in Dar es Salaam, Tanzania. We pay some attention to the event in this newsletter, as well as to World Aids day – with some more reflections from global health watchers – and to the ongoing post-2015 health discussions. By the way, the WHO/UNICEF led thematic consultation’s deadline has been extended – the consultation now runs till the end of December. You can already find a number of papers online. Some other people are already reflecting on 2012 and listing the highs and lows in health, like Dara Mohammadi in the Lancet.
In Doha, the COP18 negotiations are about to end. The general mood is glum, as usual. A Philippino diplomat even burst into tears, as he told the world about the impact of the latest – devastating – typhoon in his country, Bopha. For the latest news and many stories from Doha, see the Guardian COP18 website. There are plenty of negative stories to tell, and many more will no doubt follow when the meeting is over. New metaphors (eg. ‘the world faces a “carbon cliff”’) have been offered to tell the world about the carbon tsunami that is coming towards us. Yet, there was also some encouraging news (for example on black carbon or on the ecological changes already happening in the Gulf States). I have to say, I tend to agree with Monbiot in his latest piece in the Guardian: if we want to win the struggle against climate change, we will need to break the grip of corporate power and neoliberal dogma on the world. That will require a social movement and a political fight. PPPs are nice, no doubt, but for some corporate actors we should consider other tactics….
In this week’s guest editorial, Agnes Nanyonjo, Emerging voice from Uganda draws some lessons from her recent visit to China on the benefits of integrating traditional medicine in the health care system. Check out also two new EV blog posts on BMJ’s blog – one by Qian, Raoul and Kopano (their refreshing speech at the final plenary session in Beijing), and one by the EV BRICs group on the fight for more ‘equity’ as the mortar that should hold the BRICS together, from a global health point of view.
Enjoy your reading.
Kristof Decoster, David Hercot, Ildikó Bokros, Peter Delobelle, Basile Keugoung &Wim Van Damme
Established traditional medicine – Can we learn something fromChinato reduce excessive antibiotic prescription in low-income countries?
By Agnes Nanyonjo, Emerging Voice from Uganda
A well-defined relationship exists between sick people, the society of the healthy in which they live and their care providers, at least in the sociological literature. In 1951, the term ‘sick role’ was coined by Talcott Parsons to describe this relationship. In his view, the ‘sick role’ is a state that entitles the sick person to certain rights and obligations. Among the rights is the need for the society to accept that a sick person is not to blame for his or her condition and as such he or she should be exempted from normal social roles. Regarding the obligations, it is the role of the affected person to seek health care from technically competent people whilst cooperating with them while seeking the care. As you can imagine, the concept has often been criticized. However, it is not without its merits.
GAVI Alliance partners’ forum
1. Guardian – Polio vaccination inNigeria– a series of unfortunate events
GAVI’s partner forum took place in Dar Es Salaam, Tanzania, this week. You can find an overview of the sessions (and summaries of presentations and discussions) here.
David Olayemi, senior program adviser at Save the Children in Abuja, Nigeria, spoke at the forum. He said fewer than half of children in Nigeria are currently receiving routine immunizations for diseases such as diphtheria, tetanus, and whooping cough (DTP), and the rate is dropping. Save the Children just launched a report, ‘Immunisation for all’, that calls on GAVI to step up efforts to reach the last 20 percent of children across the developing world who are not getting routine immunization. Olayemi said part of the reason for the lack of coverage are large efforts to vaccinate children against polio, which offer incentives to health care workers to leave clinics to go into the field, leaving no one to perform routine immunizations. Integrated vaccination packages are the way forward, as well as more attention for HSS.
Among the 700 experts participating in Dar Es Salaam from various organizations and countries was also MSF. The group said ”it is deeply concerned that the current vaccination strategy is not paying enough attention to the one in five babies who go without the most basic immunization, such as DTP (diphtheria, tetanus and whooping cough) from two months and then measles vaccine, which babies should have at the age of nine months.” You can find MSF’s three main concerns here (three issue briefs).
World Aids Day & other HIV news
2. Lancet (Editorial) – The beginning of the end of AIDS?
This Lancet editorial reflects on the new PEPFAR blueprint and the strong AIDS commitment expressed last week by Hilary Clinton. The Lancet editors are not the only ones who noted one important omission – the lack of detail in terms of financing: “something important is missing—how much the ambitious goal will cost in general and where the global resources or financial investments will come from.” Tom Paulson also mentioned this, last week, on his blog Humanosphere.
Last week, IPS noted that while all attention was on the new blueprint, relatively little attention was given to a document already published in October, which stipulated how new PEPFAR funding can be used. The news service continued, “according to that guidance, PEPFAR funds may not be used to purchase family planning commodities.” Oops.
3. The Daily Beast – HIV/AIDS Funding Is in Jeopardy
The Daily Beast explores the dire financing situation for HIV from aUSpoint of view (with the looming fiscal cliff & sequestration).
Meanwhile, U.S. House of Representatives Minority Leader Nancy Pelosi on Wednesday announced the new top Democrats on House committees. Two key global health leaders are among the picks: congressman Eliot Engel will be the top Democrat of the House Foreign Affairs Committee which has programmatic jurisdiction over all global health programs, and Congresswoman Nita Lowey will assume the top Democratic post on the House Appropriations Committee — the committee charged with making annual funding decisions for all federal discretionary programs, including funding for PEPFAR & Global Fund.
4. Global Health Check – An AIDS-free generation is in sight but action is needed now
This senior Oxfam health policy & HIV advisor lists four challenges to be addressed, if we want to see an AIDS-free generation materialize: funding, health systems, medicines and prejudice. Nice blog post.
Other good blog posts reflecting on World AIDS day, the new PEPFAR blueprint and the aim of an ‘AIDS free generation’ came from Mead Over (CGD), Sharon Stash (CSIS) and Joshua Bushby (on the Global Health Governance blog). They all add different angles, so check them out.
5. BMJ (news) – Childhood HIV is in danger of becoming a neglected disease, say experts
The success in reducing the number of children born with HIV is in danger of leaving children who already have the disease with poor access to treatment, experts in HIV and AIDS have warned.
6. GFO – issue 204 & 205
The Global Fund Observer published issue 204 and 205 this week. In issue 205, we would like to draw your attention in particular to this incisive Commentary (by Josef Decosas, from HERA) on the Office of the Inspector General, a reaction to an earlier viewpoint by Bernard Rivers (in GFO 203). Decosas says the GF needs a new Office of the Inspector General, not just a new Inspector General – an interim one has just been appointed, see below. He concludes: “We don’t need to be afraid that the fraud investigation unit of the Global Fund will disappear. What is likely to disappear is an opportunity for a transparent evaluation and audit function to monitor the practices of grant funding and grant implementation.” “… If so, … the Global Fund may have rid itself of an annoying itch, only to move one step further away from the partnership approach to development financing that it pretends to practice.”
7. Devex – International auditor joins global fund
Norbert Hauser has been named interim inspector general of the Global Fund.
The recently retired lawyer and international auditor will serve in this temporary appointment for up to nine months while the Global Fund searches for a permanent inspector general to replace John Parsons. Hauser is not a candidate for the permanent position, the Global Fund has clarified, saying that his role would be to “maintain consistency in the work of the Office of the Inspector General, with a focus on providing seamless leadership and strategic guidance to staff of the Office of the Inspector General during his interim tenure.” (for some strange reason, people seem to think you need to hire a German for this kind of job)
8. Lancet – In the Global Fund’s court: experimentation, evaluation, and the AMFm
Jesse B. Bump et al.;
Reflecting on the AMFm saga, the authors of the Lancet letter say: “This one-off experiment holds crucial implications for the general role of experiments in policy making by donors and development organisations. How can the global health community thoughtfully permit, or enable, experimentation and learning?” They recommend that the Global Fund consider how experimentation can be institutionalised within its operations.
Global health governance & Post-2015
9. Lancet – Offline: The struggle for leadership
Horton draws attention to a warning by Margaret Chan and to the important role of UNAIDS in shaping global health. (We’ve already noticed in the past Horton is very fond of UNAIDS – somebody should write a blog post about that one day 🙂 )
10. Globalization and health – Zeroing in on AIDS and global health Post-2015
Kent Buse et al.;
The authors from this viewpoint start from World AIDS day but then take a long term view – post 2015. Their viewpoint argues that today’s rapidly changing world, including its shifting geo-political and economic landscape, requires policy responses that are context-sensitive. They highlight the “Shared Responsibility-Global Solidarity” agenda, as pioneered by the African Union in its recent Roadmap on AIDS, tuberculosis, and malaria, to illustrate ways in which global health can be re-thought to tackle twenty-first century challenges. In light of the emerging debate on what a Post-2015 development agenda and accountability framework should look like, they argue that the AIDS response offers lessons as a pathfinder which can pave the way for global health responses in which the most marginalised are at the centre of the debate, human rights are protected under the rule of law, strong accountability is in place for results for people and community and participatory processes are the norm.
11. WHO Bulletin – A framework convention on global health: a catalyst for justice
Michel Sidibé & Kent Buse;
In the new Bulletin issue, this editorial argues that global health advocates must think strategically about positioning health in the post-2015 development agenda. In this respect, Sidibé & Buse also refer to the work of JALI, the Joint Action and Learning Initiative on National and Global Responsibilities for Health. JALI is currently mobilizing civil society towards a vision of a global framework convention, based on the human right to health, that defines what states and the international community are obligated to do to provide conditions conducive to good health. Sidibé and Buse mention that the global response to AIDS has been championing the principles of shared responsibility and global solidarity – principles that are also common to JALI and other framework convention proponents. These principles must drive the post-2015 development agenda towards more sustainable and equity-oriented goals, they argue.
12. HP&P – An analysis of GAVI, the Global Fund and World Bank support for human resources for health in developing countries
Marko Vujicic et al.
In this paper the authors analyse the HRH-related activities of three agencies: GAVI, the Global Fund and the World Bank. They found that by far the most common activity supported across all agencies is short-term, in-service training. There is relatively little investment in expanding pre-service training capacity, despite large health worker shortages in developing countries. They also found that the majority of GAVI and the Global Fund grants finance health worker remuneration, largely through supplemental allowances, with little information available on how payment rates are determined, how the potential negative consequences are mitigated, and how payments are to be sustained at the end of the grant period.
UHC & Beijing symposium
13. HLSP institute – Health and development: global update
This document offers a very nice overview of global health & development news of the last six months. Check out the GF and AMFm articles, for example. But we put it in this section on the Beijingsymposium as a very nice section, written by Rebecca Dodd, reports (in-depth) on a selection of topics discussed in Beijing. Excellent stuff.
14. UHC forward – 10 Takeaways from Beijing: Second Global Symposium on Health Systems Research
Jonathan D. Quick;
Jonathan D. Quick, president and chief executive officer of Management Sciences for Health, also offers his ten takeaway messages fromBeijing.
Health Policy & Financing
15. Health market innovations – Sustainable Financing in mHealth: What is it and how do we achieve it?
In this Center for Health Market Innovations blog, the issues of mHealth financing and sustainability, as discussed during the 2012 mHealth Summit, held from 3-5 December in Washington, DC, were brought to the fore. Government funding and participation and user-generated revenues could, for example, be viewed as more sustainable forms of financing than donor funding in view of their greater opportunity for scaling up, as illustrated by Switchboard, which partners with large telecom providers to allow doctors in various African countries to call each other for free to share ideas and advice.
16. Report G-Finder – Neglected disease research & development – 5 year review
As reported by SciDev news, the Global Funding of Innovation for Neglected Disease Report (G-FINDER) indicates that funding for neglected diseases R&D has stagnated since 2007 and that public funding continues to shift away from product development. Although funders pay more attention to diseases other than HIV, TB and malaria, higher industry funding for commercially viable diseases such as TB and dengue may lead to a two-tier, two-speed system, and a call is made for more investment by emerging economies and identification of new actors.
According to this Nature News blog post, however, the global funding for work on neglected diseases, which totalled US$3.32 billion last year, essentially remained stable in real terms compared with 2010, which is more promising than last year’s figures.
17. BMJ (Feature) – Is abortion worldwide becoming more restrictive?
Sophie Arie examines the differences in approach to abortion around the world
18. Journal of Public Health –Syria: effects of conflict and sanctions on public health
Kasturi Sen et al.;
Syriais one huge mess for the moment, sadly. This report, however, draws attention to some of the recent achievements ofSyria’s health services – despite a dearth of published materials, the country achieved remarkable declines in maternal mortality and infant mortality rates. Its health sector now faces destruction from on-going violence compounded by economic sanctions that has affected access to health care, to medicines and to basic essentials as well as the destruction of infrastructure. The paper also explores some of the consequences of conflict and of sanctions on population health.
19. IHP – African countries need to step up their production of HIV treatment capacity to ensure the long-term sustainability of the HIV/AIDS response
Following a discussion on the HHA Community of practice on Pharmaceuticals, Besrat Hagos (from UNICEF – Eastern and Southern Africa Regional Office), submitted this viewpoint. He offers an interesting perspective on the need to develop the pharmaceutical sector inAfrica.
20. Epi-analysis – Gutting the research and development treaty
Basu reflects on the at least till 2016 “postponed” WHO health R&D treaty and some of the dirty negotiation tricks used by developed countries’ diplomats.
This Plos ‘Speaking of Medicine’ blog post (by some MSF people) focuses on the same topic.
21. Psi Impact –East Africa’s first rural cancer a product of partnership
Rwandaand (rural) cancer health care are an emerging global health story, increasingly, which is great. See also this PSI blog post. We hope other countries in the region will follow suit. On an entirely different note: most of you will probably agree that Rwanda should get rid of another – unfortunately also “successful” – “scheme” it runs – M23.
- Blogs EVs: In the introduction, we already mentioned the recent BMJ blogs by three EVs (final plenary session), and by the EV BRICs subgroup. You can also find them on IHP, crossposted: see here and here.
- Videos EVs:
Eleanor Namusoke Magongo (Uganda): How a health systems intervention contributes to reducing loss to follow up of HIV-infants: a case study in a rural health centre in Uganda
“This video is about how a health systems intervention contributes to reducing loss to follow-up of HIV exposed infants: a case study of a rural health centre inUganda. InUganda, most of the health facilities are found in the rural areas of the country. One of the biggest challenges we face in the peadiatric HIV program in the country is the high numbers of children lost to follow up at the HIV clinics. We also work in a health care system that is human resource constrained. As a low income country, we do not have the capacity at the moment to have computerized systems that can help the health workers easily track these children as early as possible especially in the rural areas where there is no electricity and where most health workers are computer illiterate. The health workers therefore need very creative ways to help them identify these infants as soon as possible. We rolled out the use of an appointment book to help health workers easily track the infants who are missing their appointments so that they can initiate immediate follow up.”
Wendy Gonzales (Costa Rica) – Assessment of perspectives of actors involved in a regional health partnership
“Global Health Partnerships (GHPs) have recently emerged as a response to global health problems. To maximize the effectiveness of GHPs, global health actors are committed to coordinate and align their priorities, but coordination is a complex and difficult task. There is broad recognition of the need to understand and overcome the challenges of coordinating GHP actors. This video presents an approach for identifying and analyzing the perspectives of actors involved with GHPs. In addition to discussing the methods and framework, I present the results of analyzing the perspectives of actors involved with a regional health partnership to improve maternal and child health inLatin America, the Regional Health Initiative (RHI). Actors involved with RHI had different, and in some instances, conflicting perspectives. Although the actors had the common goal of improving maternal and child health, they did not share other expectations and demands about MHI. The lack of alignment of the actors’ perspectives caused unintended consequences for MHI’s operations in the two countries studied. These consequences were the establishment of unrealistic goals for the country operations, tension during the negotiation of the operations, and unexpected changes to the country operations. GHPs should establish mechanisms that allow for the early identification and alignment of actors’ perspectives. By aligning perspectives during the planning of a GHP, actors can define their common expectations and demands, establish common goals, and avoid unintended consequences for country operations.”
22. Plos – Home-based HIV testing is highly acceptable inAfrica
K. Sabapathy et al.;
Voluntary counselling and testing for HIV at home is highly acceptable in sub Saharan Africa, highlighting the importance of this approach in diagnosing HIV, according to a study by international researchers published in PLOS this week.
- The organizers of the recent Cape Townconference on the ‘Future of aid’ put the presentations & discussions all online now: see here.
- In spite of its alarming report on climate change of a few weeks ago, the WB is still funding coal projects, it appears.
- Check out Owen Barder’s (CGD) new report ‘Europe beyond aid’. He summarizes the report in this blog post.
- This Aidinfo blog post reflects on “one year after Busan”.
- Finally, DFID has no longer an office inBurundi. Nothing to do with Osborne’s autumn statement, though.