Dear Colleagues,



With Easter approaching, and most of you probably already in the mood  for chocolate eggs, we think the time is right to announce another very tasty treat, our upcoming venture: Emerging Voices 2013! As you know, the previous editions EV2010 in Montreux and EV2012 in Beijing were linked to the Global Symposium on Health Systems research.  The new EV 2013 edition will be linked to the ICASA conference, the 17th Conference on AIDS and STI’s in Africa, Cape Town, 7-11 December 2013. This year’s ICASA  theme is “Now more than ever: targeting zero.”

EV 2013 is a blended training program for young researchers (below 40 years of age) on health research and scientific communication. The training program comprises several phases. The face-to-face phase, the main focus of the program, will take place in Cape Town from 25 November till 13 December 2013, and includes participation in ICASA and in a young researchers’ pre-conference. There is also a distance learning preparatory phase and a distance coaching follow-up phase aiming for publication in a scientific journal. EV 2013 is a close collaboration between ITM & the  School of Public Health, University of Western Cape (event host), where our editor Wim Van Damme recently started his SARChI  chair on health systems. Several colleagues from University of Cape Town (UCT) will also join the core organizing team. The EV venture this year and the next, EV2014, also scheduled in Cape Town, will capitalize on an emerging South-Africa.  Just this week, a BRICs summit took place in Durban.

There will be four themes for EV 2013 and applicants have to choose one of them: (1) HIV co-infection: clinical challenges anno 2013; (2) continuity of care & retention in ART & PMTCT;  (3) evaluation of combination HIV prevention; & (4) HIV & Health Systems Strengthening. The training is in English. Applicants from French- and Portuguese-speaking countries with a good command of English are welcome, and will be mentored to present their findings in English. Naturally, only people who send an abstract to ICASA can apply for the EV 2013 venture.  There is a limited number of grants available for participants from developing countries (some full grants, other partial or top-up grants).

More information on the program, requirements and on how to apply will be available from 1 May on via the Emerging Voices website (, the EV Facebook page and the Twitter account. So stay tuned.

On a separate note, Meena Daivadanam, Raoul Bermejo & Natalie Eggermont, Emerging Voices 2010 & 2012, will attend the Stockholm symposium ‘Global health beyond 2015’ next week. They will join many other young health researchers in Sweden and will no doubt emphasize that global health challenges are enormous, given the dire state of our planet.  As climate change is one of the themes of the event,  they could call themselves “Emergency Voices” for the occasion.  Next week, they’ll report about the event in this newsletter.

And now, it’s time to indulge in chocolate! Happy Easter!



Enjoy your reading.


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





1.     Lancet series on TB

To commemorate World TB Day 2013, The Lancet Infectious Diseases published a Series of papers on tuberculosis. The six Articles in this Series explore interventions such as new diagnostic tests, drugs and drug regimens that have the potential to radically improve the detection and management of tuberculosis. The Series highlights the need for sustained donor funding, and increased political and financial commitment from governments, and health policy makers worldwide. Check out the Comments (for example this one by John McConnell et al. introducing the Series) and articles, including one article stating that it’s ‘time for visionary political leadership’.


2.     CGD – TB trade-offs

Amanda Glassman & Kate McQueston;

The authors of this blog post examine spending on TB, including drugs to fight susceptible and multidrug-resistant strains of the bacteria. “Despite higher costs and relatively low rates, most international agencies have made MDR-TB a priority,” they write. “So the question is whether MDR-TB spending is displacing spending — and effort — from the adequate detection and treatment of susceptible TB, that — if done well — could actually prevent further MDR cases.” Nice blog post.


Other TB news:


* This week more than 250 scientists, researchers, and TB advocates from all over the world  gathered in Cape Town, South Africa, at the Third Global Forum on TB Vaccines (25-27 March) to share findings and look to the future of TB vaccine research and development. Some excerpts from a blog post by Tom Evans & Jelle Thole on the Impatient Optimists  blog: “It’s the first time the forum is held on the African continent….  The South African Tuberculosis Vaccine Initiative (SATVI) is playing host to the global gathering at the University of Cape Town. … South Africa is in a unique position as an emerging economy at the cutting edge of innovation and scientific research coupled with a devastating TB epidemic, …


* A new organisation, the Global Coalition of TB Activists (GCTA), has been formed  with a goal to put communities affected by TB at the centre of decision making in the fight against TB.



3.     Lancet (Comment) – A healthy perspective: the post-2015 development agenda

Seth Berkley, Margaret Chan, Mark Dybul, Keith Hansen, Anthony Lake, Babatunde Osotimehin, Michel Sidibé et al. ;

The “Who’s Who” of global health give their view on health & the post-2015 development agenda. “Whatever framework for development is agreed upon for the post-2015 era, people must be at the centre.” They published this in the run-up to the meeting in Bali (consultative meeting of the UN High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, on March 25—27, 2013).


The Bali communiqué  itself was underwhelming, according to Richard Horton  (“The Bali Communiqué: what a disappointing, empty, uninspiring piece of prose this is, lacking any ambition or vision”), Bill Easterly and others. Check out for example “this is not a satire.  The third and final set of High Level Panel talks focused on global partnerships between rich and poor countries, which is covered in MDG 8, one of the least fleshed-out MDGs. The HLP emphasised the need for a global partnership with a single, coherent agenda that embraces economic growth, social inclusion and environmental sustainability. On the plus side, the Panel identified domestic resource mobilisation and regulation of tax havens as key areas of focus. (see the Guardian on the meeting in Bali for more info).


The disability community was one of many that felt ignored in the Bali communiqué (see the Guardian).


4.     BMJ (Analysis) – What should follow the millennium development goals?

Charles Kenny;

Charles Kenny (CGD) discusses what should replace the MDGs when their target date of 2015 is reached. He comments on lessons learnt from their success and failure and looks at the suggestions for the post-2015 development agenda.


5.     BMJ (Analysis) – Commentary: new development goals must focus on social determinants of health

David Legge & David Sanders;

The People’s Health Movement has argued that the post-2015 development agenda will need to confront the underlying dynamics that are driving widening inequality, creating avoidable suffering, and accelerating global warming. We need to confront and change the structural determinants of ill health and malnutrition.  This will include regulating transnational corporations, especially in banking, agriculture, food, and pharmaceuticals. Universal health coverage is a priority but it should be clearly defined as including equitable access to quality care and strengthening public health systems.”


6.     Lancet early online (Viewpoint) – 1 million community health workers in sub-Saharan Africa by 2015

Prabhjot Singh & Jeffrey Sachs;

The authors argue that CHW scale-up in low-income countries, particularly sub-Saharan Africa, will be a crucial stepping stone towards achievement of the MDGs and the overarching aim of health for all. They explain the old and new vision on CHWs and what will be needed in terms of financing.


7.     Nature (Correspondence) – Health care: order health systems in developing world

David Peters & Gerry Bloom;

In this correspondence, the authors note that governments and policy-makers are aiming to improve health markets in developing countries as they take up the challenge of last year’s United Nations resolution to move towards UHC. They caution that governments must do more than simply legislate their way to a more orderly health system.


The Guardian ‘Development Professionals network’ organized a discussion on UHC this week: how are we going to afford it? Check it out here. (and guess who was very active)


8.     IHP – Radicalization in times like these: a personal story

Kristof Decoster;

For some reason Easter Friday seemed like the right time to publish this (rather personal) blog post and story on increasing radicalization at a supposedly mature age, a phenomenon that seems to become more common now in the age of the Internet and social media. People are supposed to become more realist as they get older, but this is no longer the case for many of us.


9.     Boston Review – What are foundations for?

Rob Reich;

Rob Reich, a Stanford professor of political science, dissects the pros and cons of foundations like the Gates foundation. This lengthy essay is the first in a series on philanthropy and definitely worth reading.



Lancet’s Europe series


A new Lancet Series on Europe examines some of the most important issues affecting the health of people in Europe today. The seven Series papers cover a diverse range of subjects, including disparity in male life expectancy between eastern and western Europe, effects of the financial crisis on health in Europe, and whether children’s health services are keeping pace with the changing landscape of child health.

Besides the editorial in this week’s Lancet issue, check out for example the  Comment by Sabine Kleinert & Richard Horton, introducing the Series, or the article by Marina Karanikolos et al. on the impact of financial austerity. (For updates on Greece, Cyprus, Slovenia, … just follow the headlines in the news.)


BRICs & health


10. Business report – Brics partners can show SA how to fix health system

John Ouma Mugabe;

We didn’t come across a document on the BRICs summit in Durban yet (for the official page of the summit, see here), with respect to health issues. This viewpoint was written by a South-African professor before the summit. (For a 2012 report on how BRICs are reshaping global health and development, see here.)


As you know, most of the attention at the BRICs summit in Durban went to the new BRICs development bank, a rival for the World Bank. See the Guardian for some more background on the bank).


11. Health Policy & Planning – Brazil’s engagement in health co-operation: what can it contribute to the global health debate?

Giuliano Russo et al.;

This commentary draws on a recent study on Brazilian projects in Africa and the authors’ direct involvement with Brazilian health co-operation to argue that, although shaped by its foreign policy goals, Brazil’s engagement is contributing to a shift in the discourse on health development co-operation, by offering home-grown examples of health development, by adopting new concepts of health co-operation and by leading unusually bold action on key global health issues. The consideration also emerges that Brazilian health co-operation, being relatively young and still learning its trade, would also benefit from a deeper engagement in the discussion on effectiveness and sustainability of development interventions.


12. BMC Public Health – Can Brazil play a more important role in global tuberculosis drug production? An assessment of current capacity and challenges

Andre Gemal et al.;

This article presents an in-depth analysis of the current status of production of tuberculosis drugs in Brazil and the bottlenecks and opportunities for the country to sustain national demand and play a role as a potential global supplier.


Global Fund



Some news on the Global Fund then, mostly thanks to Aidspan:


  • The next chair & vice chair of the GF Board were appointed, and for the first time both positions will be filled by women. The appointments take effect at the end of the June Board meeting.
  • The GF moves to a system of annual disbursement decisions and semi-annual reporting for grants.
  • The GF Board has established an Ad Hoc Nominations Committee to assist the Board with the recruitment of the next Inspector General, and has appointed seven persons to serve on the committee.
  • The GF has appointed Marijke Wijnroks as Chief of Staff at the Secretariat. In a news release issued on 27 March, Mark Dybul said that Dr Wijnroks will have “broad responsibility with a particular focus on gender and human rights and on engaging with all partners in the cause of global health.”
  • Changes to the charter of the Office of the Inspector General adopted by the GF Board specify that when the OIG conducts country audits, it will not evaluate programme impact.





13. WHO – Comments received during a public web consultation on WHO’s engagement with non-State actors

A number of individuals and organizations took part in the consultation. Here you find the overview.


14. Working Paper – Decentralisation and WHO reform: a broader perspective

Ilona Kickbusch;

This working paper is a slightly revised version of the presentation given by Professsor Ilona Kickbusch at a recent global health event, “Decentralisation in WHO: Advantages and Challenges” (Geneva, 21 January 2013). The WP offers an alternative approach to decentralisation. The paper argues that the greatest challenges of the WHO reform are governance challenges. In principle, WHO with its three tiers of governance is actually better placed to act in a multilevel and multi-actor world than many other international organizations. Its challenge is to set itself up to do so much better than at present through adopting principles of network governance. This is a challenge not only to the Secretariat but also to the Member States and how they govern the organization, Kickbusch argues.




15. Journal of Public Health Policy (Viewpoint) – The Arab Spring: Confronting the challenge of non-communicable disease

Bayard Roberts, Preeti Patel, Maysoon Dahab, and Martin McKee;

This Commentary considers the health system and policy challenges of addressing NCDs in Egypt, Libya, and Tunisia, countries in the process of re-framing state policies and institutions, including in the health sector.

16. BMJ (Analysis) – Innovate or die

Paul Corrigan et al.;

Health systems must innovate to survive the pandemic of non-communicable disease but many innovations do not spread easily. Paul Corrigan, Christopher Exeter, and Richard Smith examine why this is so and how to help them spread.


17. JAMA –Combination Therapy to Prevent Cardiovascular Disease – slow progress

Richard Smith ;

Richard Smith was also the author of this JAMA viewpoint : « The concept of combining antihypertensive drugs, a statin, and aspirin into a single, fixed-dose, combination pill to prevent myocardial infarction and stroke is now a dozen years old, but still no such pill is licensed in most countries.” Smith lists some of the barriers to widespread availability of a combination pill. Progress is undeniable, but remains slow.






18. Journal of Public Health Policy (Commentary) – Learning all the lessons: Expanding access to malaria diagnosis and treatment

Tido von Schoen-Angerer;

An independent evaluation of the Affordable Medicine Facility for malaria (AMFm) pilot phase has hailed it as a success, but important limitations and unanswered questions remain, von Schoen-Angerer argues. “In 2012, the board of the Global Fund decided to integrate the AMFm into country grants by 2014. This means that countries now need to determine how much of available grant resources to spend on expanding access through the public sector and how much, if any, on subsidizing drugs in the private, for-profit sector. The assumption of the AMFm has assumed that improving delivery of artemisinin-based combination therapy through the private sector would be more efficient than further expanding access through the public sector and community health workers. But, the advantage of expanding and improving service delivery through the public sector and community health workers is that treatments can be effectively linked with diagnosis and that diagnosis and treatment can be offered for free.


This week’s Lancet Issue also features a few letters on AMFm, focusing on a more methodological (design) debate – see here and  here.


In other malaria news, Tamara Bugembe (on the Guardian development professionals network)  acknowledges that malaria programmes are reasonably funded but stresses there is far too little support for thousands of children who survive, only to go home with epilepsy. The global health community must act now, she says.


Health Policy & Financing


19. Lancet (World Report) – The USA and global health diplomacy: goals and challenges

Susan Jaffe;

America’s new global health chief, Eric Goosby, says “diplomatic discourse” will encourage countries to take ownership of US-funded health programmes. Susan Jaffe reports from Washington, DC.


20. KFF – Congress Passes, President Signs Continuing Resolution For FY 2013

PEPFAR was the loser, GF the relative winner of the Continuing Resolution Bill passed by the House & Senate (even after the impact of sequestration).



21. Slate – Good News on AIDS in Africa

Jenny Trinnitapoli & Alexander Weinreb;

The standard narrative attributes recent (HIV in SSA) improvements to Western engagement. The heroes are the best-known acronyms in the world of AIDS (PEPFAR, UNAIDS, WHO), the Global Fund, and a host of NGOs. … This narrative contains some important elements of truth, but most of the measured improvements in AIDS in Africa are actually the result of cumulative, widespread behavior change that has led to a reduction in new HIV infections. In other words, the standard narrative is wrong. The narrative is wrong because it ignores local African responses to AIDS and characterizes religion and religious leaders as part of the problem.” The authors argue that in most cases, African religious leaders have played a positive role. The Slate viewpoint is based on their recent book, ‘Religion and AIDS in Africa’. “There is no ambiguity in the data: Religion has been central to curbing the spread of HIV in local communities across sub-Saharan Africa“.


22. Tomorrow Global – What happened to health systems for HIV?

Danielle Parsons;

Parsons examines what happened to health systems strengthening (HSS) in international HIV programming (PEPFAR, GF, including of course the Health Systems Funding Platform). She also looks ahead, for example to the GF’s new funding model & the PEPFAR reauthorization later this year.


23. Final version of the Global Vaccine Action Plan 2011-2020

The final version of the Global Vaccine Action Plan 2011-2020 was published this week. The Global Vaccine summit in the Middle East (Abu Dhabi) is coming up (24-25 April).


24. Guardian – UN report urges Africa’s leaders to put environmental health policies first

The Guardian highlights the African Environment Outlook-3, a report released last month by the United Nations Environment Programme (UNEP) that examines the multifaceted connection between environmental and human health. It concludes that these linkages deserve priority consideration in national development across Africa.

According to the report, environmental factors contribute to almost 30 percent of the continent’s disease burden.


In a somewhat related WB blog post, Tom Bundervoet wonders whether climate change will derail Africa’s rise.



25. Plos – Research Misconduct in Low- and Middle-Income Countries

Richard Smith et al.;;jsessionid=CC2367AC7F446E6DC762C91B28955D0D

Richard Smith and colleagues lay out what is currently known about research misconduct in low- and middle-income countries, summarize some high profile cases of misconduct, and make suggestions on ways forward.  (this was definitely Richard Smith’s week, even if he considers himself a ‘flop’ )


26. Global Health Check –  Private health providers are NOT more efficient, accountable or medically effective

Anne Marriott;

Marriott comes back on a recent study in Plos (by Sanjay Basu et al.), summarizes the findings and also explores what the WB has been up to recently. “Despite the lack of data about private sector performance, recent initiatives by the World Bank’s International Finance Committee (IFC) are underwriting the expansion of private sector services among low- and middle-income countries. For example in sub-Saharan Africa, the IFC has created a private equity fund to make 30 long-term investments in private health companies. These conflicts of interest pose a potential threat to the validity of World Bank-sponsored studies and raise the need for independent scrutiny.”


27. Global Health Action – Editorial: Is global health really global?

Peter Byass;

Global health, despite its rapid growth, so far remains a largely northern concept, Byass argues. Byass also lists five big issues facing global health. The editorial is based on a keynote address given at the International Conference on Global Public Health, Colombo, Sri Lanka, in December 2012. It accompanies a set of papers which were also presented at the conference.



Emerging Voices


28. BMC Health Services research – Existence and functionality of emergency obstetric care services at district level in Kenya: theoretical coverage versus reality

Elizabeth Echoka et al.;

The objective of the study (by EV 2012 Elizabeth Echoka) was to assess the actual existence and functionality of Emergency Obstetric care (EmOC) services at district level in Kenya. The gaps in existence and functionality of EmOC services revealed in this study may point to the health system conditions contributing to lack of improvements in maternal survival in Kenya. The findings thus have considerable implications for policy and local priority setting.


Global health announcements and bits & pieces


·         Vacancy Announcement: University of Western Cape – Sarchi Postdoc Research Fellowship

A SARCHI Postdoctoral Fellowship is available from July 2013 in the area of Health Policy and Systems Research (HPSR). The Fellowship is linked to the newly established SARCHI Chair in Health Systems, Complexity and Social Change in the School of Public Health, University of the Western Cape. For contact details for submission of applications and for enquiries: Dr Shun Govender at


Health Systems Global welcomes applications from its members to establish thematic working groups (TWGs). TWGs will become an important part of HS Global’s operations. It is anticipated that they will provide a platform for membership interaction and the exchange of experiences around particular issues in health systems research.


  • Indonesia & compulsory licensing:

Irin reported that the Indonesian government hopes to implement one of the largest ever examples of “compulsory licensing”, which will enable the generic manufacture of drugs still under patent. The latest use of compulsory licensing – Indonesia’s third to date – will allow the government to expand its access to second-line ARVs.


·         A UNAIDS feature story:

UNAIDS Executive Director, Michel Sidibé participated in the Annual Meeting of the Economic Commission for Africa (ECA) Conference of African Ministers of Finance, Planning and Economic Development and Africa Union (AU) Conference of Ministers of Economy and Finance, in Abidjan, Ivory Coast. He stressed that Africa has a unique opportunity to develop its pharmaceutical industry. Currently Africa is highly dependent on foreign medicines, importing 70% of its drugs. Mr Sidibé said, “Africa must change its approach, its paradigm and production strategy. Africa imports 80% of antiretroviral medicines. This heavy reliance on external markets represents a serious health risk to Africa, as evidence suggests that many leading Asian pharmaceutical companies are shifting their focus to the more lucrative markets of the West to be replaced by companies who may not have the same quality credentials. Local production can result in many benefits including: greater product quality assurance, shorter supply chains and fewer stock-outs and the production of drugs for diseases that affect Africa that the rest of the world does not supply.” Mr Sidibé also said that to encourage the development of a pharmaceutical industry in Africa the next step was to equip public and private stakeholders with key strategic information to attract funding. A new partnership among the African Union Commission, UNAIDS and other partners is seeking to redress this gap in strategic information through the establishment of the Pharmaceutical Market Data Initiative.




29. Global Health – Open Access journals

Andrew Harmer;

Harmer lists the charges of open-access global health journals.


30. Plos One –  The Impact of Official Development Aid on Maternal and Reproductive Health Outcomes: A Systematic Review

Emma Michelle Taylor et al.;

The authors conducted a systematic review to summarize the evidence of the impact on MDG 5 outcomes of official development aid delivered in line with Paris aid effectiveness principles and to compare this with the impact of aid in general on MDG 5 outcomes.


31. Globalization & health – Is the reporting timeliness gap for avian flu and H1N1 outbreaks in global health surveillance systems associated with country transparency?

Feng-Jen Tsai et al.;

This study aims to evaluate the length of time elapsed between reports of the same incidents related to avian flu and H1N1 outbreaks published by the WHO and ProMED-mail, the two major global health surveillance systems, before and after the amendment of the International Health Regulations in 2005 and to explore the association between country transparency and this timeliness gap.


32. Health Research Policy and Systems – Community-based organizations in the health sector: A scoping review

Michael G. Wilson et al.;

To better understand the literature related to community-based organizations in the health sector (i.e., those working in health systems or more broadly to address population or public health issues), the authors conducted a scoping review by using an iterative process to identify existing literature, conceptually map it, and identify gaps and areas for future inquiry.

33. Plos One – Health System Barriers to Access and Use of Magnesium Sulfate for Women with Severe Pre-Eclampsia and Eclampsia in Pakistan: Evidence for Policy and Practice

Maryam Bigdeli et al.;

Bigdeli and colleagues analyse health system barriers to access and use of magnesium sulfate for women with eclampsia and severe pre-eclampsia in Pakistan. The article illustrates the added value of a health system perspective on access to a cheap, effective, generic life-saving medicine, internationally recommended for treatment of severe pre-eclampsia and eclampsia for pregnant women.



  • The World Social Forum took place in Tunis – the PHM called for action. For a short update on the WSF, see the New Internationalist.
  • A BRICS summit took place in Durban, SA  (see above).
  • For pieces on Canada & its development agency ‘integration’ – see here.
  • Post-2015 debate: the High-Level panel met in Bali – see above. Other post-2015 stuff::



* Read this very nice blog post from new CGD recruit Alex Cobham: the UK initiative to reform international company tax has huge implications for developing countries, he says. See also the Guardian  on this tax issue, and an Action Aid brief.

* The Guardian reports on the ‘World we want’ survey findings: “A key finding is that the MDG approach, focusing on universal access to services such as health and education, rarely benefits the poorest and most marginalised. … Other findings echo those of previous surveys, particularly on governance. The message came through consistently that people viewed improved governance as central to positive change in their lives.”

*  Overview of the post-2015 development timeline  (see the Guardian’s Global Development website)

* New ODI paper: “The age of choice: how are developing countries managing the new aid landscape?”  Developing countries are entering an ‘age of choice’ says a new paper authored by Greenhill and ODI. That choice means that competition is increasing between donors and giving an increasing amount of control to countries over their development paths.   Check out also a nice blog post (by Tom Murphy on Humanosphere) on this new aid environment, ‘Will traditional donors be left in the dust?’

* Jonathan Glennie thinks the 0.7% target should apply to every country, as an aspirational goal (and thus also include low-income countries).

* Adam Wagstaff explores how inequality should be included in the post-2015 framework.

*  Simon Maxwell wrote a new blog post on business & development, reflecting on a recent speech by Justine Greening.

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