Dear Colleagues,

The One Billion Rising campaign (which yesterday culminated in events around the world to protest against violence against women and girls) arguably makes up the global health news item of the week. But there was also Obama’s State of the Union, the freezing of the EU’s aid budget, the Lancet NCD Series, another blow to the polio eradication campaign (in Nigeria this time), the global health estimates meeting in Geneva, … and yes, we almost forgot: the pope resigned.

Health Systems Global announced that the third HS Symposium will take place in Cape Town, from 30 Sept – 3 Oct 2014. Great location. Apparently, a HS Global Board retreat is ongoing in London, presumably in a less fancy venue. Meanwhile, it’s obvious the World Bank is ramping up its UHC activities – the bank just started a new webpage dedicated to UHC and next week (18-19 February), a joint WHO/WB meeting on UHC will take place in Geneva. As for the post-MDG & health consultation, you can still send your feedback on the draft report till 19 February.

Time for our weekly Richard Horton paragraph then 🙂. If you want to get a good overview of the global health estimates meeting in Geneva and statements by various speakers, we strongly recommend you check Richard’s Twitter account; he’s been tweeting throughout the meeting (as usual).   If you’re really curious and in the deciphering business, his tweets include a picture of the draft recommendations. His final assessment of the event: “The meeting on global health estimates is over. There was no World War 3. It was an extremely good process. Excellent proposals for future.” That’s a relief.

Richard has also been interviewed recently on the SDGs and MDGs (by Anthony Costello, UCL global health). Check out the Youtube videos. Just to give you a taste of a freewheeling Horton: “It’s possible health won’t be an SDG; UHC might not be the right goal for this time, given the fact that climate change is now the critical determinant; there’s a reversal of investment into mother and child health; frankly, it’s not about getting papers published in the Lancet, … but getting on the front lines of medical activism”. Presumably, Horton had just watched Matt Damon’s “toilet strike” video which went viral this week. The video draws attention to the world sanitation issue.

In this week’s guest editorial, our colleague Bart Criel reflects on a recent paper he read on chronic care in Belgium. He argues there are perhaps some lessons in it for LMICs as well, now that NCDs are rising on the international agenda. PHC hasn’t lost any of its relevance.

Enjoy your reading.

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




Managing chronic diseases: Primary Health Care, now more than ever

by Bart Criel, ITM Antwerp

I had the privilege and pleasure to comment upon the (excellent) Position paper for Chronic Care in Belgium that was recently published by the Belgian Health Care Knowledge Centre – an institution well-known in this country under its local acronym KCE. Officially, my role was to “validate” the report. This rather flattering description of my expected inputs does not match the considerable “return” I got from reading the report (that can be found on the KCE website). Yes, I learned quite a lot from studying this extremely well documented and referenced report.

Read the rest here



Lancet  Series on NCDs

The latest Lancet NCDs Series builds on a landmark high-level UN/NCD meeting held in September 2011. The Series aims to set out clear plans for countrywide implementation of NCD plans in the post-MDG era, towards the unified goal of ’25 by 25’—reducing NCD mortality worldwide by 2025.

The first paper emphasizes the importance of embedding NCDs into post 2015 MDG strategy;  paper 2 details NCD countrywide approaches including planning, implementation, accountability, and the importance of a National NCD Commission to monitor progress. An affordable step-wise approach will be the key to successful NCD implementation. Other papers discuss reducing health inequalities, ‘unhealthy commodities’ such as the food and drink industries, and the importance of the scaling-up of access to vital medicines, especially the need for wider availability of affordable generic drugs.


1.    Lancet (Comment) – Non-communicable diseases: 2015 to 2025

Richard Horton;

In this Comment, Horton emphasizes that with this new Series, the Lancet has sought to adapt the core messages of The Lancet NCD Action Group, this time around the post-MDG  notion of sustainable development. The journal also tries to build on past work by focusing on country actions (rather than merely global political or multilateral agency responses), inequalities, the harmful effects of the food and drink industries, access to essential medicines, and improving the responsiveness of health systems. The objective is to present the case for including NCDs as part of the post-2015 framework.


2.    Lancet (Comment) – Independent global accountability for NCDs

Robert Beaglehole et al.;

In this Comment, Beaglehole et al  propose an NCD accountability mechanism based on recent global experience, including: the MDGs; Every Woman, Every Child; and the reporting framework developed for the 2001 Declaration of Commitment on HIV/AIDS. The authors suggest what needs to happen globally and nationally.

Check out also the Lancet viewpoint (by Rifat Atun et al.) on improving responsiveness of health systems to NCDs.

Various knowledgeable people already commented on (parts of) the Lancet Series and on the joint Lancet/London School meeting.

In the Guardian, Sarah Boseley zoomed in on the big food, drink, and alcohol companies. According to one of the papers in the Lancet series, these companies are using similar strategies to the tobacco industry to undermine public health policies. Self-regulation is a really bad idea, the authors of the paper argue – they should be regulated.

In a blog post on Plos Translational Global Health, “Politics and Global Health – are we missing the obvious?” Greg Paton wondered a few days before the London meeting: “Are we beginning to see the limits of solving a problem that requires political change through an apolitical entity (i.e. WHO) that has little power to influence the policies that create NCDs?” He offers some suggestions.

The prolific Richard Smith also wrote a BMJ blog post on the joint meeting. “The time has come for the NCD agenda to be integrated with the broader sustainability agenda, and this was the focus of a joint meeting this week between the London School of Hygiene and Tropical Medicine and the Lancet.”

In other NCD news, an industry-backed group of experts has issued a report  (published by John Hopkins University & commissioned by the International Federation of Pharmaceutical Manufacturers and Associations) identifying significant obstacles to addressing NCDs and proposing solutions to reduce premature deaths caused by NCDs. The most prominent actions put forward by the group range from the need for “intersectoral” action to the amelioration of the supply chain of drugs as well as the restructuring of primary health care. The study is a compilation of five policy briefs written by various academics. See also this IP Watch article on the report.


3.    Lancet (Correspondence) – A human right to health approach for non-communicable diseases

Pol De Vos et al. (for the People’s Health Movement)

Effective control of NCDs requires a comprehensive approach, these PHM authors argue. Therefore, NCD targets must explicitly address global and local social determinants. Corporate behaviour, including potentially damaging marketing practices, must be regulated. Equitable access to healthy food, care, and medicines needs public intervention supported by empowering processes in communities.


Obama’s State of the Union


Ten years after George Bush’s surprising State of the Union speech in which he launched PEPFAR, it was again Obama’s turn to face the country, for the first time in his second term. In his speech, Obama outlined an ambitious (but largely domestic) agenda that included raising the minimum wage  (not very good news for McDonald’s stocks, it turned out soon), increasing spending on infrastructure, attacking climate change and passing gun-control legislation. Obama also used his State of the Union address to urge the US to pass two key trade agreements, including the controversial Trans-Pacific Partnership (TPP) that human rights activists say will raise costs and impede access to medicines.

In the (tiny) foreign policy portion of the speech, the president spoke of addressing global poverty (“the US will work together with others to eradicate extreme poverty in the next two decades”) and other humanitarian & global health issues, including realizing the promise of an AIDS-free generation. A nice CGD blog post (by Jenny Ottenhoff) looks at Obama’s SOTU from a development perspective. She was pleasantly surprised, even if “most of his remarks on development were cleverly disguised as domestic issues”. His speech was, however, in sync with the idea that rich-world development policy is about more than aid (and includes climate change, trade, …).

The one missed opportunity for her was the fact that Obama only mentioned Africa in the context of national security.




4.    Financing Health in Africa – An online debate about the UN General Assembly vote in favour of Universal Health Coverage

Compiled by Emmanuel Ngabire;

Late last year, a UHC resolution was voted at the UN. The declaration triggered a debate on an online Community of Practice discussion forum. This blog post summarizes the main points of the discussion. Practitioners involved in health systems and health care financing in Africa want to be heard in the global debate on UHC. Many implementers are concerned about UHC implementation challenges.


5.    WB – new website on UHC & UHC study series

On the World Bank’s UHC webpage, where you can find an overview of the current UHC activities of the Bank, you also find a Feature article about the just published Bank’s universal health coverage study series.  The World Bank supports countries’ efforts to achieve UHC. “The Bank’s universal health coverage study series offers knowledge and operational tools to help countries tackle challenges in ways that are fiscally sustainable and that enhance equity and efficiency. Studies from 22 countries and Massachusetts analyze the “nuts and bolts” of programs that have expanded coverage from the bottom up—programs that have started with the poor and vulnerable rather than those initiated in a trickle-down fashion. The protocol, studies, and technical papers contribute to discussions about universal health coverage, provide implementers with an expanded toolbox, and inform the universal health coverage movement as it continues to expand worldwide.”

We especially want to draw your attention to the following WB document: “The Impact of Universal Coverage UHC Schemes in the Developing World:  A Review of the Existing Evidence”. (by Ursula Giedion, Eduardo Andrés Alfonso, Yadira Díaz)


6.    Adam Wagstaff – Universal health coverage: Old wine in a new bottle? If so, is that so bad?

In this blog post, Adam Wagstaff teases the UHC crowd a bit, and wonders whether the concept is “old wine in a new bottle”. That is probably the case, he says, but he acknowledges that UHC may yet serve as a useful rallying cry for the goals of equity, financial protection, and quality of care. The post already led to quite some comments (below the post).


Global Fund


7.    Atlantic – An Optimistic Era for Global Infectious Disease Control

John-Manuel Andriote;

According to Mark Dybul, the Global Fund represents the leading edge of the new approach to international health and development efforts. The new approach is characterized by a switch from paternalism to partnership.  Countries are now expected to assume responsibility for the health and development of their people. Several other cornerstones mark this paradigm shift. Dybul also said that a better understanding of the epidemiology of the 3 diseases makes it clear there aren’t any ‘generalized’ epidemics, even in hard-hit countries, but there are what he called ‘micro-epidemics’.

So much for the optimism on the new GF direction; on Humanosphere, Tom Paulson also signals some people are worried “that Dybul’s appointment — along with other things going on regarding drug patents, mostly behind the scenes pushed by the drug industry and US politicians — threatens to undermine the very progress he is celebrating”.


Maternal & Women’s Health


We already mentioned the One Billion Rising Campaign in the intro – check out the Guardian’s live blog covering events around the world yesterday. (Michelle also looked very combative in Obama’s SOTU, by the way)

As for access to safe abortion, the Guardian ran a couple of interesting articles this week, respectively on the US aid ban on abortion for rape victims, and on the changing anti-abortion law environment in Latin America.

And in a very encouraging development, Ghana launched a TV series to spark improvement in maternal health. The Maternal Health Channel, a weekly glossy TV show, hopes to raise awareness and boost maternal health across Ghana. Hopefully other African countries will follow suit.




Plenty of pieces are being written on the blows to the polio eradication campaign, now that health workers are being murdered in Pakistan and Nigeria. We hope you find the time to read:

  • A new piece by Sania Nishtar (Project Syndicate op-ed) on Pakistan & polio, ‘Pakistan’s Polio tipping point’.
  • A blog post by Tom Murphy (on Humanosphere) in which he wonders whether movies like Zero Dark Thirty worsen the already existing skepticism of vaccine programs overseas.


Health Policy & Financing


8.    Medico International – Workshop reader: global social protection scheme; moving from charity to solidarity. International seminar on Financing For health and social protection

Edited by Jens Holst on behalf of Medico International and the Hélène-De-Beir Foundation;

Can we imagine a funding mechanism for Global Social Protection between people living in different countries, relying on each other and supporting each other, contributing to a fair and equitable global society? Medico International and the Hélène de Beir Foundation, the organizers of a three days expert workshop which took place last year, can. They (and many others) think that most people can adhere to the principles of Global Social Protection. The objective of the three days expert workshop on Financing Global Social Protection was to challenge the metaphorical devil in the detail. If we know we must move from global charity to global solidarity, the question becomes: how? This document features a number of contributions from people like Thomas Gebaeuer, Gorik Ooms, Anand Grover, Thomas Pogge, and many others.


9.    WHO – Working together for better health estimates

As already mentioned in the introduction, global leaders in health statistics gathered in Geneva this week to discuss future possibilities of collaboration to improve current practices in health estimates. At a meeting hosted by the WHO, representatives from WHO, the United Nations Population Division and other UN agencies, the World Bank, development foundations, academic institutions and scientific journals committed to working together more closely for better calculation, sharing and communication of estimates of health indicators.


10. Lancet (Editorial) – Giving children a chance

Last week, the World Policy Analysis Centre released a new report, which for the first time systematically presented comparative data on laws and public policies in 191 countries covering areas essential to children’s healthy development. Changing Children’s Chances examines policy data and their impact in the areas of poverty, discrimination, education, health, child labour, child marriage, and parental care. As Horton mentioned, this is about the wider determinants of children’s health and why we should be concerned. Material to be used in the post-2015 development discussion, obviously.


11. Lancet (Editorial) – Highs and lows in global health funding

This Lancet Editorial reflects on the most recent IHME report on global health expenditure (see also last week’s IHP newsletter). How does the good news weigh up against the bad?

In a related blog post, CGD’s Amanda Glassman stresses the story is one of stagnation in development assistance for health.


12. Lancet (Offline) – The Global Burden of Disease—“a work in progress”

Richard Horton;

Last week’s Global Health Lab at the London School of Hygiene and Tropical Medicine investigated the Global Burden of Disease (GBD) collaboration. The discussion was very lively, apparently. There were concerns about WHO’s self-exclusion, about the governance of the GBD, about transparency of methods, about risk factors not included (eg, unsafe sex, poverty, inequality, and climate change), … Many of these questions were no doubt again discussed this week, at the (WHO hosted) meeting on global health estimates,  chaired by Hans Rosling and Peter Piot. WHO wished to devise a joint statement on global health estimates to move beyond the conflict to a more constructive place. According to Horton’s tweets, they more or less succeeded.


13. Chatham House (working paper) – The Role of the World Health Organization in the International System

Charles Clift;

This is the first paper in a series related to the Centre on Global Health Security Working Groups, which are aimed at improving global health security. In this working paper, Clift goes back all the way to the end of the 19th century, but also discusses the ongoing WHO reform.

The new Health Diplomacy Monitor issue also pays lots of attention to WHO and the recent Executive Board meeting. Check it out.


14. A global village – The BRICS: What is their Contribution to Global Health?

Andrew Harmer et al.;

Since their emergence as a group, many commentators have championed the BRICS as good news for global health. This article seeks to explore whether it is right to assume that their economic accolades readily extend to the sphere of Global Health. Do the BRICS, lauded for their economic achievements, qualify as global health champions? Not yet, but stay tuned.

Things could, indeed, change quickly now that China has a new first lady – folk singer Peng Liyuan. Given her track record, she might influence public health activism in China (and perhaps beyond?) in the coming years. Robert O’Brien dwells on her potential role in an opinion piece published on Context China : “While Peng is not likely to wield the sort of power held by … most American first ladies, the combination of her fame and closeness to China’s preeminent leader with her public health activism could prove a boon for organizations, such as the Bill & Melinda Gates Foundation, that are seeking to realize a China that is both healthier domestically and more active in efforts to secure public health around the globe.” (but we’re still looking for a Chinese Matt Damon)


15. Globalization & Health – Climate change and health — what’s the problem?

Matthew HR Anstey;

Yes, what’s the problemJ? This paper examines the health implications of global warming, the current socio-political attitudes towards action on climate change and highlights the health co-benefits of reducing greenhouse gas emissions. In addition, policy development for climate change and health should embrace health systems strengthening, commencing by incorporating climate change targets into Millennium Development Goal 7.


16. Reuters – Drugmakers eye Africa’s middle classes as next growth market

Not only is Africa’s economic growth grabbing attention in boardrooms but the shifting nature of its disease burden is luring Big Pharma, as new opportunities open up for treating chronic diseases afflicting the middle classes, rather than just fire-fighting infection,” Reuters reports. “By 2016, pharmaceutical spending in Africa is expected to reach $30 billion, driven by a 10.6 percent annual growth rate that is second only to Asia and in line with Latin America. The growth will be fueled by increasing economic wealth and demand for treatments for chronic diseases in a more urban, middle-class population.  … A major shift for the pharmaceutical industry, whose main role so far has been supplying drugs for infectious diseases such as malaria and HIV in Africa, often on a humanitarian basis.”


17. Plos – Scaling Up mHealth: Where Is the Evidence?

Mark Tomlinson et al.;

Mark Tomlinson and colleagues question whether there is sufficient evidence on implementation and effectiveness to match the wide enthusiasm for mHealth interventions, and propose a global strategy to determine needed evidence to support mHealth scale-up.


18. IOM report – Countering the Problem of Falsified and Substandard Drugs

A new Institute of Medicine report looks at the global scope of fake and substandard drugs. See also this Science Speaks article.


19. Post 2015 Development Agenda Consultation, organised by PHM, supported by WHO

The People’s Health Movement has been involved in the post 2015 development agenda through:

  • Submission of a PHM statement to WHO : ‘Health in the Post 2015 Development Agenda’ 
  • Organisation of a post 2015 health related development agenda consultation supported by WHO with focus on the Asian Region. This event took place 29 January, Bangkok, Thailand and was attended by over 80 participants from over 20 different countries.  9 countries submitted country reports which, together with the dialogue during the consultation, lead to the development of a report submitted it WHO.


20. Humanosphere – Analysis: Behind the scenes with the Gates Foundation’s ‘strategic media partners

Tom Paulson;

Paulson reports (well, sort of – as he wasn’t allowed in himself ) on a recent meeting in Seattle entitled “Strategic Media Partnerships.” “What does it mean for the Gates Foundation to move from mere underwriting or media sponsorship to more active involvement as a strategic media partner? … The Seattle event was mostly a discussion about the sorry state of the media and how to improve coverage of neglected issues that concern the philanthropy in areas like global health, foreign aid, development and education.” As is well known, the Gates Foundation wants to improve the narrative on aid and development – but some people worry the philanthropy already has too much influence over the aid narrative (aiming for more success stories for example). The post also discusses ‘solutions journalism’, the difference between media & advocacy, and many other things.




21. Health Policy & Planning – Health governance: principal–agent linkages and health system strengthening

Derick W. Brinckerhoff et al.;

This overview article for the symposium on health governance presents a model of health governance that focuses on the multiplicity of societal actors in health systems, the distribution of roles and responsibilities among them and their ability and willingness to fulfil these roles and responsibilities. This focus highlights the principal–agent linkages among actors and the resulting incentives for good governance and health system performance. The discussion identifies three disconnects that constitute challenges for health system strengthening interventions that target improving governance.


22. TMIH (editorial) – Making sure that clinical trial results make a difference: operational research and the hierarchy of evidence

N. Ford & D. Maher;

Operational research is a critical step in the pathway from new knowledge to improved outcomes, Ford & Maher argue. Randomised trial data are important (for example, to demonstrate equivalence of nurse- versus doctor-delivered antiretroviral therapy), while operational research will help define the package of training and supervision required to capacitate nurses in new clinical responsibilities in different contexts. Hence, rather than viewing operational research as the poor cousin of randomised trials, the two approaches should be viewed as ‘relatives’, which can cooperate very productively if done well.


23. WHO Bulletin (online) – Deployment of community health workers across rural sub-Saharan Africa: financial considerations and operational assumptions

Gordon C. McCord et al.;

Comprehensive CHW subsystems can be deployed across sub-Saharan Africa at cost that is modest compared with the projected costs of the primary-health-care system. The average annual cost of deploying CHWs to service the entire sub-Saharan African rural population by 2015 would be approximately 2.6 billion US$. This sum would have to be covered both by national governments and by donor partners, McCord et al. argue.

For an example of how community health workers can be used, see this Guardian Development Professionals article on the decentralization of malaria diagnosis and treatment – using CHWs.


24. Globalization & Health – Antiretrovirals for low income countries: an analysis of the commercial viability of a highly competitive market

Olive N Nakakeeto et al.;

The price of antiretroviral drugs (ARVs) in low income countries declined steadily in recent years. This raises concerns about the commercial viability of the market of ARVs in low income countries. The authors conclude: “While recent price decreases indicate that there is still space for price reduction, our estimate that gross profit margin on sales decreased by 6 to 7% between 2010 and 2012 lends credibility to assertions by generic manufacturers that the ARV market in low income countries is under considerable price pressure. This might create problems for the quality and/or the continued supply of ARVs to low income countries.”




If you got this far :), let’s just flag a couple more things you might want to read to keep abreast of aid & development in general:



EU aid was more or less frozen last week – see an Impatient Optimists blog post on this, or else a Guardian article or ODI analysis. “As a result of last week’s summit, Heading 4 (Global Europe) and the European Development Fund (EDF) have been cut by 16 percent and 11 percent respectively, compared with the European Commission’s original proposal,” adding, “What that means in real terms — that is, compared with the current situation for 2007-2013 — is that the level of development aid has been frozen.” Piebalgs, the European development commissioner, has called on EU member countries to compensate the aid cuts from the bloc’s long-term budget that were agreed by EU leaders at a summit last Friday (good luck with that).




Check out a new Oeso report on the tax evasion by multinationals and a special report in the Economist on tax havens/offshore finance. (it’s clear the issue is rising on the international agenda – was about time). A Guardian article makes clear western tax avoidance restricts African development.

Finally, some other things you might want to read:

  • A CGD blog post dwells on a WB study which explores some options to do more on Global Public Goods.
  • How are the new donors doing – Turkey & South Korea for example? Check out this Guardian article.
  • John Kerry visits USAID for the first time – see for example what he thinks might be the consequences of sequestration for global health.
  • Simon Maxwell contemplates the future of UK ODA.
  • Check out how Slim & Gates work together on agriculture & food security (in the Guardian)

That’ll be it for now 🙂

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