In spite of the off-season, this week was again filled with news from the global health scene, informed by articles and reports from leading journals supported by reflections from the field. Interesting enough, but since my office is plagued by a heat wave I will not linger in editorial small-talk at this stage but get down to business straight away – which is what you’re here for anyway.
The guest editorial this week is from Pierre Massat, our man from QUAMED who has read an extensive report about the problem of falsified and substandard drugs and now speaks his tongue. We also draw your attention to an article published in a leading journal by EV2012 Joseph Zulu about the development of a human resource for health strategy in Zambia, and the launch of our new EV website which offers a more up-to-date and dynamic web environment. We hope our readers will find the site not only more attractive, but also more user-friendly.
Thanks for reading and enjoy (what is left of summer break :-/)
Peter Delobelle, Kristof Decoster, Ildikó Bokros, Basile Keugoung & Wim Van Damme
What’s the difference between fake sneakers and fake medicines?
By Pierre Massat – QUAMED Program Manager, Institute of Tropical Medicine
When people talk about the quality of medicines, they almost invariably end up pronouncing the word “counterfeit”. The problem stretches far beyond, though, and the consequences on the global public health are substantially bigger than in the case of fake sneakers or sunglasses. Although quite technical, the essence of the subject is not that difficult to understand, provided that someone takes the trouble to frame the problem with precision and show you the big picture.
Global Health News
1. WHO Bulletin (Editorial) – Universal health coverage and universal access
In the August issue of the WHO Bulletin David Evans and colleagues in their editorial explain the difference between universal health coverage (UHC) and universal access (i.e. accessibility, affordability, acceptability). In addition, Joseph Kutzin outlines the policy implications of working towards UHC in this (previously published) article and the systematic review and meta-analysis of Rahman and colleagues on interventions for common perinatal mental disorders in women in LMICs is also finally published.
2. NEJM (Review article) – Measuring the Global Burden of Disease
In this article, Murray & Lopez review the methodology used for assessing the Global Burden of Disease study 2010, its strengths and weaknesses, the improvements made over time, and some insight into the changing pattern in global health as evidenced by its findings (demographic changes, changes in causes of death, and changes in causes of disability), taking the large regional and national variations in consideration. These results can be used for benchmarking, and regular updates will be provided annually, as new data or major new studies are released.
3. The Lancet (Comment) – The dangers of being born too small or too soon
In view of the surprisingly high proportion of Asian and African newborn babies who are born too small, but neither preterm nor low birthweight, as reported in the article of Katz et al. (published earlier online), Stoltzfus & Rasmussen in a comment wonder how high the mortality risk of this category is and argue for elucidation of differences in risk of mortality among types of small-for-gestational-age babies. They also discuss some of the methodological challenges of the former study and the need for stronger datasets with fewer assumptions and additional information, such as length-at-birth.
4. IDS – Getting the key data on hunger and undernutrition
In line with the increasing global (and local) commitment to reduce malnutrition, as indicated by this comment in the The Lancet Series on Maternal and Child Nutrition, the Institute of Development Studies (IDS) has published the first instalment in a new series with key data on government commitment to reduce hunger and undernutrition in developing countries to improve transparency and accountability of policymakers.
So far data are available for Malawi and Tanzania, based on research findings from the Hunger and Nutrition Commitment Index (HANCI), which compares laws passed, policies and strategies, as well as public spending in 45 developing countries.
5. WHO – Celebrating World Breastfeeding Week: Only 1 in 5 countries fully implement WHO’s infant formula code
In line with the theme of this year’s World Breastfeeding Week, which is celebrated worldwide in more than 170 countries, WHO and its partners call for more support for breastfeeding mothers. Although exclusive breastfeeding is recommended for the first six months of life, actual practice remains low and only 37 countries, or 19% of those reporting to WHO on their implementation of the International Code of Marketing of Breast-milk Substitutes, have passed laws reflecting all of its recommendations.
Breastfeeding is the best source of nourishment for infants and young children as well as one of the most effective ways to ensure child health and survival, and although the benefits of breastfeeding are well documented worldwide, the number of children that is being exclusively breastfed has improved very little for the past several decades due in part to large countries with low breastfeeding rates and due to the general lack of a supportive environment for breastfeeding mothers.
6. Plos Medicine (Editorial) – Translating translational research into global health gains
The promise of translational medicine has attracted increased interest in translational research, and governments and funding organisations have invested heavily in global public-private partnerships to fuel the development of new vaccines, diagnostics, and treatments that might benefit the global community. In this editorial, it is argued that, while there is potential for translational medicine to improve global health (as shown by the recent development of Xpert MTB/RIF to detect TB drug resistance in a matter of hours instead of weeks), the advances must be both affordable and accessible to all countries, regardless of income. The editors also highlight how adherence to reporting standards and guidelines will lead to better quality studies in this field.
In a similar vein, Maruthappu et al. in a The Lancet Global Health Letter argue for the formulation of a global framework to translate human suffering in global health equity by integrating research, pharmaceutical, political, and non-governmental organisation interests in a multi-stakeholder network with a shared goal. Based on this framework, the authors propose to apply a translational lens to global health, by integrating basic, social, and political sciences with epidemiology, health partnerships, and eventually on-site services in order to form a science-to-service continuum that is evidence-based and focused on the global population and sustainability.
7. The Lancet Global Health (Comment) – Development of a post-mortem procedure to reduce the uncertainty of causes-of-death in developing countries
In this comment, the authors report on the creation of a global consortium of academic institutions with expertise in clinical and socio-anthropological research in LMICs to define and standardize procedures to make minimally invasive autopsy a feasible and acceptable alternative to the more problematic routine complete diagnostic autopsy in resource-poor settings. So far a validation exercise as well as social sciences research is being undertaken in order to assess the reliability and feasibility of this approach.
8. WB (Blog) – Road injuries and NCD: A hidden health burden in sub-Saharan Africa
Patricio Marquez and Jill Farrington in this blog draw attention to a recently released WB report: ‘The challenge of non-communicable diseases and road traffic injuries in sub-Saharan Africa: An overview,’ which suggests that NCDs and road traffic injuries should not be tackled as vertical health programs, but addressed together as part of an integrated approach focusing on functions (prevention, treatment and care) rather than disease categories.
9. AIDS.gov – Presidential Proclamation: World Hepatitis Day
In order to mark the global observance of World Hepatitis Day, the White House last Sunday hosted an event which brought together more than 200 stakeholders from the domestic and global viral hepatitis community. The event followed the Presidential Proclamation of World Hepatitis Day which was meant to raise awareness and ‘break the silence’ around this silent epidemic.
10. PlosMedicine – The growing problem of MDR-TB in North Korea
In the absence of surveillance data, international aid to the North Korean national TB program has ignored the possibility that drug-resistant TB strains are widespread, as is the case in Russia and China, and until effective treatment is made available MDR-TB patient will continue to be a source of transmission, the author of this article claims.
The issue is also covered in this article in The Atlantic, in which the author denounces the lack of support from global health actors to address the matter efficiently, leaving room for aggravation of the situation.
Meantime, NPR reports on an innovative program to tackle the problem of MDR-TB in Russia by using a mobile clinic with teams of nurses orbiting like satellites around the sprawling city of Tomsk, finding and treating patients with drug-resistant TB. The program is run by the local Health Department in partnership with Partners in Health and has prompted other Russian cities to start programs of their own.
Aid & development
11. IRIN – Analysis: The UN in 2023
In this news report IRIN asked analysts and UN staff what broad changes in approach, structure and attitude UN agencies need to make to better fit our humanitarian future, and based on the answers given, it looks like the sector will have to re-invent itself 😉 IRIN also asked some of the world’s leading experts to speculate on the future of food aid, and discuss some of the threats and challenges over the coming decade.
Likewise, a number of interesting blogs and articles were posted on the merger of aid, trade and foreign policy, the charitable-industrial complex and why some people have a clue about where the aid sector is heading, whilst others clearly have not, and other insights into the future of aid and development (off-season seems to be pretty good for reflecting on some issues).
12. CGD – The financial flows of PEPFAR
In this new CGD policy paper, Victoria Fan and colleagues track the financial flows of PEPFAR from donor agencies via intermediaries to prime partners, showing that in 2008 most large recipients were US based and that only 8% of the total was allocated to developing country governments as prime partners. The authors also identify some weaknesses and inconsistencies in the selection of focus countries and argue for more transparency in the process.
USAID, in the meantime, proudly announced that the organization kept its promise on aid transparency by updating its US Foreign Assistance Dashboard, including 53,000 financial transactions from the first 3 quarters of fiscal year 2013 (!). As Rajiv Shah, USAID Administrator said in this blog post: ‘Never before has our Agency published spending data so comprehensively and so soon after the close of the quarter.’
13. CGD – Global health fares relatively well in US global budget appropriations
Both the House and the Senate matched the President’s FY14 request for global AIDS spending, which is good news in the current budget climate, argues Jenny Ottenhoff in this blog post, although the $10 billion chasm between approved House and Senate bills suggest that they will likely not be reconciled. Pathfinder International also blogs about the issue and calls for action on several pro-family planning and reproductive health initiatives.
14. GF News Flash
This issue of the GF News Flash talks about the integration of a condition into its HIV grant with Vietnam requiring the government to identify an international organization to monitor compulsory drug detention centres; a pilot initiative in ten countries, which will provide additional funding to Country Coordinating Mechanism that are engaged with people living with or affected by the three diseases and key affected populations; and the need for accurate data in order to monitor program success and provide access to treatment and reliable supply of medicines, especially for populations most at need.
Meantime, the International HIV/AIDS Alliance in her monthly newsletter focuses on civil society engagement in the Global Fund, sharing the experience of organisations linked with the Alliance who represent one of the largest civil society grant portfolios across countries and epidemics as diverse as Senegal, Ukraine and India. The Alliance also features an interview with Alvaro Bermejo, its Executive Director who just ended a two-year term on the Board of the Global Fund and recounts his experience here (in addition to which he seemed both excited and determined – but not optimistic – about getting the $15 billion that will be required at the replenishment conference later this year).
15. Globalization & Health – Global health initiative investments and health systems strengthening: a content analysis of global fund investment
This study indicates that a substantial portion of GF Round 8 funding was devoted to health systems strengthening, although the dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions.
16. Globalization & Health – Global health actors no longer in favour of user fees: a documentary study
study shows that the position of global health actors in the debate on user fees seems to have shifted, although translation of the discourse into action is still to materialize in many LMICs. The authors recommend to provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced by these actors.
17. HRPS – Developing the national community health assistant strategy in Zambia: a policy analysis
In this paper Joseph Zulu and colleagues analyse the policy development related to the integration of a new cadre of community health workers, community health assistants, in the health system in Zambia. The paper clearly indicates the fact that actors’ power or position in the political hierarchy may, more than knowledge and understanding of the issue, play a disproportionate role in the process and content of policy reform.
The paper responds to a call for more health policy analysis to take the agenda of both human resources for health (HRH) and universal health coverage (UHC) forward, as it is unclear how actors and processes interact to develop health policies in LMICs. The argument is developed by Adam Koon and Susannah Mayhew of the London School of Hygiene and Tropical Medicine in this article.
18. HPP – Call for Papers ‘The Science and practice of people-centred health systems’
Finally, a call for papers has been launched by the journal Health Policy and Planning and the organizers of the Third Global Symposium on Health Systems Research to be organized in Cape Town next year, centred around the conference theme ‘The science and practice of people-centred health systems.’ You can access the call here.
19. End the Neglect – Colombia eliminates onchocerciasis
Last Monday, Colombia became the first country in the Americas to receive the WHO verification of elimination of onchocerciasis (i.e. river blindness), constituting another victory in the ongoing battle against NTDs.
20. FT – Tobacco groups blast Australia tax rise
In another ongoing battle – between tobacco companies and Australian government (after the introduction of plain packaging for tobacco products last year), the plan to raise A$5.3 billion through increased excise taxes on cigarettes has led Big Tobacco to describe the initiative as ‘a thinly veiled grab for cash from Australian taxpayers disguised as health policy,’ the FT reports.