Dear Colleagues,

 

Readers of this newsletter will be pleased to hear that the website for the third Global Symposium on Health Systems research (Cape Town, 30/9 – 3/10 2014) is up and running now. It looks bloody awesome. No doubt many of you will be thinking: Cape Town, here we come! But you should of course first submit a cutting-edge abstract (or a couple of them), so check out the call for abstracts.

 

Elsewhere in the world, the United Nations General Assembly (UNGA) meeting is probably the event to watch, and more in particular the Special Event towards achieving the MDGs  next week (25 September). The one and only Jeffrey, also known as global health’s John Wayne, Bill Gates – who tweeted earlier this week, provocatively “We won’t hit all MDGs by 2015 but millions of children’s lives have been saved. I dare anyone to call that failure.”, Jim Kim, Ban Ki Moon and many others will talk about the last big push needed and efforts to intensify progress on the MDGs. They will also discuss what needs to come next. If your name is not Jeffrey but Britney or Wesley, you can watch the event live on UN Webcast.

 

What are the stakes? In a very inspiring open letter to the healthcare students of the world, Harvard fellow Alessandro Demaio  quoted Jim Kim at the World Health Assembly: “We are at a crossroads in global health. Together, we face a moment of decision. The question is not whether the coming decades will bring sweeping change in global health, development and the fundamental conditions of our life on this planet. The only question is what direction that change will take.” Duncan Green (Oxfam) put it in more or less similar terms in an op-ed this week, “ Are we successfully completing an “age of development” or seeing the prize slip from humanity’s hands in an economic and climatic meltdown? It is hard to recall a period when developmental optimism and pessimism co-existed to such a high degree. The stakes could not be higher. The coming decades will show whether poverty enters the history books, joining slavery and the fight for women’s suffrage, or whether an age of chaos and scarcity starts to reverse the progress of the last 70 years.”

So the stakes are enormous, undeniably, and health care students have a key role to play in the battle ahead, Demaio stressed: “I believe there is no group better equipped to choose a healthier future and a fairer trajectory than you. Young, driven, intelligent, articulate and, most powerfully, informed. This is a big responsibility. Taking on the problems that were created and challenges unmet by the generations above you. ”  Etc.  If you are a young medical student this piece will make your day.

 

Alessandro does have a somewhat rosy view on medical students, I have to say, but then again, I’m no longer young, and have never been a medical student. To transform this world and address the challenges ahead of us, however, I think we will also need the old, the bald, the not so bright people, and the many other people who are struggling to survive in a world characterized by neoliberal globalization and whose voices are routinely stifled. For example in elections (yes, that one is for the German readers who face a choice this weekend between “Mutti” and a politician now mainly known for his middle finger – I hope voter turnout will be high, and that people who suffered in recent years don’t stay home). When words like de-democratization, asymmetric demobilization or post-politics are becoming fashionable, you know something has gone badly wrong.

 

And no, we’re not talking about Paul Kagame, who booked another landslide victory this week in Rwanda. He felt less comfortable in a long interview with an American journalist, apparently. Museveni, the Ugandan president, on the other hand, looked  quite cheerful in a recent meeting with UNAIDS Executive director Michel Sidibé. For good reason, as Sidibé declared: “Under the leadership of President Museveni, Uganda is uniquely positioned to reassert its role and reputation as a success story of the AIDS response in Africa.” I guess that’s what you’re supposed to say in meetings like theseJ.

 

In this week’s guest editorial, Lara Brearley (Save the Children) gives key messages from the recent report on UHC and the need to prioritize equity in pathways towards UHC.

 

Enjoy your reading.

 

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

 

 

Editorial

 

Addressing health inequities through Universal Health Coverage

 

Lara Brearley, Senior Health Policy & Research Adviser, Save the Children

 

 

Addressing inequities in access to quality needed care and financial risk protection must be a first priority in efforts to achieve Universal Health Coverage (UHC). We have the opportunity to drive countries to implement equitable pathways towards UHC by including appropriate targets and metrics in the post-2015 development framework. These are the main messages of Universal Health Coverage: A commitment to close the gapi– a joint report launched this month by Save the Children, the Rockefeller Foundation, UNICEF and WHO. Research commissioned for the report includes a structured literature review, a Lives Saved Toolii (LiST) analysis, an econometric analysis and key informant interviews.

 

Prioritising equity in pathways towards UHC is not just the right thing to do from a moral perspective, but it also brings value for money. As the LiST analysis reveals, the deaths of 1.8 million children under-five and 100,000 mothers could be averted each year by eliminating within-country wealth inequities in coverage of essential maternal and child health interventions in 47 of the 75 Countdown to 2015iii countries. This would reduce maternal and child mortality by almost one-third and one-fifth respectively.iv

 

The econometric analysis demonstrates that more equitable health financing saves lives. If the share that is pooled funding were to increase by 10 percentage points while keeping total health expenditure constant, it is estimated that 15 fewer deaths would occur per 1,000 live births in the under-five mortality rate of an average country. This could enable 13 countries that are currently off-track to achieve their MDG 4 target of a two-thirds reduction in the rate of child mortality. In countries where health services are more equitably distributed, this effect is amplified.v

 

Despite huge improvements in health outcomes and access to health care – for instance the reduction by almost half in the number of children who die each year from 1990 rates – too many people are denied their right to health. For instance, 6.6 million children still died before the age of five last year, and most of these deaths could have been prevented. Overreliance on out-of-pocket payments for health care both deters the poor from accessing care and exacerbates poverty, with 150 million people estimated to incur catastrophic expenditures for health care each year. This is a scandal that must be addressed.

 

The health system’s response to this challenge must be Universal Health Coverage – defined as ensuring “that all people obtain the health services they need, of good quality, without suffering financial hardship when paying for them”vi. Momentum for UHC is soaring at country and global levels, and this must be seized to ensure the needs of the poor and vulnerable are prioritised as countries design and implement policy reforms.
The report identifies emerging policy lessons for equitable pathways towards UHC in low- and middle-income countries, focusing primarily on health financing. It reinforces the importance of increased equitable funding for health through mandatory, progressive prepayment mechanisms including revenues from taxation and the elimination of out-of-pocket spending. Risk and resource pools must be consolidated to facilitate effective redistribution.  And a universal benefit package should be designed to meet the needs of the poorest and most vulnerable first through strategic purchasing, while aligning provider incentives to promote quality of care. The report also calls for a whole-system approach to UHC, acknowledging the importance of coordinated reforms across health system building blocks. Overcoming pervasive inequities in the coverage of quality health services and financial risk protection will also require concurrent efforts on the wider social determinants of health. And enabling factors, notably political will and strong mechanisms for effective accountability, are also critical to the implementation of equitable pathways towards UHC.

 

As the Millennium Development Goals have shown, what gets measured is more likely to get done. Negotiations on the sustainable development agenda must guide equitable progress towards UHC, embedded through clear targets and indicators that strengthen health systems and close the equity gap.

 

Please join us for a presentation of the report followed by a panel discussion in New York on the 23rd September from 18.00-20.00 at the Rockefeller Foundation 420 Fifth Avenue (between 37th and 38th Streets). For more information and to RSVP, please contact: health@rockfound.org.

 

 

 

 

i http://www.savethechildren.org.uk/resources/online-library/universal-health-coverage

ii The Lives Saved Tool is a computer-based tool that combines information about effectiveness of interventions for maternal, neonatal and child health with information about cause of death and current coverage of interventions. It permits an estimation of the differences in impact across different scenarios as intervention packages and coverage levels are varied. See http://www.jhsph.edu/departments/international-health/centers-and-institutes/institute-for-international-programs/list/

iii Countdown to 2015 is a multi-disciplinary, multi-institutional collaboration using country-specific data to stimulate and support country progress towards achieving the health-related MDGs. Countdown tracks progress in the 75 countries where more than 95% of all maternal and child deaths occur, including the 49 lowest-income countries. See http://www.countdown2015mnch.org/

iv In this analysis, the major assumptions made include: that the national coverage is scaled up to its target coverage of the highest wealth quintile linearly in their period of 2013 to 2015; that target coverage of vaccines modelled in the analysis – Hib, PCV, Rotavirus – will reach the DTP coverage of the richest quintile; that interventions coverage did not change between the estimates abstracted from the most recent DHS / MICS and our base year of analysis of 2013.

v MDG 4 achievements are based on the key following assumptions: (1) The increase in the pooled share of spending is assumed to be achieved by replacing previous OOPS with pooled spending (ie, keeping total national health spending unchanged); (2) The count of countries that could reach MDG targets by 2015 is based on projected changes in under-five mortality rates from 2012-2015, calculated using the average annual reduction rate from 1990-2011, and the difference between projected and target (based on a two-thirds reduction) rates for 2015; (3) The calculations of MDG progress and achievement are for the 75 Countdown countries. The countries that could reach MDG targets by 2015 are based on projected changes in U5MR from 2012-2015, calculated using the average annual reduction rate from 1990-2011, and the difference between projected and target (based on a 2/3 reduction) rates for 2015.

vi http://www.who.int/features/qa/universal_health_coverage/en/index.html

 


UNGA meeting in New York

 

1.    Lancet (Editorial) – What can the UN General Assembly do for global health?

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61959-5/fulltext

The annual World Health Assembly in Geneva has now been eclipsed by a gathering with even greater political weight: the UN General Assembly (UNGA), held in New York next week. At least according to this Lancet editorial. The editors give a number of reasons for this: “(1) In New York, if a Head of State chooses to lead his or her delegation on a health topic, others stop, listen, and pay attention (this is not the case for Ministers of Health, presumably). In New York next week, Prime Minister Shinzo Abe of Japan will lead on Universal Health Coverage. Prime Minister Stephen Harper of Canada and President Jakaya Kikwete of Tanzania will lead on women’s and children’s health. … (2) New York also matters because this is where an increasing number of critical reports are published and debated among policy makers, agencies, and politicians.” (see for example a new UNICEF report)

 

2.    Lancet (Comment) – High stakes at the UN on the Sustainable Development Goals

Jeffrey Sachs;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61956-X/fulltext

A special event at the UN General Assembly on Sept 25 marks a bridge between the MDGs to the end of 2015 and the SDGs that presumably will run from 2016 to 2030, Jeffrey Sachs says. The special event will address urgent actions to accelerate progress to the MDGs over their remaining 2 years, while setting a timeline and diplomatic framework for creating the post-2015 development agenda. Sachs acknowledges the stakes are high, but he unequivocally says the cynics haven been proven wrong (for the MDGs) and the same will be true for the SDGs.

 

In an Economist guest article, Jeffrey also outlines his vision for sustainable development.

3.    Lancet – Offline: Planetary health—a new vision for the post-2015 era

Richard Horton; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61936-4/fulltext

Is global health as it is currently defined truly meeting the demands that our societies currently face? According to Horton (and many others), global health does not fully take account of the substrate on which we live — the planet itself. As we all know, our planet is under severe pressure. “The post-2015 era will be characterised by “sustainability”, the idea that not only are human and natural systems interdependent, but also that non-linear transformations in those systems could be catastrophic to our future. The planet’s potential to sustain our species is slowly declining. The post-2015 era’s most important idea is that global sustainability is the precondition for human health, survival, and prosperity.” … Finally, and importantly for scientists and beyond, “planetary health also demands more open knowledge systems”, Horton stresses.

4.    Lancet Correspondence on Global Health Governance

In a Lancet article that appeared in June, Michel Sidibé & Kent Buse advocated the inclusion of key AIDS governance innovations, principles, and practices in the post-2015 development agenda, and they also aimed to ignite debate on the future of global health governance.

The new Lancet issue features a number of Letters reacting to the Comment. For example a Letter by Gorik Ooms et al, in which the Go4Health authors argue for  UHC  anchored in the right to health   (instead of the likely further fragmentation if HLP report targets are pursued post-2015); a Letter by Steven J Hoffman et al, who express concerns about Sidibé & Buse’s proposition for only three agencies in the global health architecture, one to handle financing, one to set norms and standards and one for accountability and advocacy. “… But consolidating authority among too few hegemons and assigning accountability and advocacy to one agency are not part of the future we want. Simplification and greater efficiencies are needed, but monopoly of power won’t work in a complex multipolar world.” A final letter by J Iwelunmor et al emphasizes the importance of working with local cultures in the shift from disease-specific approaches toward more holistic and people-centred approaches.

Sidibé & Buse reply to all Letters.

5.    Health post-2015: evidence and power

Kent Buse & Sarah Hawkes;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61945-5/fulltext

On Sept 25, the UN General Assembly will hold a special session devoted to progress on the MDGs and the post-2015 development agenda (as you probably already know by now). Building on more than a year of consultation, advocacy, and lobbying, the debate provides an opportunity to take stock of health-related proposals, Buse & Hawkes argue. Described as a generational opportunity, to what extent is evidence of the burden of ill health and early death setting the agenda?  So far not enough attention is being paid to NCDs, they say – and they give a number of reasons for this relative neglect. They make a similar case in a Project Syndicate op-ed.

In a Humanosphere guest contribution, Katie Leach-Kemon (IHME) gives a slightly different view. She emphasizes, reacting to an earlier piece by Tom Paulson: “Close examination of the GBD estimates shows that making the world a healthier place isn’t about prioritizing non-communicable diseases over communicable diseases or vice-versa. It’s about developing strategies that take into account the rapidly changing disease patterns in each country and region.”

6.    Guardian – Ban Ki-moon: We must do better to achieve global partnership promise

Mark Tran; http://www.theguardian.com/global-development/2013/sep/20/ban-ki-moon-global-partnership-goal

The world must renew its commitment to increasing aid and reaching a trade deal to make progress on the MDGs, according to a new UN report. The report, published in the run-up to next week’s special session at the UN on the MDGs and what follows their 2015 deadline, focuses on the global partnership for development (MDG8), the vaguest of the eight goals. MDG8 covers aid, trade technology and access to affordable essential medicines.

7.    UN SDSN Thematic report – Health in the framework of sustainable development –  Technical Report for the Post-2015 Development Agenda

K. Reddy et al.; http://unsdsn.org/files/2013/09/SDSN_Report_DRAFT_Sep15_final.pdf

The Sustainable Development Solutions Network (SDSN) launched seven reports prepared by its Thematic Groups on 18 September 2013. Report topics included: forests, oceans, biodiversity and ecosystems; human rights and gender equality; good governance of extractive resources; sustainable urban development; education; health; and sustainable agriculture. The reports were prepared by international panels of experts to help inform the discussions around a post-2015 development framework, and complement the SDSN’s flagship report “An Action Agenda for Sustainable Development” released in June 2013.

This is the thematic report on health in the SDG framework.

8.    Lancet (Review) – The unfinished agenda in child survival

Jennifer Bryce et al.; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61753-5/fulltext

10 years ago, The Lancet published a Series about child survival. In this Review, authors examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era.

9.    Lancet (Comment) – What works in saving children: the essentials

J Frederik Froen & Marleen Temmerman; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61942-X/fulltext

Getting on with what works” was not merely a slogan in the 2006 Lancet Maternal Survival Series, but defined the approach of the global reproductive, maternal, newborn, and child health (RMNCH) community to prioritise a few highly cost-effective, evidence-based interventions. Strategic global initiatives to reduce child deaths, stillbirths, and newborn deaths have followed this approach”, the authors of this Lancet Comment say. Broad interagency consortia have defined the so-called essential interventions for RMNCH, accompanied by commodities and guidelines, and introduced the Lives Saved Tool (LiST), which provides guidance for how many lives interventions can save and at what cost. The unified message has been that what works is known, so action should be taken. Acknowledging that some analysts are not overoptimistic if current trends continue, they add, however: “Increases in coverage rarely follow a linear course over time, but when policies, infrastructure, and funding all align in a moment of opportunity, coverage can increase substantially. The mean pace of change in coverage over 20 years will systematically underestimate how fast countries improve during periods when they actually strive to increase coverage.” A very clear hint aimed at the decision makers who gather in New York.

10. Lancet (Comment) – The world we want: an end to child marriage

Graça Machel et al.; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61944-3/fulltext

« We can make a difference if we act together as a global community, if we monitor our joint progress, and if we hold one another accountable. We are confident that with political will, appropriate investments, and programmes tailored to local settings, we can bring an end to child marriage by 2030. “

11. Lancet (Comment) – Time for universality to reduce inequity

Justin Forsyth; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61722-5/fulltext

Like Lara Brearley in our editorial, Justin Forsyth (Save the Children) also presents  key messages from the new Save the Children, Rockefeller Foundation, UNICEF, and WHO report, ‘Universal Health Coverage: a Commitment to Close the Gap’, which focuses on the importance of pursuing equitable progress towards UHC. The report sets out why UHC reforms must be designed so that the poorest are covered by health services right from the start. The report also makes an investment case for doing so. Pursuing equitable pathways towards UHC will accelerate progress towards the health MDGs and is a means to end preventable child mortality. As such, UHC must be a priority within the post-2015 development agenda with clear targets to guide implementation and facilitate monitoring and accountability.

12. Lancet Global Health (blog) – Community health workers can accelerate progress towards universal health coverage in sub-Saharan Africa

Biodun Awusosi;

http://globalhealth.thelancet.com/2013/09/18/community-health-workers-can-accelerate-progress-towards-universal-health-coverage-sub

Despite overwhelming support for UHC, the global health community has failed to realize the connection between CHWs and UHC, Awusosi says. He examines the link, also referring to the ‘1 million community workers campaign’ launched by the Earth institute (we do think Jeffrey Sachs has read Mao’s red booklet).

 

13. Humanosphere – How Bill Gates stopped worrying and learned to love the MDGs

Tom Murphy; http://www.humanosphere.org/2013/09/how-bill-gates-stopped-worrying-and-learned-to-love-the-mdgs/#more-60258

Bill Gates was at first a reluctant lover of the MDGs, but grew more fond of them over time. (As for Melinda, we don’t know). Read why. Also check out what Gates’ priorities are to assess post-MDG goals.

14. ODI – The Millennium Development Goals: one last push

Susan Nicolai;

http://www.developmentprogress.org/blog/2013/09/18/millennium-development-goals-one-last-push

In the run-up to the special event, Nicolai explores major efforts that are being made to intensify progress on the MDGs, aka ‘the last big push’. Building on a report issued earlier this year, ‘A Life of Dignity for All’, the draft outcome document for the special event highlights five areas that are crucial to accelerate progress: (1) targeting progress on the MDGs in areas that are most off-track; (2) emphasizing accessibility for the most vulnerable; (3) sustaining momentum; (4) creating approaches that have cross-cutting effects, particularly the empowerment of women and girls; (5)  strengthening global partnerships for development.

15. Lancet Global Health (blog) – Climate change and the shared responsibility for global health

Gorik Ooms;

http://globalhealth.thelancet.com/2013/09/19/climate-change-and-shared-responsibility-global-health

Our colleague Gorik Ooms (et al) wrote an interesting blog post on the implications of climate change on shared responsibility for global health, beyond just responsibility for infectious disease control. Recommended reading for everybody in New York.

 

Another prolific writer, Richard Smith, learned a couple of things at a recent global health meeting, most of all that people in global health need to learn from each other.

 

Global Health Governance – special issue on UHC

 

The Journal Global Health Governance dedicated a special issue to UHC.

 

It features, among others, an article by Viroy Tangcharoensathien, David Evans, and Robert Marten: “Universal Health Coverage: Setting Global and National Agendas” ;  an article by Claire Brolan et al on Global Governance for Universal Health Coverage, wondering whether a Framework Convention on Global Health could hold it together; an article on ‘Stakeholder Views Regarding a Health Impact Fund (HIF), to Incentivise Pharmaceutical Innovation Relevant to Diseases of Poverty’; an article on the critical role civil society needs to play in achieving UHC,  and a lot more.

 

We especially want to draw your attention to an article in the series by colleagues Fabienne Richard et al.: ‘Fee Exemption for Maternal Care in Sub-Saharan Africa: A Review of 11 Countries and Lessons for the Region’, a Femhealth output (see also the editorial from two weeks ago). “Several countries have recently introduced maternal health care fee exemptions as a quick win approach to reach MDG 5 goals. It has also been argued that these policies were relevant first steps towards UHC. The scope and contents of the benefits package covered by these policies vary widely. First evaluations raised questions about efficiency and equity. This article offers a more comprehensive view of these maternal health fee exemptions in Africa. We document the contents and the financing of 11 of these policies.”

 

The new issue also features a number of other – non UHC related – articles (see also below).

 

Global Fund

 

16. BMJ – Global Fund needs $15bn to fight HIV, tuberculosis, and malaria

Anne Gulland;

http://www.bmj.com/content/347/bmj.f5601

Last week, the Global Fund asked international donors for $15bn as an “absolute minimum” to fight the diseases over the next three years. See also the  report  released at the occasion, the Cost of Inaction, with key message: “The Global Fund and its partners are now in the final months of replenishment efforts to secure funds for the 2014-2016 period. One critical message to donors – who must decide before the end of the year how much they can invest – is that there is a tremendous cost of inaction. Without aggressive investment to defeat HIV, tuberculosis and malaria, we will likely face staggering costs in the years ahead, both in human lives and in money. “ So there’s a historic opportunity to control AIDS, TB and malaria and remove them as a threat to public health, but we need to seize it.

 

17. CGD (report) – More Health for the Money: Putting Incentives to Work for the Global Fund and Its Partners

The Value for Money Working Group;

http://international.cgdev.org/publication/more-health-money-putting-incentives-work-global-fund-and-its-partners

The Global Fund is foremost among organizations that could get more health for the money by focusing more on results, maximizing cost-effectiveness, and systematically measuring performance throughout its operations, authors of this report emphasize. This report, a product of CGD’s Value for Money Working Group, offers a strategy for improvement corresponding to four phases within the Global Fund’s grant-making cycle: allocation, contracts, costs and spending, and performance and verification.

Human Resources for Health

 

18. Plos – Physician Emigration from Sub-Saharan Africa to the United States: Analysis of the 2011 AMA Physician Masterfile

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001513;jsessionid=20DD5D882521B726897E9212BBE0C54E

Siankam Tankwanchi and colleagues used the AMA Physician Masterfile and the WHO Global Health Workforce Statistics on physicians in sub-Saharan Africa to determine trends in physician emigration to the US. The trend hasn’t been positive.

 

In a linked Perspective, Giorgio Cometto and colleagues discuss the steps that destination countries and countries in SSA can take to address this problem.

 

19. Lancet (Comment) – Continuity of maternity carer for all women

Petra ten Hoope-Bender;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61793-6/fulltext?_eventId=login

The effect of continuity of midwifery carer on the health and wellbeing of women and their newborn infants has been underestimated and neglected for many years. Ten Hoope-Bender comments on a new Lancet study (by Sally Tracy and colleagues) in which she sought to answer whether continuity of midwifery carer for women at all levels of risk, from booking to postnatal discharge in the community, might reduce interventions in childbirth, reduce costs, and increase women’s satisfaction.

 

NCDs

 

20. Lancet (World Report – Research Focus) – Funding: Global Alliance for Chronic Diseases tackles diabetes

Arran Frood;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61962-5/fulltext

To meet the diabetes challenge in emerging economies, the Global Alliance for Chronic Diseases (GACD) has launched a call for research proposals to prevent and treat type 2 diabetes. The GACD is an alliance of some of the world’s biggest publicly funded research organisations, ranging from the UK’s Medical Research Council to China’s Ministry of Health and the European Commission.

 

In other NCD news, “Ukraine and Honduras are reviving a dispute at the World Trade Organization challenging Australian laws that impose uniform drab green packaging and large graphic health warnings for cigarettes“, Reuters reported.

 

 

Health Policy & Financing

 

21. Lancet (Editorial) – A new German Government: leadership for health?

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61958-3/fulltext

As a leading economy in the European Union and a large, successful, and prosperous country, Germany has to step out of its self-imposed introspective role in health”, this Lancet editorial says. “4 Years of World Health Summits held in Berlin annually under the patronage of Angela Merkel have only tentatively raised German awareness and have contributed modestly beyond a general gathering and talks among the converted. It has taken some time for Germany to take its leadership in European politics and on the world stage, for perhaps understandable historical reasons. Now, Angela, is the time to show some leadership for global health as well.”

 

 

As for China’s role in Global Health Diplomacy, and more in particular how it can work together with the US on HSS in Africa, read this new article in Global Health Governance.

 

22. Lancet – Open letter: let us treat patients in Syria

Gro Harlem Brundtland et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61938-8/fulltext

A group of doctors and medical professionals from across the globe call for the UN to provide more support to medical personnel caring for Syrians in need, warning that the country’s health systems are at “breaking point”. In an open letter, the signatories highlight the acute shortage of medical personnel, supplies, and facilities afflicting the people of Syria after more than two years of conflict, with over half of Syria’s hospitals destroyed or damaged, and thousands of health workers either imprisoned, or fleeing abroad.

 

23. BMJ (Editorial) – Will India deliver on universal health coverage?

Antony Kollannur;

http://www.bmj.com/content/347/bmj.f5621

The only serious barrier to UHC in India is a lack of political will to strengthen the public health system and increase budget allocation, Kollanur says in this BMJ editorial.

24. WHO Euro – WHO reform: progress and implications for Europe

http://www.euro.who.int/__data/assets/pdf_file/0019/196210/63wd15e_WHO-Reform.pdf

WHO’s Regional Committee for Europe got together from 16 till 19 September (in Izmir, Turkey) – it was its sixty-third session. There were quite some interesting documents, for example this one on the state of affairs for the WHO reform, as well as an ‘Outcome  document for the High Level meeting on  Health systems in times of global economic crisis: an update of the (dire) situation in the WHO European Region’. Ilona Kickbusch tweeted that an emerging theme in Izmir was for WHO to act as a broker for dialogues between health and finance ministries.

 

In related news, read also a few WHO & global health governance related articles in the new Global Health Governance issue, see here for example: “Resuscitating a comatose WHO: Can WHO reclaim its role in a crowded global health governance landscape?

 

25. Swasthiya Mundial (blog) – Can Big Pharma Save the Poor?

http://swasthyamundial.com/2013/09/can-big-pharma-save-the-poor/

Can Big Pharma Save the Poor? Probably not, but the ‘Access to Medicines Index’, which ranks pharma companies essentially based on their global social responsibility with regards to the poor, is not a bad attempt to improve things.

 

26. BMJ (news) – Lilly challenges Canada’s decision to strike down patents for not meeting “inventive promise”

Owen Dyer;

http://www.bmj.com/content/347/bmj.f5651

The US drug giant Eli Lilly has filed suit against Canada, claiming that the country’s courts have arbitrarily struck down its patents. The company is seeking $500m in alleged lost business under the terms of the North American Free Trade Agreement (NAFTA).

 

27. CDC Report – Antibiotic resistance threats in the United States, 2013

http://www.cdc.gov/drugresistance/threat-report-2013/

This report  gives a first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs having the most impact on human health, for the US (but obviously also relevant for the rest of the world).

 

28. JAMA – PEPFAR’s Antiprostitution Pledge – Spending Power and Free Speech in Tension

Lawrence Gostin;

http://jama.jamanetwork.com/article.aspx?articleid=1733774

Gostin comes back on the recent Supreme Court decision.

 

29. Humanosphere – GM food fight: Why the Gates Foundation wants to make rice golden

Tom Paulson;

http://www.humanosphere.org/2013/09/gm-food-fight-why-the-gates-foundation-wants-to-make-rice-golden/#more-59617

Golden rice is a project where our goals in health and agriculture meet”, a Gates spokesperson says. Interesting article.

 

30. World Policy – From Disease to Pandemic

Amy Lieberman;

http://www.worldpolicy.org/journal/fall2013/Disease-to-pandemic

In the new issue of the World Policy Journal, Amy Lieberman examines migration and disease spread, and the (so far mostly neglected) link with UHC. “Political leaders need to collaborate and pledge, on national and regional levels, to include non-citizens like labor migrants as inclusive recipients of the same health services and basic rights their own citizens enjoy. Yet the issue of health — access to education, services, treatment, and a quality of life that can prevent migrants from getting sick with a transmittable illness — remains largely absent from regional and international agreements and discussions on migration.”

 

31. AJPH – Thinking locally, acting globally

Daniel Tarantola;

http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301636

Local thinking can and should inspire global policy through advocacy, social pressure and democratic processes. Global action should be guided by local demands and build on local capabilities. “Think Locally, Act Globally” may well be the motto of future public health.

 

32. Plos – Translating Cochrane Reviews to Ensure that Healthcare Decision-Making is Informed by High-Quality Research Evidence

Xavier Bonfill et al.;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001516;jsessionid=20DD5D882521B726897E9212BBE0C54E

Xavier Bonfill and colleagues discuss strategies to increase access and global reach of Cochrane Reviews through translations into other languages.

33. UNAIDS – Call for scale up of HIV prevention programmes for military and security forces in West and Central Africa

http://www.unaids.org/en/resources/presscentre/featurestories/2013/september/20130916remafoc/

High-level military representatives from 19 countries in West and Central Africa have called on governments to scale up HIV prevention programmes specific for military and security forces to reduce new HIV infections and sexual gender-based violence in conflict and post conflict areas in the region. The call was made during a meeting of the West and Central Africa Military Network for AIDS Control (REMAFOC) held in Dakar, Senegal from 2-4 September 2013.

 

 

Research

 

34. Social Science & Medicine – Special issue on health system reform in Asia

http://www.sciencedirect.com/science/article/pii/S0277953613004139

The special issue features for example a article by Gerald Bloom et al.: ‘Building institutions for health and health systems in contexts of rapid change’.

35. Health Policy – Evidenced Formal Coverage Index and universal healthcare enactment: A prospective longitudinal study of economic, social, and political predictors of 194 countries

Andrea B. Feigl et al.;

http://www.healthpolicyjrnl.com/article/S0168-8510(13)00171-1/abstract

Determinants of universal healthcare are poorly empirically understood. The authors undertook a comprehensive study of UHC development using a novel Evidenced Formal Coverage (EFC) index that combines three key UHC elements: legal framework, population coverage, and accessibility. Applying the EFC index measures (legislation, ≥90% skilled birth attendance, ≥85% formal coverage) to 194 countries, aggregating time-varying data from 1880–2008, this study investigates which macro-economic, political, and social indicators are major longitudinal predictors of developing EFC globally, and in middle-income countries. The EFC index and this longitudinal prospective study together indicate that investment in both economic growth and education should be seen of equal importance for development of UHC. The authors’ findings help in understanding the social and political drivers of universal healthcare, especially for transitioning countries.

 

36. HP&P – Assessment of capacity for Health Policy and Systems Research and Analysis in seven African universities: results from the CHEPSAA project

Tolib Mirzoev et al.;

http://heapol.oxfordjournals.org/content/early/2013/09/14/heapol.czt065.short?rss=1

The importance of health policy and systems research and analysis (HPSR+A) is widely recognized. Universities are central to strengthening and sustaining the HPSR+A capacity as they teach the next generation of decision-makers and health professionals. However, little is known about the capacity of universities, specifically, to develop the field. In this article, authors report results of capacity self- assessments by seven universities within five African countries, conducted through the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA).

 

37. BMC Public Health – Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review

Brynne Gilmore et al.;

http://www.biomedcentral.com/1471-2458/13/847/abstract

Community Health Workers are widely utilised in low- and middle-income countries and may be an important tool in reducing maternal and child mortality; however, evidence is lacking on their effectiveness for specific types of programmes, specifically programmes of a preventive nature. This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries.

 

 

Global Health announcements

 

  • WISH summit in Doha:  “An international health forum that will look into practical and innovative solutions to global health-care challenges will highlight the urgent need for radical innovation when some of the key participants meet in Doha later this month” (i.e. in a preparatory meeting). “The inaugural World Innovation Summit for Health (WISH) will be held in the Qatar capital on December 10-11 and will bring together heads of state, ministers, senior government officials, academics and thinkers, as well as some of the world’s most influential business leaders.” It is hoped that in time this annual event will become the ‘Davos of health care’. (Jeffrey, book your seat at the table!)

 

 

Miscellaneous

 

  • A new CGD paper explores the Palma inequality measure.

 

  • A  Guardian article summarizes a new Concord Report which states that poor countries lose $100bn annually due to tax dodges by EU firms.

 

  • In more ‘encouraging’ EU news, Euractiv reports double accounting of climate finance and development aid in the EU. “EU officials have admitted for the first time that member state donations to the developing world can simultaneously count towards meeting climate change obligations and development commitments, such as providing 0.7% of gross income for overseas aid.”

 

 

  • Spain  shifts its approach to foreign aid – focus will be more on exchange of knowledge, less on providing funds.

 

  • Tony Abbott, the new Australian prime minister, is recommending that AusAid, the government’s aid agency, be merged into the Department of Foreign Affairs and Trade (DFAT), after similar moves in Canada and New Zealand,” The Guardian reports.

 

  • Read also what Charles Kenny (CGD) thinks about whether development should be a cabinet or sub-cabinet responsibility. What does the evidence say about the performance of independent aid ministries versus the performance of aid agencies that function under another ministry (foreign affairs, for example)?

 

  • Finally, to end this week’s news on a cynic note (sorry Jeffrey!), Putin’s Russia urges the UN climate report to include geoengineering. (see the Guardian ), according to leaked documents. (now we’re just waiting for the NYT op-ed)

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