In this week’s newsletter we focus on the joint WHO/WB meeting on UHC in Geneva, the post-2015 consultation, the looming sequestration in the US and its possible impact on global health funding, the PEPFAR evaluation report, the HS Global Board retreat in London, the maternal health Manifesto, and plenty of other stuff. You choose for yourself who wins the global health Oscar this week.
The oneliner of the week came from a Thai Minister in Geneva, though: “UHC is not heaven, but means to prevent going to hell”! No doubt Margaret Chan was nodding in the back. Meanwhile, the Buffett-Gates Giving Pledge goes global, with 12 new pledgers this week, from 8 different countries. Richard Branson is one of the new people on board, as well as a guy called Vladimir Potanin J. Tom Paulson rightly argued that still only a fraction of the super-rich has made a pledge, and that’s why the most encouraging news of the week came from the G20 summit of Ministers of Finance. Ministers are increasingly pushing for transparency, even Osborne is making weird noises these days. As 2015 approaches, it appears the international agenda is shifting.
In this week’s guest editorial, Emerging Voices Agnes Nanyonjo & Eleanor Namusoke , both from Uganda, assess the draft report ‘Health in the post-2015 Development Agenda’ from a low-income country point of view. Check out also the post by EV Daniel Henao from Colombia – he combines a Latin American perspective with his concerns as a global citizen.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Are the concerns of low-income countries sufficiently addressed by the draft report ‘Health in the post-2015 development agenda’?
By Agnes Nanyonjo & Eleanor Namusoke, two Emerging Voices 4 Global Health from a low-income country, Uganda
The draft report ‘Health in the post-2015 development agenda’ draws our attention to the fact that MDGs played a key role in keeping countries focused on achieving specific goals. We share this view and hope the post-MDG health goals will do the same. The post-MDG draft is, for the time being, tailored towards maximizing healthy life expectancy and universal health coverage (UHC). Most of the international debate centers on UHC, however. If only UHC were to be the post-MDG goal, this would clearly not suffice, at least if you view UHC through the lens of its implementation in low-income countries (LICs).
WHO / WB joint meeting on UHC in Geneva
1. WHO/WB Statement – WHO/World Bank convene ministerial meeting to discuss best practices for moving forward on universal health coverage
Top officials from health and finance ministries from 27 countries joined other high-level health and development stakeholders at a two-day meeting this week in Geneva to discuss how countries are progressing towards UHC and share options and solutions. The meeting was convened jointly by WHO & the World Bank. Delegates expressed strong support for the ideas underlying UHC: that everyone, irrespective of their ability to pay, should have access to the health services they need, without putting their families at financial risk. It is obvious that for UHC to materialize, a partnership between Ministries of Finance & Health will be necessary, as well as good collaboration between WHO & WB. Encouragingly, apparently there was wide support among ministries of health and finance in many countries for UHC as a (the?) post-2015 umbrella goal.
Margaret Chan adressed the participants and said people now expect ready access to quality medicines and services across the world. On the WHO website, you can watch a couple of videos taken on the sidelines of the UHC meeting. In these videos Ministers discuss UHC in the context of their respective countries. The explanations highlight the multitude of angles and approaches that can be taken when addressing UHC. Interviews with Margaret Chan and the World Bank Vice President Tamar Atinc provide further perspective on the topic.
The World Bank plans to launch a tool later this year to help countries work toward universal health care. The tool, UNICAT, is meant to help countries evaluate their strengths and weaknesses as they work toward universal coverage. It was developed following the WB-study on 22 countries that have significantly expanded access to health care in the last decade (see last week’s IHP newsletter).
2. CGD – What will Universal Health Coverage actually cover?
Amanda Glassman & Ursula Giedion;
Against the backdrop of the UHC meeting in Geneva, CGD’s Glassman & Giedion wonder what health benefits or interventions would represent coverage, taking into account UHC’s implicit goals of improved health, equity and financial protection.
Post-2015 & health
Feedback on the draft report “Health in the post-2015 Development Agenda” was possible till 19 February. On the IHP website you can find some feedback (1) on behalf of MMI and (2) by some Emerging Voices – see also the editorial of the week, by Agnes & Eleanor.
Based on all the comments received (for an overview of the comments see the ‘world we want’ website), a revised draft report will now be prepared and posted on the same website by the end of February. This report will be considered at the High Level Dialogue on health in the post-2015 development which will take place in Botswana 5 and 6 of March 2013.
3. IHP – Some Latin American reflections on the draft report ‘Health in the post-2015 development agenda’
Daniel, EV from Colombia, assesses the draft report from a Middle-Income country point of view and as a global citizen, but he also zooms in on more specific Latin American concerns.
4. Comment by Medicus Mundi International Network on: “Health in the Post-2015 Development Agenda. Report of the Global Thematic Consultation on Health. Draft for public comment, 1 February 2013
Mariska Meurs & Remco van de Pas;
This comment was written by Mariska Meurs and Remco van de Pas, both working for Wemos, on behalf of the Medicus Mundi International Network (MMI). Meurs & van de Pas highlight four main areas of the draft Global Consultation Report: equitable and comprehensive future health goals; international financing for health; the need for strong global governance for health; the need for an inclusive and transparent process.
5. BMJ blog – NCDs, MDGs and SDGs: latest update
Cooper gives the latest update on this triple – and to some extent linked – agenda. Interesting news for example on WHO work related to SDGs: “At a meeting on ‘Preventing global NCDs through low-carbon development’ at the London School of Hygiene and Tropical Medicine on 12 February, Carlos Dora (WHO) commented that the WHO has developed a set of three potential health indicators under each of the seven headings of the Rio+20 discussions (cities, energy etc.). Other work is doubtless being done to bring health into the SDGs.”
Maternal & women’s health
6. Lancet (Comment) – A manifesto for maternal health post-2015
Ana Langer et al.;
As a contribution to the process of redefining human development for women after 2015, participants at the recent Arusha conference supported writing a manifesto for maternal health based on the best available evidence, the lessons of safe motherhood from the past 25 years, and the more recent experience of the MDGs. Langer, Horton & Chalamilla welcome a vigorous debate about this manifesto.
7. Guardian – Formula milk firms accused of targeting mothers and health workers with gifts
Manufacturers of breast milk substitutes are targeting mothers and health professionals with free gifts and samples, in violation of international codes of practice, according to a new Save the Children report. The report says marketing campaigns often promote misleading claims about the nutritional benefits of formula that have no scientific basis. Marketing practices contribute to a decline in breastfeeding in nations with some of the highest child mortality rates (for example in East Asia and the Pacific).
8. IHP – “Moving pain into the public domain”: Ghana’s Maternal Health Channel
EV 2012 Aku Kwamie from Ghana reports on the launch of the Maternal Health Channel in her country. She hopes that the Maternal Health Channel can raise awareness of maternal death and disability, provoke action, and perhaps transform Ghanaian society in the process.
9. IHP – Sex-selective abortion: the lesser of two social evils in Nepal?
In a trademark – provocative – blog post, EV 2012 Shishir Dahal from Nepal emphasizes that many people in his country probably “consider sex-selective abortion to be the lesser of two evils if the other option is to give birth to a female infant who has to live a life of relative deprivation and faces a substantial risk to become the victim of gender-based violence for much of her life.” (even if sex-selective abortion is gender-based violence).
On a more positive note for the female gender, an op-ed by Michelle Bachelet, executive director of UN Women, advertised the global Safe City initiative (in the Guardian).
10. Lancet Correspondence – Maternal underweight and child growth and development
Jenny A Cresswell et al.;
The authors acknowledge, in response to a Lancet Letter, that maternal underweight continues to be an important public health issue. Nevertheless, levels of maternal underweight and maternal overweight are now similar in sub-Saharan Africa, they say, and thus they believe discussion of both issues is merited. Low-income countries now face a double burden, with increased risk at both ends of the weight spectrum – a holistic approach is needed.
We also want to draw your attention to the launch of WHO’s Health Equity Monitor.
The Health Equity Monitor includes reproductive, maternal, neonatal and child health indicators, disaggregated by child’s sex, place of residence (rural vs. urban), wealth quintile, and education level. Data are based on Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted in 91 countries, 90 of which are LMICs.
11. Plos – Who Should Pay for Global Health, and How Much?
Roman Carrasco et al.;
Roman Carrasco and colleagues propose a “cap and trade” system for global health involving a cost-effectiveness criterion and a DALY global credit market, mirroring global carbon emission permits trading markets to mitigate climate change.
Bloggers wonder whether this is a brilliant idea, a destructive one or just an irrelevant proposal. (probably it’s a mix of all three) To be continued no doubt.
12. Globalization & Health – Aid alignment: a longer term lens on trends in development assistance for health in Uganda
Elizabeth Stierman, Freddie Ssengooba and Sara Bennett;
Over the past decade, development assistance for health in Uganda has increased dramatically, surpassing the government’s own expenditures on health. Yet primary health care and other priorities identified in Uganda’s health sector strategic plan remain underfunded. Despite efforts to improve alignment through the formation of a sector-wide approach for health in 1999 and the creation of a fund to pool resources for identified priorities, increasingly DAH is provided as short-term, project-based support for disease-specific initiatives, in particular HIV/AIDS, the authors argue.
13. The Cable FP – Kerry warns of serious sequestration cuts for State and USAID
The US State Department will suffer in many ways if budget sequestration goes into effect next month, according to John Kerry, who made his first public appearance as Secretary of State this week. He also visited USAID headquarters this week. In a February 11 letter to Sen. Barbara Mikulski, chair of the Senate Appropriations Committee, Kerry wrote, “Sequestration would force the State Department and USAID to make across-the-board reductions of $2.6 billion to fiscal 2013 funding levels under the continuing resolution. Cuts of this magnitude would seriously impair our ability to execute our vital missions of national security, diplomacy, and development.” Cuts for global health funding are reported to be $400 million if the worst case scenario materializes.
14. Lancet (World Report) – UNDP to re-engineer funding strategy
Becky McCall spoke to Helen Clark, head of the UN Development Programme, about the agency’s funding woes and its plans to protect important projects during the difficult economic climate. As is well known, “although UNDP is not a specialised health agency, everything it does impacts on the broader social determinants of health. Notably, UNDP plays a valuable role in disseminating funds within countries that may have difficulty in this respect. For example, UNDP disperses aid money for the Global Fund to Fight AIDS, Tuberculosis and Malaria in this way.” UNDP funding matters, in other words, for more than one reason.
15. Lancet (Correspondence) – UNITAID can address HCV/HIV co-infection
Tido von Schoen-Angerer et al.;
Inclusion of HCV/HIV co-infection in UNITAID’s new strategy would have a dramatic effect on health and keep UNITAID at the forefront of market impact interventions, MSF’s Tido von Schoen-Angerer argues. (why does not everybody in global health have such a wonderful fairytale name, we wonder… )
16. Lancet (Comment) – The future of the US response to global HIV/AIDS
Robert E. Black;
PEPFAR’s Congressional reauthorisation in 2008 asked the US Institute of Medicine to assess the effectiveness of PEPFAR. The assessment, done over 4 years, examines PEPFAR since its inception. The in-depth analysis allows the Institute of Medicine to speak forcefully about how to improve the federal government’s support for the global response to HIV/AIDS. The report, Evaluation of PEPFAR, was released on Feb 20, 2013. Black summarizes some key messages in this Lancet Comment and also outlines challenges for the future.
In a blog post just before the release of the PEPFAR report, CGD’s Victoria Fan & Rachel Silverman expressed their hopes that the report would also cover two important areas: the (nitty-gritty) Institutional Arrangements of Implementation; and the (Big Picture) Investing for impact.
A BMJ news article also reflects on the PEPFAR analysis report, and on another new (South-African) study which shows that ARVs have had a profound effect in terms of life expectancy of patients.
17. NEJM (Perspective) – When to Start ART in Africa — An Urgent Research Priority
Kevin M. De Cock et al.
In this opinion piece, the authors make a strong case for more research to determine the best time to initiate ART in African patients. Citing that there is a lack of conclusive data to back ART initiation guidelines, De Cock and El-Sadr call for an RCT to determine when to initiate ART in Africa for maximal individual health benefit.
18. GF news flash issue 14
The Global Fund plans to launch its new funding model (NFM) soon. (yes, we’ve been saying that for a while now, I know)
More news you can find on Aidspan: “The Global Fund expects to invite between 50 and 60 “interim” applicants to access funding in 2013, through re-programming and top-ups for existing grants. This is in addition to the handful of “early” applicants that will able to submit a concept note leading to the creation of a new grant. As the new funding model is phased in, there will be three types of applicants: early, interim and standard. Both early and interim applicants have to meet at least one of the following criteria: (a) are considered by the Global Fund to be significantly underfunded; (b) face service disruption in 2013 and through part of 2014; or (c) are considered by the Global Fund to be “well positioned” for impact.”
HS Global Board retreat
19. IHP – Health Systems Global board retreat – vision, mission, goals and the next symposium
Our colleague Natalie Eggermont (and the most junior Board member of the HS Global Society) reflects on the Board retreat last week in London. In general, she’s quite enthusiastic about the Board’s start.
Health Systems Global also sent out a newsletter about the meeting. If you’re not a member of the Society yet, here’s a short summary: The Board met in London on 14-15 February to discuss the strategic and operational planning for the coming years. An evaluation of the Second Symposium was the basis for discussions on forming the structure and creation of new committees for the Third Symposium (Cape Town 2014). Following the retreat, the Board will be consulting members on a first strategic plan. HS Global will be developing its first strategic plan over the coming months to guide the organization in making decisions over the next years. The plan will include a vision, critical issues affecting HS Global, the definition of strategic goals and corresponding activities, implementation strategies, an action plan and a monitoring and evaluation plan to track progress. The plan will address both programmatic and organizational elements. You can all inform the Board of themes and key topics you would like to see addressed at the Cape Town Symposium, through email or via social media (Twitter @H_S_Global, Facebook). And of course, you’re encouraged to become a member of the Society.
Global Health Estimates meeting
20. Science Insider – Global Health Needs More Statistics
Last week, at a 2-day meeting organized and hosted by WHO, 60 leaders in the field of global health statistics drew up a set of proposals to improve the world’s ability to count the sick and the dead. They called for helping countries to collect better information on disease and death and pledged to work together to produce the best estimates from the sparse data sometimes available. But the computer models that they and others use have become so complex that it is difficult for outsiders to test and validate the estimates. « We are in a time of big data. », a famous global health voice said.
21. Lancet – Offline: The darker corners of our world
Horton, another influential global health voice, reports on the global health estimates meeting that took place in Geneva last week, « paid for by the Bill & Melinda Gates Foundation, hosted by WHO, and chaired by sword-swallowing global health impresario, Hans Rosling, and the London School of Hygiene and Tropical Medicine’s own political chameleon, Peter Piot”. In this contribution, there’s a lot of emphasis on the Global Burden of Disease & WHO’s (reluctant/ambiguous) role in it.
22. CFR (Expert Brief) – Big Data, Better Global Health
Thomas Bollyky ;
In a very nice article, Thomas Bollyky also reflects on the global health estimates meeting. “Indeed, the GBD study is unlikely to dramatically alter donor policies or mobilize significant new foreign aid. The more likely and better use of the study and its future iterations are as evidence and sources of accountability for national governments in addressing the needs of their citizens. As such, the legacy of the study may be helping to usher in the emerging era of global health, in which donor aid matters less and improved governance, efficiency, and better collaboration among trade, regulatory, and technical agencies matter more.”
23. Lancet (Editorial) – Strengthening global action against poor quality drugs
This Lancet editorial comes back on last week’s IOM report, Countering the Problem of Falsified and Substandard Drugs. The report was commissioned by the US FDA.
24. CSIS (report) – Global Health Policy in the Second Obama Term
J. Stephen Morrison et al.;
This volume analyzes seven important dimensions of a complex, widening U.S. global health agenda: HIV/AIDS; malaria; polio eradication; women’s health; health security; health diplomacy; and multilateral partners.
25. Lancet Oncology series on childhood cancer
Although 80% of childhood cancers are potentially curable with current treatments, every day roughly 250 children around the world lose their lives to cancer. A new Series published in The Lancet Oncology focuses on improving cancer care for children and young people worldwide. Papers in this Series discuss the educational, research, and care needs of children and young people with cancer, and present new policies to address the global burden of childhood cancers.
In this Comment for example, Kathy Pritchard-Jones & Richard Sullivan write: “The vast majority of children with cancer live in countries with far fewer resources than are available in high-income countries. In every way, from adequate research to access to affordable care and palliative services, children in low-income and middle-income countries are in greatest need. Macgrath and colleagues (in their paper on paediatric cancer in LMICs) have focused on solutions to this global challenge by emphasising the broad partnerships that are necessary and the successes already achieved with various models around the world. Thus, the message is that although childhood cancer is a complex challenge, it is tractable.”
26. Lancet Infectious Diseases (Editorial) – 2018 must be the final target for polio eradication
This editorial zooms in on the Global Polio Eradication Initiative’s draft Polio Eradication and Endgame Strategic Plan (2013—18). The plan has four main objectives and four milestones for eradication. The editorial also reflects on the deadline, 2018.
27. JAMA (Viewpoint) – Approval of a Tuberculosis Drug Based on a Paradoxical Surrogate Measure
On December 31, 2012, the US Food and Drug Administration announced its approval of a new drug to treat MDR-TB. The agency granted bedaquiline (Sirturo) “fast-track” approval, assessing its efficacy by a surrogate measure rather than an actual clinical outcome. The criterion was the capacity of the drug, compared with placebo, to convert a patient’s sputum culture from positive to negative for Mycobacterium tuberculosis when added to a standard MDR-TB regimen. Avorn is not entirely convinced this was the right approach.
Global Health bits & pieces
- Vaccine delivery: A Business insider article reports on an innovative new way to deliver vaccines – in the form of a “vaccine patch” – which could drastically improve the health of the third world by making vaccines cheaper and easier to distribute and use.
- Synthetics: an international group of academic experts working under the umbrella of UNEP and WHO issued their findings in a paper updating a 2002 study on the potential dangers of synthetic chemicals. “Man-made chemicals in everyday products are likely to be at least the partial cause of a global surge in birth deformities, hormonal cancers and psychiatric diseases. … The panel of 16 scientists from 10 nations in North America, Europe, Africa and Asia found that endocrine-related diseases and disorders are on the rise.”
- People’s Health Movement: in preparation for the Steering Council meeting taking place 27-28 January 2013, Bangkok, PHM’s regional representatives prepared regional reports on activities that took place within their region since the third People’s Health Assembly meeting. Here’s a summary of the regional reports. Links to the respective regional reports you find here.
- Revised draft action plan for the prevention and control of NCDs covering the period 2013 to 2020 (WHO); Third round of informal consultations on the development of a WHO global action plan for the prevention and control of NCDs 2013-2020.
28. JAIDS – Global Policy Review of Antiretroviral Therapy Eligibility Criteria for Treatment and Prevention of HIV and Tuberculosis in Adults, Pregnant Women, and Serodiscordant Couples
Gupta Somya et al.;
This article reviews the ART initiation criteria from national treatment guidelines for 70 countries and determines the extent of consistency with the current WHO recommendations. Published guidelines from a significant number of countries are not following WHO recommendations. Although published guidelines may not reflect practice, it is important to adapt recommendations and services quickly to reflect the emerging science on the health and prevention benefits of earlier access to ART, the authors argue.
29. Journal of Public Health Policy – MDGs – A public health professional’s perspective from 71 countries
Marta Lomazzi et al.;
The World Federation of Public Health Associations executed a quali-quantitative survey to explore the opinion of public health professionals worldwide and their experience concerning the implementation and achievement of the MDGs with a focus on sub-Saharan Africa. The respondents’ main activities focused on MDGs 4, 5, and 6. Some results: Their answers do not differ significantly between respondents’ position, WHO regions, and country’s Gross National Income. All the 8 MDGs were considered as relevant by some in the public health community. However, the importance assigned to each MDG varies significantly, with MDGs 4 and 5 considered most important in the African Region, and MDGs 7 and 8 in the Western Pacific Region. Low-income countries attach high relevance to MDG 1. Altogether 51 per cent agree fully and 40 per cent partially with a positive statement on MDGs achievement.
* G20 summit of finance ministers in Moscow; after the meeting, Osborne revealed that the UK wants to rewrite the rules of the corporate game to help developing countries collect the tax that is due to them. “In remarks hailed by anti-poverty campaigners, he promises to drive forward a “new agenda of transparency” and to force oil, mining and gas giants to publish key financial data project-by-project wherever they operate.” In any case, his clear commitment to help the world’s poorest countries tackle corporate tax avoidance is indeed “a stunning development”, to say the least. Let’s see whether Osborne, the tax warrior, can deliverJ
* A South-African report: A year after Busan: where is the Global Partnership going?
* The most urgent threat to the world is inequality, argues Jayathi Gosh in a Guardian op-ed. She has a point.
* David Cameron, who is visiting India, said the aid budget could be used to fund military spending, but only in three areas – security, demobilisation and peacekeeping. Obviously, there is fierce debate on this – check out this ODI analysis for example.
* The Economist is scathing about the Commission’s FTT proposal, in today’s issue.
* Finally, Sub-Saharan African countries have seen major advances in freedom and democracy, according to the report “Freedom in the world 2013” presented in the European Parliament on 20 February (see this Euractiv article). This goes somewhat against the international trend in recent years.