it also has another history, as we know) With its vast geographic reach, long-standing partnerships with foreign governments, ability to rapidly mobilize significant resources, and scientific and technical expertise, the Defense Department has significant resources for activities that impact the health of people around the world. (and with Mitt Romney at the helm of the US, Defense global health activities might even get a boost! One of the many ‘unknown unknowns’ in this race…)
14. Lancet (editorial) – Depression and the global economic crisis: is there hope?
Unemployment, poverty, debt, and diminished public services also have direct implications for human health. Depression, and its associates suicide and alcohol-use disorders, are known consequences the world over. It is timely, then, that this year’s World Mental Health Day on Oct 10 focuses on depression as a global crisis.
15. Lancet (World Report) – Southern African declaration targets TB in mining sector
15 southern African countries have recently pledged to improve treatment and care for current and former miners with tuberculosis and their families. Adele Baleta reports from Cape Town.
16. Nature – Malaria plan under scrutiny
As a US$463-million pilot programme to test the AMFm strategy in seven African countries winds down, public-health experts are questioning whether the approach makes sense given shrinking global health budgets and a steady decline in malaria prevalence. Although no official decision has been announced about whether to continue the programme, many of those familiar with it have told Nature that it must change or be phased out after this year. So the future looks bleak for AMFm. Read also Tom Paulson on this issue, in a Metrics Mania article.
In other malaria news, a malaria drug made by India’s Cipla has been pre-qualified by the WHO, an important step towards its roll-out across Asia.
Not related to malaria (at least not in the short term), but related also to prequalification by WHO, is this news item onChina. A Chinese-made vaccine against Japanese encephalitis is on the verge of being approved for aid agency use by the WHO, a move that would be a first for China and open the door to lucrative regional and global markets.
17. Irin Plus -UGANDA: HIV trust fund in the works
The government of Uganda is planning to establish a US$1 billion-dollar HIV trust fund to finance local HIV programmes.
Irin also reported on concerns over allegations of misuse of GF money in Uganda.
18. (Wider) Working Paper 069 – Aid effectiveness in the health sector
Melisa Martínez Álvarez and Arnab Acharya;
This paper explores the current evidence underlying the debate on aid effectiveness, with a specific focus on the health sector. It summarizes the history of aid and outlines the methodological challenges encountered when assessing its effectiveness. The current evidence on ‘what works’ in the different aid modalities is outlined, highlighting examples of success. The review finds that resource allocation, lack of predictability of funds, fragmentation, fungibility and the system of relationships foreign aid generates all hinder its effectiveness.
19. Healthsys 20/20 – Indicators for Measuring Universal Health Coverage: A Five-Country Analysis
This study aimed to advance the dialogue on measurement of UHC by taking a practical, bottom-up approach – specifically, cataloguing indicators of UHC that have already been defined in the literature, assessing the feasibility of producing those indicators from already-available data sources, and reflecting upon their strengths and weaknesses. The authors aimed to expose key issues related to the feasibility and applicability of commonly proposed metrics of UHC, in order to help prioritize areas for further research and development, especially as donors and policymakers demand accurate metrics to gauge progress towards UHC. Countries areBangladesh,Ethiopia,Peru,Uganda, andVietnam.
20. Aids and behavior – Substantive Review Can Money Prevent the Spread of HIV? A Review of Cash Payments for HIV Prevention
Audrey Pettifor et al.
Cash payments to improve health outcomes have been used for many years; however, their use for HIV prevention is new and the impact not yet well understood. The authors provide a brief background on the rationale behind using cash to improve health outcomes, review current studies completed or underway using cash for prevention of sexual transmission of HIV, and outline some key considerations on the use of cash payments to prevent HIV infections. (This article was already published online in July.)
21. Global Public Health – Evidence-based medicine and the governance of pandemic influenza
This paper explores the role that Evidence Based Medicine has played in shaping the global governance of pandemic influenza, and how it has served to reinforce and reify the authority of particular groups of actors, including policy-makers, elected officials and the medical community.
Development & Aid
We already mentioned the brand new World Development report focusing on jobs. Meanwhile, Kim’s campaign “what will it take to end poverty?” is taking off. An Alertnet article points out that Kim hinted that many more changes are to come at the Bank.
Some other articles you might want to read on the Bank:
- a critical piece on the Bank in Al Jazeera: anthropologist Jason Hickel says The World Bank can be an effective tool in the fight against poverty with fundamental changes in its power structure.
- An article in the Russian press, in which the Russian deputy Foreign minister stresses that BRICs is not an instrument of global governance, but rather a catalyst for global governance reform. That’s probably also why plans for a (BRICs) World Bank alternative are on their way.
- ODI researchers published 2 new challenge papers on sustainable development: “Inclusive and sustainable development: challenges, opportunities, policies and partnerships”.
- In a CGD essay, J. Brian Atwood, chair of the OECD Development Assistance Committee (DAC), analyzes the process and achievements of the Fourth High-Level Forum on Aid Effectiveness, held inBusan,South Korea, in 2011. He provides a firsthand account of the negotiations that ultimately overcame political opposition and created trust among diverse actors. His essay provides a better understanding of how consensus is reached among nations, institutions, and individuals with diverse interests, orientations, and personalities. It is a story, he argues, of how a unique organizational entity, the DAC and its member states, backed by a highly competent secretariat and strong leadership at many levels, exercised effective leadership at critical moments to achieve a positive outcome.
- In a nice article on the ‘Aid on the edge’ website, Andy Sumner and Sergio Tezanos Vázquez explore new approaches to classifying developing countries, based on an IDS Working Paper published last week. In the paper, they develop a more precise and accurate classification system for low and middle income countries, and suggest that this can support a more complex, non-linear appreciation of development trajectories. They distinguish five clusters of LMICs.
- Donors’ transparency was ranked again. The Guardian reports.
- The ‘real’ Obama was not just absent in the first debate with Romney, Todd Moss argues he’s also been missing in Africa(in a Foreign Affairs article ) in his first term.
- Nevertheless, a Guardian article emphasizes that, when it comes toUS aid, the president’s relation with Congress is what really matters.