Dear Colleagues,

Two new (open-access) global health journals were  announced this week, World TB day  is coming up against a worrying backdrop,  the UK joined the 0.7 % club and we all chanted ‘OM’ on the first International day of Happiness (including an overjoyed Jeffrey Sachs). The tiny island Cyprus is suddenly the centre of the world and you’ll probably agree with me when I say some deep meditation at the EU headquarters is urgently needed. Now that scientists want to reframe sustainable development (see their piece in Nature this week), maybe we should also inject ‘meditation for beleaguered decision makers’ into each of the six SDG goals they advocate?

Let me offer some free meditation advice: breathe in, bail out a bank; breathe out, rip off tax payers from the North and tax savings from ordinary citizens in the South. Do this thirty times. Don’t let your mind wander. Then try to visualize a fading idea of European solidarity for about ten minutes. End your meditation session with steamy tantric sex with your Deutsche Bank or ECB guru before he can utter a word about deficits or moral hazard. Open your eyes then and feel that you’re fully alive!  

Meanwhile, the new pope definitely looks more alive than the previous one. Pope Francis listed his priorities in Rome this week. He intends to focus on the poor and the environment. Even if people are divided about the track record of this pope, the time seems more than right for these sorts of priorities. Encouragingly, at the height of the Argentinian financial crisis, in November 2000, Bergoglio didn’t exactly mince words. Mark Engler (in the New Internationalist) quotes the Argentinian bishops at the time, led by Bergoglio. In their statement, they argued that the true debt of Argentina was not financial but social, they blasted the ‘growing gap between rich and poor’, the ‘negative aspects of globalization,’ and ‘the tyranny of the markets’. ‘We live in a world in which the primacy of economics, without a base of reference in… the common good, impedes the resurgence of many nations,’ the statement read. Etc. Engler emphasizes that pope Francis is not exactly a revolutionary, but I can’t wait to hear him about the mess in the eurozone. At the very least, the People’s Health Movement should recruit him.

CGD’s Owen Barder was one of many people this week who applauded the fact that Britain joins Sweden, Norway, Luxembourg and Denmark as the first G-8 member of the small club of countries which meet the UN target of spending 0.7% of Gross National Income on ODA.  I wonder whether it’s not a Pyrrhic victory though. Don’t get me wrong, 0.7 % is necessary, and probably a lot more will be needed, if we want to ensure global public goods in this century (the same goes for policy coherence, which is also a must). But personally I think the fact that it’s Cameron/Osborne who pride themselves on this achievement, makes the target almost “toxic” (and thus less sustainable in the longer term, I’m afraid). You just have to look at the Netherlands, which has been above 0.7 % for a long time, but now seems happy to leave the club. It would be the same if the EU leaders indulged in ODA grandstanding in these dire financial times. Fortunately, they refrain from doing so. It’s great the UK joined the 0.7 % club.  But the fact that a big part of the (increasing) precariat class doesn’t exactly cheer is totally understandable.  As long as they see the likes of Cameron, Osborne & Merkel going for neoliberal and austerity policies in their own countries, slashing social benefits, advocating labour market “flexibilization”, shrinking the state & privatizing public systems, or defending bankers’ bonuses (in Cameron’s case), they’ll be tempted to ridicule other policies of these leaders too. Even if some of these policies actually make sense and are the right thing to do, as Bill Gates argued in the Daily Mail. I’m afraid the 0.7 % target is for many “guilty by association”.

Finally, let’s already announce an upcoming event so that you can schedule it in your agenda – MSF’s annual Scientific Day  is fast approaching. The conference aims to present scientific research carried out in MSF programmes around the world.  It will be hosted on the 10th May 2013 at the Royal Society of Medicine, London, and MSF will be streaming the event live online (no registration is possible anymore).  The agenda is currently being finalised, but for sure Hans Rosling will do the keynote speech. MSF are keen to reach as many health professionals and academics as possible, so make sure you watch the live stream online if you didn’t register.  

In this week’s guest editorial, Mauricio Torres (EV 2010) and Pol de Vos (ITM) zoom in on Correa’s government in Ecuador, now that he’s been re-elected and Chavez is no longer there.


Enjoy your reading.

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




The Correa ‘phenomenon’ in Ecuador: between ‘buen vivir’ and neo-developmentalism

 By Mauricio Torres-Tovar & Pol De Vos 

Ecuador, a country of the Andean region of South America, has been characterized by the combativeness of its people in recent decades. A highly dynamic social mobilization, led mainly by the indigenous movement, generated a wave of riots since the early ’90s that led to the resignation of eight presidents, three of them directly because of social protests. Since 2007, when President Rafael Correa was elected, the country returned to stability.

Read the rest here


World TB Day


1.     WHO – World Health Organization and Global Fund cite tuberculosis threat

Earlier this week, WHO and the Global Fund said in a joint statement that strains of tuberculosis with resistance to multiple drugs could spread widely and highlighted an annual need of at least US$ 1.6 billion in international funding for treatment and prevention of the disease. The agencies said most of the extra money was needed to step up the accurate diagnosis of TB, and the process of establishing which drugs it may resist. Cash is also needed to improve access to effective medicines.  The organizations said that without expanded treatment, global gains in fighting the disease can be easily lost.

Check out also GlobalPost’s  Global Pulse  blog which examines the global impact of childhood TB:While health officials did not single out the devastating impact of the disease on children … WHO estimates that at least 500,000 children contract TB each year and that 70,000 die from the disease, largely in Asia and Africa.”

2.     Financial Times (Special Report) on TB

The Financial Times published its annual ‘combating TB’ report. Check out for example Andrew Jack’s excellent article on funding challenges and the general environment for TB, both in the West and in BRICs countries. The FT report also features an op-ed by Mark Dybul et al.

3.     IPS – Advocates See Historic Chance to Turn Tide on TB

Patients, doctors and international aid groups are calling on donors and governments to support measures that would make treatment of drug-resistant tuberculosis more effective and accessible,” Inter Press Service reports. It adds, “On Monday, MSF released a manifesto, signed by TB patients and their doctors in 23 countries around the world calling for research to determine the best way to use these (i.e. two imminent new) drugs.”

Health leaders from Africa and international agencies gathered in Swaziland this week to launch a fresh offensive against tuberculosis, including TB among people living with HIV. Armed with a package of new investments and initiatives worth more than US $120 million, the leaders signed the Swaziland Statement, committing them to accelerate progress against the two diseases in the next 1000 days and work with Southern African Development Community (SADC) countries to achieve the international targets of cutting deaths from TB and HIV-associated TB by half by 2015, compared to 1990 levels.


Some other TB related articles & news:

  • The Wall Street Journal examined a new effort to combat drug-resistant TB in India. “An international health initiative has brokered a landmark accord that aims to halve the price patients pay for advanced tests for a strain of tuberculosis that is resistant to standard drugs. … The accord is coordinated by the non-profit Clinton Health Access Initiative and a McGill University professor. … The deal is between the makers of diagnostic equipment that can detect multidrug-resistant TB and private Indian clinics that test patients.”
  • A JAMA Perspective  (by Anita Slomski) focuses on the threat of totally drug resistant TB – zooming in on South-Africa.
  • Our colleague Basile Keugong (et al.) published an article on the history of TB control in Cameroon: “30 years of TB control in Cameroon: Alternating ‘vertical’ and ‘horizontal’ health care delivery systems.” (in Rev Epidemiol Santé Publique).


Post-2015 & UHC


4.     Botswana meeting – High Level Dialogue on Health in the Post-2015 Development Agenda Gaborone, 4-6 March 2013 – Meeting report

The High Level Dialogue on Health in the Post-2015 Development Agenda took place in Gaborone, Botswana, from 4-6 March, 2013. This is the meeting report of the event. The outcomes of the meeting will inform the final report of the Health Thematic Consultation which will normally be available at the beginning of April.

5.     Heartfile – High Level Dialogue on Health in the Post 2015 Development Agenda

Sania Nishtar;

Sania Nishtar was one of the participants in Botswana, and gives some of her impressions and take-home messages on the debates.  Nice blog post.

6.     Lancet – Offline: Why governments should take health more seriously

Richard Horton;

In his weekly Offline article, Horton focuses on ‘health as a capability’ – in line with Sen & Nussbaum.

7.     Lancet (Comment) – GBD 2010 country results: a global public good

GBD 2010 Country Collaboration;

This article was already published online on March 5, but it’s definitely worth a close look if you haven’t done so yet. It focuses on the GBD as a global public good, and pays a lot of attention to the visualizations that are being used.

In this week’s Lancet issue, a number of Letters debate some of the GBD estimates, for example on mortality from HIV (see  here  – UNAIDS vs GBD figures ), mortality due to physical inactivity (  see here ). More debates will no doubt follow in the coming months.

8.     Lancet (Correspondence) – Time-critical mortality conditions in low-income and middle-income countries

Marvin Hsiao et al.;

The authors have a suggestion for the GBD compilers.  “GBD estimates would benefit not only from efforts to quantify mortality and disability, but also to better relate burden to health and treatment systems. We propose to classify the International Classification of Diseases, 10th version (ICD-10) into time-critical mortality conditions.”  Time-critical mortality conditions are defined as causes of death requiring prompt medical care within 12 h from the onset of symptoms recognised by a layperson to prevent death. The authors emphasize that classification of diseases into time-critical mortality conditions has practical implications for improving health-care provision and access in LMICs.

To wrap up our section on GBD, check out also this blog post by Todd Summers on Smart Global Health.  He summarizes a recent presentation on the GBD by Chris Murray (and lists 5 key messages).

9.     WHO – Universal Health Coverage: 5 questions

A nice concise WHO resource on UHC (and possible indicators).

We also want to draw your attention to an upcoming conference (Harvard), titled: “Universal Coverage in Developing-Country Health Systems: Ethical Dilemmas”. It takes place on April 18-19.  We quote: While maintaining a constructive and optimistic frame of mind is essential for progress toward UC, it is necessary also to identify the key ethical dilemmas arising in trying to extend the health system to all with so few resources. The choices are unavoidable: (1) Between goals of UC (including financial protection against catastrophic medical expenses; health; and personal and national overall wellbeing); (2) Between dimensions of UC (who is covered; what is covered; what share of costs are covered); and (3) Trade-offs within and between each of these.




10. Lancet (Editorial) – Taking on Big Soda

This Lancet editorial comes back on the bottling of the New York soda ban. It also sketches the way forward. For the ones interested in the American situation, check out this CSPI report on ‘soda philantropy’.

For a more general discussion on the merits and disadvantages of philantrocapitalism, check out recent articles in the Huffington Post  (by Uri Dadush, ‘The limits of philantropy’), the Atlantic  (‘Why the rich don’t give’) and a blog post on Impatient Optimists (‘Creating catalytic change in global health’). Next time you run into Bill Gates or Carlos Slim, you’ll know what to say 🙂

11. BMJ – Nestlé: a force for good or ill?

Richard Smith;

In this blog post, Richard Smith gives a fairly nuanced view of Nestlé, one of a number of notorious Big Food companies. He focuses on the concept of shared value, in the areas of improved nutrition, water preservation, and rural development.

Meanwhile, the US and the EU are blocking Chile’s effort to label junk food at the WTO.


Social determinants


12. WHO – Closing the Health Equity Gap: Policy Options and Opportunities for Action

This report brings together a series of policy briefs and is aimed at policy-makers and others interested to improve health equity by acting within the health system and on broader governmental policy.  The report provides an update and overview of the vast amount of evidence produced during the Commission on Social Determinants of Health and identifies policy options to implement the main recommendations of the Commission. It draws from the extensive work of the nine global knowledge networks set up by WHO to generate evidence for the Commission.

13. International Journal of Epidemiology – Commentary: The global health multiplier: targeting common social causes of infectious and non-communicable diseases

David Stuckler, Martin McKee & Sanjay Basu;

It is necessary to look upstream to tackle the social determinants that are driving both groups of conditions (infectious diseases & NCDs). The long-established social determinants of infectious diseases, such as inadequate housing, poor nutrition, and poverty, also increase the risks for chronic diseases, the authors argue. An optimal public health response will target all of these common causes, with investment in what they term ‘global health multipliers’, or interventions that address the causes underlying both infectious and NCDs. The rationale for this term is that by addressing these common social causes, governments can multiply the return on their investment in interventions.


Pope Francis & social justice


We reckon you already got your dose of pope coverage this week. But if you haven’t, check out this ABC news story on how the selection of pope Francis might impact

Catholic organizations’ work in disease prevention, including HIV/AIDS prevention.

As already mentioned in the introduction, the pope’s stance on poverty and social justice is widely applauded, for example by UN staff.  The most balanced article we encountered on the pope & social justice, based on a thorough examination of the past, was the one by Mark Engler in New Internationalist. He describes the divided reactions and distinguishes two camps.

George Monbiot firmly belongs to one camp: he doesn’t believe a word of it (in the Guardian). “In the war on the poor, pope Francis is on the wrong side”.


Health Policy & Financing


14. Lancet (Comment) – The Lancet Global Health: a call for papers

Zoë Mullan & Richard Horton;

As mentioned by Karen Grepin in a blog post, two new open-access global health journals will see the light soon or already did so. The Lancet launches The Lancet Global Health. Check out their call for papers.  The first issue is due in June.

The other one is Global Health: Science and practice and is linked to Johns Hopkins & USAID. Check out their inaugural (March 2013) issue. With an editorial by Pablo-Méndez et al., introducing the new journal,  an article on global health diplomacy (by Josh Mishaud et al.), and much more.

15. Guardian – Activists welcome hard-fought UN agreement on women’s rights

Liz Ford summarizes the outcome of the CSW meeting in New York. A 17-page blueprint to combat violence against women materialized in the end.  Rowan Harvey (Action Aid)  also analyzed the outcome (in the Guardian). There are more battles ahead, she argues – attitudes need to change on sex workers, identity and domestic violence.

After the meeting, Michelle Bachelet, head of the UN agency promoting women’s equality, announced that she is giving up the post and returning home, an announcement that came amid widespread speculation she plans to run for president of Chile again this year. (see Associated Press/Washington Post )

16. Guardian – Malaria vaccine test results disappoint

Sarah Boseley;

Optimism over the new malaria RTS,S vaccine being tested in Africa could be set to fall after results in Kenya suggested its effect could reduce over time and that it disappears fastest in children who are most exposed to malarial mosquito bites. Another piece of discouraging news on the RTS,S vaccine…

17. Evidence Review: Results-Based Financing in  Maternal and Newborn Health Care in Low- and Lower-Middle-Income Countries

Study commissioned and funded by the German Federal Ministry for Economic Cooperation and Development (BMZ)

Anna Gorter, Ir Por & Bruno Meessen;

The German Federal Ministry for Economic Cooperation and Development (BMZ) commissioned an Evidence review on RBF in maternal and newborn care in order to base the discussion on solid evidence – being aware that no “yes or no”-answer would be generated what countries should do or whether German Development Cooperation should definitely support RBF in partner countries or not. A three-step process produced an evidence review (by Gorter et al.), a peer review of the evidence review by independent experts and an Evidence Brief – the latter is not a summary of the Evidence Review and the Peer Review, but outlines German Development Cooperation’s understanding of the evidence available about RBF at present.  The papers were written for experts working for development cooperation agencies, their national partners and all other actors contemplating starting RBF operations in low and lower-middle income countries.

Check out also the interview with Anna Gorter on the Health Financing in Africa blog. She is interviewed by Isidore Sieleunou on the RBF review, and also gives her view on vouchers.

18. Humanosphere – Rwanda: the humanitarian’s dilemma

Tom Paulson;

Paulson links the news on Bosco Ntaganda ( a war criminal who sought refuge in the US embassy in Kigali this week) with the dazzling performance by Agnes Binagwaho at a recent global health conference in Washington. Well worth a read.

19. Lancet (Correspondence) – Integration not competition: surgical care in low-income and middle-income settings

Ashton Barnett-Vanes et al.;

“To achieve sustained and reproducible advancements, the surgical community must continue to adapt and, where appropriate, integrate within existing health systems geared towards medical disciplines well established in LMICs.”

20. NEJM (Perspective) – Security of Health Care and Global Health

Robin Coupland;

The global health community has taken a long time to recognize that conflict, violence, and insecurity are more than constraints on the delivery of health care in many parts of the world: they are showstoppers. The responsibility for addressing this massive global health issue does not ultimately lie with the global health community, but rather with the national and international organizations responsible for ensuring people’s security. The responsibilities of the health care community, however, must include fierce advocacy for the maintenance of this security.” (given recent trends, he focuses on North-Africa and the Middle East, but his Perspective laments the lack of global attention to attacks on health care facilities and personnel.)

21. Speaking of Medicine – Is Disease Eradication Always the Best Path?

Sara Gorman;

Sara Gorman from Harvard University discusses the pitfalls of disease eradication efforts.

22. Plos (Policy Forum) – Strengthening the Expanded Programme on Immunization in Africa: Looking beyond 2015

Shingai Machingaidze et al.;;jsessionid=FB2EBC13D299F442DD8CAB07C4059BEA

Shingai Machingaidze and colleagues reflect on the successes and shortfalls of the Expanded Programme on Immunization (EPI) in Africa, and the considerable challenges that must now be addressed to improve immunization systems.

23. Humanosphere – How a new trade agreement will hurt poor’s access to medicines

James Love;

James Love, director of Knowledge Ecology International, points out what is at stake at the Trans Pacific Partnership (TPP) negotiations. Quite a bit, it turns out.

24. Going international – Global Health Trends: 2013 update

Bonnie Koenig;

This is an update on the piece on Global Health Trends (Whither Global Health?)  Bonnie Koenig wrote about two years ago.  These are some of the additional global health trends she and her peer group have been noticing.

25. Smart Global Health – The New State Department Office of Global Health Diplomacy: A Second Chance to Get Things Right

J. Stephen Morrison;

Morrison gives three pieces of advice to Eric Goosby and his Office of Global Health Diplomacy (OGHD).


Global health bits & pieces


  • Aids accountability: Researchers revealed that the Global Fund processes in place in South Africa and neighbouring countries discriminate against gay and lesbian people as well as youth. (mainly due to the CCM’s).
  • AmfAR, The Foundation for AIDS Research, has published two new issue briefs examining U.S. investment in global health. (see here and here ).
  • New CSIS report : ‘The Future of the U.S.-South Africa HIV/AIDS Partnership’. This report examines the joint U.S.-South Africa effort “to transition responsibility for HIV/AIDS programming and policies to the South African government”.
  • After some government & institutional changes, China could be close to ditching its one child policy – check out this Lancet World Report. China’s notorious National Population and Family Planning Commission (NPFPC) will fall under the Ministry of Health from now on.




26. London School (Resyst Working Paper) – Fiscal Space for Health: A Review of the Literature

Powell-Jackson, T.; Hanson, K.; McIntyre, D.

This paper surveys the literature on fiscal space for health.

27. WHO – PMNCH Knowledge Summary #24 The economic benefits of investing in women’s and children’s health

The economic case for investing in women’s and children’s health is strong, this Partnership for Maternal, Newborn and Child Health knowledge output argues. Work to quantify returns is ongoing, but existing evidence suggests that investment in RMNCH has a potential return of more than US$ 30 for every dollar spent. The economic case should inform policy and resource allocation decisions, alongside human rights and the intrinsic value of good health. Investing in women’s and children’s health is vital for sustainable economic and social development.

28. WB – Scaling Up Affordable Health Insurance: Staying the Course

The World Bank Group, in collaboration with PharmAccess Foundation Health Insurance Fund, USAID, PAHO, and the ILO will present a one-day conference entitled Scaling Up Health Insurance and Financial Protection in Health on March 28, 2013. The conference will discuss new and integrative approaches to health insurance as well as the nuts and bolts of implementation. The publication Scaling Up Affordable Health Insurance will be launched at the event.

On a separate note: the WB also seems to be “staying the course” in another respect, according to this underwhelmed  analysis of the WB’s “new” vision on tackling poverty (in the Guardian). Claire Provost: “Optimism about the prospects of significant change at the World Bank could fall after leaked strategy documents revealed what critics have called an “unambitious” and “business-as-usual” approach to development, prioritising economic growth over pressing social issues such as rising inequality.”  The draft document proposes two new goals to guide the bank’s development work: Promoting “shared prosperity” by monitoring the income growth of the bottom 40 percent in every country, and reducing the percentage of people living in extreme poverty to 3 percent globally by 2030.

29. Social Science & Medicine (Review) – How effective has the essential health package been in improving priority setting in low income countries?

Lydia Kapiri;

The Essential Health Care Package (EHP) approach has been promoted as a tool for guiding priority setting in LICs. However, the EHP approach has not met the expectations.

30. BMC Public Health – EDCTP regional networks of excellence: initial merits for planned clinical trials in Africa

George M. Miiro et al.;

The European and Developing Countries Clinical Trials Partnership (EDCTP) intervened to combat poverty-related diseases including malaria, tuberculosis and HIV/AIDS, and to conduct multi-centre clinical trials and multi-disciplinary health research through an innovative model of regional Networks of Excellence. This article outlines the initial experiences of the merits, outputs and lessons learnt.




Some of the aid & development news you already got in the introduction or in other sections of the newsletter: the reaching of the 0.7% target in the UK, the pope & social justice, the World Bank’s new but still familiar vision on development and tackling poverty.

Other relevant articles, reports and papers include:

  • Poverty is shrinking in the world (see a Guardian article reporting on the use of the Multidimensional poverty index ) .
  • A new ODI report analyses the European Union’s role in the provision of global public goods.
  • Another ODI paper (by Claire Melamed et al.) tries to integrate human development & environmental sustainability in a new global agenda   (remark: this is in line with the scientists in Nature, also this week – for a summary of their case, see John Vidal in the Guardian, or read an op-ed by the main author, David Griggs, on Project Syndicate ).
  • Charles Kenny says USAID needs to reform further – although he admits two important reforms are being implemented.
  • Andy Sumner & Alex Cobham argue for the use of the Palma Index (instead of the GINI index). ( Psst, tell the World Bank)
  • Finally, some more post-2015 news then: emphasis in the national consultations seems to lie on job creation (see the Guardian ), governance and equality. And if you want to know what the people expect, check out this document – “The World we want 2015 – the global conversation begins: emerging views for a new development agenda.”

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