Dear Colleagues,


This week the World Bank and the Institute for Health Metrics and Evaluation released six regional reports using findings from the Global Burden of Disease. The Go4Health  research consortium argues in a just published interim report that ‘realizing the right to health for all’ would make a great post-2015 health goal. The report will be presented  in Copenhagen next Monday – you can follow the satellite session here.


A special theme issue of the WHO Bulletin zooms in on women’s non-reproductive health this week – many of the authors reckon this should be part and parcel of the post-2015 health agenda. We also pay some attention in this newsletter to the WHO AFRO meeting in Brazzaville this week. Meanwhile, the preparations for the HSR symposium in Cape Town, 2014, are gaining momentum. For an update on HS Global and the preparations for Cape Town, see the HS Global newsletter. The call for abstracts will be launched shortly, by the way. No doubt many of the “most frequent” global health authors will again show up in Cape Town next year. To know who they are, you might want to check out this short  blog post: authors are ranked according to how many of their article titles included global health. Ronald Labonté is a worthy number one, if you ask me, but global health “conscience” Richard Horton is only number 5 …   On Twitter, he’s the champ though – Richard just tweeted about the need to get surgery taken seriously in global health (from the first meeting of the Global Surgery Commission).


You probably also keep an eye on the icy G20 summit in St Petersburgh – where health is not really part of the agenda, it appears (apart from the humanitarian crisis in Syria and neighbouring countries, of course). For the official Russian agenda ahead of the conference, see here;  if you want some analysis of the (likely) real agenda, see Andrew Norton (ODI).


The global treaty on domestic labour was  ratified this week, good news for the 100 million domestic workers around the world. A Lancet editorial zoomed in on child labour  – sadly, child labour is still a massive global problem. The International Labour Organization estimates that there are more than 215 million child labourers worldwide — robust and sustained action by nations and international bodies is needed to address this scandal, the editorial argues. Maybe the G20 can take this up, now that they have a robust chairman?


In this week’s guest editorial, our colleague Karen Van der Veken reflects on a recent FEMHealth consortium workshop at ITM.  In the process, she also assesses the shifting women’s health agenda at the global level.




Enjoy your reading.


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






Fee exemption policies for better maternal health… New tools, new knowledge?


Karen Van der Veken (Maternal and Reproductive Health Unit, Public Health Department,  ITM)


From 2 to 4 September, we welcomed our colleagues from the FEMHealth project for a workshop at the Institute of Tropical Medicine in Antwerp. It has been a fruitful workshop, so we see this week’s newsletter as an excellent opportunity to share what the FEMHealth project is about, and to give some preliminary results that have been discussed during this workshop. ITM’s partners in FEMHealth are the London School for Tropical Medicine and Hygiene, the University of Aberdeen, AFRICSanté (Burkina Faso), CERRHUD (Benin), CAREF (Mali), INAS (Morocco) et IRSS (Burkina Faso). Fabienne Richard, Bruno Marchal, Vincent De Brouwere, Dominique Dubourg and Karen Van der Veken take part in this project for ITM.

The FEMHealth project – short for Assessing the impact of fee exemption on maternal health in West Africa and Morocco: new tools, new knowledge – is part of the Seventh Framework Programme (FP7) of the European Union. This 3-year research project started in 2011 and its outputs will be discussed at a meeting of the Community of Practice “Financial access to health services”, to be held in Ouagadougou from 25 to 29 November 2013.

The objectives of FEMHealth are three-fold:

1)      to develop new methodological approaches for the evaluation of complex interventions in low income countries

2)      to improve the health of mothers and their newborns by performing comprehensive evaluations of the impact, cost and effectiveness of the removal of user fees for delivery care and Emergency Obstetric Care on maternal and neonatal health outcomes and service quality

3)      to improve the communication of this evidence to policy-makers and other stakeholders

The timing of FEMHealth is, of course, not a coincidence.  After the publication of country progress reports on the Millennium Development Goals (MDGs), to be achieved in 2015, it became clear that the 5th MDG showed little or insufficient progress. Mainly sub-Saharan African countries were found to lag behind. MDG 5, aiming to reduce maternal mortality drastically – among other measures through increased coverage of skilled assistance during delivery – and MDG 4 with decreased child and infant mortality as objective, are closely linked to the aim to reach universal health coverage. In an attempt to accelerate the progress on the 4th and 5th MDGs, several African countries have implemented fee exemption policies, targeting or including maternal health care services. Most of these policies aim at increasing the offer of high quality prenatal, obstetrical and postnatal care, and at making these services more accessible, especially for the poorest – often also those living furthest away from the health facilities. However, while the efficiency of these policies has often been the subject of evaluation,  very few studies have focused so far on the implementation process and the unintended, possibly negative, effects on both non-targeted services and population groups, and the target group itself.

Four focal countries are involved in the FEMHealth research project. Three of these countries belong to francophone West Africa – Benin, Burkina Faso and Mali – and one is situated in the Maghreb region, Morocco. All four countries introduced policies to remove fees  for (or largely subsidize) deliveries and caesarean sections and expressed a strong commitment to evaluating their reforms. None of them has as yet got a full evaluation of their policies. Policymakers from these countries worked in close collaboration with FEMHealth researchers. The research was organized along three thematic work packages: policy, local health systems and quality of care. Within each work package, research tools were developed or refined and research has been conducted. The teams responsible for the different work packages are currently refining and adapting the tools for other contexts and preparing the dissemination of the results.

Preliminary analyses of the abundant quantitative and qualitative data collected during this project indicate some methodological difficulties. These include the creation of tools that aim to capture the differences of impact in different sites within the same country, as well as tools to allow comparison between the four countries, each with a different policy.

Initial results from the POlicy Effect Mapping (POEM) studies and the realist case studies on policy implementation (carried out by work package 3 under the responsibility of the ITM team) show how effects of the (national) fee exemption policies are not only influenced by the policy design and its implementation modalities, but also to a large extent by factors at the local health system level and the context. The absorption capacity of the system, resource availability and power relations between health providers, community, managers and politicians interact constantly in the implementation process.

The existing literature on fee exemption policies focused mainly on good practices for policy implementation, based on the logic that the accompanying measures (such as communication towards the targeted public and health work force, guidelines and training for implementers, estimation of expected increases in service utilization and concomitant budget allocation for drugs, equipment, human resources, incentives…) will determine the degree of implementation. The FEMHealth project, however, found that whether a fee exemption policy will be adopted, ignored or adapted to the local context (in a positive or negative manner), depends very much on context-specific factors, timing, the nature of the motivation of the implementing actors (managers, service providers), and above all, on the  presence of effective stewardship which is able to align all actors’ interests with the public interest and to adapt the introduced policy to local and perceived health needs.

The outcome of fee exemption policies in terms of maternal and neonatal health status is difficult to assess. Maternal mortality is notoriously difficult to measure and financial barriers are not the sole barriers to qualitative health care. FEMHealth has confirmed that fee abolition without accompanying measures to increase the availability of care (including transport opportunities) and to preserve and increase the quality of care, may in the best scenario increase service utilization (including emergency interventions like caesarean sections), without necessarily improving the health outcomes for mothers and newborns. Partly depending on the reimbursement modalities and potential opportunistic behavior of health staff, a variety of perverse effects of these (potentially well intentioned) policies exist: health structures inducing the utilization of caesarean sections because they represent a financial advantage, service providers demanding informal payments in return for qualitative care, or worse, as a condition for treatment, or simply the users of the health system turning to private sectors in a desperate attempt to be treated correctly. This sometimes even leads to catastrophic household expenditure – the exact opposite of the policy’s main objective.

The dissemination of the results of FEMHealth aims at informing the discussion between technical and implementing partners in the preparatory stages of fee exemption policies in other countries. The hope is that this will lead to better design of the policies, including reimbursement modalities and sustainable financing methods, as well as enhancing monitoring and evaluation activities in order to effectively reach the intended positive effects of fee abolition for maternal health.

One might wonder though whether targeted fee exemption policies will live a long life. In an ideal world, targeted exemption policies will be replaced by subsidized insurance schemes. However,  recent experiences have shown that implementing UHC is even more complicated than implementing targeted fee exemption policies. Moreover, now that the debate on the post-MDG era is gaining momentum, the international community seems to be in need of some encouragement to continue the investment in maternal and neonatal health, which has shown insufficient progress despite years of increased financial and operational efforts. Some large institutional donors, traditionally prioritizing maternal and child health care aid in their budgets, are leaving countries where maternal mortality remains unacceptably high – e.g. Haiti where both UNFPA and CIDA will have withdrawn by 2014. It tastes somewhat  bitter that where development progress is not clear or rapid enough, objectives and priorities are reset before they get a fair chance to be reached. Donor-dependent NGOs copy-paste this attitude and hide behind carefully crafted logical frameworks where only those results that will be achieved for sure, are proposed.

Earlier this week, the World Health Organization set a new agenda in a special theme issue of the WHO Bulletin: women’s health beyond reproduction. The prevention and control of non-communicable diseases, including breast cancer and chronic diseases, now rightly receive the attention they deserve since many years. Several countries, especially those with significant progress on MDG 5, are confronted with a higher mortality and morbidity burden related to NCDs than to reproductive health matters. Priorities should indeed be reset according to actual and perceived needs. However, we should not forget that universally accepted objectives on maternal and neonatal health outcomes are far from achieved. It is too soon for development partners and external donors to disengage.


Post- 2015


1.    Interim Report Go4Health – Realising the right to health for everyone: the health goal for humanity

Go4Health is a research consortium that includes academic and civil society partners from Africa, Asia, Australia, Europe, North- and Latin America. The acronym stands for goals and for governance, both for health. Researchers are tasked with offering scientific evidence to the European Commission on the next set of global health goals, beyond 2015. Based on evidence from different research streams and a series of consultations with people in marginalized communities in 11 countries, they have formulated a first proposal of a new health goal for humanity and the elements of a supportive global social contract. They propose a single overarching health goal, the realization of the right to health for everyone, with two targets, universal health coverage anchored in the right to health and a healthy social and natural environment.


A Satellite session linked to the 8th European Congress on Tropical Medicine and International Health, will take place on Monday 9 September 2013, 5-7 pm, in Copenhagen.  Place: Tivoli Hotel and Congress Center, Arni Magnussons Gade 2-4, Copenhagen

You can follow the session online (live streaming) – see In case you want to ask a question during the session via Twitter, mention #Go4Health and the session organizers will notice.


2.    JAMA – Poverty, Health, and Societies of the Future

Jim Kim & Margaret Chan;

The growing momentum for UHC coincides with a new chapter in the global fight against poverty, Kim & Chan argue.

3.    Health Financing in Africa – The way to UHC: ideas beyond the dominant paradigm

Manuela de Allegri and Isidore Sieleunou were in Berlin last week at the GIZ Forum on Health and Social Protection. They enjoyed the conference on UHC,  but were really surprised by the fact that user fee removal was not discussed at all. (we know you often hear “this is a must-read”, but in this case you definitely won’t regret it; read also Rob Yates’ incisive comment below the post).


In other post-MDG & health news, the Skoll World Forum partnered with Johnson & Johnson, the United Nations Foundation and the Gates Foundation to produce an online debate focused on the last 850 days before the MDGs expire in 2015. They asked some of the world’s leading experts what is one thing we must do differently or better to achieve MDGs 4, 5 and/or 6 by the deadline.



Regional Reports GBD2010  by WB & IHME


4.    IHME & WB – Regional reports GBD 2010

The World Bank Group and the Institute for Health Metrics and Evaluation (IHME) have released six regional reports as part of The Global Burden of Disease: Generating Evidence, Guiding Policy. The reports explore changes in the leading causes of premature mortality and disability in different parts of the world and compare the performance of countries in a range of health outcomes. Individual reports, which document how each region is working to reduce health loss from most communicable, newborn, nutritional, and maternal conditions and what new challenges lie ahead, are available for sub-Saharan Africa, East Asia and Pacific, Eastern Europe and Central Asia, Latin America and the Caribbean, Middle East and North Africa, and South Asia.


The event at the World Bank featured Christopher Murray and Tim Evans. As  Katie Leach-Kemon points out on the Humanosphere blog, this is “a continuation of a longstanding partnership between the bank and burden of disease researchers that began two decades ago when the World Bank funded the first such study and featured its findings in the influential ‘World Development Report 1993: Investing in Health’ ”. A video of this week’s event can be found online here.



WHO Afro meeting in Brazzaville


5.    WHO Afro – Sixty-third Session of the WHO Regional Committee for Africa

The sixty-third session of the WHO Regional Committee for Africa took place from 2 to 6 September (in Brazzaville). You find the agenda, interviews, background documents, speeches (including one by a rather upbeat (or is it bullish?) Margaret Chan) on the website. The press releases you can find here. UHC Forward also has a short post on the appeal by the Regional Director for Africa of the WHO, Angolan physician Luís Gomes Sambo, to Health ministers to engage in the implementation of the sectorial reforms process, with a view to achieving  universal sanitary coverage. Apart from greater involvement of the countries in the implementation of the International Sanitary Regulation, UHC obviously also featured prominently in the discussions.



A team of WHO watchers is also attending the meeting and watching the process. The watchers include PHM Ghana, PHM Congo and MMI representatives. There’s already a report on the first day available on the website.


As for one of the important background documents, see :

6.     Health in the post-2015 UN Development agenda – Draft paper for WHO regional committees, 2013

This was one of the interesting background documents for the meeting in Brazzaville.

World Health Assembly resolution WHA 66.11 requested the Director-General to include the discussion of health in the post-2015 UN development agenda as an agenda item in the 2013 meetings of the WHO regional committees and to present a report on those discussions (through the Executive Board at its 134th session in January 2014, to the Sixty-seventh WHA).


At the United Nations High-level Plenary Meeting on the MDGs in New York in 2010 and the Rio+20 conference in Brazil UN Member States gave clear mandates to the UN Secretary-General on how the process of preparing for the United Nations’ post-2015 development agenda should unfold.  This Information report summarizes what has happened to date in response to both mandates and outlines the process leading up to 2015. It also briefly reviews the narrative that emerged from the global thematic consultation on health as well as how health has been addressed in the reports of the High Level Panel (HLP) and the Sustainable Development Solutions Network (SDSN), and during the initial discussions of the Open Working Group (OWG) in June 2013.


  • A shorter background document, ‘towards UHC in the African context’, gave the objectives of a panel discussion on accelerating progress towards UHC (see also here – scroll to the bottom).

WHO Bulletin special theme issue on women’s health beyond reproduction

This special theme issue wants to set a new health agenda for women, as 2015 (and thus the post-MDGs) are approaching and next year is also the end of the 20-year International Conference on Population and Development (ICPD) Programme of Action. This theme issue of the Bulletin and other initiatives, such as the Lancet Commission on Women’s Health, are intended to stimulate interest in women’s health beyond reproduction and to encourage joint, decisive action on the part of multiple stakeholders in promoting a life-course approach to women’s health.


In a nice interview with the Bulletin, Ana Langer talks about this new women’s health agenda: “The world still focuses very much on maternal health and, more recently, family planning, which definitely reflect critical needs. The predominant view today is still of women as reproductive beings, which unfortunately leads to neglect of women’s health in other stages of life. Women’s non-reproductive health (i.e. NCDs mainly) is becoming important as a public health issue, mainly due to population ageing and changing lifestyles, but health systems, especially in LMICs, are not prepared to deal with the double burden of disease among women.”


7.    Editorial – At the crossroads: transforming health systems to address women’s health across the life course

Flavia Bustreo et al.;

The authors of this editorial state: “Our intention is to underscore the changing nature of the health problems confronting women and to highlight policies and strategies that low- and middle-income countries can implement.” Also: “… The development of an evidence-based policy framework on the health of women across the life course is a formidable task for which WHO and its partners are seeking to bring together policy-makers and public health experts from around the world.



8.    WHO Bulletin (Perspective) – Recommendations towards an integrated, life-course approach to women’s health in the post-2015 agenda

Gustavo S. Azenha et al.;

Given the links between NCDs, maternal conditions and infectious diseases in women, it is essential that women’s health advocates and NCD experts unite in their commitment to promote women’s right to health throughout the lifecourse as a central component of efforts to strengthen health systems and to protect women’s health in a post-2015 environment.


9.    WHO Bulletin (Perspective) – Accelerating action towards universal health coverage by applying a gender lens

Judith Rodin;

As countries develop strategies for transitioning towards UHC, it is critical that government leaders and policy-makers take into consideration the unique health

needs of women, the president from the Rockefeller Foundation argues. She provides a number of suggestions on how to do this.


10. WHO Bulletin (Perspective) – Policy directions to improve women’s health beyond reproduction

Flavia Bustreo et al.;

In general, health systems, especially in LMICs, are not responsive to women’s needs and perspectives throughout the life course, even though

women remain the greatest users of health care. Many women do not have access to the health services that they need beyond those that focus on a narrow range of objectives linked to reproductive health and infectious disease control.    Several measures are required at the policy level to break down the barriers to improving women’s health. These policy directions need extensive discussion and require consultations within each country. Bustreo et al focus here on the three main objectives that should underpin policy directions: achieving UHC,  realizing human rights and strengthening health governance.



Various other articles are worthwhile reading:


  • “Why the time is right to tackle breast and cervical cancer in low-resource settings” (a Policy & Practice article by Vivien Davis Tsu et al): “The health concerns of women in their mid-adult years have long been given little or no attention in most low-resource settings, despite the heavy burden of suffering that diseases such as breast and cervical cancer impose on women and their families. The time has come to tackle these two cancers.
  • A ‘Lesson from the Field’ article by Agnes Binagwaho et al.  on  ‘Integration of comprehensive women’s health programmes into health systems: cervical cancer prevention, care and control in Rwanda’.  Rwanda has become the first country in Africa to develop and implement a national strategic plan for cervical cancer prevention, screening and treatment. Political leadership was critical in developing and launching a strategic plan, securing funding and commodities and building partnerships to address “a triple epidemiological, economic and moral imperative. Rwanda serves as an example of how cervical cancer control interventions can be integrated.



In other women’s health news, this week’s PLOS featured an article on preconception care in LMICs. In the Perspective, Joel Ray and colleagues discuss the challenges and opportunities for improving pre-conception care for women in developing countries.



Infectious Diseases





11. Scientific American – Malaria Mosquitoes Gain Ground as Search for New Defenses Intensifies

Cheryl Katz;

Companies and public health agencies are trying to develop low-toxic and inexpensive—yet powerful and long-lasting—new insecticides. (very nice article)



12. Guardian Global Development professionals network – The drugs don’t work: exposing fake and substandard antimalarials

Jasson Urbach;

What can be done stop the distribution of substandard drugs that make resistance worse, Urbach wonders. Among other things, tougher border control and regulation.


13. Lancet Editorial – Malaria prevention: civilisation versus disease

This editorial focuses on larval source management as a possible accompaniment to indoor insecticide spraying and long-lasting insecticide-treated bednets, and to socioeconomic development to counter malaria.




14. Science Speaks – Report highlights global HIV donor landscape

This article comes back on the KFF report on the global HIV donor landscape. (Science Speaks also has an article on the TB donor landscape (which was also the focus of a KFF report recently).)


15. Science Speaks – Study finds medical circumcision scale up reduces HIV incidence in the community

The roll out of voluntary medical male circumcision (VMMC) programs in highly affected areas not only reduces HIV/AIDS acquisition among heterosexual men, but also significantly reduces HIV levels in the community, according to a study published in PLOS Medicine this week.  The study also found that VMMC is not associated with changes in sexual behavior that may affect HIV infection rates.


16. Health and Human Rights – Access to HIV prevention in Rwandan prisons

Agnes Binagwaho;

By now, Agnes Binagwaho probably deserves her own section in this newsletter. In this blog, she assesses access  to HIV prevention in Rwanda prisons. She concludes: “With the evidence of HIV infection risk among prisoners, Rwanda should seriously consider whether it would be a smart decision to provide all tools for HIV/AIDS prevention in prisons—without restriction—in order to advance our fight against HIV/AIDS.  Such prevention could also lower costs associated with care and treatment. This fight is a global one, too. If we continue to ignore prison populations as a major risk group for HIV transmission, we will also continue to place intense pressure on national health systems and cause deep suffering amongst those infected and affected.”


In related news (on another risk group, though), the Lancet features a number of  Letters on HIV antiretroviral prophylaxis for injecting drug users  (see here and  here, for the most policy relevant ones).





17. WHO Bulletin (Editorial) – Rallying United Nations organizations in the fight against noncommunicable diseases

Oleg Chestnov et al.;

The demand for “how to” policy advice to support national efforts to deal with NCDs is very high. According to an analysis of 144 World Health Organization

country cooperation strategies that national authorities agreed to jointly, 136 strategies included requests for technical support for the prevention and control

of NCDs.  Nonetheless, current plans for meeting individual country needs in this

area are inadequate and will need to be replaced by a more holistic approach to

meet the rapidly growing demand from LMICs, Chestnov et al. contend.


On 22 July 2013, ECOSOC adopted a resolution requesting the

Secretary-General of the United Nations to establish a United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases. The Task Force, created by expanding the mandate of the existing United Nations Ad Hoc Interagency Task Force on Tobacco Control, will coordinate the activities of relevant UN organizations and other intergovernmental organizations as they support countries in their efforts to implement the WHO Global NCD Action Plan 2013–2020.


18. CGD – USTR: Export Good Tobacco Policies in the TPP

Amanda Glassman;

The Obama administration in the – by now familiar – role of public health villain, here in the TPP negotiations:

At home, the United States has enacted smart policies and made tremendous progress against tobacco-related deaths — efforts that should be ‘exported’ and replicated around the world.  In fact, more US effort to help LMIC improve their regulatory policies on tobacco would be a huge improvement on the current inattention to the issue in the global health space. For its part, the US Trade Representative Trans Pacific Partnership proposal is a step further back for international US leadership against tobacco.”  Hopefully, the Obama Administration will revisit its position ahead of a next round of talks, Glassman concludes.

19. CFR (Expert brief) – The Tobacco Problem in U.S. Trade

Thomas Bollyky;

The Obama administration should exempt tobacco control measures from legal challenge under the TPP in three ways, argues Bollyky.


20. Irin  – Rethinking mental health in Africa

As African countries strive to meet the MDGs by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill. It turns out Uganda is a role model.


In related news, read also (on Humanosphere ) how psychiatrists and traditional healers in West-Africa form an unlikely alliance.


Health Policy & Financing


21. Germany launches its global health strategy

On July 10th, so already a while ago, the German government launched its global health strategy entitled “Globale Gesundheitspolitik gestalten – Gemeinsam handeln – Verantwortung wahrnehmen” (Global Health Policy – Acting Together – recognizing responsibility). The goal of this concept is to make an active and consolidated contribution to solving the global health challenges of our time. As such it defines areas of action where Germany can play a vital role in improving health globally. At the core of the German global health strategy are the following three principles: (1) Protecting and improving health in Germany through global engagement; (2) Recognizing Germany’s global responsibility for health; (3) Strengthening international institutions for global health. The German strategy identifies the following key global health issues: tackling cross border threats, strengthening health systems worldwide, ensuring intersectoral cooperation for health, promoting and strengthening health research and the health economy, strengthening the global health architecture. (for the ones among you who know Goethe’s language, read all about it here).


22. Lancet World Report – India’s amended trials regulations spark research exodus

Shubhlakshmi Shukla;

Changes to trials regulations in India, designed to improve patient safety, have caused some research funders to halt their clinical work in the country. Shubhlakshmi Shukla reports.


23. JAMA  – Industry-Sponsored Clinical Trials in Emerging Markets – Time to Review the Terms of Engagement

Stephen MacMahon et al.;

The rapid expansion of clinical trial activity in emerging markets has raised concerns, including questions about the quality of data generated and the relevance of the products being tested to local health care priorities.


24. Equinet Editorial (of newsletter 151) – Health literate populations are the core of effective health systems

René Loewenson et al.;

In this editorial of the new Equinet newsletter, Loewenson argues that investing in health literacy should be as central to health systems as supplying medicines or training health workers.



25. Globalization & Health – Canada and access to medicines in developing countries: intellectual property rights first

Joel Lexchin;

Canadian reports have recommended that health as a human right must be Canada’s overarching global commitment and that the primacy of human rights should be prioritized over other elements of international law including international trade and investment law as it applies to access to pharmaceuticals. This paper uses a series of case reports to examine Canada’s commitment to this goal since 1998. Turns out Canada tends to prioritize intellectual property rights over access.


26. Speaking of Medicine – How Access to Life-Saving Antisera is Dwindling Fast, and What to do About it

Julien Potet, Policy Advisor on Neglected Tropical Diseases for the Access Campaign at MSF, describes the underlying causes limiting access to antisera in low- and middle-income countries. He wants this issue higher on the international agenda.


27. BMJ (Feature) – Compound interests: how a partnership between academics and a drug company came unstuck

Andrew Jack;

Andrew Jack reports on the latest twist in the debate over the role of an organisation that aims to broker greater collaboration in pharmaceutical research and development. The failure to reach agreement between a leading Italian medical research organisation (the Mario Negri Institute ) and the British pharmaceutical group GlaxoSmithKline on an important research project highlights broader challenges in forging partnerships between academics and drug companies across the European Union.


28. JAMA – What the United States Has to Gain From Global Health Research

Roger I. Glass;

A lot, Glass says, in an eloquent viewpoint.  “Major discoveries have occurred through collaborations with other countries, competitiveness has been expanded by enlisting new partners to research, and the nation’s humanitarian spirit has been demonstrated by addressing some of the most compelling medical problems today and by assisting economic development. Now, as life expectancy in low- and middle-income countries approaches that in the United States, there is even greater urgency to cooperate and collaborate to confront these shared health problems.”


29. NEJM – Big Pharma and Social Responsibility — The Access to Medicine Index

Hans V. Hogerzeil;

Since 2008, an independent initiative called the Access to Medicine Index has been ranking the world’s 20 largest research-based pharmaceutical companies according to their efforts to make their products more available, affordable, and accessible in developing countries. Hogerzeil zooms in on the 2012 ranking results, and shows why this is such a wonderful tool.


Also in NEJM: for the ones who want to see how Community Health Workers are being used in the US, and how they need to be scaled up further in the future (as a very cost-effective reform, also creating jobs and improving health outcomes in the process) see this viewpoint by Prabhjot Singh et al.

Global Fund update


30. Global Fund news – Nordic Countries Pledge $750 Million to the Global Fund

The Global Fund (obviously) welcomed a pledge of US$750 million by Nordic countries, a significant contribution to defeating these three infectious diseases. The announcement was made in Stockholm on 4 September in a joint statement by Sweden, Norway, Finland, Denmark, Iceland and the United States, and coincided with meetings by their leaders with President Barack Obama, hosted by Sweden.

31. Aidspan (news) – Major Improvements Needed to Make External Audits More Reliable in Six of 10 Global Fund Regions, OIG Says

David Garmaise;

The Office of the Inspector General says that major improvements are needed in the reliability of external audits of Global Fund grants in six of the 10 regions it examined. Mark Dybul also added his view on the report in a letter.


Global Health bits & pieces



  • Sanitation: The UN wants a greater focus on sanitation and an end to open defecation (see  the Guardian ):  The UN Deputy secretary general, Jan Eliasson, used his World Water Week address to push the social and economic case for renewed efforts on sanitation. “We must break taboos. As was the case for the word ‘toilets’ a few years ago, it is time to incorporate ‘open defecation’ in the political language and in the diplomatic discourse,” the deputy secretary general said in a keynote speech at a annual World Water Week event in Stockholm, Sweden. He also laid out the financial case for improving sanitation and hygiene. According to the WHO, inadequate water supply and sanitation amounts to annual economic losses of $260bn, while the benefits of meeting the MDG target on water and sanitation would amount to $60bn. Poor sanitation, on the other hand, costs countries some countries billions of dollars a year, according to the UN – with India as the most obvious case in point.


Global Health Announcements


·        Upcoming World Health Summit in Berlin (20-22 Oct)

The 2013 World Health Summit will take place from October 20th till October 22tnd in the German capital. By then, we will already know the new chancellor. The event will, among others, focus on ‘Global Health for development’ and on ‘foreign policy & health’. In this document, you find all information related to the event. (Like it or not, Barroso is one of the ‘patrons’ )





32. NEJM (global health review article) – Behavioral and Dietary Risk Factors for Noncommunicable Diseases

Majid Ezzati et al.;

In this article, the authors summarize the available data on trends in selected behavioral and dietary risk factors for NCDs and examine the effects they have had, or may have in the future, on the health of populations around the world.


33. TMIH – Viewpoint: scaling up testing services for non-communicable diseases in Africa: priorities for implementation research

S. Jaffar et al.;

The burden of NCDs in Africa is rising rapidly and implementation of evidence-based control strategies is needed urgently. Testing people for hypertension and diabetes will be an important component in the fight against these diseases, as voluntary counselling and testing was for HIV-infection. The authors discuss below the areas where they believe evidence is needed to inform policy.


34. Health Research Policy & Systems – The global stock of research evidence relevant to health systems policymaking

Michael G Wilson, Kaelan A Moat and John N Lavis;

The authors examined all types of research evidence about governance, financial and delivery arrangements, and implementation strategies within health systems contained in Health Systems Evidence (HSE) ( They conclude that greater effort needs to focus on assessing whether the current distribution of systematic reviews corresponds to policymakers’ and stakeholders’ priorities, updating systematic reviews, increasing the quality of systematic reviews, and focusing on LMICs




  • Jonathan Glennie is no fan of Cameron’s ‘Golden Thread’ idea (in  the Guardian ).


  • Norway is once again a frontrunner – this time in providing aid to help break the resource curse (see ):  Norway has agreed to give $4.9 million to the African Development Bank (AfDB) to help African governments negotiate “fair and balanced” deals with oil, gas and mining companies operating on the continent. The money will go to the African Legal Support Facility, a body set up by the AfDB to help African governments hammer out complex commercial deals.

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