It’s been a hectic week for news watchers. The 132nd WHO Executive Board meeting will get some coverage in this newsletter, obviously – although we have to admit the WHO website is still not very user-friendly/transparent. WHO can learn a thing or two from the Davos crowd when it comes to (fake) transparency and efficient PR. On the advocacy front, the anti-hunger If campaign kicked off in the UK and the ‘one billion rising’ campaign to combat violence against women is also gaining momentum worldwide – check out Nandini Oomman’s very personal Huffington Post article on the sexual harassment she experienced during her life in different countries. In Africa, a new and controversial Ugandan HIV prevention campaign addresses sexual infidelity, aka cheating.
The last campaign ensures a smooth transition towards men’s interests 🙂
Football for example: the African cup of Nations is in full swing, with stars like Didier Drogba who care about malaria. Or money: in the far East, an innovative Japanese minister offered a very macho suggestion to deal with the health system financing crisis in his country. And posturing disguised as politics, of course: David Cameron gave a few speeches this week, on an EU referendum and on the G8 agenda. He said a few sensible things on both occasions but unfortunately, the guy has a serious credibility issue as soon as he opens his mouth.
That can’t be said of his overseas colleague. In spite of the fierce competition, the inauguration speech of Obama received the most attention this week, and for good reason. Amongst other pledges and promises, the US president vowed to take on climate change in the next four years, saying that America must lead the transition to sustainable energy sources. “We will respond to the threat of climate change, knowing that the failure to do so would betray our children and future generations,” he said. “The path towards sustainable energy sources will be long and sometimes difficult. But America cannot resist this transition; we must lead it. …” Etc. This time no talk of ‘leading from behind’. Well, the man is a politician – this is his job. But he’d be wise to read this inspiring though not exactly uplifting message from an aging Zen master on the only path towards tackling climate change.
In this week’s guest editorial, Emerging Voice Aku Kwamie from Ghana reflects on the Arusha maternal health conference. In lovely prose, she calls for a moral revolution in maternal health care. The maternal health people might also want to check out another blog post on Arusha, on the maternal health task force website: “building a global network of maternal health policymakers” by Sandeep Bathala (Wilson Centre), and Richard Horton’s weekly Offline contribution on Mahmoud Fathalla’s incredibly impressive speech in Arusha.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
26 Years On: A Need for a Moral Revolution in Maternal Health Care
By Aku Kwamie, Research Fellow, Ghana Health Service/University of Ghana; Emerging Voice 2012
We gathered at the foot of MountMeru for three days: 800 researchers, practitioners, advocates, policy-makers and donors, to discuss the state of quality maternal health care. The fact that we were congregated in one of the oldest inhabited regions on Earth, where women and girls had been dying in childbirth – for millennia – was not lost on the delegates.
WHO Executive Board meeting
1. IHP – The 132nd Executive Board meeting of the WHO and the institutionalization of Multi-bi Financing
Remco van de Pas;
In this blog post, Remco van de Pas (health policy advisor, Wemos) analyses the ongoing 132nd EB meeting, Margaret Chan’s speech and the WHO reform process. He distinguishes two trends. You can find WHO background documents on the reform here.
As mentioned by Remco in his blog post, WHO Watch is a civil society advocacy & analysis platform that follows the WHO activities & reform closely. They also compiled some useful documents around the agenda. See for example this People’s Health Movement document listing some of the Movement’s concerns around the EB agenda, addressing the Board.
For the ones among you who are good at deciphering 144-character tweets, it’s probably a good idea to check out some of the critical (read: Horton’s, for example on the dysfunctional governance of the EB, and the rather lackluster performance of some regional and country offices ) and less critical tweets sent around the world about the EB, look for hashtag #EB132. Ilona Kickbusch, Slim Slama & MMI tweeted quite a bit on the Board meeting, for example.
More in-depth analyses of the Board meeting & WHO reform will probably be produced next week, so stay tuned.
In 2013, nobody doubts anymore that Davos has some dubious strategic partners – its interests are corporate, and unashamedly so. This year’s theme was ‘resilient dynamism’. A few excellent examples of this attitude are Goldman Sachs and Shell, who won this year’s Public Eye shame prizes ‘for particularly glaring cases of companies’ greed for profit and environmental sins’. My guess is that some of their corporate buddies actually think deep in their heart: “Well done, boys”.
Nevertheless, it’s a fascinating event. As in every event where human beings gather, the messages produced by keynote speakers and panelists are a mix of utter nonsense and deep wisdom – check out for example Richard Smith’s blog post on his 2004 visit to see this for yourself. For this year’s Davos batch of alpha males & females, the jury is still out, but the quote by Graham Mackay, executive chairman of South African brewing giant SABMiller is definitely in the race for most myopic corporate thinking: he urged Africa‘s leaders to let private-sector businesses “fix” Africa’s problems. As for wisdom, David Cameron is a contender this year, with a keynote speech in which he outlined the G8 agenda for June. Trade, tax and transparency will be the three themes of Britain’s presidency of the G8. A Guardian op-ed pointed out that on none of these three issues, he has a good domestic record, but hey, that’s the fairytale world we live in, isn’t it?
What are the key global health messages this year?
- Bill Gates on the MDGs: when asked what improvements might be made in the MDGs, Gates said he believed no extra goals were needed and only the targets should be revised. “Leave it alone,” he said. “It’s hard to argue with success because this success is measured in lives.” He also emphasized that the world can halve childhood deaths in the next 15 years.
- Oxfam obviously disagrees with Gates on the post-MDG agenda. The organization criticized extreme wealth in the run-up to Davos, and even offered a – very necessary, in my opinion – ‘end extreme wealth by 2025’ post-MDG goal.
- Novartis CEO Jimenez said a couple of sensible things on going beyond traditional corporate social responsibility (as in donating medicines), and gave some examples of innovative Novartis programs.
- A Reuters article lays out some of the Davos divisions on the obesity issue.
- Seth Berkeley enthused about the power of vaccines.
- Global Fund update: the Global Fund ‘Big Push’ campaign was revived, with some help from Charlize Theron and obviously a big role for the new boss, Mark Dybul. He also advertised the Big Push in this Huffington Post article. Germany committed 1 billion to the GF, for the next five years. Less positive GF news came from a report published by Harm Reduction International (HRI). The report questions how financing for harm reduction will be prioritised as part of the Global Fund’s new funding model.
- A key 1 million health workers initiative targeting rural Africa was announced by Kagame, Jimenez and Sachs. “Across sub-Saharan Africa, community health workers using mobile phones and broadband access to sophisticated medical resources are delivering health care to where it is most needed, among the rural poor. A new campaign aims to greatly expand that effort by training, equipping and deploying one million health care workers by the end of 2015, reaching millions of underserved people.” Great news.
- A WEF report on ‘sustainable health systems’ was published. The report, prepared in cooperation with the very sustainable McKinsey company, is based on the assumption that health systems need to change fundamentally to become more sustainable. Sustainability is unlikely to be achieved through incremental changes. Instead, transformative solutions will be needed. That sounds surprisingly familiar in these dire times of austerity. A diverse group of health system leaders across five countries was asked to describe their ideal health system in 2040. Their visions are remarkable in their consistency. The preferred health system of the future is strikingly different from the national healthcare systems of today, with empowered patients, more diverse delivery models, new roles and stakeholders, incentives and norms. Three scenarios were developed: Health Incorporated, New Social Contract and Super-empowered Individuals. Eat that.
- A NEJM Perspective (by Brad Spellberg et al.) dwells on the major risk of antibiotic-resistant bacteria, a global risk stressed in a recent WEF report.
Health Policy & Financing
2. Lancet (Comment) – Is Option B+ the best choice?
Anna Coutsoudis et al.;
In this comment the Option B+ program to reduce mother-to-child-transmission of HIV, which provides lifelong ART treatment to all pregnant women irrespective of CD4 cell count, is questioned based on ethical, medical, programmatic, and economic concerns. The South-African authors argue that the ethics of early treatment initiation need to be discussed; that the experience in terms of medical benefits, safety, and treatment adherence remains limited; and that the assumption based on economies-of-scope may be invalid.
The program has been piloted by MSH in Malawi and gained international support at the XIX International AIDS Conference, fuelled by the call for eliminating pediatric HIV by 2015. An earlier viewpoint on the Option B+ in which some of our colleagues were involved (but focusing on a resource poor setting, Malawi) was also published in the Lancet (in 2011). (To be continued, we reckon…)
3. Lancet (Editorial) – Neglected tropical diseases: progress and priorities
This Lancet Editorial links the two recent (and encouraging) reports on NTDs with essential health R&D financing. “… This week WHO’s Executive Board has been asked to endorse a less ambitious plan by member states for a more vaguely defined WHO Observatory on Global Health R&D, which is weak on concrete action despite international consensus that the current R&D model needs revision. The 2013 World Health Assembly should be more ambitious and put back on the agenda the proposal for new global rules to secure sustained financing mechanisms for essential health R&D.”
More on NTDs: a Scidev.net article emphasizes that developed countries and emerging economies must join forces to support research into new drugs for neglected diseases, according to research by MSF and the Drugs for Neglected Diseases initiative (DNDi).
On the IHP blog, Daniele Dionisio, a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases, acknowledged the progress made, but criticized the highly fragmented landscape.
4. Health Policy & Planning –An alternative mechanism for international health aid: evaluating a Global Social Protection Fund
Sanjay Basu et al.;
Several public health groups have called for the creation of a global fund for ‘social protection’—a fund that produces the international equivalent of domestic tax collection and safety net systems to finance care for the ill and disabled and related health costs. All participating countries would pay into a global fund based on a metric of their ability to pay and withdraw from the common pool based on a metric of their need for funds. The authors assessed how alternative strategies and metrics by which to operate such a fund would affect its size and impact on health system financing.
5. China Daily – China, UK unveil joint global health program
The Chinese and British governments are cooperating on a program to improve global health policy for developing countries, with the launch in Beijing on January 16 of a new UK-China partnership. The Global Health Support Program will run until September 2017. “The program will help the UK Department for International Development and low-income countries to learn from China’s success in reducing infant, child and maternal mortality rates, and its disease prevention and control; and China’s health development and health-sector reforms.”
6. Scidev.net – Nations agree first global treaty to ban mercury emissions
Yojana Sharma ;
A legally binding global treaty to curb mercury in the environment was agreed this week. It will also include a funding facility to assist developing countries in phasing out the toxic heavy metal in industrial processes and in artisanal gold mining in Africa, Asia and Latin America (but see the Guardian on this issue of artisanal mining). The treaty did not ban use of mercury as a preservative in vaccines, which many in the public health community feared would make vaccines more expensive and harder to deliver safely. WHO produced the following statement on the treaty.
7. Plos – Reducing Vulnerability to Climate Change in Sub-Saharan Africa: The Need for Better Evidence
Robert Fryatt et al.;
Robert Fryatt and colleagues argue for more attention to climate change in sub-Saharan Africa, a region that has contributed the least greenhouse gas emissions to the world’s total but is more vulnerable to the impacts of climate change than any other.
8. Value in Health – supplement on Universal Health Coverage
The articles in this special supplement, based on a conference held at Bocconi University in Milan, Italy, earlier this year, remind us that there are large and important policy issues that rely on ‘‘big thinking’’—with less hard evidence—to understand and try to reform what is going on in health systems and health policy.
The supplement features a wealth of very interesting articles, for example on the impact of global trade liberalization on health systems pursuing UHC, an editorial on Big Thinking versus Big Data, the interaction of political, economic and social sustainability (for UHC), the McKee et al. article on UHC from a historic perspective which we covered before, etc.
To wrap up UHC related material for this week, Heartfile has a nice blog post on the 2012 UHC milestones.
9. Epi-analysis – Private and public linkages of soda companies
In this blog post, Basu takes a more systematic look at which institutions and people have close ties to Big Soda, and what sorts of relationships they have. Who in the public sphere of governance is linked to “Big Soda” companies, and how?
And while we’re at it, read also how Andrew Harmer’s interprets Coca Cola’s “delivery in remote areas” success. (Andrew and Sanjay for Davos!)
Maternal and Child Health
10. Lancet (Comment) – A tipping point for change: saving millions of additional lives in 2013 and beyond
Goodluck Ebele Jonathan & Jens Stoltenberg;
The Global Campaign for the Health Millennium Development Goals – Report 2013, initiated by Prime Minister Jens Stoltenberg of Norway in 2007, brings together a number of initiatives, all aimed at fulfilling the promises given by world leaders in the Millennium Declaration in 2000. Contributors to the Report include Ban Ki-moon, Margaret Chan, and government leaders from Nigeria, Norway, Malawi, Indonesia, Tanzania, US, UK, Ethiopia, and Canada. The president of Nigeria & the Norwegian Prime minister, who serve as co-chairs of the UN Life-Saving Commodities for Women and Children, comment on the 2013 report, ‘Accelerating Progress in Saving the Lives of Women and Children’. This year will be ‘a tipping point for change’ and global awareness for saving more lives, especially those of women and children.” Though they said progress has been made in saving the lives of mothers and children, “‘we are off-track to reach our goals of reducing child deaths by 67 percent and maternal deaths by 75 percent by 2015. “
11. Global Post – Latin America takes action to decriminalize abortion
Mandy Van Deven;
This month is the 40th anniversary of one of the most important legal decisions of our time: Roe v. Wade. This article depicts the changing tide in Latin America, 40 years after the US legal decision.
12. Bloomberg Business week – Billionaire Horse Breeder’s Polio Shot to Undercut Glaxo
Indian billionaire Cyrus Poonawalla, founder of the world’s biggest maker of vaccines, will slash the price of polio immunization and introduce shots for diarrhea and pneumonia, undercutting Pfizer Inc. and GSK. As Tom Paulson points out, this story is also interesting because of the role Bill Gates plays in it: “Gates is investing in an Indian drug company, the Serum Institute, which plans to produce much lower-cost polio vaccines and other immunizations. Reducing costs in vaccines translates directly into more people, mostly children, getting vaccines. That makes sense from a public health perspective. But by backing this Indian company (the article doesn’t provide the funding amount), Gates is also undercutting some big guns in the Western pharmaceutical industry.”
In other Gates related news, on the Gates blog ‘Impatient optimists’, Jennifer James highlights the Family Planning 2020 Reference Group, announced last month with the aim of ensuring the commitments made at the 2012 London Family Planning Summit are honored. “The partnership, led by Dr. Babatunde Osotimehin, executive director of the U.N. Population Fund (UNFPA), and Dr. Chris Elias, president of global development at the Gates Foundation, will provide strategic direction for all partners and ensure that the $2.6 billion in financial commitments are fulfilled and implemented in order to provide voluntary contraceptives to women in developing countries.”
13. Plos – Why Do Women Not Use Antenatal Services in Low- and Middle-Income Countries? A Meta-Synthesis of Qualitative Studies
Kenneth Finlayson et al.;
In a synthesis of 21 qualitative studies representing the views of more than 1,230 women from 15 countries, Kenneth Finlayson and Soo Downe examine the reasons why many women in low- and middle-income countries do not receive adequate antenatal care.
14. Global Public Health – The impact of vouchers on the use and quality of health care in developing countries: A systematic review
Carinne Meyer Brody et al.;
One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. This systematic review summarizes the findings of 16 health voucher programmes.
15. BMJ (Analysis) – Reduced premature mortality in Rwanda: lessons from success
Paul E. Farmer et al.;
Rwanda’s approach to delivering healthcare in a setting of post-conflict poverty offers lessons for other poor countries, say Paul Farmer and colleagues.
16. Globalization & Health – Brazil-Africa technical cooperation in health: what’s its relevance to the post-Busan debate on ‘aid effectiveness
Giuliano Russo et al.;
This paper looks at Brazil’s health cooperation projects in Portuguese-speaking Africa with a view on the post-Busan debate on aid effectiveness.
- Leading academics and public officials have urged Ban Ki-moon (in a letter) to appoint an internationally respected figure to lead UNCTAD amid fears that a weak appointment will further sideline the UN trade and development body.
- Some Guardian articles on the new anti-hunger If-campaign: see here and here. « UK NGOs and aid agencies on Wednesday launched the anti-hunger If campaign, the largest coalition of its kind since Make Poverty History(MPH) in 2005. If goes further than MPH, calling for action to address the causes of hunger, including land “grabs”, loopholes that allow companies to dodge paying tax, and murky investments in poor countries by governments and the private sector. … The If campaign is different because it is focused on policy change, rather than just more money. “
- An incisive Guardian editorial on how the post-2015 consultation process is going (or not going anywhere?).
- Great news came from the EU, this week – for a change. An agreement was reached to set up a FTT, and 11 countries approved. Development aid organisations hailed the agreement, and called on the European Commission to follow France’s example by allocating 10% of the revenue “to the benefit of the poorest in the world”.
- The Open Working Group (OWG) on Sustainable Development Goals is now officially up and running, in accordance with this recent UN General Assembly draft decision. The OWG will hold its first meeting early next month, and discussions have already started on both substance and process.
- The World Bank’s 2013 development statistics reveal a changing composition of developing countries’ debt. The share of private debt in developing countries’ total external debt may now exceed the public share, although the true picture is unknown.