Dear Colleagues,


How did the global health week feel like in “Twitter land”? Well, as usual we received a few bland tweets from Mr. Gates. Bill, if you have that many followers, your tweets could perhaps use a ‘Grand Challenge’ of their own? Or maybe some of the people behind the Foundation’s excellent Youtube video on World Toilet Day could teach you a thing or two? Better even, why not hire the Obama staff member responsible for the ‘four more years’ tweet? Having said that, now that some of the World Toilet Day campaigns begin to smack of Freud’s “anal stage”, the enthusiasm of some of the PR guys in the aid sector perhaps needs to be curbed somewhat.    

This week we also learnt – through a tweet from Rob Yates – that the pope is “the newest UHC recruit”. Great news, if you ask us: “Now more than ever our society needs ‘good Samaritans’ with a generous heart and arms open to all.” The pope rightly understands that health care should be universal, instead of a commodity. Consequently, he probably chuckles as much as other (mainly Southern-)European citizens when he watches (on his tv screen in the Vatican) the noisy complaints and actions by the European institutions’ employees’ trade union against austerity measures threatening European civil servants. Together with Benedict, we call this some form of “immanent justice”. There’s no sign of immanent justice in Gaza, unfortunately, but we did nod in agreement when reading Martin McKee’s tweet: “If Obama thinks no country should have to tolerate missiles raining on them (and I agree) can he please ground his drones?” 

There’s no guest editorial this week, but we hope you find the time to reflect again on some of the eloquent opening plenary presentation statements by three Emerging Voices in Beijing (a shorter version you can find now on BMJ blog). Other EVs turn out equally eloquent. On the IHP website, EV Vincent Okungu dwelled on his – dreadful – last day in Beijing, and did so in marvellous prose, while Godson Eze even turned to poetry for his Ode to EVs ! Starting from this week, we also want to draw your attention to some videos of presentations by EVs at the preconference. Check them out!

Enjoy your reading.

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


 Global Fund & AMFm


1.    Global Fund Observer – two new issues

This week Aidspan published two issues of the Global Fund Observer on the latest GF developments. They obviously pay a lot of attention to Mark Dybul’s appointment and the main decisions taken at the Board meeting last week, including the new funding model. No doubt you also want to know everything about the 5 reasons why the inspector general was fired (and another reason why he should have been fired, according to Bernard Rivers).


2.    Lancet (World Report) – Mark Dybul appointed to lead the Global Fund

Danaiya Usher;

The new Executive Director of the Global Fund takes over an organisation that has been through an excruciating year of restructuring and financial uncertainty. Ann Danaiya Usher reports.


3.    Irin – HEALTH: New Global Fund executive director on the Fund’s future

Irin reports on an interview with Mark Dybul on the future he sees for the Fund.

For the full interview with Dybul, see also a Global Fund news flash special.

As always, Amanda Glassman has some good advice for Dybul – under the form of 4 reforms she deems essential to the GF future.

Some other news on the Fund: the German government released the remainder of the 2012 GF donation after the appointment of Dybul. And there was some turmoil about a GF grant to Uganda (and fraud) – Museveni chipped in.


4.    Nature (Editorial) – Too much to ask

The board decided that the stand-alone AMFm programme will now be integrated into the Global Fund’s existing grants system, but did not ring-fence any new money for it. Because existing funds for the AMFm run out at the end of 2013, many experts assert that this move effectively kills the programme.” This Nature editorial regrets this Board decision: “It would be senseless to give up on the AMFm’s strategy of using the vast existing private-sector infrastructure in Africa to get good medicines where there were none before. Anyone who doubts the power of the continent’s private-sector distribution networks should consider how the free market has made Coca-Cola and other soft drinks available in even the remotest locations. That force should be harnessed equally for lifesaving malaria therapies.”   An article in the Economist also zooms in on the AMFm decision.

On Oxfam’s Global Health Check website, Mohga Kamal-Yanni makes the case against AMFm, and does so forcefully. (Definitely worth a read.)




5.    HP&P – Access to medicines from a health system perspective

Maryam Bigdeli et al.;

The objective of this article is to embed Access to Medicine in a health system perspective. The authors propose three essential paradigm shifts that take into account complex and dynamic relationships between medicines and other components of the health system.


6.    BMJ (editorial) – Time for global action on fake and substandard drugs

Fiona Godlee;

As already mentioned in last week’s IHP newsletter, a self defined “diverse group of authors from the health professions, health charities, legal and medical academia, and former or current government officials in health” recently presented the world (via a BMJ article) with a troubling paradox: the world currently has tighter laws to tackle fake tobacco products than it does to tackle fake drugs. At the moment, there are laws that promote an open global medicines trade but no binding international health law on drug safety. The result is that fake and substandard drugs continue to harm and kill people around the world, affecting both proprietary and generic drugs, and haunting rich countries as well as poor, argues Fiona Godlee in this editorial. It’s time to do something about it.

Also in BMJ, Andrew Jack explains that the rapid growth of unregulated internet sales of drugs has raised the stakes even further.


Universal Health Coverage


7.    Value in health – Universal Health Coverage: A Quest for All Countries But under Threat in Some

Martin McKee et al.

This article describes how many countries, both developed and developing, have pursued the quest to achieve universal health care. This has been an explicitly political process. Having noted the substantial benefits accruing from universal healthcare, the article concludes with an analysis of how universal healthcare is under threat in some European countries and a warning about the risks posed by current radical austerity policies.  (the read of the week, we reckon)

Meanwhile, in the European region, UHC is apparently a central strategy for achieving the goals of “Health 2020”. “WHO/Europe supports countries with a range of products and services to promote policies that help them move towards or sustain UHC. WHO/Europe offers tailored advisory services and policy dialogues in Member States on key issues in health financing policy. … WHO/Europe works with a number of countries, and is developing lessons and policy recommendations to prepare health systems to manage future crises and strengthen their resilience.”

We also want to draw your attention to a nice blog post (by Lara Brearley) on a session on UHC she attended inBeijing, chaired by Joe Kutzin.


UNAIDS 2012 report


8.    UNAIDS – World AIDS Day Report

The new World AIDS Day Report: Results, released on Tuesday, indicates that the ‘unprecedented acceleration in the AIDS response is producing results for people,’ according to a UNAIDS press release. The report indicates a more than 50 per cent reduction in the rate of new infections between 2001 and 2011. AIDS-related deaths in sub-Saharan Africa have been reduced by one third in the last six years, while the number of people on antiretroviral treatment increased by 59% in the last two years.

According to a KFF report, challenges still remain, as some countries aren’t using the right strategies, and prevention programs for specific risk groups are far too limited. In addition, the funding gap remains cause for concern, although the ‘report shows that countries are increasing their (domestic) investments despite a difficult economic climate.’

Sarah Boseley (in the Guardian  and Tom Paulson (Humanosphere ) also reacted on the UNAIDS report – Paulson struck a somewhat different tone than most observers and tweeted the obvious (but often ignored) thing: “No, the end of Aids is not in sight, unfortunately’. The main reason: financing…

On a different note, Nobel peace prize winner Aung San Suu Kui has accepted the UNAIDS invitation to serve as Global Advocate for Zero Discrimination, in line with the UNAIDS vision of achieving zero discrimination, zero new HIV infections and zero AIDS-related deaths, the UN News Centre reports.


Climate Change


9.    Guardian – The latest predictions on climate change should shock us into action

Jim Yong Kim;

Yes, that’s right. Jim Kim himself warns the world of a future world that could turn out ‘too hot to handle’, based on a report commissioned by the World Bank – thePotsdam institute for Climate Impact research authored the report on Climate change.


10. Think Piece for post-2015: Climate, Scarcity and Sustainability in the Post-2015 Development Agenda

Alex Evans;

A must-read. (or the read of the week (bis)). Climate, scarcity and sustainability are among the most important – and politically challenging – elements of the post-2015 development agenda on what should succeed the MDGs. Yet, sustainability advocates have some hard thinking to do, argues Evans, on both their policy objectives and their political tactics. He sees two options to frame and incorporate sustainability concerns in the global agendas – “Option 2”, focusing goals on ‘planetary boundaries’ and fair shares within them, is arguably the way to go. (now tell Obama, Xi, Merkel, Cameron and all the rest in Doha, provided they show up)


Maternal health


11. Lancet (Editorial) – Women’s choice is key to reduce maternal deaths

“Together with the 2015 post-MDG discussions, we need to make the strongest effort possible to give every woman in every country the right and choice to decide when and how to plan a family. Not only will there be fewer maternal and child deaths, but also families will lead healthier lives, will be better educated, and will be economically better off. Sustainable development requires the full participation of women in society worldwide.”


12. TMIH – Achieving the Millennium Development Goal of reducing maternal mortality in rural Africa: an experience from Burundi

K. Taylor-Smith et al.;

Impact of a recent MSF intervention: provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve MDG5 inrural Africa.

Check out also a recent MSF briefing paper on emergency obstetric care, including ambulance service.




13. WHO – WHO sets the record straight on work with the food and beverage industry

This week, Margaret Chan reacted on the “PAHO case”, distancing WHO from PAHO. See also Anne Gulland, in a remarkable BMJ news article. No doubt the last word hasn’t been said about this.


14. BMJ (blog) – Katy Cooper: NCDs, MDGs, SDGs – a crowded space explained

Katy Cooper;

This blog unpicks recent developments in three related areas – MDG+, SDGs and establishment of a new global framework for NCDs – with a focus on the impact on NCDs.


15. Lancet – Global burden of cancer: opportunities for prevention

Ahmedin Jemal;

Opportunities exist to reduce these major risk factors and the associated cancer burden through broad implementation of proven interventions specific to every country’s economic development level. These interventions include tobacco control, improvement of opportunities for physical activity and healthier dietary patterns, and vaccinations against hepatitis B virus and carcinogenic human papilloma virus infections, which cause liver or cervical and other genital and oropharyngeal cancers, respectively. … Implementation of comprehensive and sustainable interventions to challenge the growing cancer burden in LMICs will require the coordinated efforts of many stakeholders from the public and private sectors, including national and international public health agencies, health industries, philanthropic and government donors, and local and regional policy makers, argues Jemal.

Encouraging news came from the Philippines, where a sin tax was passed in the Senate. You might remember the guest editorial by Raoul Bermejo from a while ago, on this very issue.


16. Journal of Tropical medicine – Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care

Josefien Van Olmen et al.;

There is growing attention for chronic diseases in sub-Saharan Africaand for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. The authors argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care.


Health Policy & Financing


17. NEJM (Perspective) – The future of Obamacare

Jonathan Oberlander;

Now that the threat of repeal has faded, what is the future of Obamacare? What challenges and conflicts lie ahead on the long road of implementation for health care reform? The short term focus is on the states, argues Oberlander, but there remain also political challenges to getting more Americans behind the ACA.

See also BMJ news on the issue of health exchanges (with the extension of the deadline by Obama) in states.


18. Devex – WHO ‘scales up’ health interventions inAfrica

The WHO has unveiled a new set of priority actions to better address preventable health conditions in Africa. The UN agency presented its updated health promotion strategy at the 62nd WHO Regional Committee for Africa session inLuanda,Angola.

The new 10-year strategy highlights what WHO, member states and other stakeholders can do to “scale up” efforts to reduce primary causes of preventable deaths, illnesses, injuries, and new and re-emerging threats to health in the African region. It suggests 7 actions.


19. NEJM (Perspective) – Intensive Care in Low-Income Countries — A Critical Need

Paul Firth et al.;

Unlike what many people might think, intensive care in LICs is a critical need, although there are marked differences between the critical care requirements of LICs and HICs.




20. HP&P – Exploring the utility of institutional theory in analysing international health agency stasis and change

Eduardo J. Gomez;

Of recent interest is the capacity of international health agencies to adapt to changes in the global health environment and country needs. Yet, little is known about the potential benefits of using social science institutional theory, such as path dependency and institutional change theory, to explain why some international agencies, such as the WHO and the Global Fund, fail to adapt, whereas others, such as the World Bank and UNAIDS, have. This article suggests that these institutional theories can help to better understand these differences in international agency adaptive capacity, while highlighting new areas of policy research and analysis. (the article was obviously written before the major GF overhaul, but is a nice read nonetheless).


21. SS&M – Health financing in fragile and post-conflict states: What do we know and what are the gaps?

Sophie Witter;

There has been a growing concern with post-conflict and fragile states over the past decade, both in relation to their high level of health and development needs but also for the risk they pose to the wider international community. This paper presents an exploratory literature review to analyse the themes and findings of recent writing on one important pillar of the health system – health financing – in these countries.
Check out also a blog post written by some of our ITM colleagues on the health systems research challenge in fragile states, based on two sessions inBeijing.


22. Health Planning & Management – Forty years of USAID health cooperation inBolivia. A lose–lose game?

Herland Tejerina, Marie-Christine Closon, Pierre De Paepe, Christian Darras, Patrick Van Dessel, Jean-Pierre Unger;

This article proposes an analysis of the USA–Bolivia relationships in the health sector between 1971 and 2010 based on a grey and scientific literature review and on interviews. The authors examined USAID interventions, objectives, consistency with Bolivian needs, and impact on health system integration. “USAID operational objectives—decentralization, fertility and disease control, and maternal and child health—may have worked against each other while competing for limited MoH resources. They largely contributed to the segmentation and fragmentation of the Bolivian health system.UScooperation in health did not significantly improve health status while the USAID failed to properly tackle anti-drugs, political, and economicUSinterests inBolivia.”


23. Plos – Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation

Nicolas Menzies et al.;

Nicolas Menzies and colleagues investigate the potential impact and cost-effectiveness of implementing Xpert MTB/RIF for diagnosing tuberculosis in five southern African countries.
In other TB news, according to a new report  released by MSF at the Union World Conference on Lung Health inKuala Lumpur, many tuberculosis  programs under-diagnose, under-treat or completely leave children with TB out, despite the increase in pediatric TB, and rising numbers of children who are infected with drug-resistant forms of TB strains. The report found that diagnosis of children using the most commonly used TB test is inaccurate and pediatric TB drug formulations and treatment guidelines are inadequate. MSF called for the development of new TB tests that do not require sputum samples or laboratory infrastructure and urged WHO to provide clear guidance to drug manufacturers on needed fixed-dose combinations of first-line drugs to support implementation of the new WHO-recommended dosages.


Emerging voices


  • BLOGS: As already mentioned in the introduction to the newsletter, Emerging Voices are very active in “bloggersland”, both on IHP and BMJ – stay tuned for more blogs on BMJ in the coming weeks!
  • VIDEOS: Every week, we also want to highlight two EV videos – with their often innovative presentations on their reseach projects and results. The EVs  performed at the preconference inBeijingas well as at the symposium itself. This week, Judy Daire’s and Paola Mosquera’s are the Youtube videos to watch. You find a short summary of the presentations below.


Judy Daire (Malawi): Exploring what shapes leadership and management practice of PHC facility level managers in Mitchell’s Plain Sub-district in Cape Town, South Africa

It is widely accepted that leadership and management spread across all the levels of the health system is a critical element of governance for health system performance. However, there is less attention given to the leadership and management at the lower levels of the health system. As a result there is limited evidence in the literature and indeed the practice of supporting leadership and management of the lower level managers in the health system. This video presents a study of exploring the transition process from being a professional nurse to being a PHC facility manager in one of the Sub-districts inSouth Africa. The purpose of the study is to understand what shapes leadership and management practice of PHC level facility managers. The aim is also to generate ideas about what sort of support would be appropriate for Professional Nurses who then become managers and how best to offer that support. The presentation focuses on the study methodology.

Paola Andrea Mosquera (Colombia): Results of increasing access to Primary Health Care in Bogota-Colombia

This study provides evidence about the improvements of the health status ofBogota’s population through the implementation of a PHC strategy in a (difficult) context of constraints and limitations imposed by the insurance market logic of the Colombian health system. In spite of the adverse contextual conditions,Bogota’s initiative to reinstate the PHC principles has successfully contributed to risk reduction of under-5 mortality and infant mortality due to pneumonia as well as an increase of the DPT vaccination coverage.




24. ODI Discussion paper – Who foots the bill after 2015? What new trends in development finance mean for the post-MDGs

Romilly Greenhill et al.;

This paper looks at the past and likely future trends in development finance and reviews the interests and priorities of the main players in the post-2015 negotiations to propose 10 recommendations on how the post-2015 agreement should be structured and monitored.
Some other articles and reports you might want to read:

  • A Guardian article on looming cuts in EU aid (by Mark Tran). Read also this ODI opinion on the EU budget, claiming that it is quality, not quantity that matters.
  • A new UNICEF paper on demographic trends for children: Generation 2025 and beyond.
  • An overview of what happened (various meetings and roundtables) at the recent High-Level panel meeting inLondon.
  • Ghana’s GDP figures were ‘adjusted’ recently – Nigeriais probably next. Check out what Morten Jerven thinks about African development statistics.
  • If you want to know all about the nasty Swiss and their Rubik agreements, check out this Guardian op-ed.
  • The 2013 Hunger report, Within Reach—Global Development Goals, was released earlier this week. The report calls for a renewed push to achieve the MDGs by the 2015 deadline and urges a focus on ending hunger and extreme poverty in new global development goals.


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