Today, 14 June, we celebrate World Blood Donor day. Our guest editorialist from El Salvador, Ana Amaya, currently studying in the UK, uses the occasion to reflect on global health donors in Peru, an upper-middle-income country, and sustainability issues.
This week we also pay attention to the Hunger summit which took place in London last week, and the upcoming G 8 summit in a posh resort in Northern Ireland. In the run-up to the G8 meeting, über-provocateur Vladimir Putin slammed the EU for its ‘dependency mentality’. He’ll be happy to hear that the UK doesn’t want this to be a pledging summit.
The 8th Global conference on Health promotion in Helsinki is covered too in this newsletter (with a key role for Mrs Chan). Meanwhile, in another Scandinavian country, Norway, a PBF workshop is ongoing, ‘Performance-based financing of health care provision in low-income countries: Going beyond impact evaluation’ (see next week).
The Lancet has a themed issue on HIV this week, to coincide with the 2013 International AIDS Society meeting taking place in Kuala Lumpur from June 30 to July 3. On NCDs, some of our colleagues published an article in PLOS Medicine on the lack of policies addressing NCD prevention in LMICs; Stuckler & Basu, two global health scholars who write faster than John Wayne can shoot, commented.
To kick off this weekend’s reading in a pleasant way, check out why Laurie Garrett thinks Dan Brown’s new bestseller, Inferno, is just dumb. In the book, there’s a key role for the WHO director-general (again) and the Council on Foreign Relations.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Blood, aid & sustainability: The case of HIV in Peru
Ana B. Amaya (MPH, currently DrPH candidate at the London School of Hygiene and Tropical Medicine)
June 14th marks world blood donor day, a date when we celebrate the countless selfless individuals all over the world who decide to donate blood. The day also serves to raise awareness about the need for safe blood and blood products to save lives. According to the WHO, the blood donation rate per 1000 population in middle-income countries is around 12 donations, while in low-income countries this drops to a staggering low figure of 4 donations. Despite the importance of this issue, today I want to discuss another type of donors, global health donors. These donors, while not completely selfless in their motivations and frequently criticized for imposing their priorities over national needs, also save lives through the activities they fund. However, similar to the blood donor situation, money is becoming increasingly scarce in the current economic climate, generating the need to target funding towards areas that need it most. The importance of financial and technical support and the effects it has produced on the health of populations in developing countries have been widely documented. However, information on the sustainability of this aid at the national level and the long-term effects of it, is still in its infancy.
This is particularly relevant for nations that are currently heavily donor-dependent (to plan for the future, towards a sustainable scenario or in the case international money ceases) and for those countries whose economies are growing and thus at some point no longer “require” aid. The latter is the case for HIV/AIDS in Peru. Peru has boasted robust economic growth rates in recent years, and the country is now classified by the World Bank as an upper-middle-income country. In principle, Peru now has the fiscal space to invest more in social sectors and the country is therefore no longer eligible for Global Fund HIV/AIDS grants. Yet equity in the country remains a challenge and although the national HIV prevalence is below 1%, some reports estimate the prevalence among most-at-risk populations to be up to 40%. The Global Fund’s involvement in HIV/AIDS in Peru via four successful rounds, propelled the provision of free antiretroviral treatment in the country and also helped increase the visibility of the rights of people living with HIV/AIDS. At the same time, a large amount of these funds were aimed at supporting health promotion and a significant number of prevention activities were implemented through non-governmental organizations.
With these Global Fund grants winding down, many local actors now wonder what will happen next. What has already happened is the inclusion of HIV together with TB in the government’s results-based budget (as one of the strategic lines). So the economic component of sustainability seems feasible; but how about the other components of this process, such as the political, technical and social dimensions of sustainability? The shift occurs against the political backdrop of a still expanding decentralization process, in which the regions are tasked with managing this budget and thus must be prepared for these added responsibilities. In question is also how the absence of the Global Fund will affect the work of the non-governmental sector in the country, a sector which has had a large role in implementing projects and has a rather lukewarm relationship with the government, to say the least. Also, what will be the fate of the already formed country-coordinating mechanism; and most importantly, how to build on achieved successes?
While we were analyzing the effectiveness of aid, we seem to have forgotten to think beyond aid and help build the foundations for making aid at some point redundant. This is not only about money, but also about establishing the political, social and technical pillars for countries to be able to successfully manage their own projects once they have the fiscal space. Arguably, the focus on strengthening health systems and fostering country ownership has done a great deal to prepare countries but it is evident that what we have been doing so far has not been enough. Fortunately, it is not too late to reconfigure our thinking and to begin to engage stakeholders, as well as include clear criteria for sustainability in order to reduce uncertainty in the future (or at least enable us to cope better with uncertainty). What is more than certain, however, is that unlike aid, blood is easily replaced in your body so please consider visiting your local blood bank today!
Hunger summit & upcoming G8 summit
1. Guardian – London hunger summit yields $4bn commitment on child malnutrition
The Guardian’s Mark Tran gives an overview of the commitments and the Global Nutrition for Growth compact at last week’s Hunger summit in London. Bill Gates addressed a rally in London organized by the campaign Enough Food for Everyone IF.
On the Guardian Global Development site, there’s been quite some discussion on the pros and cons of the Nutrition for Growth summit and more in particular on the New Alliance for Food Security and Nutrition (set up at a previous G8 meeting, in 2012), starring Guardian columnist Monbiot and others. You might also want to read our very own Olivier de Schutter.
2. G8 Lough Erne Accountability Report
Last week, the G8 Lough Erne Accountability Report was released by the U.K. government in the lead-up to the G8 summit. The report naturally contains a health chapter (but you can also read the summary of the report).
So Britain is hosting this year’s G8 summit (June 17-18) in Northern Ireland. By now you’ve probably heard about the Potemkin-style shops and coffeehouses. Luckily, at least the agenda genuinely looks good this year. Read CFR’s ‘internationalist’ Stewart Patrick on the focal points of the G8 summit: “Under the theme of supporting “open economies, open governments and open societies,” Downing Street has chosen three topics for discussion: advancing global trade, ensuring tax compliance, and promoting greater transparency.” For the latest (and the trademark unconstructive role played by the Canadian prime minister), see here. Cameron also just revealed that Britain is going to invest £50m over five years in Global Development Innovation Ventures.
Antibiotic resistance will also be on the agenda. UK science minister David Willetts will meet his G8 colleagues in London, at the Royal Society. Apparently it’s the first conference of science ministers from the group of eight wealthiest nations in five years. (see the Guardian on this).
8th Global Conference on Health promotion
The 8th Global Conference on health promotion finishes today. The event was co-hosted by WHO and the Ministry of Social Affairs and Health, Finland. Main theme of the conference: “Health in All Policies” (HiAP). The focus of the event was on implementation, the “how-to”. (there was relatively limited attention for the conference in mainstream media, we feel, including on the Guardian Global Development (with exception of the speech by Mrs Chan which could not be ignored); could it be that some powerful global health stakeholders are not too fond of Health in all Policies? )
Twitter hashtag: #healthinall
3. Speech Margaret Chan in Helsinki;
Read and enjoy J.
But in case you don’t have the time to read the speech in full (shame on you!), here are some excerpts:
“‘… Today, the tables are turned. Instead of diseases vanishing as living conditions improve, socio-economic progress is actually creating the conditions that favor the rise of non-communicable diseases.’ In the 1980s, when we talked about multisectoral collaboration for health, we meant working together with friendly sister sectors. Like education, housing, nutrition, and water supply and sanitation. When the health and education sectors collaborate, when health works with water supply and sanitation, conflicts of interest are rarely an issue. Today, getting people to lead healthy lifestyles and adopt healthy behaviours faces opposition from forces that are not so friendly. Not at all. … It is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics, such as front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that ‘confuses the evidence and keeps the public in doubt.”
Ilona Kickbusch, dubbed the ‘mother of health promotion’ in Helsinki, and many others in the audience were probably nodding and cheering. Good to see global health feels a bit like Star Wars, at times.
4. Helsinki Statement
A Helsinki Statement was distributed today at the conference (in hard copy – for the weblink, see this weekend, I guess). It’s supposed to be as robust a document as the Ottawa Charter. However, from what I hear from our IHP correspondent in Helsinki, it’s not clear that is the case. The document seems to have been watered down a bit during the week – and instead of a Declaration, it’s now a conference Statement.
So the firebrand People’s Health Movement drafted an alternative call to action to critique the official Conference Statement. They developed a progressive call for action based on strong social justice principles. (A must-read.)
On a more encouraging note, a Framework for Country action was developed which offers a blueprint for intersectoral collaboration at several levels (national, regional and global) with a clear mandate for WHO, including research on the health policy implications of international trade etc. Of course, now this has to be put into action…
Plenty of countries are already pro-actively working on HiAP, the parallel sessions showed. And the conference was useful to boost the political support for HiAP and for exchange of knowledge & experiences.
5. Bloggers on the Helsinki conference;
Fran Baum blogged frantically about the conference – 5 posts in total, and counting (Laurie Garrett holds the world record of number of blogs about one global health event, since the last WHA). Check them out.
6. Lancet themed issue on HIV
The Lancet published an HIV themed issue, to coincide with the 2013 International AIDS Society meeting taking place in Kuala Lumpur from June 30 to July 3.
An Article suggests a new therapeutic option for second-line antiretroviral therapy after first-line treatment failure; a Review discusses an exciting new era of basic science, which aims to ultimately find a cure for HIV; other content includes pre-exposure prophylaxis with antiretroviral therapy for injecting drug users in Thailand (see the Comment here) and the cultural issues concerning HIV in the Islamic world. There a number of Comments too. This Lancet editorial, ’30 years of HIV: where next?’ sets the scene and introduces the themed issue.
7. UNAIDS – International consultation focuses on access to HIV medicines for middle-income countries
In news related to this week’s guest editorial, the critical issues that middle-income countries face in ensuring they have access to affordable and high-quality HIV medicines were explored during a consultation held in Brazil’s capital Brasilia this week.
World Blood donor day
8. WHO – More voluntary blood donors needed
On World Blood Donor Day, WHO calls for all countries to obtain 100% of their supplies of blood and blood products from voluntary unpaid blood donors by 2020. (we also encourage the actors of True Blood to do their share, instead of selfishly keeping all the goodies for themselves )
9. Huffington Post – Better Health, Better Human Rights
The Global Fund began with a commitment to advancing human rights in its fight against the diseases, Executive Director Mark Dybul notes, but the need to expand that focus becomes clearer as research confirms the effectiveness of focusing on the most vulnerable populations. This, he points out, is not only humane, but intelligent investment, he writes.
10. Aidspan – Description of the Global Fund’s General Approach to Managing Risk
In the last two years, the Global Fund has implemented a comprehensive set of measures to better manage risk, particularly the risk of fraud and misappropriation of grant funds. The Fund has established a Grant Management Assurance Framework (also referred to as the “risk framework”) that sets out the Global Fund’s general approach to managing risk. The Framework allows the Fund to identify, document, assess and act on all risks that could affect the success of a grant. The Framework describes the Global Fund’s general approach to risk management and specific measures to combat fraud. This article provides a summary of the Fund’s general approach to risk management.
11. CGD consultation report – More health for the money: A practical agenda for the Global Fund and its partners
Amanda Glassman et al.;
Amanda Glassman convened a Value for Money working group over the last year to consider the following question: How can the Global Fund to Fight AIDS, TB and Malaria get more health for the money it invests? CGD is now sharing a consultation draft of the working group’s report – More Health for the Money: A Practical Agenda for the Global Fund and its Partners. The document is available for public comment until July 12. The report identifies four domains for policy action within the Global Fund’s grant cycle – allocation, contracts, costs and spending, and verification – and makes practical recommendations for how the Global Fund and its partners can get more health for their money throughout. This short blog introduces the working group’s approach and recommendations. All are invited to comment.
12. Plos – Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review
Carl Lachat et al.;
Carl Lachat and colleagues evaluate policies in low- and middle-income countries addressing salt and fat consumption, fruit and vegetable intake, and physical activity, key risk factors for noncommunicable diseases.
13. Lancet (Correspondence) – Addressing NCDs: is it really a global coalition?
Rodrigo M Carrillo-Larco et al.;
In its Series on NCDs, The Lancet acknowledged the importance of NCDs particularly in LMICs, the authors of this Lancet letter acknowledge. They continue, though: “These Series stress, among many important points, the need for global cooperation and partnership towards addressing NCDs. However, it is surprising to observe the over-representation of researchers based in high-income countries and the limited participation of LMIC-based researchers in all four Lancet Series.”
The authors of the Series reply.
Health policy & financing
14. Lancet (Editorial) – The right to health for Syrian refugees
20 June is World Refugee day. This Lancet editorial says ‘the day should act as a reminder of the most pressing refugee crisis at present: that created by the brutal conflict in Syria’.
Last week, the United Nations made the largest humanitarian appeal in its history, sharply increasing its estimate for the funds needed for Syria. (see the Guardian). Whether it will be enough, is anybody’s guess, unfortunately.
15. Plos – Why Aren’t We Listening Yet? A Decade of Road Safety Begins Quietly
Tracey Pérez Koehlmoos;
Tracey Pérez Koehlmoos offers a personal view on road traffic crashes and the disappointing lack of visibility of the WHO-led Decade of Action for Road Safety.
16. Lancet (Comment) – Public and global engagement with global health
Peter Friberg et al.;
In April, a public consultation called Global Health Beyond 2015 was organised by the Swedish Society of Medicine in Stockholm. The event produced a Stockholm declaration for Global Health (see the article). The authors report on the event and emphasize: “Global health is widely regarded as being grounded in public and global engagement. But much of the process of global health is dominated by Northern institutions, expert groups, think-tanks, high-level meetings, and the like. Indeed, the exponential growth of global health in the past decade may soon turn into terminal decline unless truly global and broad-based ownership of the concept can be achieved.” Very true.
17. CGD – Nudging global health
Amanda Glassman & Denizhan Duran;
Glassman & Duran explore the application of behavioral economics in global health. No doubt they have the ear of David Cameron, among others.
18. Euractiv – EU and Gates Foundation sign disease research agreement
On June 10, the EU and the Gates Foundation pledged to pool resources for research into HIV/Aids, tuberculosis, malaria and other poverty-related diseases. A lot of the work will be carried out through the European and Developing Countries Clinical Trials Partnership (EDCTP), it appears.
19. Get involved in global health – WHO Global Code of Practice – lost in translation?
The “WHO Global Code of Practice on the International Recruitment of Health Personnel” was adopted by the World Health Assembly, in May 2010. Three years later, back in Geneva at the World Health Assembly, it looked as if the Code has gone lost somehow in its translation from paper to practice, Thomas Schwarz argues. In this lengthy but very nice blog post, he reports on a civil society side event to the World Health Assembly organized by the Medicus Mundi International Network and the European “Health workers for all and all for health workers”. (yes, some people in global health still love Bryan Adams).
Remco Van de Pas (Wemos) also wrote a blog post on the relative lack of attention for the health workforce in the last two years – in spite of the fact that HRH is essential to attain UHC. ( by the way, Remco doesn’t like the term “Human Resources for Health” much, and for good reason)
20. WHO – Pandemic Influenza Risk Management – WHO Interim Guidance
The WHO on Monday published a new plan on how to alert the world to possible flu pandemics, following harsh criticism of its handling of the H1N1 swine flu pandemic in 2009. The new influenza guidance simplifies the pandemic phases structure (four phases instead of the previous 6 – interpandemic, alert, pandemic and transition), emphasizes the risk assessment and risk-based approach, and increases the flexibility of Member States to take actions. The definition of a pandemic has also been simplified – to a period of global spread of human influenza caused by a new subtype
21. The Atlantic – Fake Drugs From China: What’s Stopping a Cure for Malaria in Africa?
The Atlantic examines whether the Chinese pharmaceutical industry can overcome its reputation for producing bogus medicine. McLaughlin, an American journalist based in China, describes China’s role in the discovery of artemisinin and the resulting artemisinin combination therapies, used to treat malaria, as well as the country’s role in manufacturing and distributing counterfeit anti-malaria drugs. There is a severe safety issue with malaria drugs, to say the least. The magazine also examines China’s role in health care in East Africa.
22. Scidev.net – Chinese ‘container hospitals’ ready to deploy in Africa
On a more positive note, Africa’s first ‘container hospital’, developed by Chinese scientists, could be ready for use by the end of the month, following two years of development. It will be located in either Cameroon or Namibia, depending on government approval. ( The Chinese obviously have their own idea about health systems strengthening and ‘building blocks’). Interesting development.
23. News Pakistan – Bill Gates’ offers to assist Pakistan in health sector
Bill Gates has offered to assist Pakistan with its health sector in a letter to Prime Minister Nawaz Sharif.
24. UHC Forward – Thoughts from African civil society on UHC (Briefing Paper)
Some thoughts (including concerns) from African civil society on UHC.
25. Science Speaks – United, led by AIDS patients and advocates, world’s most impoverished countries get extension on affordable access to critical goods
The globe’s poorest nations, the least-developed countries, have won an eight-year extension of a waiver on intellectual property rules. A session of the WTO’s TRIPS Council — standing for trade-related aspects of intellectual property rights — ruled that the waiver for 34 countries can now run until July 1, 2021. “The extension of the agreement giving the world’s least developed countries exemption from implementing the full standards of patent protection observed by wealthy countries means impoverished countries will, for the time being, preserve access to generic antiretroviral drugs essential to fighting HIV effectively in some of the hardest-hit countries.”
See also Oxfam’s Mohga Kamal-Yanni on this issue.
26. BMC supplement – Improving primary health care to achieve population impact: the African Health Initiative
The BMC Health Services Research journal published a supplement on the African Health Initiative of the Doris Duke Charitable foundation. The Doris Duke Foundation launched the African Health Initiative to catalyze advances in strengthening health systems by supporting Population Health and Implementation Training (PHIT) Partnerships in five diverse sub-Saharan African contexts (Ghana, Tanzania, Rwanda, Mozambique and Zambia).
27. Book by Dominique Kerouedan – Géopolitique de la santé mondiale
Dominique Kerouedan (SciPo) recently published a new book “Géopolitique de la santé mondiale.” As you might recall, early next week a Global health & policy/diplomacy event is scheduled in Paris, see here for the program.
28. Nossal institute for global health (Working paper) – Mapping the regulatory architecture for health care delivery in mixed health systems in low- and middle-income countries
Kabir Sheikh et al.;
Many LMICs in Asia share an emerging climate of health care provision that is increasingly recognised as ‘mixed health systems syndrome’. Regulation of health care remains a pre-eminent challenge for future health policy in these LMIC. The failure of regulation can be most proximally located in the failure of regulatory institutions. Yet, the specific institutional and systemic contexts for failures of regulatory policies remain poorly explored and represent a significant gap in the knowledge.
29. HP&P – When do vertical programmes strengthen health systems? A comparative assessment of disease-specific interventions in India
Krishna D. Rao et al.;
Disease-specific programmes have had a long history in India and their presence has increased over time. This study has two objectives: first, it reports on the interaction between local health systems and key disease-specific programmes in India, and second, it examines which factors create an enabling environment for disease-specific programmes to strengthen health systems.
30. ODI background note – Old age, disability and mental health: data issues for a post-2015 framework
Inequalities associated with old age, disability and mental health issues did not feature in the MDGs. This ODI Background Note argues that these inequalities should be considered salient sources of group-based difference, given the number of people affected, their marginalisation and vulnerability, and their relative neglect in international agreements to date. The paper identifies lack of data as a particular concern, but one that can be addressed through revisions to standard household surveys. To this end, it discusses the available data and their limitations, constraints to better data collection and efforts needed to adjust key international survey instruments to collect reliable data on these issues. The paper concludes by commenting on how measures to address the inequalities that affect these groups could be incorporated within a new post-2015 framework agreement. The Background Note also includes an online annex, which presents selected survey questions on disability and mental health issues from key international survey instruments.
Global health bits & pieces
- Reuters: The WHO on Monday urged health workers around the world to be on the alert for symptoms of the Middle East Respiratory Syndrome coronavirus (MERS). With the Ramadan and the Haij to Mecca coming up, concern is mounting. For the latest WHO update, see here.
- Oxfam’s Duncan Green, who attended a Royal Society panel discussion, blogged on the science needed for the post-2015 development agenda.
- Jeffrey Sachs dwells on the post-MDG future (in an interview with Scidev.net) and on what the road to 2015 will look like. The Sustainable Development Solutions Network (SDSN) also presented its suggestions to Ban Ki Moon last week and follows thus on the HLP report. Sustainable development is set to be at the heart of the post-2015 agenda. Nanotech and better data will aid future development efforts, Sachs says, and scientists must help to draw up roadmaps for problem-solving.
- High Level Panel Report: you can find (a constantly updated) compilation of responses to the HLP report here.
Some new analyses came from Simon Maxwell, the Center for Economic and Social Rights – which says the HLP recommendations fall short of the human rights litmus test. And a blog post on how to finance all of this, post-2015, came from Gail Hurley.
For a report of ODI’s event on the HLP report, see the Broker.