World media focused on a former cycling star this week, but for the global health community the Arusha maternal health conference – “the most important conference on maternal health this decade”(R. Horton) –was the obvious highlight. Quality of care was a prominent theme there but presentations also focused on respectful maternal care as a basic human right, Horton floated a 5- point code of conduct for ethical (North-South) research on Twitter as well as a provisional 10-point manifesto for maternal health, and one blogger was very impressed by Rwanda’s Minister of Health. Another common theme was mentioned by Jocalyn Clark in one of her blog posts: “ Many presentations and conversations raised troubling questions about our push/promotion of institutional births when facilities in many regions are so ill-equipped, filthy, under-staffed, and otherwise inadequate to meeting women’s needs.”
Given the importance of the conference, we hope to offer you a guest editorial on Arusha next week. Yet, although women hold up half the sky (Mao) or even more, there was plenty of other global health news too this week. So forgive us if the IHP newsletter feels a bit like a global health tsunami this week. Just use your survival skills.
In this week’s guest editorial, EV 2010 Sanjib Sharma from Nepal wonders what his country needs most: new fancy technology or affordable solutions. Just today, Globalization & Health also published an article on Nepal & international health aid. So we hope you use this weekend also to delve into the health sector in Nepal. Reading about Nepal is not as enjoyable as hiking in Nepal, but it comes close J.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
What do we need in a country like Nepal: innovative technology or affordable solutions?
by Sanjib Kumar Sharma (MD, EV 2010 from Nepal)
Let me start by recalling our teenager days, when we saw on television how glamorous doctors saved lives using sophisticated equipment. It inspired many of us to become a doctor too, a true “hero”. After studying medicine, we did become doctors. However, now we have to face the real world which turns out to be totally different from the glamorous lifestyle we had fancied. If we look around, the huge gap between Western nations (or “privileged” people anywhere) and the poor countries (people) becomes painfully acute. When I look at my own country, Nepal, I see poverty, lack of awareness about diseases, death from very treatable simple conditions, a growing disparity between the poor and the rich, and an increasing burden of chronic diseases in a setting where communicable diseases continue to dominate. What actually do we need now – sophisticated, genomic or stem cell research, or simple, needs-driven basic applied and operational research and services to uplift the most needy ones?
Read the rest here
Global maternal health conference 2013 in Arusha
In the introduction we already referred to the three-day conference in Tanzania. Lancet editor Richard Horton was one of the many people tweeting (#GMHC2013) and/or blogging about the event. For example, with tweets like: “We need to set out achievements, priorities, opportunities, and the cost of inaction. RMNCH risks slipping off the global agenda.” Or: “Data on HIV and maternal mortality reveal a huge burden of HIV on women. The new Global Fund funding model must include RMNCH.”
Horton, prolific as always, also presented a draft manifesto on maternal health, which will be circulated for comment and input in the coming days, with the aim to publish before March 5 when the next in-depth round of consultations for the post-2015 international targets take place in Botswana. The provisional manifesto you can find on Twitter.
Check out a few blog posts on the maternal health conference, by Jocalyn Clark, senior editor of Plos ( on day 2 & day 3 ), who talked about the launch of the Plos maternal health collection (see below) and human rights & maternal health, and Crystal Lander (here) who commented on Agnes Binagwaho’s dazzling performance; it inspired yet another Horton tweet – that she would make a wonderful WHO Director-General.
1. Plos (Perspective) – Translating Coverage Gains into Health Gains for All Women and Children: The Quality Care Opportunity
Wendy Graham et al.;
In a commissioned Perspective, Wendy Graham and colleagues reflect on quality of maternal health care, the focus of Year 1 of the MHTF-PLOS Maternal Health Collection and its 18 new articles. In Arusha, PLOS Medicine and the MHTF celebrated the official launch of the Year 1 Collection.
Some other maternal & women’s health news:
2. BMJ (editorial) – Preventing and managing violence against women in India
Prevention and managing violence against women in India requires a systems approach to reforming the culture of the health system. Next week, we hope to offer you an IHP blog post by two Indian EVs on the gang rape and the societal backlash in their country.
To wrap up this week’s maternal health care & women’s section, you might also want to read a Lancet World Report on free health care in Sierra Leone, obviously a “work in progress”, and a CGD blog post by John May & Kate McQueston’s on demographic opportunities and challenges in Western Africa
Executive Board meeting WHO & post-2015 consultation
The 132nd Executive Board meeting of the WHO is coming up. You can find plenty of useful background material in the Global Health Diplomacy network’s 132nd Executive Board companion to the (provisional) agenda. The companion highlights resources available on the GHD-Net website for use in preparation for the Assembly.
You can find the agenda here as well as the main preparatory documents & draft action plans and reports prepared by the Secretariat. Check out documents on the draft action plan for prevention and control of NCDs, on social determinants of health, WHO’s role in global health governance, health in the post-2015 development agenda, and many other documents. The MMI webpage on the WHO reform is also a nice resource.
Speaking of the health in the post-2015 development agenda, it’s definitely worth to have a look at the health consultation “the world we want – health” website. You find all the submitted papers there ( by the way, you definitely need to read the one by the People’s Health Movement, if only to see how much the final document in a few weeks from now will differ from the Movement’s position), digests of papers (with a number of summarizing blog posts), specific thematic consultations (in which you can still contribute, like the one hosted by UNAIDS to discuss the ways in which the global AIDS response can and should inform the Post-2015 Development Agenda, …).
Meanwhile, in encouraging news for WHO, according to a new poll by the Better World Campaign, US voters still seem to like the WHO – 92 percent say the US should continue contributing money to the agency. (guess they like WHO more than Lance Armstrong’s Livestrong these days)
3. Lancet (early online) – Correspondence: Action to preserve WHO’s core medicines-related roles—1 year on
Philippa Saunders & Mogha Kamal-Yanni;
A year ago, Oxfam staff highlighted (in a few letters to the Lancet) the serious impact of the WHO financial crisis on WHO’s core functions, focusing on access to medicine. In a follow-up letter, they give an update on the situation and mention that this is going to be a crucial year for WHO.
4. Lancet (Comment) – Universal health coverage: the post-2015 development agenda
The passage of a UN General Assembly resolution on UHC in December, 2012, underlines how UHC is becoming a key global health objective, argues Jeanette Vega. “Using the post-MDG process as a platform to build on the movement that sees health systems as the backbone of a healthy population, we hope to ensure that in another 15 years, all of the world’s people will have access to health at an affordable cost. The time is ripe to be bold. A system-level approach working towards UHC could have a transformative effect in the battle against poverty, hunger, and disease.” ( we agree, but we also hope Jeanette and many others find the time to read the PHM’s post-2015 health document, including their assessment of UHC and what the starting point should be for the post-2015 development agenda)
Health Policy & Financing
5. Delhi communiqué – 2nd Brics health ministers meeting
Last week, the second BRICS Health Ministers’s meeting took place in Delhi (Luckily, it didn’t take place in Beijing this time). A Delhi communiqué was released with the BRICS countries’ global health priorities. NCDs obviously, including mental health, MDR-TB, and much more…
For some more background info on BRICs and global health, have a look at a recent report by Global Health Strategies Initiatives: “How the BRICS Are Reshaping Global Health and Development”.
Meanwhile, Russia seems to be moving away from UHC, unlike the other BRICs countries: less money will go to public health financing, more will go to … you guessed it – the army. (Putin is a fan of universal defense coverage).
6. Chatham House – Looking ahead at global health in 2013
A few experts, including Andy Haines, give their global health predictions for 2013 in this blog post. (in the future, global health bigwigs should perhaps consider Ophrah’s sofa for this sort of thing)
7. Psi – The daily impact: African nations renew child survival promise
A conference in Ethiopia –The African Leadership for Child Survival – A Promise Renewed conference – followed up on last year’s Child Survival Call to Action. African Ministers of Health renewed promises to address child survival in their respective countries.
8. Euractiv – Drugmakers suffer decline in trust, report says
The overall corporate reputation of pharmaceutical companies declined in 2012 compared to 2011, according to an independent study by patients’ organisations. The study – “The corporate reputation of pharma in 2012: the patient perspective” – was funded by PatientView, which represents 600 patient groups. Check out also a Pharmalot article on the same report.
9. Guardian – Mobile phones may not solve health challenges in poor countries
Mobile phone technology is frequently heralded as a solution to many health challenges facing the developing world, but two systematic reviews have found that evidence to back such claims is still largely non-existent. There is a lack of rigorous studies in LMICs – where experts agree that mobile health (mHealth) initiatives have tremendous potential – according to the reviews, led by Caroline Free, senior lecturer in epidemiology at the London School of Hygiene and Tropical Medicine and published in PLoS Medicine on Tuesday. ‘Our systematic review shows there is good evidence that text messaging interventions can increase adherence to antiretroviral medication and can increase smoking cessation,’ but “The reviews call for additional rigorous tests of mobile health interventions, especially in LMICs where the control group of ‘standard care’ might be very different from the standard care available in high-income countries. Read the two review articles in Plos (here and here).
10. NEJM (Perspective) – Should Blood Be an Essential Medicine?
Harvey G. Klein;
Klein wants blood to be included in WHO’s Model List of Essential Medicines, and gives some compelling reasons for doing so. (Twilight actors might agree)
11. Global Health Technologies Coalition’s Breakthroughs blog – Halting the fiscal cliff: how will the latest budget negotiations impact global health and development?
In this blog post, Ashley Bennett provides a summary of what the fiscal cliff compromise means for the federal budget, and what might happen to global health and international development programs. She discusses the “new ‘fiscal cliff’ date … when the new FY 2013 sequester is now scheduled to occur and how sequestration might affect global health research and development spending.
12. BMJ (news) – Doctors pledge to spread evidence based healthcare in Africa
Insecticide treated bed nets to prevent the spread of malaria and male circumcision to prevent HIV infection are just two of the evidence based healthcare measures that should be more widely used in Africa, doctors say. Last month doctors from nine African countries, alongside European colleagues, met in Rwanda to sign the Kigali declaration, which urges governments, NGOs, and healthcare professionals to implement evidence based healthcare.
13. NYT – Stick With the Science
Government representatives are meeting in Geneva this week to decide whether to introduce a global ban on mercury that could include thiomersal, a mercury-based preservative that has been used in some vaccine manufacturing since the 1930s to prevent bacterial or fungal contamination of multidose vials of vaccine. GAVI’s Seth Berkeley thinks that would be a bad idea.
14. Sarah Boseley (Guardian) – Somewhat less neglected tropical diseases
One year after an NTD meeting in London which included Big Pharma, where they promised to help eliminate neglected tropical diseases, two reports suggest progress has indeed been made. A WHO report heralds a new phase in the fight against neglected tropical diseases, but emphasizes sustained commitment is necessary. Another report, “From Promises to Progress: The First Annual Report on the London Declaration on NTD”, looks at progress made over the last year, since the meeting in London. Check out also a IPWatch article on the NTD news, including an assessment by MSF for example.
WHO now considers dengue a pandemic threat: “In 2012, dengue ranked as the fastest spreading vector-borne viral disease with an epidemic potential in the world, registering a 30-fold increase in disease incidence over the past 50 years.”
And Tom Paulson reckons we need a good definition of NTDs – as he rightly mentions, mental illness is a very “neglected” issue too.
15. Business standard – Drug pricing: government decides to bypass three patents
The access to (cancer) medicine fight is heating up. The Indian government issued compulsory licenses for three more patented drugs. (Maybe Big Pharma should consider a Coca cola-style ad in India.)
Last week, twelve countries signed a new UN treaty that aims to counter the illegal tobacco trade, which undermines regulation policies and represents a burden for health care systems. The Protocol to Eliminate Illicit Trade in Tobacco Products was signed by representatives from China, France, Gabon, Libya, Myanmar, Nicaragua, Panama, South Korea, South Africa, Syria (?), Turkey, and Uruguay during a ceremony held at the WHO headquarters in Geneva.
16. CGD – When and how much TasP is Value for Money?
Amanda Glassman et al.;
Glassman and colleagues reflect on a recent paper by Till Barninghausen, David Bloom and Salal Humair in which they published the results of a modeling exercise for South Africa, assessing whether Treatment as Prevention is indeed a game changer or if comparable benefits are obtainable at similar or lower cost by increasing coverage of medical male circumcision and antiretroviral treatment at CD4 <350/microliter. Glassman et al consider the Barninghausen et al approach as “the way to go for the future. To maximize value for money, global health funders and technical agencies should support the development of these models –in close collaboration with country officials- for all of their major recipients.”
17. Science Speaks – Does the anti-prostitution pledge violate the first amendment? Supreme Court to decide
This spring, the Supreme Court in the US will hear arguments on whether requiring organizations getting federal AIDS-fighting money to explicitly condemn prostitution is constitutional.
18. Global Fund news
- Belgium cut its contribution for the Global Fund in half, but Japan’s contribution to the Fund in 2012 was the highest one in 10 years.
- Check out the GF news flash 13: “Estimates, while still preliminary and unaudited, show that the Global Fund disbursed a total of US$3.3 billion in 2012 …. That is 26 percent more than was disbursed in 2011. At the same time, the Global Fund cut operating expenses by 5 percent.” The Global Fund will launch its new funding model in February 2013.
- An Aidspan GFO news article reported: the ability of the community sector to influence decisions made by country coordinating mechanisms is to some extent determined by national contexts and by structures that exist outside of the CCM. This is one of the conclusions of a report released by the Civil Society Action Team (CSAT) in December 2012.
- According to another GFO news article, the Global Fund Secretariat is developing a guidance document on health and community systems strengthening (HCSS) for use by applicants who are planning to request funding for HCSS under the new funding model (NFM).
19. Nature – Infectious disease: TB’s revenge
Efforts to control TB have split into two very different stories recently. One narrative says the disease is relatively easy to treat with proper medication and patients who adhere to the treatment plan. The other story is of an infection that is becoming increasingly resistant to available treatments and is beating back efforts to control its growth. This Nature article gives a nice summary of the two tales.
20. Lancet (Editorial) – Detonating a viral time bomb—the hepatitis C pandemic
On Jan 15, the Economist Intelligence Unit supported by Janssen Pharmaceuticals published a report: The Silent Pandemic: Tackling hepatitis C with policy innovation. The report examines the health challenge posed by the hepatitis C virus (HCV), and how comprehensive approaches that reflect the local needs and available resources can improve the health-care response to this deadly virus worldwide. Yet another 21st century ‘silent pandemic’… this century is increasingly shaping up as a very explosive cocktail of potential catastrophes.
Global health bits and pieces
- A Nature article reported on a potential breakthrough in the quest to prevent HIV and AIDS which has collided with sensitivities about testing expensive drugs in poor parts of the world. Some of the involved people say “antibody therapy is too expensive for its African target population. Others say it’s premature to worry about the cost – given examples in recent (ART) history, they are probably right.
- A nice Humanosphere article discusses cost effectiveness in the context of cholera.
- Nature reports on a new WHO polio strategy: WHO proposed a shift in vaccination strategy from oral vaccines to injected ones that may have to be administered in clinics.
- In a December brief, the People’s Health Movement gives an overview of highlights and PHM activities in Africa.
21. Global Public Health – Abstinence promotion under PEPFAR: The shifting focus of HIV prevention for youth
John S. Santelli et al.;
Abstinence-until-marriage (AUM) became a key element of initial HIV prevention efforts under PEPFAR. AUM programmes have demonstrated limited efficacy in changing behaviours, promoted medically inaccurate information and withheld life-saving information about risk reduction. A focus on AUM also undermined national efforts in Africa to create integrated youth HIV prevention programmes. PEPFAR prevention efforts after 2008 shifted to science-based programming; however, vestiges of AUM remain.
22. Global Health Action –Restructuring brain drain: strengthening governance and financing for health worker migration
Tim K. Mackey et al.;
Health worker migration from resource-poor countries to developed countries represents a serious global health crisis and a significant barrier to achieving global health equity. Using acceptable methods of policy analysis, the authors of this article first assess current strategies aimed at alleviating brain drain and then propose their own global health policy based solution to address current policy limitations. They conclude: “In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.”
23. Health Planning & Management – Reflections on the frameworks we use to capture complex and dynamic health sector issues
Huff-Rousselle reflects on recent and less recent health systems frameworks. “It is essential that we continue to have multiple perspectives from which to view the health sector, as complexity demands the multi-disciplinary analytical thinking that is so essential to effective problem-solving in an increasingly complex globalized world.”
24. HP&P – Paying health workers for performance in a fragmented, fragile state: reflections from Katanga Province, Democratic Republic of Congo
Sarah Fox et al.;
A new paper on P4P in a fragile country, focusing on a P4P programme in Katanga Province, DRC, which combines paying for performance with a reduction in fees to users. Sophie Witter is a co-author.
25. Institute of medicine (Discussion paper) – Strengthening Mechanisms to Prioritize, Coordinate, Finance, and Execute R&D to Meet Health Needs in Developing Countries
Peter Hotez et al.;
In response to issues raised in the report of the WHO-affiliated Consultative Expert Working Group (CEWG) on research and development (R&D) financing and coordination, several members of the Institute of Medicine Global Health Interest Group and other experts combined efforts to produce an IOM discussion paper to capture their views on approaches to research priority-setting, the leading gaps in global health R&D, R&D planning and costing, the private-sector role in global health R&D, the creation of effective global health research networks, the building of R&D capacity in developing countries, innovations in financing the global health R&D enterprise, and principles of global health R&D management.
International journal for equity – The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá – Colombia: an ecological analysis
Paola Mosquera et al. ;
This study by EV 2012 Paola Mosquera and colleagues aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá.
Pan African medical journal – Quality of Antenatal care services in eastern Uganda: implications for interventions
Moses Tetui et al.
This study by EV 2012 Moses Tetui assessed quality of ANC services in eastern Uganda with a goal of benchmarking implications for interventions.
BMJ rapid response to a recent BMJ editorial, “What must be done about the killings of Pakistani healthcare workers?”
Asmat Malik et al.;
Asmat Malik, EV 2010 & 2012, does not fully agree with Zulfiqar Bhutta, when the latter says “it’s time to stop trying to accommodate those spread fear and terror.” Asmat gives some recommendations to break the vicious public health circle in his country.
Social Medicine – Experiences in Latin America, lessons from the Thumb of the Americas: the right to health is built through social movements
Ivan M. Sandoval & Maurico Torres;
This article co-authored by EV 2010 and activist Mauricio Torres describes the journey that El Salvador began in the late 1990s. A broad coalition of social movements, community groups, unions, and citizens blocked reforms designed to privatize Salvadoran public health services. They also advanced a participative agenda to establish a national health system and promote pro-health social policies. This experience can teach us quite a bit on the struggle for health rights in Latin America.
- Jim Yong Kim urged poor countries to boost growth.
- A few more insightful articles on the new – but different – Oxfam campaigns in the UK and US: see here and here. “… The British have gone in for landscapes, showcasing the verdant and varied biosphere, while the Americans have gone for the individuals, encapsulating the personal side to Africa. … Oxfam GB and Oxfam America target different audiences with their respective campaigns. There are similarities between the target audiences, but there are enough differences that varied campaigns are a prerequisite. Each campaign is also focused on different issues; for GB it’s about reimagining Africa, for the US it’s about not cutting foreign aid for the sake of the national budget…” By the way, Oxfam international has a new boss, an African female grassroots activist.
- The World Trade Organisation also needs a new boss in the coming months – check out this nice Guardian article with some background on how WTO is faring these days. Not well, it seems.
- Read also this in-depth analysis article (by Rick Rowden, Center for Economic and Social rights Consultant) on how to integrate fiscal and finance issues into a transformative post-2015 development agenda.
- Greening, the UK development secretary, introduced a new code of conduct – aid agencies are to be paid by results “to reduce costs and waste”, from now on.
- David Cameron has said he will make tax secrecy – both in developed and developing countries – a top priority during his Presidency of the G8 starting this month. (grinning is allowed)
- Lethal air pollution is a problem not just in Beijing, but in plenty of Asian cities, John Vidal reports in the Guardian.
- Finally, a Yale Global article zooms in on a new trend – conservative causes are going global (see last week’s mass protest in France against gay marriages)