As a Plos ‘Speaking of medicine’ blog post explained this week, the debate around health aid displacement is far from over. Plos Medicine published two new -commissioned – perspectives from leading groups working in the area of foreign aid effectiveness. Jocalyn Clark & Virginia Barbour concluded their blog post on the ongoing debate like this: “… what is clear is that the question of whether (and how) foreign aid displaces domestic health expenditures remains important and unanswered.” In other words: stay tuned…
The debate reminds me of another notorious controversy – the so called “fiscal multiplier” debate. Recently, another episode could be witnessed in the multiplier saga. The surprising new IMF working paper by chief economist Olivier Blanchard and the reactions it triggered (see for example here for an assessment of Blanchard’s position by Ann Pettifor) will no doubt not be the end of the multiplier story. Yet, as we can witness every day in the newspaper and on television, these sorts of debates can and do have a massive impact in the real world, although sometimes it takes some time before new insights are fully taken into account. Just this week, a new draconic IMF plan for Portugal was leaked that doesn’t exactly seem to heed Blanchard’s cautionary message. The butchers still rule in much of the eurozone.
In our series on post-MDGs and health, in this week’s newsletter’s guest editorial, our ITM colleague Thérèse Delvaux reflects on recent sexual and reproductive health trends with a view on the post-2015 agenda. She has a déjà vu feeling.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Sexual and Reproductive Health and Rights after 2015: Are we back in the pre-Cairo MCH era?
by Thérèse Delvaux, Public Health Department, ITM
The Safe Motherhood initiative was launched in 1987. After an era of maternal and child health (MCH) services often limited to the provision of antenatal care services, preventive care services for children and vertical family planning services that were successful in some settings, a landmark paper published in the Lancet served as a wake-up call to the international community. In “Maternal mortality, a neglected tragedy. Where is the M in MCH”, Rosenfield & Maine emphasized there was an urgent need to address main complications of pregnancy and delivery, and focus on quality obstetric care services. […]
Health aid displacement
1. Plos – Considerations in Assessing the Evidence and Implications of Aid Displacement from the Health Sector
Eran Bendavid et al.;
Eran Bendavid and Rajaie Batniji provide a perspective on the ongoing debates about aid displacement – whether giving development aid to governments leads to reductions in their own domestic health financing.
2. Plos – More Data and Appropriate Statistical Methods Needed to Fully Measure the Displacement Effects of Development Assistance for Health
Christopher Murray et al.;
Christopher Murray and colleagues provide a perspective on displacement due to development assistance for health, and argue for more data and better statistical methods to measure aid displacement. (maybe they can hire Stata Über-Geek David Roodman?)
Pakistan & polio eradication
3. Humanosphere – A renewed push to ban spies from overseas health and aid work
Tom Paulson and Tom Murphy;
A lot has happened in recent weeks – both in Pakistan and in the US – after the murders of polio vaccination staff in Pakistan. Paulson & Murphy give a pretty good overview of the action taken by the public health community in the US against the use of public health vaccination as a tool by intelligence. Karen Grepin (who published the letter written by the deans of public health departments addressed to the Obama administration) and CGD’s Charles Kenny also chipped in. You find Kenny’s proposal – intelligence-community participation in public health services should be explicitly banned – also in this document. Public health programs should not be used as cover for covert operations – let’s hope John Kerry pays attention.
Meanwhile, in Pakistan, polio vaccination programmes have resumed – accompanied by heavy security measures. Glancing at today’s news headlines, it appears these security measures will be more than welcome.
4. BMC International health and Human rights – Under the (legal) radar screen: global health initiatives and international human rights obligations
Rachel Hammonds et al.;
Many of our colleagues worked on a 6 year EC funded project examining the impact of Global Health Initiatives on the architecture of development partnerships and country-level health systems’ functions in Africa. (See Global Health Observer). One strand of this research led to this recently published article, “Under the (legal) radar screen – global health initiative and international human rights obligations”, co-authored by two of our colleagues, Rachel Hammonds and Gorik Ooms, in conjunction with University of Antwerp Law Professor Wouter Vandenhole. Their research brings together public health concerns, the human rights framework and a legal approach to social constructivism, namely the transnational legal process.
Their analysis focuses on enhancing understanding of how and why donors, policy makers and global health advocates were influenced by on-going interaction with the Global Fund. Their article explores how this experience impacted on the acceptance of international obligations to help (fulfil) the right to health beyond borders. They suggest, “Although far from perfect, the Global Fund has highlighted the power of transparency and multi-stakeholder partnerships in creating new legal meaning including how to engage in global health cooperation.” Some advice for those thinking about the structure of global health governance and the post-2015 agenda.
5. World we want – Universal Health Coverage in the post-2015 agenda
Plenty of papers have been submitted to discuss the role of health in the post 2015 development agenda, as part of the WHO/UNICEF convened consultation. For an overview of the papers, see here.
In this blog post, four papers are discussed that address the issue of Universal Health Coverage. All agree that UHC has potential to be included as a new goal in the post-2015 agenda. However, they also concur that further work is needed to clarify the concept and to develop verifiable and feasible targets and indicators. Several papers note that because of its focus on service provision and financial access, UHC does not address the underlying social and economic determinants of health which are as important for achieving progress towards health goals as is the use of health care services. Aside from concerns about the philosophy underpinning UHC, the papers also point to the practical issues of implementation and the complexity involved in monitoring progress across the major dimensions of UHC.
For an overview of the proposals so far submitted in the other (non-health) thematic consultations, see here.
6. Health Policy & Planning – The emergence of global attention to health systems strengthening
Tamara Hafner & Jeremy Shiffman;
This article is part of the new January issue of HP&P. Hafner & Shifman zoom in on the rise of HSS on the global health agenda since 2005 and try to find out why this attention emerged. They argue that critical factors behind the recent burst of attention include fears among global health actors that health systems problems threaten the achievement of the health-related MDGs, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. They wonder whether the agenda is sustainable though, for a number of reasons.
As Karen Grepin notes in another blog post ( regular blogging is obviously one of her new year’s resolutions 🙂 ), the article is a must-read. Grepin hopes it can inspire the ongoing post-MDG debate, but points out that part of the reason that HSS is now less sexy than a few years ago is because UHC has taken over. Rob Yates rightly tweeted that UHC has made HSS “politically attractive”.
7. Arogyaworld – NCDs and development: is Aid the right solution?
The author of this blog post, Greg Paton, previously coordinated the campaign for the 2011 UN summit on NCDs while working for the NCD Alliance and International Diabetes federation. In this piece, he argues that NCDs are unlikely to be successfully fought within the context of aid. Although there is a place for aid, more pressure needs to be put on governments in LICs to make much needed domestic reforms.
Health Policy & Financing
8. Lancet (World Report) – HIV prevention: new pilots for beleaguered Swaziland
Swaziland, which has the world’s highest incidence of HIV, is embarking on pilot projects to offer treatment to people who are HIV-positive, irrespective of their CD4 count. Barbara Sibbald reports.
In other HIV news, a Plus news article discusses potential cuts in U.S. funding for HIV-related activities in Ethiopia and the role of greater in-country funding for health. “‘Next year, Ethiopia will experience a 79 percent reduction in U.S. HIV financing from PEPFAR,'” according to CGD’s Amanda Glassman.
9. KFF (report) – Donor Funding for Health in Low- & Middle-Income Countries, 2002-2010
The Kaiser Family Foundation on Wednesday published a new report, titled “Donor Funding for Health in Low- & Middle-Income Countries, 2002-2010,” that tracks the most recently available data on funding from donor governments, including the US, and from multilateral institutions for health in LMICs. The report examines funding data through 2010 for a variety of health efforts, including malaria, AIDS and HIV, family planning, basic health and other areas.
Meanwhile, with aid spending on the chopping block in the EU’s 2014-2020 budget draft and many European capitals failing to meet their commitments to poor nations, health organisations are bracing for cuts in financing to prevent malaria, Euractiv reports (see also below- Miscellaneous section).
10. Nature Medicine – Neglected diseases see few new drugs despite upped investment
Over the past decade, neglected diseases have attracted increased attention and larger investments in research, but a new analysis by MSF and the Drugs for Neglected Diseases Initiative (DNDi) finds that the rate of approvals for new compounds over the past decade is roughly the same as it was during the previous two-and-a-half decades, when the diseases received little attention. The new analysis, presented at a symposium in New York on 13 December, shows that of the 850 new therapies and vaccines approved by the U.S. Food and Drug Administration, the European Medicines Agency and other agencies between 2000 and 2011, 37 focused on neglected diseases, and just four of those were new chemical entities.
11. Science speaks – Deal leaves risks for global health to fall or be pushed off the cliff
The ‘fiscal cliff’ deal reached in the US on the 1st of January reflected an agreement not to jump off the fiscal cliff — at least until March — “but leaves suspended in mid-air the fates of programs essential to meeting the goals of continued global health responses — including the implementation of PEPFAR’s Blueprint for an AIDS-free generation, and whatever promise the new Office of Global Health Diplomacy will offer.”
A Kaiser Family Foundation’s Policy Tracker provides additional information on the “fiscal cliff” deal, known as the “American Taxpayer Relief Act of 2012”, which averts scheduled increases in income tax rates and postpones, until March 1, 2013, the sequestration process as required by the Budget Control Act of 2011.
Rolf Rosenkranz expects relatively few changes from US aid policy under John Kerry in a Devex article. “President Barack Obama’s “perfect choice” for state secretary is not only expected to advance the administration’s agenda on global health and food security, but he might also lend new heft to efforts to rein in climate change, one of Kerry’s long-time priorities, with a team of advisors that is expected to include several with a background in international development.”
12. RH reality check – Five things to look for in Family Planning in 2013
Philip D. Harvey and Christopher H. Purdy;
DKT International is one of the largest NGOs working on providing family planning and reproductive health products and services in the developing world. Harvey and Purdy (both from DTK) argue in this post that there are five things to look for in family planning in 2013: the London Family Planning Summit 2013 (we will learn whether commitments of 2012 were sincere and how they translated into real programming), the private sector (for its increasingly important role in the delivery of products and services), new contraceptive technologies (better and cheaper!), misoprostol and medical abortion (making abortions more available, accessible and affordable), aid to MICs (suggesting that donors move away from these countries prematurely).
In a related blogpost on RH Reality Check, Leila Hessini and Alyson Hyman from Ipas (a global NGO dedicated to ending preventable deaths and disabilities from unsafe abortion) argue that abortion pills (a.k.a. medical abortion (MA)) help women to gain control over their bodies and reproductive rights. Last month Ipas hosted an event in Kenya entitled “In Women’s Hands: Increasing Access to Medical Abortion Drugs and Information through Pharmacies and Drug Sellers” that brought together 66 participants from 11 countries to discuss the issues around MA.
13. Guardian – India rejects claims it exported fake medicine to Africa
A Guardian article from December on the export of large quantities of counterfeit medication to Africa by the likes of India and China has been denied by both countries. In this Guardian follow-up article, India denies these claims. The Indian health ministry even launched a huge campaign last month to check the quality of medication manufactured across the country. Earlier, Chinese officials also denied the charges made in the report.
14. Forbes – AnthonyLake, Executive Director of UNICEF, on the Best Buy in Global Health
In a recent in-depth interview conducted by the Skoll World Forum‘s Rahim Kanani,Executive Director of UNICEF Anthony Lake discussed the urgent need to create a commodities market of life-saving medicines in the developing world, arguing that healthy children are good for business. “This isn’t just the right thing to do; it’s the smart thing to do. The economics are compelling.”
Finally, for a quick update on the 2nd BRICs health ministers meeting, in Delhi – check out this article.The first meeting took place in Beijing a while ago. In Delhi, ways are being discussed to strengthen cooperation in areas of manufacturing affordable health products and developing advanced health technologies. “The meeting will result in adoption of a Delhi Communique, which will see concrete plans on issues like integrated management of non-communicable prevention, coordination and financing of research and development for medical products, strengthening health surveillance and drug discovery and development.”
15. Plos Medicine – Preventing Antiretroviral Treatment Interruptions among HIV/AIDS Patients in Africa
Edward Mills & Christine Nabiryo;
Norma Ware and colleagues conducted a large qualitative study among patients in HIV treatment programs in sub-Saharan Africa to investigate reasons for missed visits and provide an explanation for disengagement from care. Edward Mills and Christine Nabiryo provide a Perspective on the article.
16. SS&M – The natural resource curse and the spread of HIV/AIDS, 1990–2008
Indra de Soysa et al.;
Experts suggest that effective public action can prevent the spread of HIV/AIDS. Countries dependent on natural resource wealth, such as oil, are likely to suffer from governance failures and thereby suffer lower quality public health. Since the cost of fighting disease redistributes income away from rulers, resource wealth is likely to lead to neglect of public action aimed at stemming a deadly disease. The authors test this proposition in 137 countries from 1990 until 2008 using oil wealth as a proxy for endogenous policy choices on the prevalence of HIV/AIDS, a proxy outcome for ineffective policy and neglect of public action. They find that the ‘resource curse’ seems to affect the spread of HIV/AIDS, even though oil-rich countries ceteris paribus should have more financial resources for effective public action.
17. Facts Reports – Solidarity-based financing of medical evacuations to improve access to emergency care, Keita Medical District (Niger)
Mamoudou Barro et al.;
In recent years, a number of African countries, including Niger, have adopted policies abolishing user fees at point of service, targeting categories of people or services. This paper by EV 2010 Mamoudou Barro and colleagues documents an experiment illustrating the importance of considering the place of medical evacuation in fee exemption schemes for vulnerable population groups. The introduction of a solidarity-based financing mechanism resulted in an increase in the number of evacuations, for which the average cost was too high for most rural households. Policies aimed at abolishing direct user fees by integrating the cost of medical evacuations offer an effective strategy for health risk coverage and for counteracting the impoverishment caused by ill health.
EV 2012 videos Beijing
Aku Kwamie (Ghana) – How and why do district managers make decisions? Understanding maternal and newborn health policy implementation in Ghana
The complexity of maternal health outcomes requires many health system elements to be functional. In the run-up to achieving MDG 5 inGhana, emphasis remains on prioritising access to quality maternal health services. This includes a focus on improving district-level governance, management and leadership. In line with the current health sector Programme of Work, continuous quality improvement (CQI) is being introduced as one approach to strengthening district-level decision-making. The presentation introduces the first part of an ongoing realist evaluation to understand how the introduction of CQI influences existing district-level dynamics in one district of the Greater Accra Region.
Shishir Dahal (Nepal) – Tele Safe Motherhood Pilot Project in Rolpa District of Nepal
Rolpa district is one of the remote districts of Nepal, with a high maternal mortality rate (MMR) of 352 per 100,000 live births (The national MMR being 240 per 100,000 live births). Although 54% of pregnant women attended hospitals for the first antenatal check-up, only 19% of the total numbers of pregnancies completed the 4th antenatal check-up. Institutional deliveries were only 5%.
Low antenatal care (ANC) rates during the 3rd trimester and low institutional delivery rates were responsible for high maternal mortality in the district. As is the case in other remote districts, the main reason behind the low rate of institutional deliveries in Rolpa seems to be remoteness of health facilities and lack of health education among women. The objective of this project was to reduce maternal mortality by giving pregnant women access to obstetric care using mobile technology. We started our project with female community health volunteers (FCHVs) who used their cell phones to send information about pregnant women to the district hospital, and use templates written in their own language to send information. The district hospital collected all the data and acted to encourage pregnant women to have the last 4 ANC visits and institutional delivery. The district hospital sent health workers to pregnant women for antenatal check-ups if they were not willing to come to the hospital. The hospital divided pregnancies into normal and high-risk pregnancies. High-risk pregnancies were followed accordingly and, if necessary, referred to maternity-care centres for better management. At the end of the project we found over 90% of pregnant women got 4 ANC visits and the percentage of institutional deliveries had increased to 25 %.
EurActiv: new section dedicated to EU Development policy
We already referred above to an article on an expected decrease in malaria funding on Euractiv.
On 9 January, EurActiv launched a section dedicated to Development Policy. EurActiv journalists in Brussels, Paris, Berlin, and Madrid will track news and trends related to EU development policy at both the pan-European and national levels, and secure interviews with the policy area’s biggest names. They will publish this content in English on EurActiv.com, in French on EurActiv.fr, in German on EurActiv.de, and in Spanish on EurActiv.es. Also from 9 January on, EurActiv will be producing a free fortnightly email newsletter in the same four languages, catering to development professionals. You can sign up for the development policy newsletter here. This initiative is sponsored by the Gates Foundation and comes at a critical juncture for this topical EU policy area, as you probably know.
- A new ODI working paper depicts the new aid landscape for developing countries, in the so called ‘Age of choice’.
- This Foreign Policy article questions the new ‘Africa rising’ narrative. Check it out.
- Oxfam’s new “stunning landscapes” campaign on Africa is quite controversial, to say the least. By way of example, have a look at this – baffled – reaction from Tolu Ogunlesi (in the Guardian).
- A somewhat related blog post on Humanosphere wonders whether the latest trend in the fight against poverty and inequity – focusing on good news and success stories – is as biased as the old one that focused on bad news.
- ODI’s Allison Evans reflects on the aid & development challenges ahead in 2013.
- In a Guardian article, Liz Ford and Claire Provost wonder whether the UK government has so far lived up to its pledges on international development (in terms of aid, debt and trade).