Dear Colleagues,

 

This week saw lots of awareness raising campaigns – aka “World … Days” – for diabetes, pneumonia, preterm birth, … you name it. No doubt they are all important causes but you do wonder whether this inflation of World Days is the way to go. Perhaps inspired by the powershift in Beijing, some people even reflected on the legacy of SARS 10 years later.

 

By now Emerging Voices are also beginning to reflect on the EV programme in Beijing. This week’s guest editorial is written by EV2012 Radhika Arora, from India. She had a dazzling time in Beijing, for a number of reasons. Do check out also the blog posts by EVs Woldekidan (on his EV experience) and Lalith (on the spirit of the EV venture) as they complement Radhika’s story. We hope others will follow suit.

 

 

Enjoy your reading.

 

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

 

 

Editorial

 

What’s that Noise?

 

Radhika Arore, EV 2012

 

In October this year 50 young public health professionals from low and middle income countries in Africa, Asia andSouth America, with varying academic and professional experiences came together for the second Emerging Voices programme. Conceptualized by the Institute of Tropical Medicine, Antwerp as an initiative towards bringing voices from the global south into the global research arena the Emerging Voices programme was first held in 2010 along with the First Global Symposium on Health Systems Research in Montreux, Switzerland. Two years later, in 2012 the Emerging Voices programme took place once again, this time in association with the Peking University Health Sciences.

 

So what is it about a training programme that deserves a blog post? As one of the fifty participants to the Emerging Voices programme, I spent three weeks in a new country with some of the most incredible and inspiring people I have ever met. That deserves a blog post.

 

Full of excitement and nervous anticipation, bags packed for three weeks, I arrived in Beijing on a warm mid-October afternoon. Learning can take place at different levels, in different spaces and in very different ways. Three weeks in Beijing taught us that. Any doubts about how three weeks in a foreign country would pass were quickly dispelled. We hit Go! the moment we landed. Received by volunteers at the airport we were settled into our cozy quarters at the Master Inn hotel, located opposite the School of Public Health on Campus at the Peking University’s Health Sciences Center, which was to be our home for the next twenty-two days or so.

With unprecedented ways to access and disseminate information today, how do you create a learning environment for over fifty public health professionals who are at varying stages at their career? You bring them together for three weeks and watch the flow of information transfer from Africa to China to India to South America to Belgium and all the way back. Learning took place organically.  With representatives from different countries in Africa, South and South-East Asia the crux of the learning came not just from classroom sessions on language training, presentation skills, health systems research and content, but from the immense knowledge that every participant brought to the programme.

 

Instead of working in independent silos, the programme offered a unique collaborative learning environment, giving all of us participants the opportunity to share our experiences bringing alive not just numbers and data, but also sociocultural contexts to health and development issues facing numerous countries. Each person was given a voice loud enough to be heard all the way from Nigeria to Colombia via Beijing. Common problems were shared, ideas exchanged and collaborations initiated.  The collaborations that were forged weren’t just among the emerging voices and their mentors, but my colleagues and I also had the opportunity to interact with prominent figures in different aspects of health system research from our host organizations as well as from other organizations and field trips to see the Chinese health system in action.

Two weeks of language and presentation skills training, revisions of presentations and poster contents, countless cups of instant coffee and many dragon fruits later the voices emerged in the pre-conference. With a well trumpeted vuvuzela, the ITM team calmed frayed nervous with tai-chi and customized speed dating, helping emerging health system researchers connect with senior researchers. The information environment facilitated easy interaction between EVs, senior researchers and other participants to the pre-conference. It gave a platform to build networks, encouraging interactions during the pre and main conference.

 

As an Indian I have often read and heard of casual comparisons being made between India and China. As a resident ofIndia’s capital Delhi, I will suppress the urge to draw comparisons between the two countries, after spending just a few weeks in the Chinese capital. However, three weeks in Beijing was enough to make me realize just how evolved the infrastructure, systems and the cityscape in the city and suburban areas were. Despite the dust and pollution, of which Delhi has plenty as well, Beijing offered a safe, user-friendly urban space with well-constructed roads, sidewalks for pedestrian, public transport system and more importantly, a safe space for women to move around in, a welcome change for someone like me who lives in a city known to be unsafe for women, pedestrians and drivers as well.

 

I also had the opportunity to be part of a field visit to the community health center at Tongzhou district, approximately 19 kilometres from Beijing.  For most of our field visit group, include myself, we were surprised to find fully constructed and developed transport infrastructure and housing along the roads, instead of a rural town dotted with paddy fields, that some of us equate with a rural setting. Unlike many primary health centers in my home country, the rural-level Community Health Center had a well-made, clean physical structure, with a well-stocked pharmacy and the presence of sufficient health personnel at the center. In Beijing itself, the well planned and very clean campus and services of the Peking University’s Health Sciences Center has many lessons that schools of health in India can learn from.

 

So much for my own very casual comparison between the two emerging giants, back to the EVs venture.  Personally, as a recent entrant to public health research, I was thrilled at being given the opportunity to be able to participate in a training track such as the Emerging Voices. As a broadcast journalist by training with work experience as a features writer, I have always been interested in health and development issues. I believe that solutions to health and development cannot emerge from one sector only. It is only through intersectoral participation that issues of healthcare can garner the support it requires to be part of mainstream discourse as well as to develop policies and programmes that look at issues of health systems from different points of view. That said, without the requisite academic and professional experience in the subject of healthcare, it is often hard or difficult to break into the public health research for those who are interested. Opportunities to encourage such a diverse group of health systems researchers can only boost the quality and kind of health systems research that the world needs.  I believe the emerging voices programme has the potential to introduce candidates with an interest and some professional experience in health and development to health research.

 

Being part of a team as opposed to an independent delegate really helped us get into the thick of things at both the pre-conference and the main HSR conference. With our newly found ability to communicate across accents and cuisine, we strode across the slippery floors of the Beijing Convention Center with ease and confidence in our training to make our voices heard. Bright red-and-white, context-appropriate colored badges set each one apart from the other 1700 participants.

 

The emerging voices track is still in its early stages. With a growing alumni list and increasing interest in the programme I hope the programme attracts more participants in future, including young professionals working at the programme implementation, communications and even policy level. Encouraging media personnel – documentary filmmakers, development writers would make the programme richer and also help build a global network of communicators. Yes, you would expect me to say so, I know.

 

For some Emerging Voices, the journey from Antwerp to Montreux to Beijing was as winding as the road to universal health coverage, board memberships and standing ovations. A second group of young individuals dedicated to improving health systems through research gathered in Beijing for the first time. Here is hoping for a new year of noisy collaborations and information sharing through this rapidly expanding network of young health systems researchers.

 

Time to blow the vuvuzela, I guess!

 

 


Global Fund

 

1.     NYT – Global Fund Sees Changes, Not All of Them Welcomed

http://www.nytimes.com/2012/11/16/health/change-rattles-leading-health-funding-agency.html?smid=tw-share&_r=0

As expected, the Global Fund Board meeting delivered. The appointment of Dybul was announced, the transition to a new funding model, the integration of AMFm into core GF grant processes, and perhaps more surprisingly also the termination of the contract of Inspector General John Parsons.  This NYT article provides some background, both on the appointment of Mark Dybul (and the fears it triggers in some quarters) and on Parsons’ exit. Kazatchkine, the former head of the GF, welcomes Dybul and expects no ‘Pepfarization’ of the Global Fund. Jim Kim and WHO also already congratulated Dybul. For some more background, check out also Tom Paulson’s article in Humanosphere and a short analysis by Andrew Jack in the Financial Times.

 

In a CGD blog post earlier this week on AMFm (the second one, in fact), Victoria Fan had listed the options for the GF board and the factors they needed to factor in.

 

In another CGD blog post, reacting on the disappointing malaria vaccine news of last week, Owen Barder argued for an Advance Market Commitment for a malaria vaccine.

 

2.     BMJ (Feature) – Make or break for the Global Fund?

Sophie Arts;

http://www.bmj.com/content/345/bmj.e7561?etoc=

Earlier this week, in the run-up to the Board meeting, BMJ had a feature article on the challenges and changes contemplated at the GF. Still recommended reading.

 

NCDs & tobacco control

 

3.     WHO – Monitoring framework agreed to assess progress on NCDs

http://www.euro.who.int/en/what-we-do/health-topics/noncommunicable-diseases/sections/news/2012/11/monitoring-framework-agreed-to-assess-progress-on-ncds

WHO Member States agreed on a global monitoring framework to prevent and control noncommunicable diseases including cancer, diabetes, heart disease and chronic lung conditions. The framework focuses efforts to address and assess the progress made in reducing associated illness and death; the reduction of exposures to the main risk factors for NCDs, including tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity; and national health systems’ response. 9 voluntary global targets and 25 indicators are put forward.

4.     WHO – New international protocol adopted to combat illicit trade in tobacco products

http://www.who.int/mediacentre/news/releases/2012/illicit_tobacco_20121112/en/index.html

On Monday, the delegates of more than 140 Parties to the WHO Framework Convention on Tobacco Control (FCTC) adopted a new international treaty, setting the rules for combating illegal trade through control of the supply chain and international cooperation. The Protocol to Eliminate Illicit Trade in Tobacco Products commits countries to establishing, as a central measure, a global tracking and tracing system to reduce the illicit trade of tobacco products.

 

5.     Tobaccocontrol.BMJ.Com – The ‘diverse, dynamic new world of global tobacco control’? An analysis of participation in the Conference of the Parties to the WHO Framework Convention on Tobacco Control

Evgeniya Plotnikova, Sarah E Hill, Jeff Collin;

http://tobaccocontrol.bmj.com/content/early/2012/11/14/tobaccocontrol-2012-050849.full.pdf

The authors of this article examined participation in FCTC governance based on records from the first four meetings of the Conference of the Parties (COP),

comparing representation and delegate diversity across income levels and WHO regions.  They conclude that developing countries face particular barriers to participating in the COP process, and their engagement in global tobacco control is likely to diminish in the absence of specific measures to support their effective participation.

 

In an editorial, the November issue of the Global Health Diplomacy newsletter had looked ahead to COP5 inSeoul.

 

6.     Report Asian development bank – Tobacco taxes: a win-win measure for fiscal space and health

Jha, Prabhat et al.;

http://www.adb.org/sites/default/files/pub/2012/tobacco-taxes-health-matters.pdf

ADB commissioned an expert group to estimate the health and fiscal impacts of higher taxes on cigarettes in the Asia Pacific region, with a focus on the People’s Republic of China, India, the Philippines,Thailand, and Vietnam. The report finds that there is a win–win situation in terms of reduced disease and disability from smoking as well as increases in revenue.

 

Health Policy & Financing

 

7.     BMJ (editorial) – Ensuring the health of future populations

Hilary Graham;

http://www.bmj.com/content/345/bmj.e7573?etoc=

The author of the editorial argues that social determinants need to be set within the wider biophysical environment. The boundaries of the causes of the causes must be extended to include the climate systems and ecosystems on which future health depends. A starting point for the public health community is to assume the position and perspective of future generations. The urgent need is to give substance to the call for health equity across generations.

 

Meanwhile, ‘no drama Obama’ promised to make climate change a priority in his second term. However, on Wednesday, he put it like this: “While jobs and economic growth remain top priorities, if we can create jobs, advance growth and make a serious dent in climate change and be an international leader, I think that is something the American people would support.” So, yes, climate change is on the agenda, but after economic growth and jobs.

 

Meanwhile, “two-thirds of the world’s proven fossil fuel reserves cannot be used without risking dangerous climate change”, the International Energy Agency (IEA) warned this week.  (I think we need a few more Sandy’s before everybody understands that the writing is on the wall.)

 

 

8.     Lancet (editorial) – A timely arrival for Born too soon

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)61970-9/fulltext

World Prematurity Day falls on Nov 17 this year. Earlier in 2012 a report, “Born Too Soon: The Global Action Report on Preterm Birth”, documented the disturbing facts that, worldwide, more than 15 million babies are born prematurely each year, with over a million deaths from complications of preterm birth.” “Born Too Soon is welcome”, this Lancet editorial argues, “because of the attention and commitment to the dangers of preterm birth that the initiative can inspire across a range of settings. Yet it has to be acknowledged that preterm birth and other health needs could struggle to attract funding in today’s difficult financial climate.”

 

Check out also this early online Lancet Comment (by Jane E. Norman) on the prevention of preterm birth (and our lack of results).

 

 

9.     IRIN –  HIV/AIDS: “Mild growth” in privateUS, EU funding for HIV

http://www.irinnews.org/Report/96743/HIV-AIDS-quot-Mild-growth-quot-in-private-US-EU-funding-for-HIV

Private philanthropists in the EU and the USspent some US$644 million on global HIV/AIDS programmes in 2011, a5 percent increase from 2010, largely driven by funding from a small number of large donors – read: mainly the Gates foundation. Several other donors have, in fact, reduced their funding. You can find the report here.

 

10. Action for Global health (report) – Results or rhetoric? What you didn’t know aboutEurope’s aid for health

http://www.actionforglobalhealth.eu/fileadmin/AfGH_Intranet/AFGH/ODA/oda_singles.pdf

Talking about donors reducing their funding, let’s go to the Eurozone. This AFGH report sketches a bleak picture on ODA for health: “The findings show that many of Europe’s biggest economies are not living up to their commitments on ODA and that many are also not reaching the 0.1 per cent of Gross National Income (GNI) target for global health, set by the WHO a decade ago. Perhaps most worrying from a health perspective is that not only is the volume of aid being cut by many EU countries, but the percentage of aid donated to health projects and infrastructure is also being squeezed, putting the lives of the poorest and most vulnerable at risk. We are also very concerned about the increasing use of loans instead of grants by countries like Franceand Germany– loans that many low income countries may struggle to pay back in the future.”  (Meanwhile, we’re getting some well-needed advice from the Chinese on how to maintain social stability in the EU. As long as they refrain from sharing best practices, that’s fine. But the times are definitely a-changing…)

 

11. BMJ Analysis – How to achieve international action on falsified and substandard medicines

Amir Attaran et al.;

http://www.bmj.com/content/345/bmj.e7381

Substandard and falsified medicines kill patients, yet progress on the twin challenges of safeguarding the quality of genuine medicine and criminalising falsified ones has been held back by controversy over intellectual property rights and confusion over terms. Amir Attaran and colleagues propose a global treaty to overcome the problems

 

In an interesting twist to the story, Reuters reported that some of the experts involved in this call for a global treaty had been barred (apparently by the Indian government) from attending a WHO meeting inBuenos Aires. To be continued.

 

12. BMJ – Commentary: Substandard medicines are the priority for neglected tropical diseases

Thomas P C Dorlo, Raffaella M Ravinetto, Jos H Beijnen, Marleen Boelaert;

http://www.bmj.com/content/345/bmj.e7518

These authors would welcome a global treaty as it would provide a necessary legal framework, but they also want to see problems with medicine quality anticipated rather than dealt with afterwards. Medicine quality issues are disproportionally affecting neglected tropical diseases. Internationally, guidance should be provided for the quality assurance of medicines for neglected tropical diseases.

 

13. CGD blog – Improving PEPFAR’s Data Management and Disclosure

Mead Over;

http://blogs.cgdev.org/globalhealth/2012/11/improving-pepfars-data-management-and-disclosure-2.php

In a CGD blog post, Mead Over argues: “The U.S. government, and in particular U.S. Global AIDS Coordinator Ambassador Eric Goosby, the head of PEPFAR, have a unique opportunity to make the program’s money stretch farther and do more good, at very little cost to U.S. taxpayers: release the reams of data that PEPFAR and its contractors have already collected, at substantial cost — perhaps as much as $500 million each year. …This would be a first step in what I hope will be a 2013 drive to improve the efficiency, the quality and the accountability of the U.S.’s most frequently praised foreign assistance program.”  (whether US taxpayers really care is another matter, though – they had far more important business to take care of this week with the 24-hour Petraeus/power women soap opera)).

 

14. Guardian – Family planning must be development priority, says UNFPA report

http://www.guardian.co.uk/global-development/2012/nov/14/family-planning-development-priority-unfpa?intcmp=122

Access to family planning is a human right and a sound economic investment at a time when the number of young people in developing countries has reached an all-time high, according to the UN Population Fund. The latest State of the World Population report makes the case for additional spending on family planning in poor countries, claiming it would save more than $11.3bn a year on maternal and newborn health. (How about funneling some CIA money to the cause?)

 

15. Financial Times – Vaccine raises hopes for drugs groups

Andrew Jack;

http://www.ft.com/intl/cms/s/0/c62c610a-2e80-11e2-8bb3-00144feabdc0.html#axzz2CCKyJzsu

Pharmaceutical companies could sell their products to millions of additional people living in hot climates following groundbreaking regulatory approval of an Indian-produced vaccine shown to be stable even when exposed to high temperatures.

The Drugs Controller General of India, with support from its counterpart Health Canada and the World Health Organisation, have approved the use of MenAfriVac, a meningitis vaccine, even when it is left unrefrigerated for up to four days at 40°C.”

The decision marks a pioneering example of a vaccine authorized for use without the protection of an uninterrupted ‘cold chain,’ following tests showing that it retained its safety and efficacy and paves the way for broader use of such expanded approvals for a wide range of vaccines by other companies that have invested substantially in the field in recent years, including in emerging nations.

 

16. Lancet World Report –UShealth reform still faces challenges

Susan Jaffe.

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)61974-6/fulltext

Surprise, surprise… Implementation of the Patient Protection and Affordable Care Act is unlikely to run smoothly despite the Nov 6 election result. Susan Jaffe reports from Washington, DC.

 

17. Lancet Correspondence – Technologies for global health author’s reply

Peter Howitt et al.;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)61989-8/fulltext

Howitt and co-authors reply to a variety of letters which show the diversity of issues raised by the topic of technologies for global health.

 

18. Consultancy Africa – Performance-based financing for health systems in Sub-Saharan Africa: What have we learnt so far? – Part 2

Adanna Chukwuma;

http://www.consultancyafrica.com/index.php?option=com_content&view=article&id=1169:performance-based-financing-for-health-systems-in-sub-saharan-africa-what-have-we-learnt-so-far-part-2&catid=61:hiv-aids-discussion-papers&Itemid=268
Part 1
 of this series examined the evolution of PBF within health systems in Africa, the underlying theory supporting these models and the evidence for their effectiveness from research and practice. This second and final paper considers some of the potential setbacks that could arise with the adoption of PBF models and, based on experience from within various contexts, identifies factors that appear to be instrumental to successful implementation.

 

19. IS Global (Working paper) – Global health diplomacy: health promotion and smart power

Manuel Manrique Gil;

http://www.isglobal.org/en/web/guest/publication/-/asset_publisher/ljGAMKTwu9m4/content/global-health-diplomacy-health-promotion-and-smart-power

This Working paper by the ISGlobal Think Tank was discussed at the Global Health and Globalization seminar hosted on 13-14 September 2012 in Barcelona.

 

Research

 

20. Globalization and health (Debate) – Conceptualising global health: theoretical issues and their relevance for teaching

Mike Rowson et al.;

http://www.globalizationandhealth.com/content/8/1/36/abstract

There has long been debate around the definition of the field of education, research and practice known as global health. In this article the authors step back from attempts at definition and instead ask what current definitions tell us about the evolution of the field, identifying gaps and points of debate and using these to inform discussions of how global health might be taught. The authors emphasize the importance of an approach to teaching global health that is flexible, interdisciplinary and acknowledges the different interpretations and values of those practising and teaching the field.

 

21. Health Policy & Planning – Transforming governance or reinforcing hierarchies and competition: examining the public and hidden transcripts of the Global Fund and HIV inIndia

Anuj Kapilashrami et al.;

http://heapol.oxfordjournals.org/content/early/2012/11/10/heapol.czs102.short?rss=1

This article aims to better understand and reveal the public and the hidden transcript of the Global Fund and its activities in India, arguing that while its public transcript abdicates its role in country-level operations, a critical ethnographic examination of the organization and governance of the Fund in India reveals a contrasting scenario.

 

 

Miscellaneous

 

* The UKwill not give aid to India anymore after 2015 – Owen Barder disagrees.

And this week, a Lancet editorial argues: “…a new type of Millennium Development Goal may be needed for fast-developing countries with a substantial legacy of poverty and ill health—Mutual Development Goals. Perhaps, under the umbrella of the World Bank and other actors, donors and recipient countries can agree matched financial commitments to continue essential support to disadvantaged regions in countries that are becoming rich. “

 

* An ODI blog post summarizes the ‘Golden thread’ discussion, sparked by David Cameron’s op-ed from a while ago. This week, in Cape Town, there was a conference on the future of aid. Check out #CAPE2012 on Twitter.

 

* An ECDPM (European Centre for development policy management) article provides the dire picture on the ongoing EU budget negotiations. For development funding, that is. “Development funding faces proportionally the biggest cut of all headings – a 7.3% reduction, from €70 billion to €65 billion compared to the EC’s proposal.” Oxfam’s Duncan Green even mentioned a proposed 9.65 billion cut in Europe’s aid budget by our very own Herman Van Rompuy, “a Christian-democrat”, we are told. A new ODI publication on the (apparently positive) effects of EU aid on receiving and sending countries  might soon be dated, in other words.

 

* Finally, a recent WB report explores whether (local) participation works. “New Policy Research Report analyzing community development and decentralization projects, shows that such projects often fail to be sensitive to complex contexts – including social, political, historical and geographical realities – and fall short in terms of monitoring and evaluation systems, which hampers learning. Citing numerous examples, including projects and programs supported by the World Bank, the authors demonstrate that participatory projects are not a substitute for weak states, but instead require strong central support to be effective.” The Economist reckons this is recommended reading for Jim Kim, now that he wants the Bank to focus on service delivery.

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