Dear Colleagues,


African hearts warmed up a bit to the US this week, as Obama ended his visit to Africa and was even joined by former president George W. Bush at some point. Obama said  food security is a top priority of his development agenda, and announced a few new initiatives, including one on electricity access. More in general, he projected a more upbeat image of a “new” Africa for the American audience, which was more than welcome. In another joint appearance, Michelle Obama and Laura Bush both attended  a “Ladies summit” of African first ladies.


The 7th IAS  conference on HIV pathogenesis, treatment and prevention in Kuala Lumpur produced the usual reports, including new WHO HIV treatment guidelines. The Clinton foundation has a new boss, Eric Braverman. Elsewhere in the world there is rising anxiety about MERS. It is perhaps appropriate that World War Z is currently playing in movie theatres all over the world. I personally can’t wait till zombies wreak havoc among the global health community, as all of us have again produced an enormous amount of news and reports, this week. Maybe because we all want to finish some things before going on well-deserved holidays?    


In this week’s guest editorial, Xing Lin Feng, Jin Xu (both from Peking University, as well as EVs 2012) and myself reflect on China’s long and winding road towards UHC in recent decades, after listening to Jim Kim’s speech at the 66th World Health Assembly.


Enjoy your reading.


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






China’s road to Universal Health Coverage: beyond the diagonal approach

Xing Lin Feng1*, Jin Xu2 and Kristof Decoster3

1 Department of Health Policy and Administration, School of Public Health, Peking University.

2China Centre for Health Development Study, Peking University, currently Research Degree Student, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine

3 Department of Public Health, Institute of Tropical Medicine, Antwerp.

*Correspondence to


Disease-specific programs could be harnessed diagonally to strengthen a country’s health system, World Bank President Jim Kim emphasized at the 66th World Health Assembly. “For decades, energy has been spent in disputes opposing disease-specific “vertical” service delivery models to integrated “horizontal” models. Delivery science is consolidating evidence on how some countries have solved this dilemma by creating a “diagonal” approach: deliberately crafting priority disease-specific programs to drive improvement in the wider health system.  … Whether a country’s immediate priority is diabetes; malaria control; maternal health and child survival; or driving the “endgame” on HIV/AIDS, a universal coverage framework can harness disease-specific programs diagonally to strengthen the system.”

With this well received speech by the World Bank President, the 66th World Health Assembly witnessed a converging stance of the World Bank to the WHO’s on post-2015 health priorities and development. It appears that “Health for all” is back, but now reframed as Universal Health Coverage (UHC). The horizontal approach of a few decades ago is replaced by a diagonal one, after the experiment with vertical programs in the 1990s and early 2000s was less convincing than anticipated by some. Equal access to quality primary health care is thus back on the global agenda, 35 years after Alma Ata. As the largest developing country in the world, China not only inspired the horizontal approach in the 1970s, but also experienced a substantial shift to a “laissez-faire” paradigm in recent decades, in the belief that this would boost economic efficiency.

In this editorial, we reflect on China’s health development paradigm shift from a historical perspective and argue that there are other paths conceivable towards UHC, going beyond the diagonal approach now advocated by the World Bank. Strengthening a country’s health system with a view on making progress towards UHC can focus on some specific building blocks and functions, step by step, “crossing the river by feeling for the stones”, as Deng Xiao Ping would have called it.

Even if there are some dissenting voices, it is well documented that in Mao’s time, China managed to achieve a dramatic health improvement through a grassroots-based, deprofessionalized and low-tech health development paradigm. A three tiered village-township-county referral system with so called “barefoot doctors” serving at the village level, supported by a cooperative medical scheme (CMS) funded by the collective economy, was established to cover more than 80% of the rural population. By focusing on and adopting a feasible solution for the vast rural areas, China underwent its epidemiologic transition (in terms of control of infectious diseases and increase in life expectancy) at a very low economic development level, many years ahead of similar nations. China’s public health success in the 1970s was obvious, as can be inferred from the great reduction in infectious diseases. The barefoot doctor approach, aiming at delivering basic health care by people who had received little modern medical training, inspired the “horizontal approach” and became one of the role models for the Primary Health Care initiative in Alma Ata. However, no rigorous study has yet been conducted to identify the Chinese “magic bullet”. Although acknowledged by some international authors, the pivotal role of the Chinese national “Patriotic Health Campaigns”, which engaged the whole society to improve hygiene and sanitation, has been somewhat neglected so far. In Mao’s era, “People’s War” was actually considered as the solution to all public problems. What really mattered for the success, and is widely accepted as such by most Chinese national policy analysts, was not the roll-out of barefoot doctors that had no more than secondary education and no formal medical training in providing quality care, but rather the involvement of the whole Chinese society, through mass mobilization. Mass campaigns, embedded in a so called “mobilization culture”, helped improve hygiene and sanitation and were probably the decisive factor. The battles against smallpox, schistosomiasis and lepra were all typical examples of this approach and even the presence of barefoot doctors all over the country was one of its products.

The market-oriented economic transition since 1978 posed great challenges to China’s health system, as it was trying to catch up with a rapidly changing context. In the early 1980s, the CMS almost collapsed overnight along with the rural collective economy, transforming village doctors into profit-chasers who heavily began to rely on selling drugs. In 1992, Deng Xiaoping reaffirmed the need for fast and large scale adoption of market forces to boost economic development. Under Deng and his successors, China became, at least partially, a market economy, and the country leaders opted for a more “laissez-faire” paradigm than in Mao’s era. With the gradual withdrawal of the central planning system, the government was unable to financially support the oversized public sector (for example public hospitals and schools) any longer. Efficiency and modernization increasingly showed up in central considerations. “Autonomization” of public providers became the buzzword and health facilities were allowed to fund themselves through profit from more services, prescription of drugs and adoption of new technologies. Health development in China thus witnessed a major shift from a community-based approach to a facility-based one (especially hospitals), providing increasingly specialized care.

As China moved away from the horizontal approach, there were at least two major consequences. Firstly, boosted by increasingly common beliefs on science and technology as the primary productive forces in society, many health providers in China voluntarily and eagerly jumped on the modernization bandwagon. A quick glance at some of the large hospitals in China 30 years later, not only in developed metropolitan areas like Beijing and Shanghai, but also in second tier cities, shows a great convergence with the most advanced hospitals in the developed world, if not technological superiority. Secondly, the reforms towards more autonomization were accompanied by deregulation and monopolies, which fundamentally altered the behavior of the various health organizations considered as public providers. They, along with the lack of health insurance coverage, were responsible for the high incidence of medical impoverishment since the 1980s. As a result, in 2000, when the World Health Organization ranked the health systems of its 191 member states, China’s health system showed up in the lowest quartile with respect to providing fair financial protection.

After SARS (2003) and particularly after 2005, when the Development Research Center of the State Council, a key advisory body which recommends policies to the central government, concluded that China’s health reform had basically been a failure since 1978, policy makers gradually started to recognize the problem with China’s health system in shifting away from the primary health care focus. Central policy makers, international agencies and scholars discussed ways forward. Finally, after receiving nine proposals of reform suggestions from various think tanks and institutions, including the WHO and World Bank, a new health reform was kicked off. Aided by substantial financial investment, the new campaign-like movement achieved universal population coverage by introducing various types of social health insurance in a remarkably short time (2003-2009). However, there was no consensus on whether the rapid extension of coverage really made a difference in achieving its ultimate goal – reducing medical impoverishment -, partly due to the distorted incentives for health providers (see here and here, for example).

The government realized that the huge financial investments were compromised by the system’s fragmentation in terms of service delivery, since patients in China now prefer large hospitals over community health services for primary care. Moreover, due to the financial decentralization, a key aspect of China’s transformation since the 1990s, coordination between fiscal capacity and responsibility of different levels faced great challenges. Huge fragmentation could also be seen at the central level. At some point, no less than a dozen ministries were responsible for health issues, with all the bickering and jockeying for departmental interests that can be imagined. Now the biggest challenge for China is how to integrate and coordinate the financing and service delivery functions of its health system. Should the public hospitals go further on the path of the last decades, from increasingly autonomous entities towards fully privatized corporations, in which case the government could shift its focus to the provision of community health care? Or should public hospitals instead again become fully funded by public resources and function as real public providers? Since formal staff nominations in public hospitals are currently based on government tenure quotas, a deepening of political reforms should be on the agenda.

Two points warrant attention according to China’s experiences in recent decades. Firstly, contexts are always important. The horizontal approach was inspired by the barefoot doctor system, which was successful in Mao’s time. The approach needs to be adjusted to changing settings and environments; for example, it is unlikely mass mobilization like in Mao’s time still has a lot of appeal in an increasingly individualized society. Moreover, the Chinese example showed that the approach has its limits in terms of – sustainably – providing quality care. The primary health care approach needs the support of qualified staff to deliver the services, if it is to be successful and sustainable. Secondly, as China has demonstrated in recent decades, strengthening a national health system towards UHC may go beyond application of a diagonal approach, or “crafting priority disease-specific programs to drive improvement in the wider health system”, an approach which is no doubt valuable in many settings towards health systems strengthening and UHC reform. In China, however, reforms started in the 1980s by strengthening the service delivery function, along with the market-oriented transition. Unfortunately, with the increasing focus on efficiency, equity issues arose. Reforms then focused again on the financing function to correct the equity problem, after 2005. Again this was easier said than done, as substantial government financial efforts proved to be compromised by the new service delivery situation, whereby people had “learnt” to bypass community health centres and go straight to big hospitals. The road towards UHC can thus be complicated, and policy makers should be nimble in dealing with the many and sometimes surprising hurdles they encounter on the way. Without any doubt, though, national ownership and stewardship are indispensable to make progress. This, also, China has proved over the last decades.



Obama & Bush in Africa


1.    Washington Post- Bush AIDS policies shadow Obama in Africa

The Washington Post examines how a focus on policies implemented under President George W. Bush — specifically PEPFAR — overshadowed President Obama’s three-country tour of sub-Saharan Africa. Obama obviously read the article himself, as he reacted to it on Monday. He obviously defended  his administration’s efforts in Africa. “The program (i.e. PEPFAR) is treating four times as many people as it did when it began in 2003, Obama said, and it has reduced costs considerably.” He also said his administration has shifted some of the savings to other global health initiatives, including tuberculosis and malaria alleviation. And he pointed to the very different situation he faced in Congress, as compared to his predecessor – with the budget constraints now, and a hostile Republican House not very keen on aid. He added in Cape Town that the goal of U.S. policy under his administration is to increase capacity for South Africa and other nations to manage their own programs to fight the disease, rather than rely largely on U.S. funding.


As already mentioned in the introduction, Obama’s focus was, first and foremost, on food security. He’s in sync with the times and the mood in Africa, it appears: check out a Guardian report on a recent meeting of African leaders on agriculture in Addis Ababa. At the meeting, the African leaders pledged to reprioritize agriculture in their national policies.  “Ministers promised to accelerate efforts to meet the targets of the Comprehensive Africa Agriculture Development Programme (CAADP), which emerged from the Maputo agreement in 2003 and committed African governments to spend 10 percent of national budgets on agriculture and increase productivity by six percent.”

Another key focus of Obama was electricity access, see  Humanosphere on the new Obama initiative for Africa in this area. In Tanzania, he also announced another new venture, ‘Trade Africa’, which aims to increase the flow of goods between the US and SSA.

2.    Foreign Affairs – Missing in Africa

Todd Moss;

CGD’s Todd Moss updated his Foreign Affairs article of October 2012, during Obama’s visit. “U.S. President Barack Obama’s ongoing trip to Senegal, South Africa, and Tanzania is his best — and perhaps last — chance at Africa policy redemption. After the five disappointing years of false starts, inattention, and policy drift that I wrote about below, this visit could set the stage for a strong finish.”   A nice read, and it will be interesting to see whether Obama’s visit is indeed the beginning of a strong finish in the last years of his presidency.

  • You might also want to read a NYT profile of George Bush’s current work in Africa. “…. Now out of office, he has devoted his post-presidency in part to continuing to aid the world’s poorest continent.  Since leaving office, Bush has quietly returned to Africa three times, renovating health clinics and expanding screening and treatment programs to fight cervical cancer (see also this new UNAIDS Feature article on UNAIDS support to the Pink Ribbon Red Ribbon initiative); … Africa and global health have become a Bush family affair,” as the newspaper points at the global health-related activities of Laura Bush and daughters Jenna and Barbara.


  • As for the Ladies Summit (2-3 July), Laura Bush & Michelle Obama joined First Ladies of Africa in Tanzania to advocate for improved health and welfare for women across Africa. The Summit, ‘Investing in Women: Strengthening Africa’, was convened by the George W. Bush Institute, in partnership with ExxonMobil. (Americans will always be Americans) The summit highlighted the critical role First Ladies can play as advocates for women and girls, emphasized success stories and best practices and encouraged public-private partnerships that lead to sustainable results for women in Africa.


7th IAS conference in Kuala Lumpur and other HIV news


3.    BMJ (news) – Access to HIV drugs should be widened, says WHO

Anne Gulland;

Antiretrovirals to treat adults with HIV should be given earlier and to more people, new guidelines from the WHO have said. The guidelines, which are aimed at low and middle income countries, state that all countries should start treatment in adults with HIV when their CD4 cell count falls to 500 cells/mm3 or fewer, even if they are not sick or showing any symptoms. The guidelines were released on the opening day of the 7th International AIDS Society (IAS) conference, and also provide some other recommendations. The guidelines also mean the total global spending on AIDS  will rise by about 10 percent, according to Gottfried Hirnschall, director of WHO’s HIV department, but it’s unclear how willing donors will be to pitch in for even more AIDS treatments…


4.    Report UNAIDS, WHO & UNICEF – Global update on HIV treatment 2013: Results, impact and opportunities

A new report from UNAIDS, the WHO and UNICEF, titled “Global update on HIV treatment 2013: results, impact and opportunities” was also released at the 7th IAS Conference, in conjunction with the new WHO treatment guidelines. It shows a “record 9.7 million people living with HIV were accessing treatment in 2012 compared to just over 8.1 million in 2011 — an increase of 1.6 million in one year alone.” By making smart choices, UNAIDS estimates that treatment can be further expanded within the existing resource needs of between $22-24 billion for 2015.


5.    MSF report – Untangling the Web of ARV Price Reductions

Also on Tuesday at the conference, MSF warned that rising intellectual property rights are blocking the generic production of newer drugs to treat HIV and are keeping them out of reach for developing countries. “The price of first- and second-line antiretrovirals to treat HIV are falling because of increased competition among generic producers, but newer ARVs continue to be priced astronomically high.”


A number of other reports were also released, including an important report on HIV prevention R&D.  Recent breakthroughs in HIV prevention research have confirmed the promise of new prevention options to help end the AIDS epidemic and highlight the urgent need for ongoing research to develop additional prevention options and support rapid rollout of proven ones. However, sustained funding is vital, as funding has actually plateaued. (see also a Science Speaks article on this report).


6.    UNAIDS – UNAIDS and Lancet Commission address strategic challenges for the future of AIDS and global health

Strategic challenges for the future of the AIDS response and global health were discussed at the first meeting of the UNAIDS and Lancet Commission: From AIDS to Sustainable Health, which was held in Lilongwe, Malawi, from June 28-29. “Three main issues were debated during the two days: the need to harness shifting global and domestic resource flows for health; trade, innovation and commodity security; and the democratization of global health.”




7.    Foreign Policy – The Middle East Plague goes global

Laurie Garrett;

Laurie and many others are worried about MERS, especially as many pilgrims will visit Mecca this fall.



8.    Lancet (Comment) – Assessing the pandemic potential of MERS-CoV

Chris T. Bauch et al.;

Laurie might feel relieved when reading the conclusion of Bauch et al in the Lancet, commenting on a Lancet study: “The analysis by Breban and colleagues concludes that MERS-CoV—in its current guise—is unlikely to cause a pandemic.” A key reason lies with MERS’ (likely rather low) basic reproduction number (R0), the average number of infections caused by one infected individual in a fully susceptible population.   But true, “in its current guise”, doesn’t sound that comforting.


UHC & post-2015  (including Turkey lessons)


9.    MSH – Achieving Successful Universal Health Coverage Depends on Medicines Management

Douglas L Keene;

Management Sciences for Health (MSH) has a number of very interesting articles and blog posts on the importance of access to medicines for UHC. Check out this one by Dr. Keene, for example, but also this this one on ‘ten takeaways for a dialogue on Medicines as part of UHC’ (by Anita Wagner & Dennis Ross-Degnan). The one by Megan Rauscher is also a good read.  More in general, the blogs report on a recent meeting (June 2-4) by  Management Sciences for Health, in collaboration with the Rockefeller Foundation and Harvard Medical School’s Department of Population Medicine, and additional support from PAHO and USAID, which  brought together representatives of countries working towards UHC, private insurance schemes, and medicines and financing experts from across the globe to start a dialogue around medicines coverage under UHC.


10. Lancet (Correspondence) – Embracing delivery science for universal health coverage

Albert Mulley et al.;

Mulley at al welcome the growing support for UHC as a unifying post-2015 health goal, but stress that “unless UHC is associated with a commensurate commitment to apply health-care delivery science, improvements in coverage risk hitting the target while missing the point”.

11. Lancet (Global Health blog) – The power of ideas and the ideas of power: from research to policy in global health

Julio Frenk;

When you think of Julio Frenk, the word ‘power’ naturally comes to mind. So it is appropriate the Lancet Global Health invited him to write on the power of ideas and the ideas of power, with respect to the current UHC momentum. “The path is clear: research and policy should walk together. Scientifically derived evidence must be the guiding light for programmes and policies in national governments, bilateral aid agencies, multilateral institutions and civil society organizations. When we can achieve this convergence, we will have at last integrated ideas and power.” Nice blog post.

12. UHC forward – Post-2015: Sustainable health development requires universal health coverage

Jonathan Quick;

Jonathan Quick, President of Management Sciences for Health urges the global community to include UHC as a part of the post 2015 health target. (he’s not alone)


13. Lancet Global health (blog) – The road to Abuja +12: Africa is moving

Mustapha Sidiki Kaloko

Mr Kaloko, the Commissioner of Social Affairs of the African Union Commission, looks ahead to the upcoming Special Summit on AIDS, TB and Malaria (“Abuja+12”). He sounds upbeat.


14. WHO Bulletin (Editorial) – Placing populations’ health at the heart of the post-2015 agenda

Carole Preserna for the Post-2015 Working Group of the Partnership for Maternal, Newborn and Child Health;

WHO Bulletin has a new issue. In this editorial, Carole Preserna emphasizes: “The post-2015 sustainable development framework, with its focus on four overarching areas, offers an opportunity to build on the MDGs. A transformative agenda that prioritizes the most disadvantaged people everywhere, and especially women, children and adolescents, will yield the greatest benefits.


There’s a lot more in the Bulletin’s July issue (see also below).


15. Guardian – El Salvador abortion controversy shows lack of progress on Cairo agenda

Luisa Cabal;

On Sunday, delegates from the UN, governments and civil society will gather in The Hague for a four-day conference. The event is part of a comprehensive process taking place at the UN ahead of the 20th anniversary of the International Conference on Population and Development in September 2014. The aim is to review and assess progress towards goals aimed at ensuring women’s reproductive rights. The sorry Beatriz case in El Salvador of a while ago shows there’s still a lot of work. “As the world prepares to review progress on the Cairo agenda and set the stage for the new development agenda in 2015, when the millennium development goals expire, we must ensure that human rights are non-negotiable so that women are able to live their lives with dignity, respect and equality”, argues Mrs Cabal.


16. Lancet (Offline) – Offline: The Turkish paradox

Richard Horton;

Horton says the Turkish health care reform offers many valuable lessons for the world, on the road towards UHC, but argues the current social unrest and the poor reaction of the Turkish government should also give the world’s leaders food for thought, as they embark on reforms. “When your politics is out of step with public hopes, tension will build, and perhaps explode.” (by the way, Horton himself exploded on Twitter, yesterday, for a very different reason: “We need to topple the meagre “leaders” who are taking our universities into the circles of hell. We need a peaceful coup.”  etc. (I feel your pain, Richard)  )


17. World Bank – Universal Health Coverage in Turkey: “Pearls” Emerging from the Pressures of Ambitious Reforms

Tim Evans;

Tim Evans went to Turkey recently, and his first WB blog post thus focuses on the Turkish Health Transformation Program (HTP), which offers a number of lessons for other places in the world who are also contemplating UHC reforms. Professor Akdağ, who was the Minister of Health during the HTP, provided seven UHC “pearls” distilled from his experience leading the HTP in Turkey. A good read.


18. UHC forward – AfDB facilitates Africa-Asia knowledge exchange on Universal Health Coverage

Poverty still remains a major barrier to healthcare access in Africa”, said Dr. Agnes Soucat, Director, Human Development Department of the African Development Bank setting the tone for the Africa-Asia dialogue on achieving UHC in Africa that took place in Lusaka, Zambia from June 25 to 28. During this 4-day experience, participants benefitted from lessons learnt on health financing reforms in Cape Verde, China, Ethiopia, Ghana, India, Malaysia, Mongolia, the Philippines, Senegal, Singapore, South Africa and Thailand.


19. NEJM (review article) – Mental Health and the Global Agenda

Anne E. Becker et al.;

The authors assess mental health’s current position on the global health agenda. They conclude: “Despite the dispiriting near-term forecast regarding improved quality and accessibility of mental health services in poor countries, important advances have been made in the requisite scientific knowledge base and political will to develop and implement policies that can upend these inequities and reset expectations for both the quality of global mental health care and the access to it. Closer alignment with the overarching agenda for global health is evident in the strengthened political commitment to mental health care and in the multilateral partnerships marshaling the resources to improve mental health in countries with limited resources. Several major initiatives have directed funding and attention toward addressing global mental health needs.”  So mental health has arrived on the global health agenda; establishing it as a priority at the highest level will be essential to match aspiration to need.


Global health data


20. Lancet Global Health (Comment) – A database on global health research in Africa

Francis Collins et al.;

This comment describes the portfolio of nine major research-funding and research organizations active in sub-Saharan Africa in an attempt to improve the coordination of international efforts in this field. The data are available on the World RePORT website created by the US National Institutes of Health, showing clusters of investments and gaps in research funding.

21. PLOS (Essay) – Reflections on the Global Burden of Disease 2010 Estimates

Peter Byass et al.;;jsessionid=766789676A752646774F6E4FA06ED688

In this essay, Peter Byass and colleagues raise some questions about the recent high-profile Global Burden of Disease estimates, pointing out the data gaps (especially in LMICs) and the flaws of complex estimation techniques. By highlighting their strengths as well as challenges the authors contribute to the debate concerning the validity, reliability, transparency and plausibility of GBD-2010 findings.

22. Lancet Global Health (Correspondence) – INDEPTH launches a data repository and INDEPTHStats

Osman Sankoh et al.;

In a bid to improve the data and estimates for country, regional, and global health decision-making, the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) Network, which was created in order to fill vital gaps in global epidemiology, has also announced it will launch the first online data repository specializing in data from health and demographic surveillance systems in LMICs. Associated with the repository is INDEPTHStats, a website to visualise key demographic indicators that is freely accessible online.


Check out also the Letter in the Lancet, from the same INDEPTH network.

In this letter, INDEPTH Network experts also emphasize the role of health and demographic surveillance systems (HDSSs) for tracking universal health coverage, based on the need for comprehensive data on health and service utilization to understand coverage patterns and monitor progress, and the need to complement less comprehensive national datasets with the rich HDSS data from vulnerable and marginal populations.

23. Lancet Global Health (Comment) – The global public health burden of sex work: a call for research

Brian Willis;

In this comment, a call for research to understand the global health burden of sex work is launched, in line with work on other issues which affect large and vulnerable populations, such as HIV and violence against women. The author provides some compelling arguments to start researching not only the unrecognised health issues of sex workers, but also their effect on other populations, including their clients, partners and, above all, their children.



Health Policy & Financing


24. Laurie Garrett (blog) – The “New Normal” is a Tight Belt

Laurie Garrett describes the sequestration in the US as the ‘new normal’, with all dire consequences you can imagine for global health programs.


As for the EU, you might want to read this short Action for Global Health blog post. Now that the EU budget negotiations are finished, the author argues for a 20% allocation of the development budget towards health & basic education: “Today the European Parliament approved a resolution on the EU budget, allowing the European institutions to begin work on how the funds will be spent within the different EU policies. Action for Global Health is calling for the institutions to ensure that 20 per cent of the development budget will go to health and basic education and ensure a better future for all”.


25. Chatham House (Meeting summary) – Identifying Sustainable Methods for Improving Global Health Security and Access to Health Care

In 2012, the Chatham House Centre on Global Health Security established two high-level Working Groups which aim to identify sustainable methods for improving global health security and access to healthcare, and to influence international and national policy-makers. This document gives a summary of the second meeting of the Global Health Working Groups on governance and financing, held on 17-18 April 2013. It also gives an overview of all the working papers you can still expect in the coming months.


26. CSIS (paper) – Indonesia steps up global health diplomacy

Murray Hiebert;

Indonesia is the new kid on the block in global health diplomacy. Read why.


27. Lancet (Editorial) – Legal highs and lows—illicit drug use around the world

This Lancet editorial gives some key messages from the just released annual World Drug Report, a report produced by the UN Office on Drugs and Crime (UNODC). The report summarises information on the worldwide manufacture and marketing of illicit drugs and guides appropriate actions by legal authorities and public health agencies. Although the overall situation is described as “stable”, the 2013 report highlights a striking rise in the availability of new psychoactive substances (NPS).


28. WHO report – Women’s and Children’s Health: Evidence of Impact of Human Rights

Flavia Bustreo, Paul Hunt et al.;

This report, the first of its kind, asks: what evidence is available to policy-makers that human rights have helped to improve women’s and children’s health? It considers whether or not evidence of beneficial impact supplements the compelling moral, political and legal reasons for adopting a human rights-based approach (HRBA) to women’s and children’s health.


29. Guardian – Environment, education and health need urgent progress, says MDG report

Mark Tran;

With less than 3 years till the deadline, Sub-Saharan Africa and southern Asia lag behind the rest of world, according to the annual MDG (update)  report, with targets on child and maternal deaths, and sanitation significantly off-target.


Read also a post on Global Post’s Pulse blog on this UN progress report, by Elizabeth Stuart. “”In all regions of the world, fewer children are dying. But wealthier regions are progressing faster. …The most progress has been made among children between the ages of one and five, … because interventions for many deadly diseases, like measles and polio, are logistically simpler to address.” In addition, “while overall child mortality rates have dropped 2.5 percent per year since 1990, infant death rates have declined by just 1.8 percent.


30. Guardian – Encourage countries to strengthen their own health systems, DfID told

The UK needs to do more to encourage poor countries to strengthen their own health systems so that aid for malaria has a more lasting impact, a government watchdog said on Wednesday.


31. Performance Based Financing – Proving impact: options in terms of research designs

Ellen van de Poel

In this blog post, Ellen van de Poel (Erasmus University Rotterdam) summarizes discussions held at a recent workshop in Bergen  between academics and PBF implementers about the desirability and feasibility of various research designs to identify the causal impact of PBF. She covers discussions held within the dedicated working group (facilitated by Atle Fretheim from the Norwegian Knowledge Center for the Health Services, Oslo) and in plenary sessions.


32. WHO Bulletin (Editorial) – BRICS and global health: a call for papers

No need for an explanatory sentence here.


33. Plos – Combatting Substandard and Falsified Medicines: A View from Rwanda

Agnes Binagwaho et al.;;jsessionid=766789676A752646774F6E4FA06ED688

Agnes Binagwaho and colleagues describe Rwanda’s experience of pharmacovigilance for malaria and tuberculosis and call for a global treaty and leadership by the World Health Organization to address the global manufacture and trade in substandard and falsified medicines. See also her viewpoint in the Guardian on the same topic.


34. WHO Bulletin – Using TRIPS flexibilities to facilitate access to medicines

Dianne Nicol et al.;

Another article in the new WHO Bulletin tissue, on using TRIPS flexibilities to facilitate access to medicines, drawing upon an Australian example.


In related news, read also the recent JAMA  viewpoint, ‘Balancing Access and Innovation India’s Supreme Court Rules on Imatinib’. The viewpoint puts the recent court cases in India in perspective.


35. – Innovative finance can boost global health R&D

Trevor Mundel;

There is vast untapped capacity to develop and deliver medical products, says Trevor Mundel of the Gates Foundation.


36. BMJ (Editorial) – Health in all policies

Ilona Kickbusch;

Ilona Kickbusch comes back on the book ‘Health in all policies’, which was launched in Helsinki. Although she’s fairly critical, she concludes: “Nonetheless, if this new focus means that after decades of medicalising health we accept that most of health is created not by the actions of health ministries or the healthcare system, but by many different policies and by actions in society and everyday life, that surely is progress. If health in all policies is successful as a proxy term to highlight that we need to govern health differently I am 100% on board.”



Global Fund update


37. Aidspan – Several Aspects of the NFM Have Yet to Be Finalised

David Garmaise;

With only six months to go before the expected full rollout of the new funding model (NFM), several aspects of the model have not yet been finalised. Garmaise lists these issues.


Read also this short AFGH blog post, which says there’s still a lot of uncertainty about the Incentive Funding Stream.

38. Aidspan (Analysis) – The Global Fund Has Provided Few Details on the Recovery of Funds Identified as “Losses”

David Garmaise;

The Global Fund Secretariat says that it has taken measures to speed up the recovery of amounts identified as “losses” by the Office of the Inspector General (OIG), and that it expects to be able to report significant progress during the rest of 2013. However, few details have been provided so far, either on the amounts that the Secretariat is attempting to recover and has recovered, or on the measures that have been taken to speed up the recovery process.




39. Plos One – Global Epidemiology of Mental Disorders: What Are We Missing?

Amanda J. Baxter et al.;

This paper reports an overview of the strengths and limitations found in current epidemiological research on mental disorders, identifying strategies to strengthen the data needed to inform effective planning and public health policy. As expected, most studies identified through systematic review focus on the prevalence of mental disorders in high-income countries, while low prioritization of epidemiological research and wide variation in study methods severely limit efforts to advance the global mental health agenda.


40. Equinet Africa (discussion paper) – Literature review on codes of practice on international recruitment of health professionals in global health diplomacy

Yoswa M Dambisya et al.;

In this paper authors from the Regional Network for Equity in Health in Eastern and Southern Africa assess the extent to which African policy actors and stakeholders were involved in drafting and implementing the WHO Global Code of Practice on the International Recruitment of Health Personnel, discussing its strengths and weakness and implications for global health diplomacy.


Equinet also published an annotated bibliography to inform people working on different dimensions of social power, participation and accountability in health, which is central to developing people centred universal health systems. This useful resource can be found here.


41. BMC Public Health – The illusion of righteousness: corporate social responsibility practices of the alcohol industry

Sungwon Yoon et al.;

An interesting paper on corporate social responsibility tactics employed by the alcohol industry to counter attempts to regulate the sector, calling for urgent global public health action to reveal the misleading nature of these practices and develop an internationally binding instrument to enable countries to differentiate between genuine concerns and spurious altruism – which seems quite akin to what has been dubbed the ‘health-washing’ attempts of corporate food industry.


42. Global Public Health – Constitutional rights to health, public health and medical care: The status of health protections in 191 countries

Jody Heymann et al.;

This article examines the level and scope of constitutional protection of the right to health in 191 UN countries, examining how rights protection varied across the year of constitutional adoption, national income group and region, and vulnerable groups. Not surprisingly, only a minority of countries guarantee the constitutional right to public health, medical care and overall health, while the rights of children, disabled persons, elderly and socio-economically disadvantaged groups are guaranteed  in even fewer countries.

43. Journal of Health Planning & Management – The pursuit of political will: politicians’ motivation and health promotion

Yair Zalmanovitch et al.

In this paper, the authors claim that lack of political will to implement health promotion policy is usually not due to lack of individual courage or good sense, but to the lack of attraction of this policy area due to its unique features and structural conditions. Using tools related to public policy theory, the authors suggest a conceptual framework to explain these conditions and try to find answers to address the gap between declared policies and actual practice – in line with the need to better understand the political process to drive the SDH agenda.






  • Martin Ravaillon wrote a (timely) blog post on why cutting development assistance after a coup might be a bad response.


  • Jim Kim’s first year’s was assessed by Nicolas Mombrial, head of the Oxfam International’s Washington office. “Pretty good so far, but in terms of Jim Kim’s impact on the world’s poor, I’m afraid the jury is still out….”


  • Check out a few new ODI publications on localizing aid (see here and  here )



  • Read how the Green Climate Fund was almost “sold” to multinationals, in a Guardian article.



  • OECD’s (first) take on post-2015 development: (see here )

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