Dear Colleagues,


Let’s start this newsletter by drawing your attention to the deadline of June 20th for submitting abstracts for the  2013 Emerging Voices venture. The deadline is less than two weeks away in other words. As you know, the EV4GH 2013 edition will be linked to the AIDS in Africa Conference (ICASA), ‘Now more than ever: targeting zero’ in Cape Town, South Africa, 7 to 11 December 2013; and will be hosted by the School of Public Health and Centre for Research in HIV and AIDS at the University of the Western Cape, South Africa. Three tracks are foreseen, a clinical track, a prevention track and a health systems track.


We also hope you take the time to fill in the IHP newsletter reader satisfaction survey, if you haven’t done so yet (and chances are you indeed haven’t done so yet, if we look at our underwhelming (and thus very unscientific) response rate so far). This is your last chance to do so – we will wrap up the survey in a few days from now. So if you want this newsletter to engage more in real science and less in politics, this is your final chance!


In this week’s newsletter, we pay plenty of attention to nutrition. It’s clear that nutrition is rising on the international agenda. The Lancet series on undernutrition and the upcoming Hunger Summit in London are just some of the latest examples of the rising prominence of the issue. No doubt it will also get plenty of attention in the post-2015 development framework (if this blueprint ever materializes).


The Lancet series updated the contribution undernutrition makes to child mortality and morbidity. Apparently it’s even worse than we thought: 3.1 million children younger than 5 years die every year from undernutrition, or a staggering 45 % of total child deaths in 2011. The Lancet also pushes for the implementation of 10 low-cost interventions. How about donor aid for nutrition? Although the impetus for improving nutrition is stronger than 5 years ago (for example via the Scaling Up Nutrition movement, which emphasizes the importance of a child’s first 1000 days), the international financing situation is not very bright for the moment. For the moment aid for basic nutrition amounts to 418 million dollar (2011). The Lancet says 9.6 billion is needed, annually – with about 3, 4 billion to come from international donors. So there’s still a way to go. However, this relative neglect can be quickly turned around, argues Richard Horton. “As sustainable development becomes the dominant idea post-2015, nutrition emerges as the quintessential example of a sustainable development objective.” The key issue is political commitment, though. When countries have the political will to tackle malnutrition, it’s possible to deal with it. Maybe the big shots attending the secretive 2013  Bilderberg conference also discussed the nutrition issue, who knows. But it seems likely they discussed, first and foremost, what the Chinese would call “social stability” around the world.


Unfortunately, when it comes to dealing with China, the Lancet editors are somewhat less brave than when they draft global health manifestos. In this week’s Lancet themed issue on China (the fourth themed issue on the Middle Kingdom), they refrain from making politically sensitive comments altogether. That, in my opinion, amounts to self-censorship. When discussing public health in China, one way or another, a ‘political economy’ article in the series or a Comment discussing the good, bad and ugly of China’s authoritarian regime for the public health of its citizens (and the implementation of Xi’s ‘Chinese dream’), seems a must. The omission of such an article/comment is a shame, even if we Europeans are rightly shamed about the imperfection of our own democracies these days. Or maybe it has something to do with the Lancet’s business model? Let’s hope Obama will be less shy in his meeting with Xi. Shouldn’t be too hard, they seem to have a lot in common these days.


For this week’s guest editorial, we invited Bruno Meessen, our colleague at ITM. He recently was appointed as a professor (in health economics) at the institute, and gave a lecture related to one of his core areas of research, Performance-Based Financing. Jean Pierre Unger was the discussant – he already summarized his ideas in an editorial for us a few weeks ago. In this guest editorial, Bruno Meessen reflects on the criticism he has heard on PBF over the past years. He identifies seven main causes of disagreement and offers each time ways to improve the debate and have a more fruitful discussion. The editorial is a bit longer than normally – but you only become professor once in your lifetime, so we were happy to offer him the space needed.



Enjoy your reading.


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






Performance based financing: let’s try to have a more constructive conversation


In almost 15 years of commitment to a cause which is now known as PBF, I’ve heard plenty of different criticisms on PBF. Let’s say I’ve had my share. These criticisms are sometimes cautiously formulated or formulated as questions or hypotheses, but you often sense that the real dispute goes much deeper. Also, unfortunately, critics often mix different types of arguments. If such a strategy can be effective as a rhetorical strategy for a specific audience, it doesn’t necessarily help the debate, I believe.

To enable a more constructive discussion, it’s important to clarify the nature of criticisms by trying to identify the underlying causes of disagreement. In this blog post, I  distinguish seven main elements of criticism. For each, we can also identify a possible solution.


1st pattern: a different informational basis

I have observed over the years that one possible cause of disagreement is a different ‘informational basis’, for lack of a better word. We have encountered a lot of situations like this in recent years. A case in point was the debate  held last summer between researchers who had conducted a Cochrane Review ‘from their office’ and PBF experts who answered them ‘from the ground’.  Faced with such a problem, the obvious recommendation is to try to reduce the information gap between the two sides. Both sides can do their share. I often recommend, for example, external commentators to go and see a PBF experience with their own eyes. Maybe then they will discover aspects (both positive and negative ones) that they didn’t know before. Conversely, it is the responsibility of PBF proponents to convert their experience-based knowledge into more explicit knowledge, for example by describing PBF experiences in written documents and papers. They must also make the effort to try to understand the information base of ‘adversaries’ as it can be partly complementary, as this summer’s debate has shown. When talking to each other, the aim should always be to learn from each other.


2nd pattern: different analytical frameworks

The second cause of disagreement may arise from the use of different analytical frameworks. When I talk about an ‘analytical framework’, I refer to Elinor Ostrom’s (2005) definition of an analytical framework: “the analytical level that identifies the elements and relationships among these elements that one needs to consider for an analysis”.

As an analytical framework strongly influences the information we deal with, this second cause of disagreement is related to the first one. The underlying idea is that, faced with the same raw data, two people starting from different analytical frameworks will not necessarily see the same thing. Here, the recommendation for a good dialogue is of course to make the analytical framework one uses as explicit as possible, to allow other people to assess it (What are the underlying assumptions? Does it capture the important elements? Is it consistent? ) From our side, we have tried to be as explicit as possible about the analytical framework we use. I have even written a Phd thesis on the topic (for a simplified version, see here ). Our framework has helped, I think, to highlight weaknesses of previous analytical frameworks (which have shaped the political vision of an earlier generation of experts, see also point 6).

It’s on this basis that I dismiss all criticisms made on PBF referring to European P4P experiences or arguments relying on experiences in Costa Rica or China. PBF is much more than just a strict provider payment mechanism or a contract for performance related bonuses: it’s a substantial revision of institutional arrangements to structure health systems. The discussion should be based on a thorough understanding of the intricate web of institutions and contextual elements. Discussing the effect of a contract while ignoring all contracts in which the economic agent inserts itself, is not only bad economics, it’s also lousy social science.


3rd pattern: different normative choices

A third cause of disagreement has its  roots in what economists would call different normative preferences. One could imagine a scenario in which two experts share the same information and analytical framework, but have a different opinion on the political conclusions to draw from these.

For example, those in favour of PBF probably think the rule ‘to each according to his effort (and the quality of his effort)’ should also apply to health staff, whereas others might think that the rule ‘to each according to his needs’ also pertains to health staff.

This third cause of disagreement is more difficult to manage. On the one hand, because the question ‘what is a just society’ does not have a unique answer. On the other hand, because this source of disagreement is sometimes confused with the second source of disagreement. Some will rely on their own normative vision of human beings to reject some analytical frameworks (eg, a framework based on economics). With respect to this, I would recommend that we make a clear distinction between  three things: what human beings really are, how we, scientists, model human beings,  and finally, how we, as individuals, would like human beings to be. I don’t deny that there are links between these three elements; as a citizen, I’m well aware that the policy proposals inspired by an economic framework, when accumulated, are not value-free. Yet, I’m also convinced that such blueprints can be extremely useful in some contexts today, for improving the welfare of the most vulnerable populations, and that justice dictates that we worry about them first. This rational and pragmatic choice is a deeply humanistic one, I believe, so I decided to act upon it. Personally I prefer this approach to a discourse starting from a perhaps more generous vision of mankind, which is, I fear, based on a fantasy idea of what humanity is and will be in the coming years.


4th source of disagreement: speculation on different trajectories

To the extent that PBF addresses complex social systems, it is inevitable that large areas remain undetermined – these gaps will be filled through speculation. This is the fourth source of disagreement.

Ideally, of course, the knowledge gap would be filled. The first recommendation is therefore to design an ambitious scientific program. In this respect, PBF is very fortunate, thanks to the Health Results Innovation Trust Fund. I like to say (without having it checked though) that the PBF research program coordinated by the World Bank is probably the most important research program, size wise, in the history of health economics.

If I can’t deny my commitment as a ‘policy entrepreneur’ in favour of PBF, I also try to contribute to the debate as a scientist, by conducting empirical studies (ITM has just been tasked to do an impact study in Burundi), but more fundamentally by supporting researchers keen on studying PBF. For example, I co-organize a scientific workshop  on 13-14 June, in Bergen, Norway, where some of the issues raised  by my colleague Jean-Pierre Unger will be discussed.

However, I also know that in health policy, research does not have all the answers. Very often, research follows, with some delay, political developments (see for example  free maternal health care policies).

There is thus room for speculation, and this speculation will inevitably be influenced (or is it ‘polluted’ ?) by faith or personal distrust. My recommendation would be to try to reduce the emotional aspects of the equation by formulating what hasn’t been proven yet as a hypothesis (and not as a principle or fact). This recommendation applies to both PBF champions and critics… by the way, I think we have our work cut out here.


5th source of disagreement: a conflict of interests

The fifth source of disagreement is much more prosaic (and brings us back to the notorious ‘homo economicus’ !): personal/institutional interests. In 15 years of PBF related activities, I have learnt who could be the losers of the PBF momentum.  These include the aid technocrats whose job it often is to find and implement solutions instead of others (with all the bureaucracy this involves), and whose expertise will be made obsolete by PBF. They  tend to reside in a comfort zone of the type ‘in poor countries, progress comes slowly’ and are typically found in agencies with no desire to change their ways and procedures (plan, build, equip, train). Losers can also be found among the national bureaucrats who want to control everything but make sure to attribute their poor performance to the context, the lack of resources or to other stakeholders.

The winners are also obvious: the health staff of course, but also African and international experts who will build their careers on PBF: PBF has indeed also become an enormous market of expertise recently (and we are particularly pleased that this time it’s the Southern experts who are in charge).


6th source of disagreement: the sociology of the field of international health

Linked to the fifth cause of disagreement is a sixth element: there exists a certain sociology of international health. There are exceptions, of course, but I’ve found, by and large, that the PBF opponents often come from a population of older experts, Europeans mostly. I do not believe that one generation can be smarter than the previous one. I believe instead that in international health we all formulate hypotheses (as mentioned under point 4), based on values (point 3), analytical frameworks (point 2) and experience (point 1), marked by a certain era, one in which our professional commitment began. It is obvious, for example, that if you could build local health systems in the 80s without needing PBF, you know that PBF is not indispensable and you thus hope that your conceptual and operational toolbox has lost nothing of its relevance. Maybe you also developed a certain affection for your solutions over the years. Conversely, if you subscribe to the contemporary ‘results culture’ (see the MDGs), the solutions of the past definitely seem to require a thorough revision. My main recommendation is to go beyond the caricature and try to talk with each other. By way of example, I hope that at the  upcoming conference on health districts, PBF experiences will be presented. A synthesis is possible.

7th source of disagreement: our “all too human” flaws

Maybe I don’t need to mention this last reason, but there is a seventh source of disagreement: the human factor. Many people involved in this debate, as proponents or adversaries, are not always consistent with themselves, we have noticed. For example, some people are critical of PBF, but try to “do PBF” at an operational  level themselves.  I have also encountered at least one stubborn (pro-PBF) expert, who refused all cooperation with other PBF-minded actors. I have also sometimes observed a certain amount of ‘bad faith’ on both sides. As a PBF advocate, I have to say I don’t feel comfortable when I hear a too rosy vision of PBF, when people hide failures or when rhetoric doesn’t match reality. I’ve also seen some awkward communication by PBF proponents which sometimes radicalized the opposition of certain strategic actors with whom an alliance needed to be set up. In short, just like in every human activity, we will not avoid the clashing of egos in the PBF debate, occasionally. I don’t have much else to offer here than pleading for a real dialogue, mutual respect and introspection.



The PBF debate is crucial for the future of health systems in Africa in particular. We have crossed the Rubicon: the strategy is now present in almost all African countries. We thus encourage all PBF stakeholders and actors to focus on constructive contributions in order to ensure that these reforms are well done, and/or quickly  amended if necessary.

The strategy can be improved and will continue to evolve: a health system should be seen in a dynamic way, and institutional arrangements which structure health systems should be revised when disadvantages outweigh benefits.

So we urge both critics and supporters of PBF to engage in a constructive discussion. This will ultimately benefit the population we have in mind.



Lancet  series on maternal and child undernutrition


As leaders of the G8 group of nations prepare to meet for their annual summit (June 17-18), preceded by the UK and Brazilian governments co-hosting a high-level event on Nutrition for Growth on June 8, The Lancet published a new Series on maternal and child undernutrition, providing (startling) new estimates of the numbers of children dying from malnutrition every year. The Series highlights how the persistent burden of malnutrition can be tackled, presenting the best evidence and latest developments in the field.


1.    Lancet series – Executive summary

Read this document and you’ll have the key messages of the Series. But of course, you should also read the many Comments (for example, the one by Horton on nutrition as a quintessential sustainable development goal) and Series articles.


Some coverage in the Guardian (of the Lancet’s shocking new findings) and on the global cost of malnutrition (3.5 trillion a year, or Germany’s annual GDP, according to a recent FAO report – (as covered in a Humanosphere article)).


2.    WHO – WHO issues guidance on emerging double threat of childhood obesity and undernutrition in low- and middle-income countries

Many low- and middle-income countries are neglecting overweight and obesity as major health threats, with policies in place to tackle undernutrition, but lack policies to halt the growing burden of diseases due to the rise of overweight, and obesity, according to new information released by WHO earlier this week. To help countries close these policy gaps, WHO has issued a consolidated package of 24 Essential Nutrition Actions, which outline the most effective ways countries can improve their peoples’ nutritional status by preventing both undernutrition and overweight.



More reactions on the HLP report


As expected, many more people – including global health community voices – commented on the High-level Panel report on the post-2015 development agenda. Opinions differ.


3.    Lancet – Offline: Ensuring healthy lives after 2015

Richard Horton;

Richard Horton is quite happy about the HLP report. In ‘Horton speak’, that becomes: “It isn’t perfect, but it is a passionate, rigorous, and radical statement about the scale of our common predicaments and the need to initiate an inflection point in the trajectory of nations.”


Action for Global Health, in a statement, also generally applauds the HLP report, but regrets the lack of attention for the ‘right to health’, the fact that UHC is only seen as an enabler to health outcomes (rather than a target in itself), and the fairly restricted definition of UHC.


4.    UHC Forward – Why is UHC out of the post 2015 goals?

Abiodun Awosusi;

Why, oh why is UHC not among the post-2015 goals? (Well, according to the Twitter rumour mill, there were two camps on UHC inside the High-level panel.)  This Nigerian author is one of many (see also Simon Wright from Save the Children)  to regret UHC’s omission among the goals. He also has his doubts about the goal ‘ensuring healthy lives’ as a call to action.


Many other global health communities also have their opinion on the HLP report – for example the HIV community – and no doubt we’ll be able to offer more of these views in the coming weeks. The NTD community, for one, seems to be fairly happy (see this blog post by Neeraj Mistry on End the Neglect)). “As a South African-born, US-based public health physician, with specific involvement in addressing neglected tropical diseases (NTDs), I read through the document with much interest. Unsurprisingly, I was delighted to see explicit mention of NTDs for the first time in a report of this nature.”


Some more general assessments of the HLP report, focusing less on global health but on the overall quality and direction of the report came from Jon Lidén (on the

Chatham House website); Saskia Hollander (very nice analysis on  the Broker, “Highly ambitious or empty rhetoric?”), David Woodward (on the  Guardian, zooming in on poverty eradication) and Charles Kenny (CGD, in his second analysis of the report).


Needless to say, all analyses are very much worth reading.


Lanced 4th themed issue on China


5.    Lancet (Editorial) – Towards better health for people in China

This editorial introduces the themed issue on China. Based on 2010 GBD findings, it’s obvious a health transition is ongoing in China. Achieving better health outcomes in China should not be limited to the health sector, this editorial argues. “It requires the highest-level and strongest political will, mobilising the efforts of many government departments together to address problems, such as China’s immense tobacco industry, hazardous air pollution, and recurring food safety issues.” As already mentioned in the introduction, there’s more to the story than that, even if admittedly, the Chinese government is doing a lot of good stuff (as acknowledged in the World Report on China’s air pollution problem, for example).


Just today, the Guardian (re)published a Caixin article on the lack of transparency  around contaminated land in China. “Even though some plots of contaminated land have come to light, news about them is strictly blocked. It is only for internal discussion by specialists and closed-door decision-making by the government.” (Sounds like the ongoing ‘closed door’ Europe-US trade agreement negotiations or the equally murky discussions on (tearing apart) the EC FTT proposal, in the Eurozone – Karel De Gucht and colleagues have more in common with their Chinese counterparts than they perhaps realize).


To complement the Lancet series, you should probably read Yanzhong Huang’s  article for Yale Global, on the dark side of China’s growth. Yanzhong Huang is a senior fellow for Global Health at the Council on Foreign Relations.  China’s intense focus on rapid growth carries huge health, environmental and social costs. Unlike the Lancet, Huang doesn’t shy away from the more contentious political statements (like the entrenched corruption and the huge socio-political problems in China).


In sum: it is obvious, that if China is to realize the ‘Chinese dream’ in the coming years, and address the many public health problems, it will also have to make more progress in terms of the political rights of its citizens, the rule of law, independent media, …  even if we acknowledge that due to the scale of the population, challenges are so much bigger than in many Western countries. I hope China will have made progress in this respect by the time the 5th Lancet themed issue on China is published.

World Health Assembly coverage


6.    New Health Diplomacy Monitor issue


The Health Diplomacy Monitor team covered the 66th World Health Assembly.  In this issue, you find articles on some of the key areas that were covered during the WHA, including Universal Health Coverage, the Pandemic Influenza Preparedness (PIP) Framework, WHO reform, the International Health Regulations, health in the post-2015 development agenda and noncommunicable disease. Also in this issue, an editorial from Yoswa M Dambisya commenting on the first review on progress in implementing the WHO Global Code of Practice on International Recruitment of Health Personnel (which appeared first in the Equinet newsletter ).


Well worth a read, this issue.

7.    Nature – Agency gets a grip on budget

Declan Butler;

Nature also focused on the WHO reform (and more specifically on the budget aspects of the reform). The reforms increase flexibility and shift spending towards non-communicable diseases.  However, “although the budget changes are helpful, they do not necessarily overcome the fundamental problem, says Lawrence Gostin, head of the WHO Collaborating Center on Public Health Law and Human Rights at Georgetown University in Washington DC. Too large a piece of the WHO budget pie comes from voluntary contributions, making the agency’s work and policies ultimately reflective of its wealthiest donors, and leaving it scant margin to set its own. “It simply is not sustainable to have wealthy states and foundations control some 80% of WHO’s budget.


8.    Lancet – World Health Assembly adopts Comprehensive Mental Health Action Plan 2013—2020

Shekhar Saxena et al.;

On May 27, the World Health Assembly adopted the Comprehensive Mental Health Action Plan 2013—20201 that has great potential to change the direction of mental health in countries around the world in the next 8 years. This action plan and the accompanying resolution—a first in the history of WHO—represent a formal recognition of the importance of mental health for WHO’s 194 member states. It is also a commitment by all member states to take specified actions to improve mental health and to contribute to the attainment of a set of agreed global targets. Implementation won’t be easy, though.


9.    WHO Bulletin (Early online) – Debating the scope of a health research and development convention

Mary Moran;

This early online WHO Bulletin article discusses a possible binding health R&D convention (and the lack of clarity on its remit so far).




10. Lancet (Editorial) – MERS-CoV: a global challenge

Margaret Chan said MERS-CoV is her present greatest concern, in her closing remarks at the WHA. This Lancet editorial emphasizes ‘free information sharing, trust, and research cooperation will be crucial to aid prevention, diagnosis, and treatment of this evolving global health threat’.

11. Foreign Affairs – Who Owns MERS?

David Fidler;

The outbreak of the Middle East Respiratory Syndrome has led to a global controversy over who legally owns the intellectual property of a virus, whether a virus can be patented, and how to share samples of it once it is. But all the bickering has obscured the fact that pandemics aren’t problems that can be litigated away, David Fidler argues.


Women deliver conference


12. All Africa – Women Deliver 2013 Concludes With a United Call to Invest in Girls and Women

Last week, the Women Deliver 2013 conference in Kuala Lumpur concluded with a call for continued investments in girls and women. The final day of Women Deliver 2013 focused on the critical need to prioritize girls and women in the lead-up to the 2015 MDG deadline and beyond. (By the way, the maternal health movement is probably quite pleased with the HLP report – see target 4c: “ensure universal sexual and reproductive health and rights”; and goal 2 “empower girls and women and achieve gender equality”.)

13. BMJ (news) – National data on women’s health mask inequalities, conference hears

Patralekha Chatterjee;

This BMJ news article gives a short overview of the discussions (and released reports) at the Women Deliver conference. The author also noted that a focal point at the conference was that “women from ethnic minorities and poor or vulnerable women need to be targeted in efforts to improve women’s health”.


Global Fund


14. Aidspan – Global Fund Joins Pledge Guarantee for Health

David Garmaise;

The Global Fund is participating in an initiative to leverage private sector funding to speed up delivery of, and expand access to, health products such as contraceptives, bed nets and medicines. The initiative is called the “Pledge Guarantee for Health.”

15. Aidspan (Analysis) – The Evolution of “Country Ownership” at the Global Fund

David Garmaise;

David Garmaise explores what ‘country ownership’ means at the Global Fund and how it has evolved over the years (and will probably continue to do so now that there’s a new funding model).



Health Policy & Financing


16. WHO Bulletin (Editorial) – Why are we failing to promote physical activity globally?

Philipe de Souto Barreto;

This editorial is part of the new June issue of WHO Bulletin. Physical inactivity is one of the most common and persistent contributors to poor health in the world. Our persistent failure to promote physical activity throughout the world suggests that public campaigns and social recognition of the health benefits of a physically active lifestyle are not enough to change people’s behaviour. The author suggests a way forward.


A Lancet editorial also focuses on physical activity, this week.


17. Reuters – Japanese drugmakers open ‘libraries’ in $100 million health project


Five top Japanese drug companies will open their ‘libraries’ of experimental compounds to scrutiny by scientists hunting new treatments for malaria, tuberculosis and other diseases affecting the world’s poor.  The public-private Global Health Innovative Technology Fund (GHIT Fund) was set up in April and brings together Japan’s foreign affairs and health and welfare ministries, a consortium of five pharmaceutical companies, and the Gates Foundation. The GHIT Fund is working with established nonprofits  to help develop candidate drugs. According to the FT, “the move marks an important shift for Japan’s drug companies, which have traditionally been less focused on emerging markets or involved like their western counterparts in partnerships to develop medicines for the poor”.


18. Equinet policy brief – Overcoming barriers to medicines production through South-South co-operation in Africa

This brief outlines the factors that affect medicines production in East and Southern Africa, drawing on the African Union, Southern Africa Development Community (SADC) and East African Community (EAC) pharmaceutical plans. It identifies the barriers to local production as: lack of supportive policies, capital and skills constraints, gaps in regulatory framework, small market size and weak research and

development capacities. There are potential opportunities available through

south-south cooperation in medicines production.


19. PBF – Researching PBF: time to open the black box

In this blog post, Gaute Torsvik (University of Bergen) introduces a forthcoming scientific workshop, which will take place in Norway on June 13 and 14. He argues that researchers studying PBF schemes should go beyond measuring impact only. (We hope to run an IHP blog post/guest editorial on this workshop one of the coming weeks)


20. KFF – WHO Approves PrePex Adult Circumcision Device; PEPFAR To Support Countries’ Use Of It For HIV Prevention

The WHO on Friday approved PrePex, a medical device for adult circumcision, and the only adult circumcision method, other than conventional surgery, to gain WHO acceptance. PrePex, a three-part device that includes size-adjusted rubber bands and a ring to compress blood flow to the foreskin, … does not require injected anesthetic, sutures, or a sterile environment, and takes a total of five minutes across two visits. (Lovely. Bring in Hannibal Lecter.)


PEPFAR supports the implementation of VMMC programs in 14 East and Southern African countries and is ready to support countries that wish to introduce PrePex™ right away. (I’m sure many of PEPFAR’s staff have carefully read the new blog post

on the blog Aid thoughts, “Astonishingly, demand for circumcisions is lower than expected”.)


21. WHO – Social Determinants of Health Discussion Paper Series – Policy & Practice

This is a WHO publication series devoted to the social determinants of health.
The series explores themes related to strategy, governance, tools and capacity building for addressing the social determinants of health to improve health equity. There are 8 discussion papers, including ‘Action on the SDH: learning from previous experiences’ (see here)  and ‘A conceptual framework for Action on the SDGs’ (see here ).


22. Plos One – World Health Organization Guideline Development: An Evaluation


David Sinclair et al.;

Research in 2007 showed that World Health Organization recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization’s own ‘‘Guidelines for Guidelines’’. In response, the WHO established a ‘‘Guidelines Review Committee’’ (GRC) to implement and oversee internationally recognized standards. The authors examined the impact of these changes on WHO guideline documents and explored senior staff’s perceptions of the new procedures. They conclude: “Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance standards they have set, are fully embedded within the organization.”


23. NEJM (Perspective) – How AIDS Invented Global Health

Allan Brandt;

The changes wrought by HIV have not only affected the course of the epidemic: they have had powerful effects on research and science, clinical practices, and broader policy.” “… Most notably, the AIDS epidemic has provided the foundation for a revolution that upended traditional approaches to ‘international health,’ replacing them with innovative global approaches to disease. Indeed, the HIV epidemic and the responses it generated have been crucial forces in ‘inventing’ the new ‘global health.'” Brandt describes the epidemic’s impact on disease activism, health funding, philanthropy, the cost of essential medicines, and human rights. These complementary innovations are at the core of what we now call ‘global health’.  (whether we see of much of ‘global health’ in the new HLP report is another matter, though)

24. NEJM (review article) – Response to the AIDS Pandemic — A Global Health Model

Peter Piot et al.;

Yet another global health review article in NEJM’s global health series. Piot and colleagues summarize the international response to AIDS, describe the challenges ahead, progress in treatment and evolution of prevention strategies, … They conclude: “In conclusion, great progress has been made in the global response to the AIDS epidemic, but these achievements are fragile because of the enormous challenge of sustaining political, programmatic, and technical commitment, along with national and international funding. A certain level of AIDS fatigue on the part of funders and public health and political leaders coincides with the unprecedented opportunities for using new tools to control AIDS. Prevention and care now need to be targeted strategically, and creative combinations of behavioral, biomedical, and structural interventions need to be widely implemented. These programs will require universal access, large-scale implementation, careful monitoring and evaluation, financial and technical resources, and robust commitment. Only then may we begin to see a substantial effect on the global spread of HIV infection.”


25. Open Democracy – The neoliberal epidemic striking healthcare

John Lister;

Healthcare systems across the world are facing a ‘man-made disaster’ – the imposition of market-style ‘reforms’ that are neither appropriate nor effective. Journalist John Lister introduces his new book ‘Health Policy Reform: Global Health versus Private Profit’ that unpicks the facts behind the ideology.


(As for neoliberalism@work, you might want to read this BMJ Feature article, ‘Trade secrets: will an EU-US treaty enable US big business to gain a foothold?’ It focuses on the UK’s NHS, but we should probably all be worried in the EU if US ‘best practices’ are to be implemented throughout the Eurozone (well, at least we will then again have ‘growth’J. Hurray!)


26. UN – Ban appeals to philanthropists to help fight five deadly diseases, curb cholera in Haiti

U.N. Secretary-General Ban Ki-moon on Wednesday appealed to philanthropists to ‘make a smart investment in the world’s future’ by joining the United Nations in accelerating the fight against five of the most deadly infectious diseases which kill millions of people every year: malaria, polio, tetanus, measles and HIV infections in newborns. Ban addressed the Second Annual Forbes 400 Summit, which took place at U.N. Headquarters in New York. (yet another example of neoliberalism@work, I’m afraid – you shouldn’t be begging, Ban, we need to tax’em! Use the tax equivalent of PrePex!)

27. Global Health Governance –

Lenias Hwenda;

An NCD index that assesses the food and beverage sector’s corporate policies and practices towards its commitments to voluntary global standards for tackling NCDs could increase accountability, Hwenda argues. She points to the relative success of the Access to Medicines index, which has successfully galvanized the global pharmaceutical industry to promote greater access to medicines for the poorest. An NCD index could have a similar ‘name and shame’ function.



Global health research


28. HP&P – How to (or not to) … measure performance against the Abuja target for public health expenditure

Sophie Witter et al.;

Everybody who reads this newsletter probably knows about the Abuja target for public health expenditure. This article sets out some of the areas of ambiguity and argues for an interpretation of the target which focuses on actual expenditure, rather than budgets (which are theoretical), and which captures areas of spending that are subject to government discretion.


29. Plos – Household Air Pollution in Low- and Middle-Income Countries: Health Risks and Research Priorities

William Martin et al.;;jsessionid=4375FAC927CCE383BDCB51B37C4180A0

William Martin and colleagues report on their stakeholder meetings that reviewed the health risks of household air pollution and cookstoves, and identified research priorities in seven key areas.

30. HP&P – Health system strengthening in Myanmar during political reforms: perspectives from international agencies

Isabelle Risso-Gill et al.;

International aid agencies have found engagement with the Myanmar government difficult but this is changing rapidly (for the reasons you know) and it is opportune to consider how Myanmar can engage with the global health system strengthening (HSS) agenda. Nineteen semi-structured, face-to-face interviews were conducted by the authors with representatives from international agencies working in Myanmar to capture their perspectives on HSS following political reform. There is little consensus on how HSS should be approached in Myanmar, but much interest in collaborating to achieve it. Despite myriad challenges and concerns, participants were generally positive about the recent political changes, and remain optimistic as they engage in HSS activities with the government.

31. Globalization & Health – Understanding how and why health is integrated into foreign policy – a case study of health is global, a UK Government Strategy 2008–2013

Michelle L. Gagnon & Ronald Labonté;

This paper reports on an empirical case study of Health is Global: A UK Government Strategy 2008–2013. It aims to build understanding about how and why health is integrated into foreign policy and derive lessons of potential relevance to other nations interested in developing whole-of-government global health strategies. (essential reading in the run-up to the upcoming high level summits chaired by David Cameron)


32. Alliance –  Access to Medicines Policy Research

The goal of the Alliance’s Access to Medicines Policy research project is to increase access to, and improve the use of, medicines in low- and middle-income countries. The specific purpose of the project is to build an evidence-informed policy-making culture around the access to, and use of, medicines.


The website features new papers on Pakistan (see here )   and Latin America (see here).




Global Health Announcements




  • WHO/Europe developed a new tool to help Member States estimate the costs associated with damage to health due to climate change, and those of adaptation in various sectors to protect health. WHO launched the tool at a side-event at the climate change conference in Bonn, Germany on Thursday, 6 June 2013, in which it hosted a panel discussion of these costs. Member States, citizens or advocacy groups can use the tool to make basic estimates of the economic costs of the health effects of climate change, and the costs and benefits of adaptation measures to minimize these effects. In particular, it can help strengthen the case for health adaptation in settings where climate change adaptation measures are just beginning.


For the latest on climate change (and the strategy to deal with it), see this excellent short article by Paul Rogers (on Open Democracy). Rogers sees two glimmers of hope, the second one being ‘asymmetry’ (with asymmetry being an obvious feature of the changing climate: some regions are experiencing much more rapid changes than others.) “The second (i.e. glimmer of hope) echoes the earlier mention of asymmetry – which may actually prove to be the most substantial cause of hope. If climate disruption was uniform across the world, then it might be well into the 2020s before the consequences were being seriously realised in practice. It now looks ever more probable that some regions are going to race a decade or more ahead of the global system in its entirety – and that there, in the later 2010s, it will become clear what the worldwide impact might look like.”



  • The First Arab World conference on Public Health took place in Dubai (early April). The conference led to the following  Declaration .






  • Cameron calls in (British) tax haven leaders, in the run-up to the G8 summit: (see the Guardian ).


  • In this ODI blog post, ODI director Kevin Watkin looks ahead to the G8 summit in Lough Erne. He identifies two reasons not to be too cynical about what can be achieved.


  • The Robin Hood tax is under attack. (see this Guardian op-ed by Philippe Lamberts)



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