Dear Colleagues,

In case you didn’t know, today is World Sleep Day. So, folks, that’ll be it for today –  get some rest.

 As global health people tend to be “Me? – no need sleep” machos (and that includes the women), I assume you’re still with me. The global health highlight of the week was obviously the selection of a new pope. Just like anybody else, I was slightly bewildered when I saw the cheering crowd in Rome on tv, reacting to the smoke signals as if this were the 19th century in the Far West. So much for the evolution of the human species. Together with the frantic waving of national flags (mostly Italian & Brazilian ones), it felt like a globalized version of the Eurovision song contest (withouth the scantily clad women though).  We just didn’t find out how many votes he got.  

This week a global health conference takes place in  Washington (for the latest on this event, see Twitter  ( #cugh2013 ), and another one is coming up in Stockholm (‘Global Health beyond 2015’) early next month. If you really take a long term vision, and crave an Al-Gore style ecological footprint, you can already think about the next PMAC conference in Bangkok on transformative learning for health equity, in 2014 (see a BMJ editorial on PMAC’s tentative agenda).

Ten years after George Bush just couldn’t stop saying ‘we need to stay the course’, The Lancet has a themed issue on Iraq.  Meanwhile, In the People’s Republic, Xi Jinping is now also officially the new president – red smoke almost immediately came out of the Great Hall, according to the Chinese version of Twitter. Chinese people tend to give Xi Jinping the benefit of the doubt, for the time being. His no-nonsense style is very different from the previous Chinese leader, which is something he has in common with the new pope. By the way, Pope Francis should, according to me (a former catholic), also get the benefit of the doubt.

The elections in Kenya inspired a number of public health commentators, check out for example the very gloomy blog post from Vincent Okungu (EV 2012, on the IHP website), as well as a more hopeful blog post on Oxfam’s Global Health Check. We also want to draw your attention to a few nice UCL interviews (on Youtube) with Martin McKee, respectively on the global rise of NCDs and the impact of austerity  on health in Europe. As you might have guessed, I don’t give the benefit of the doubt anymore to the bunch of European leaders currently gathering in Brussels at a so called ‘summit dedicated to growth’. In his own version of “we need to stay the course”, Herman Van Rompuy tells European citizens to have a bit more patience. I preferred the Guns’N Roses version.  Axl Rose also didn’t have a clue, but at least the song was going somewhere.  

In this week’s guest editorial, Ugandan EV 2010 Victoria Kajja zooms in on the new (mandatory) provider iniated HIV testing and counseling strategy in her country.

Enjoy your reading.

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

  

Editorial

 

Provider Initiated HIV Counseling and Testing – The Ugandan Case

By Victoria Kajja (EV 2010 from Uganda)

Under a new strategy to increase access to HIV prevention and treatment, all people who seek treatment in public health centers in Uganda will undergo mandatory HIV testing. The decision to implement this intervention under the Provider Initiated Counseling and Testing (PICT) strategy, was announced five weeks ago during the launch of the ‘Know your status’  campaign by the Ministry of health. The provider initiated counseling and testing approach involves health care providers offering routine HIV testing and counseling services to persons attending health care facilities as a standard component of medical care. The strategy was initially piloted at regional referral hospitals on expectant mothers attending ANC and patients seeking general health care. The new roll out system will now include government supported private health facilities and public health referral facilities referred to as health centres, more specifically health centers III’s and IV’s.

Read the rest here

 


Pope Francis

 

Pope Francis made a blast on the global scene this week. The words used to frame him tend to be ‘conservative, genuinely humble, the first Southern pope, maybe social justice and the poor will be higher on the catholic agenda, etc.’ Good to read up on the new pope, as he will have quite some global health influence in the coming years. He already said he doesn’t want the church to become just a ‘compassionate NGO’.  Francis’s humble style definitely seems in sync with the austerity times.

On the Adam Wagstaff measure,  ‘can the man enthuse your old mother?’, I can definitely answer affirmatively. My (catholic) mother is already sold.

So my mother won’t bother, but we hope you check some out in-depth analyses and op-eds, for example in the Economist  (here and here)  and the Guardian (John Vidal  (‘hopes are high that the election of a Latin American pope will help social justice rise on the Catholic Agenda’) & the lovely Simon JenkinsThe new pope is on record as strongly opposing abortion, contraception, euthanasia and homosexuality”).

 

1.     Speaking of Medicine – Neglected Tropical Diseases and the new Pope

Peter Hotez;

http://blogs.plos.org/speakingofmedicine/2013/03/12/neglected-tropical-diseases-and-the-new-pope/

Hotez wrote this blog post a few days before the election of the new pope. He stresses  that a huge burden of disease and poverty is facing some of the world’s Catholic-majority countries, especially from the neglected tropical diseases (NTDs).  “The new Pope will need to consider a hidden burden of NTDs, especially soil-transmitted helminth infections, schistosomiasis, lymphatic filariasis, onchocerciasis, and Chagas disease now affecting the world’s 1.2 billion Catholics.”   (should be a piece of cake, Francis, at least in comparison with cleaning up the Vatican mess)

 

Post-2015

 

2.     Lancet  – Offline: A rainbow on my desolate land

Richard Horton;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60638-8/fulltext

Horton comments on last week’s meeting in Botswana. He’s still very much in favour of UHC. “The umbrella goal for health post-2015 should be universal health coverage: it is the only proposal that embraces the whole health system and puts rights and equity at the centre of its vision. But there are nuances.  … ” He lists some of them.

Check out also what a Gates Foundation’s spokesman said at the Botswana meeting, for example on the post-MDGs (hint: it sounded a bit like ‘we need to stay the course’ J)

3.     Lancet (Correspondence) – Measuring progress on diet-related NCDs: the need to address the causes of the causes

Sharon Friel, Ronald Labonte & David Sanders;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60669-8/fulltext

The authors don’t believe that the WHO NCD monitoring framework reaches the core of the NCD problem. “These targets focus on the individualised causes and could lock interventions within a behavioural risk factor paradigm that has been challenged by evidence on the importance of societal factors. To address diet-related NCDs, interventions (and targets) must “tackle the systemic problems that generate poor nutrition in all its forms” and reflect how “our food systems are making people sick”.  (and yes, Lenin again made it into the Lancet)

At a colloquium in New York, Ban Ki Moon told public health educators to get involved in the post-2015 development agenda (in case they aren’t yet). He also gave his view on how health could be integrated in the post-2015 framework.

This week Bill Gates addressed the Royal Academy of Engineering, at the Global Grand Challenges Summit. He listed a number of daunting challenges for the world (like feeding 10 billion people soon), and also gave his view on capitalism (“governments and philanthropic organisations have to step in to offset flaws in the pure capitalistic approach”) & climate change (and how to solve it). By the way, Tom Paulson informed the world of an interesting Grand Challenge this week: how to make condoms more fun  (even if some of them are already being labeled ‘Fiesta’, we’ve been told). Do check out Paulson’s blog post, you won’t regret it. ( setting up impact evaluations shouldn’t be a problem in this case).

Earlier this week, a group of journalists met with Jeffrey Sachs (and a few other people) on Post-2015 Development Planning. Jeffrey discussed progress on the MDGs and the outstanding challenges, and stressed that the MDG cynics have been proven wrong.

Finally, Tim Evans took the really long term view – 100 years from now – at a recent Rockefeller event in Beijing. And yes, he’s definitely also an optimist.

Global Burden of disease & cost-effectiveness

 

4.     CGD paper – The Moral Imperative toward Cost-Effectiveness in Global Health

Toby Ord;

http://www.cgdev.org/content/publications/detail/1427016/

In this essay, Toby Ord explores the moral relevance of cost-effectiveness, a major tool for capturing the relationship between resources and outcomes, by illustrating what is lost in moral terms for global health when cost-effectiveness is ignored.

5.     BMJ (Analysis) – The true cost of antimicrobial resistance

Richard Smith & Joanna Coast;

http://www.bmj.com/content/346/bmj.f1493

Richard Smith and Joanna Coast argue that current estimates of the cost of antibiotic resistance are misleading and may result in inadequate investment in tackling the problem.

Obviously, you also got the news (via the UK’s chief medical officer) that antimicrobial resistance presents an apocalyptic threat similar to that of climate change. See a BMJ news article and the Guardian’s Sarah Boseley on this warning. Now what are we going to do about it?

6.     CGD – Global Burden of disease estimates: secret recipes or spoiled ingredients?

Victoria Fan;

http://blogs.cgdev.org/globalhealth/2013/03/global-burden-of-disease-estimates-secret-recipes-or-spoiled-ingredients.php

Fan admits that the GBD is a landmark in global-health history and deserves praise, but points out that the underlying ‘raw’ data the researchers use are of poor quality, and that this hasn’t improved much over the last few decades.

7.     Lancet (Correspondence) – Moving the goalposts for tuberculosis targets in Africa

Agnes Binagwaho et al.;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60672-8/fulltext

The authors advocate for the inclusion of more clear and consistent methods for generating and communicating (TB incidence & mortality ) estimates of country progress on its list of priorities.  (we read on Twitter today: “one day, Agnes Binagwaho will be the new WHO boss” – so presumably she’ll be able to fix things then)

As for the provisional agenda of the next World Healthy Assembly, see here.

8.     Lancet (Viewpoint) – Beyond disease burden: towards solution-oriented population health

Ian Roberts et al.;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60602-9/fulltext?_eventId=login

The challenge for policy makers is to maximise population health with the resources at their disposal, taking into account equity and social values. From this perspective, taxonomies of solutions are more useful than are taxonomies of disease burden, the authors argue. “The important problems are the ones that we can do something about, those for which we have effective interventions. Because of budget limits, a decision to invest in a particular set of interventions means that we are implicitly deciding not to invest in others. By prioritising cost-effective interventions we make the most of available resources. However, budgets are not the only constraint. Because ecosystem disruption is a major threat to survival, ecological limits must also be considered. Maximisation of health gain requires a focus on cost and carbon effectiveness.”  (great article)

 

UHC

 

9.     WB – Universal Health Coverage and the post-2015 development goal agenda. And Mrs Gauri

Adam Wagstaff;

http://blogs.worldbank.org/developmenttalk/universal-health-coverage-and-the-post-2015-development-goal-agenda-and-mrs-gauri

Just like many other people, Adam Wagstaff wonders whether UHC could be the right health goal for the post-2015 development goal agenda. Yes, he says, as it’s a goal that resonates with people (including your mother).

Meanwhile, Jim Kim declared that he would be “personally” involved in fixing India’s faulty universal healthcare programme. “If tackled effectively, this could become an important model for healthcare delivery in the rest of the world.”

10. Financing health in Africa – Free health care as a step towards Universal Health Coverage? Maybe, but only if we learn from the recent past

Bruno Meessen;

http://www.healthfinancingafrica.org/3/post/2013/03/free-health-care-as-a-step-towards-universal-health-coverage-maybe-but-only-if-we-learn-from-the-recent-past.html

In this blog post, our colleague Bruno Meessen, brand new professor at ITM but also a prolific blogger, revisits the gaps in the implementation of fee exemption policies in numerous African countries. He attempts to draw useful lessons for the UHC agenda, for African governments, the international community and researchers.

On the same topic, check out also a new paper by the publishing “Match made in Heaven”, Sophie Witter & Valéry Ridde (in International Journal for Equity in Health).

 

CSW meeting in New York & women’s health

 

11. Reuters – Iran, Russia, Vatican threaten to derail U.N. women’s rights appeal

http://www.reuters.com/article/2013/03/13/us-women-un-rights-idUSBRE92C1EN20130313

An “unholy alliance” of IranRussia, the Vatican and others is threatening to derail a U.N. declaration urging an end to violence against women and girls by objecting to language on sexual, reproductive and gay rights, some U.N. diplomats said on Wednesday. Delegates to the UN Commission on the Status of Women

(CSW) are racing to reach a consensus deal on a final document by today and some diplomats say the future of the commission (a global policy-making body created in 1946 for the advancement of women) is at risk if they fail to broker a compromise. Most people think the end result will be a watered down document though.

For more info on some of the debates of the last two weeks in New York, see

KFF and the Guardian (see  here (some African ministers say the link between HIV and gender-based violence must be made explicit) and here (analysis by Liz Ford) : “While sitting through events, debates and discussions in New York, my recurring thought was why, in 2013, are we still arguing over whether women should have ownership of their own bodies?” “…The mention of sexual and reproductive health and rights in the draft CSW agreement this year has become a major source of contention among negotiators — much like it did at the Rio+20 summit last year.” (obviously, we can’t blame pope Francis yet, for the role played by the Holy See)

12. Lancet (Comment) – The contraceptive revolution: focused efforts are still needed

John Cleland et al.;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60588-7/fulltext

The authors comment on a new report in the Lancet, which presents country-specific information about trends between 1990 and 2010, with projections to 2015, in two key family planning indicators for married or cohabiting women: use of any contraceptive method (contraceptive prevalence) and non-use in women who want to avoid childbearing for at least 2 years (unmet need).

 

HIV

 

13. Treatment Action Group – Funding Scientific Innovation: Global Investments in HIV Treatment Research and Development in 2010 and 2011

http://www.treatmentactiongroup.org/hiv/publications/2013/hiv-treatment-rd-2010-2011

With financial support from UNAIDS, AVAC and TAG joined together to analyze investment trends in HIV/AIDS R&D in this report.  They found that $2.6 billion was invested in HIV/AIDS treatment R&D, a 12 percent increase in funding from the baseline year of 2009.  They also found that the majority of funding was targeted at research for new medications.

14. Scidev.net – A new set of HIV targets can create long-term impact

Stefano Bertozzi;

http://www.scidev.net/en/health/hiv-aids/opinions/a-new-set-of-hiv-targets-can-create-long-term-impact.html

By measuring the right things, health providers can improve HIV response and save lives, says Stefano Bertozzi of the Gates Foundation. He gives some suggestions of new HIV targets.

 

Health Policy & Financing

 

15. Lancet (Editorial) – Iraq: putting people first

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60655-8/fulltext

This editorial introduces the themed issue on Iraq. The issue aims to crystallise Iraq’s current and future health priorities, and to offer possible solutions for its health system, inextricably linked to the need for strong leadership and commitment from Iraq’s national government.

16. Lancet (Comment) – More action needed to protect vulnerable road users

Tami Toroyan et al.;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60606-6/fulltext?_eventId=login

This is the Decade of Action for Road Safety (2010-2012). A series of global status reports is expected to monitor this, and WHO’s Global Status Report on Road Safety 2013 was launched on March 14. Toroyan et al. provide some background.

17. Devex – GAVI GEARS FOR WIDER REACH IN ISLAMIC WORLD

https://www.devex.com/en/news/blogs/isdb-pledges-support-for-gavi

The GAVI Alliance and the Islamic Development Bank entered into a partnership earlier this week, with the goal to vaccinate at least 400 million children by 2020 in the bank’s member countries. The alliance said it would need an estimated $7 billion to reach its target under the partnership.

18. Global Health Council – Global Health Council advocacy brief

http://www.globalhealth.org/Advocacy.html#Advocacy_Brief

This is a busy time budget-wise in Washington DC, with multiple developments happening simultaneously on parallel tracks. This article gives an update on the most important developments, like sequestration & fiscal years 2013 & 14.

Check out also the KFF Policy Tracker which provides information on proposed legislation released by the Senate Committee on Appropriations that would designate funding for the remainder of FY 2013, including funding for global health programs at the State Department and USAID under a Continuing Resolution.

19. Smart Global Health – The Potential Contribution of the Global Health Service Partnership to Reducing Medical Brain Drain

Matt Fisher;

http://www.smartglobalhealth.org/blog/entry/the-potential-contribution-of-the-global-health-service-partnership-to-redu/

Remember Vanessa Kerry? In March 2012, the Peace Corps, PEPFAR and the Global Health Service Corps launched the public-private Global Health Service Partnership (GHSP), a promising initiative that could improve the health sector in a number of developing countries. The CSIS Global Health Policy Center played a modest role during the planning stages of this innovative enterprise. As the Partnership moves forward, a number of potential concerns will require careful attention, Matt Fisher argues.

 

Polio

 

A short update on polio then. A global vaccine summit is coming up in Abu Dhabi, which will focus quite a bit on polio. Also good news from Japan, as the country provided a grant to UNICEF to aid Pakistan’s polio eradication program. Less positive news came from Afghanistan: “The Taliban have halted an annual polio vaccination campaign in a remote part of Afghanistan, according to a senior official, raising concerns that opposition to the critical immunization drive could be spilling across from insurgent groups in neighboring Pakistan,” the Guardian reported.

 

Global Fund

 

For an update on the Global Fund, we refer to the latest Global Fund news flash and to the new issue of the Global Fund Observer. Obviously a lot of attention goes to the new Funding model (including some clarification on the new model and the transition phase by Mark Dybul in an email sent to Board members). Aidspan also provides a series of articles on UNDP as Principal Recipient (see  here). Michael Borowitz was appointed the Head of Strategic investment & partnerships.

You also find an analysis of the new funding model on the Impatient Optimists blog.

On the Smart Global Health blog, Todd Summers draws some lessons from the recent PEPFAR evaluation for the Global Fund.

 

Global Health bits & pieces

 

  • HRH :  The Global Health Workforce Alliance, as part of its strategy for 2013 – 2016, is working in partnership to launch a global HRH movement– Health Workers Count – to increase awareness on health workforce issues and elicit new HRH commitments ahead of the Third Global Forum on Human Resources for Health. From April onward – through popular mobilization, advocacy events and media they want everyone to be seeing and hearing about health workers everywhere they turn. The theme of the movement for 2013 is Human resources for Universal Health Coverage. The shared recognition that moving toward UHC depends upon everyone having access to a skilled, motivated, supplied and supported health worker within a robust health system will be the foundation of the movement which links to the theme of the Third Global Forum.  The World Health Workers Week will be celebrated in the week April 8-12.
  • Trade Negotiations Raise Concerns Among NGOs About Implications For Thailand’s Public Health Policies. “The negotiations launched this week for a Free Trade Agreement (FTA) between Thailand and the European Union have raised concerns among both Thai and European non-governmental organizations [NGOs], who fear that E.U. demands could have a negative impact on Thailand’s progressive public health policies,” Inter Press Service reports. (you can safely blame our Commissioner, Karel De Gucht – yesterday we heard at a post-MDG meeting organized by a Belgian senate work group that De Gucht represents ‘going back to the neoliberal 80s’)
  • TB:   The Guardian reports on the rollout of the GeneXpert tuberculosis testing machine in Mozambique. In July, UNITAID, with the support of the Gates Foundation, USAID and PEPFAR, reduced the price of the relatively expensive cartridges by 40 percent — from $16 to $10 — for 145 low- and middle-income countries.
  • HIV: Plus news reports on third-line ARVs being considered by the Zimbabwean government.

And check out more some very fresh & encouraging news on a possible HIV functional cure here  (Guardian reports on recent French research, published in PLOS Pathogens).

Research

20. Plos – The Cost and Impact of Scaling Up Pre-exposure Prophylaxis for HIV Prevention: A Systematic Review of Cost-Effectiveness Modelling Studies

Gabriela Gomez et al.;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001401;jsessionid=BD97CBE3089E44AC2B8819E0D5C6A21D

Gomez & colleagues systematically review cost-effectiveness modeling studies of Pre-Exposure Prophylaxis (PrEP) for preventing HIV transmission and identify the main considerations to address when considering the introduction of PrEP to HIV prevention programs.

21. TMIH (editorial) – Informing family planning research priorities: a perspective from the front line in Asia

Eliana Jimenez-Soto et al.;

http://onlinelibrary.wiley.com/doi/10.1111/tmi.12094/full

The authors identify seven knowledge gaps and provide an essential ‘front-line’ perspective to inform research priorities for effective scaling-up of family planning.

22. African Affairs – Sexual minorities, human rights and public health strategies in Africa

Marc Epprecht;

http://afraf.oxfordjournals.org/content/111/443/223.abstract

Remarkable progress has been made towards the recognition of sexual minority rights in Africa. At the same time, a marked increase in attacks, rhetorical abuse, and restrictive legislation against sexual minorities or ‘homosexuality’ makes activism for sexual rights a risky endeavour in many African countries. This article examines specific initiatives that are using subtle, somewhat covert means to negotiate a path between rights activism and secretive bisexuality. It argues that strategies primarily focused on health concerns that simultaneously yet discreetly promote sexual rights are having some success in challenging prevalent homophobic or ‘silencing’ cultures and discourses.

23. Health Policy Research & Systems – Determining quantitative targets for public funding of tuberculosis research and development

David R. Walwyn;

http://www.health-policy-systems.com/content/11/1/10/abstract

South Africa’s expenditure on tuberculosis R&D is insignificant relative to both its disease burden and the expenditure of some comparator countries with a minimal TB incidence. Although it has a large TB treatment program, TB R&D funding is small both in absolute terms and relative to its total R&D expenditure. Given the risk and the high cost associated with drug discovery R&D, such neglect may make strategic sense. However in this analysis it is shown that TB R&D presents a unique opportunity to the national treasuries of all high-burden countries. Using two separate estimation methods (global justice and return on investment), it is concluded that most countries, including South Africa, are under-investing in TB R&D. Specific investment targets for a range of countries, particularly in areas of applied research, are developed.

 

Miscellaneous

 

  • The 2013 Human Development report , ‘The rise of the South’, was released this week. It points out we already live in a changed world, but also urges (see the Guardian) action on climate change, deforestation and pollution before it is too late. Environmental degradation could push three billion people more into extreme poverty.
  •  For some insightful African views on the post-MDG world: see here.
  •  Jonathan Glennie mentions  that the radical nature of development in the near future is already assured. Universality, sustainability and equality – “like a non-violent French revolution, all are now central to discussions on what should come after the millennium development goals.” Now that’s a relief.

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