Some weeks ago we informed you about the call for Emerging Voices 2013 related to the AIDS in Africa Conference (ICASA), ‘Now more than ever, targeting zero’ in Cape Town. After Emerging Voices (EV) at the Montreux and Beijing Health Systems Research Symposium, a new batch of forty-eight researchers and policy workers from twenty LMICs are on track to have their voices heard on the international biomedical and public health scene. This time the health research and scientific communication training will be hosted by the School of Public Health and AIDS at the University of the Western Cape.
The EVs 2013 will showcase their key messages at the EV symposium (4 & 5 December 2013) and the ICASA conference (7-11 December 2013). Three thematic tracks prevail: a clinical, a prevention and a health systems track. To make sure their ideas hit the mark, the EV programme uses a blended learning approach. At this stage they are exchanging their own expertise in the field of HIV through Moodle, a virtual discussion and training platform. The EVs are engaged in debates centered around 8 topics: 1) “Organization of care”; 2) “PMTCT”; 3) “Protective and risk factors associated with HIV transmission; 4) “HIV testing”; 5) “Co-infection HIV-Tuberculosis”; 6) “Antiretroviral treatment response”; 7) “Pediatric and adolescent care” and 8) ”Global Health”. The discussions are animated and they go beyond disciplinary and sectoral boundaries.
The next step will be a face-to-face skills training and content immersion with peers and experts in South Africa. This should lead to state-of-the-art presentations and talks at the EV Symposium that can stand up to scrutiny from the international scientific community. Furthermore through field visits EVs will be inspired by the South African innovative AIDS care and prevention strategies. During the ICASA conference EVs will present their abstracts, join the debates and network with peer researchers and experts. After the ICASA conference EVs will get further online coaching and follow-up with the aim to publish scientific articles and blogs that reach the wider global health scene.
Emerging Voices gathers young health thinkers and doers around an event that many already describe as the highlight of their year. Do you want to join in this health brain spa? There are several ways to participate… either by joining us in person during the symposium (at the University of Western Cape, Cape Town) or ICASA conference or online. ITM alumni too are warmly invited to join during the satellite meeting on 6 Dec by registering via AlumniMPH@itg.be
And for those who missed the Emerging Voices selection 2013 deadline, prepare for the call of Emerging Voices 2014 linked to the Third Global Symposium on Health Systems Research, Science and Practice of People-centred health sytems and be there in Cape Town in 2014!
An Appelmans & Tom Decroo
(on behalf of the Emerging Voices team)
In this week’s guest editorial, Bruno Meessen, Ir Por and Cathérine Korachais report live from the final HEFPA meeting in Yogyakarta, Indonesia.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Health Equity and Financial Protection in Asia (live from Yogyakarta, Indonesia)
Bruno Meessen (ITM), Por Ir (NIPH, Cambodia) & Catherine Korachais (ITM)
It is not the size of a conference which determines its quality. With around 40 other experts, we had the chance this week to take part in the final conference of the Health Equity and Financial Protection in Asia (HEFPA) research project. The event took place in Yogyakarta, Indonesia.
HEFPA was an ambitious project: the aim was to evaluate the impact of a variety of health financing initiatives in 6 Asian countries: Cambodia, China, Indonesia, the Philippines, Thailand and Vietnam, with a focus on access to health care and households’ protection from the financial burden of medical expenses.
This 4-year project, led by Eddy Van Doorslaer, Owen O’Donnell and Adam Wagstaff, mobilized a team of very talented researchers. As you might have guessed from these names, emphasis was on rigorous quantitative methods.
During these 3 days, we had the opportunity to listen to the findings from the 6 countries. It was a very rich event and you may be somewhat surprised, but econometrics were nowhere to be seen: the focus was on the results and the lessons for policy making. We had fascinating discussions based on empirical analyses and enriched by comments by a few senior international experts and national policy makers invited to the event.
The HEFPA studies will be published in the near future – several are already available as working papers by the way (tips if you are interested: check health economics journals for the next 1-2 years, follow @EllenVandePoel and @adamw2011 on Twitter, and of course check this newsletter!).
In this editorial, we will share some non-rigorous thoughts, related to a non-representative sample of the presented studies.
Extending coverage: what works?
On day 1, we heard about different experiences and strategies for expanding (household) coverage so that also households working in the informal sector (a notoriously hard to cover population segment) would be covered. We learned from Vietnam that a voucher scheme – with a financial subsidy for the premium of 25 % and the transfer of information – aimed at encouraging people to enroll in a voluntary insurance scheme did not bring the results hoped for. A similar experience in Philippines was a bit more successful, partly because it paid attention to the different barriers households encounter when they want to enroll (such as how to complete the subscription form!) and perhaps also due to a higher level of subsidy (50 % of the premium). After watching these presentations, we realized that selling a health insurance scheme to households is not an easy job. Whether it’s a State agency or an NGO trying to persuade households, they face an uphill task (even if we learned that tablets now allow promoters to use movies for this purpose – in India, even with seductive Bollywood actors! ). The height of the premium is an important, but not the only, barrier to enrolment in voluntary insurance (and subsidizing part of it is thus important); what the enrollees will get in exchange for the payment (the quantity and quality of the benefit package) also matters a lot – and this is an issue in many places. But even with high quality care, it is probable that many households won’t subscribe. At some stage, this made authors of this editorial wonder whether compulsory enrollment or user fee reduction (Rob Yates, who was with us, argued for user fee removal), would not be the best way to nudge people towards appropriate coverage of their own health risks. But UHC encompasses making choices on societal values, including freedom (for households, providers…). Asian countries will find their own way to make UHC a reality.
On the importance of getting the design and implementation right
During the first two days, there were several presentations on health insurance schemes (especially those targeting the poorest – a popular strategy in Asia), but also on innovative health care financing arrangements (pay-for-performance, capitation payment, vouchers, health equity funds…). All studies reported on the effectiveness, but several also provided quite a good view on the care given to the design and implementation of the schemes.
We may be biased, but we saw, across presentations, an emerging lesson validating another side of our own professional experience: re-inventing one’s health care financing strategy cannot be improvised; technical guidance can be helpful. In Indonesia, hundreds of district bureaus launched new schemes, but probably because of a lack of coaching, they developed quite simple interventions which did not lead to real changes. One can also doubt whether a thousand flowers will bloom in China this time. Conversely, we were quite impressed by the pay-for-quality scheme (with a yardstick competition component) piloted by Winnie Yip and colleagues in China: they showed how things are indeed difficult, but we also got some interesting ideas which will deserve to be tested elsewhere.
In general, our feeling is that many health care financing policies would benefit from efforts by policy entrepreneurs to make the theory of change on which the intervention rests more explicit, including by contextualizing it. This is an aspect where scientists can contribute, and we may prevent a few big failures by putting more effort into that.
UHC is not Universal Health Insurance
At the Yogyakarta conference, there was the evidence (plenty of it!), but also the (equally numerous) discussions, during the sessions and in the corridors. Let us just pick one among many.
It is clear that we do not know much yet on the alternative possible paths (including pace and sequencing) towards UHC and their relative advantages. This indicates a broad avenue for scholars, political scientists but also economists – political economy is an under-developed branch of health economics, we regret to say.
We know some of the objectives: UHC requires pooling of resources and illness to the extent possible. We know the starting points: often the co-existence of different schemes (one for civil servants, one for the poor…) with varying generosity, often with a lack of appropriate coverage for households from the informal sector – the middle of the so called UHC ‘sandwich’.
At international and national level, this situation is pushing attention towards developing a specific (insurance or insurance-like) scheme for this informal sector group or towards including it in an existing scheme (see Thailand with its 30 baht scheme). This certainly is a priority, but one should not forget that UHC is about 3 dimensions: population coverage indeed, but also benefit packages and height of the remaining out-of-pocket payment.
We don’t give away a secret if we say that over the last years, most attention has gone to the first dimension mainly. This is partly due to the emphasis put on some (admittedly, very successful) experiences (like the Thai one – by the way, we heard again strong evidence on its effectiveness), but also owing to the term universal health coverage itself. As a matter of fact, in many countries identifying themselves as still far away from UHC, there is already some coverage for everyone through government-financed health services.
We also noted Adam Wagstaff runs a panel discussion like a panel data regression – it almost felt like art. Adam had the opportunity to come back on his (by now notorious) assessment that UHC is ‘old wine in a new bottle’. UHC is indeed about ensuring that everyone gets the health care they need and protection from the financial burden the utilization of health services entails. This is exactly what HEFPA was about.
Clearly, as also discussed during a panel, research will be critical for UHC. We need more of such evaluation research of new schemes or policies, but we also need more research on how to implement changes and reform existing systems. There is definitely room for research beyond quantitative impact evaluations. Which is nice for the ones among us who don’t have Wagstaff’s, O’Donnell’s or Van Doorslaer’s almost magical quantitative skills…
Reflections on New York & post-2015
1. MSH – Global movement emerges for UHC
As you could already read in last week’s IHP newsletter, an emerging movement of global leaders of government, civil society and finance (!) is urging UN member states to include UHC as a priority in the post-MDG framework. The arguments for improving access and affordability have never been stronger, as highlighted by a recent statement signed by 15 global civil society organizations (including Management Sciences for Health (MSH), Oxfam, Save the Children, and MSF, among others). This MSH article also gives a good overview of the UHC related discussions at UNGA meetings and side events. (see also All Africa coverage).
In another blog post, Lara Brearley covered the Rockefeller events on UHC, listing also the two targets put forward by WB and WHO. “This week we have heard promising emphasis on public financing and equity in current efforts to develop metrics for UHC in light of the post-2015 agenda. The World Bank and WHO are proposing two targets — one to end impoverishment from health expenditures and another to achieve 80% coverage in poorest 40% of population of two composite measures for MDGs 4, 5 & 6 and non-communicable diseases. The health report by the Sustainable Development Solutions Network proposes minimum thresholds for public financing, ODA, and a maximum for out-of-pocket payments.”
On Twitter, we learnt that WHO and the WB will jointly present their UHC measurement framework in Tokyo in December. Shinzo Abe will be pleased.
2. MSH – Rallying For UHC (IV): Aligning UHC with Civil Society Priorities
This excellent blog post is part of a “Rallying for UHC” series in which MSH bloggers expand on the themes raised by these events and consider the road ahead for UHC in post-2015 discussions. ( without any doubt, a must-read)
“… I observed that the global UHC movement can gain broader support by refining its messages to connect with the core values of civil society and provide reassurance that UHC is feasible for low-income countries. … In order to gain support among disease-specific advocates in post-2015 discussions, the UHC movement must also clarify how a UHC goal would relate to disease-specific priorities in the new development framework.”
The author concludes: “Contrary to fears, global health advocates really can rally around UHC. (And many already have.) Everyone sees the problems of healthcare access and affordability. Everyone’s inspired by a vision like Sachs’, transforming opportunities for a healthy life worldwide, and especially in developing countries. UHC skeptics are on board with the aspiration; their doubt is whether, in practice, essential priorities might be left out. The best accounts of UHC have described a lofty ceiling—now there’s got to be more attention to the floor.”
3. IHP – Universal health coverage, real or selective? Time for global health advocates to unite
Gorik also thinks it’s time for global health advocates to unite around UHC, and he sees signs of this already happening (for example among Aids activists). He also draws attention to a recent report (the UN SDSN thematic report) that would make “real UHC” a real option, financially speaking. (On Twitter, people are already talking about ‘real UHC+’ – I hope public opinion is not the target of these tweets)
4. IS Global – Public Expenditure on Health in the Post-2015 Agenda: Let’s Think About it Again
Another must-read, especially for the Europeans among us. Tallada also comes back on the SDSN report. “A recent report drawn up by an expert panel set up by the United Nations is proposing that high-income countries should allocate at least 5% of their GDP to public spending on health and a further 0.1% to funding international aid in the same field.” Tallada has his reservations, based on the view from Spain, a country struggling with austerity policies. For example, he’s afraid the 5 % figure will be abused by people who want to cut the public health system further. He has some other concerns too.
5. JAMA forum – Looking Beyond the Millennium Development Goals Toward a Sustainable Development Agenda
Gostin assesses where we are now, after the week in New York. He also offers his own health-related post-MDG vision: “…Instead (i.e. of narrow health goals), the international community could boldly pronounce a goal of “health throughout the life span for all” based on the human right to health, with a rich array of public health and health care services, and assurance of the key social determinants of health. That promise would be backed by a global health treaty such as an FCGH that would hold states and stakeholders accountable for ensuring the human right to health.”
6. Lancet (Editorial) – Bringing action on climate and human development together
As you probably know (unless you happen to live on the planet Mars), the first working group of the Intergovernmental Panel on Climate change concluded that active decisions need to be taken to substantially and sustainably reduce greenhouse-gas emissions. The Conference of the Parties of the UN Framework Convention on Climate Change (COP) was installed to work on an agreement and process to reduce the emissions between 2015 and 2020. But doesn’t 2015 sound familiar ? Yes, it’s also the year the MDGs will end and be moved towards the ‘new era’ of sustainable development, the post-MDG period that will be handled too at the UN General Assembly. Hence a strong plea to let the negotiations go hand in hand by “you know whom”. But in a world where Vladimir Putin is suggested as a peace Nobel Prize candidate, that doesn’t seem very likely.
7. Lancet – Offline: Notes from the East River
Despite all evidence, the UN General Assembly prefers to focus on the positive MDG mantra and stays blind for the critical messages and lessons learnt from the MDGs. In his own style, Horton pleas for a realistic approach that dares to face the truth at the next assembly. Refraining from doing so, he says, is “obscene”.
8. WHO Bulletin (Editorial) – Health rights in the post-2015 development agenda: including non-nationals
Claire Brolan et al.;
In the new Bulletin issue, Go4Health right-to-health lawyers submit in this Editorial that the discourse surrounding the post-2015 development agenda must progress to expressly include non-nationals. The “right to the highest attainable standard of health” applies to non-nationals as well, they say. “The right to health obligates governments to facilitate access to health care to non-nationals and nationals alike. This is not simply a matter of human rights: it is a global development imperative.” (and given the horror we’re witnessing in European waters, this editorial is more than timely – at the very least, Lampedusa should be on the curricula of European children)
9. KFF – GAVI Alliance Announces 2 New Initiatives Using Private Sector Funds To Improve Vaccine Delivery
At this year’s Clinton Global Initiative, the GAVI Alliance announced a few new initiatives that aim to leverage private sector funds and expertise to improve delivery of vaccines worldwide: a new ‘Supply Chain Technical Improvement Facility’ and a ‘Supply Chain Centre of Excellence’.
10. Irin – Minorities suffer worse health outcomes – report
Minority groups suffer worse health outcomes than the rest of the population, according to a new report published by Minority Rights Group International (MRG). ‘State of the World’s Minorities and Indigenous Peoples 2013’, released to coincide with the UN General Assembly meeting on the post-MDG agenda, calls for greater measures to combat disparities in global health outcomes between minority groups and majority communities.
US & (global) health
11. Lancet (Editorial) – Health care in the USA hanging in the balance
That Oct 1, the implementation deadline of the Affordable Care Act, would hang as a sword of Damocles over the US administration was to be expected. A complete government shutdown in a global economic down spiral shows that the stakes are high. This editorial looks through the first glitches and problems of the new US health insurance that aims at facilitating financial access to health care for all. It concludes that there is still a long and bumpy road forward but isn’t that the case for any reform that turns real? A huge thorn in the flesh of some, the US health care reform has started budding. It may be pruned but that often results in delayed but improved flowering. (whether US Republicans are in the mood now for gardening metaphors is a different matter)
12. UHC forward – The Substance and Politics of US Health Reform: A Primer for the Rest of the World
If you live in the US, chances are you already know everything about Obamacare and the political ‘debate’ around it, including its role in the shutdown. But this article is still a nice read for everybody else, even if you have gone through the Lancet editorial.
Meanwhile, as already mentioned above (in the Lancet Editorial), Obamacare moved forward, on October 1st, with the launch of new health insurance ‘exchanges’, among others (in sync with the UHC momentum in the rest of the world?). In the words of Nils Daulaire, at the PAHO meeting in Washington (see below on this meeting): “ “Here in the United States, President Obama’s health-care law has put us on the cusp of reaching a major milestone in progressing toward that goal (i.e. UHC).” The new health insurance exchanges that become available this week under the law will put health coverage within reach of millions of American citizens who do not have coverage.”
As for the implications of the shutdown on US aid, the State Department and the Millennium Challenge Corp., see KFF (or the NYT). For the moment, things are not too worrying, it appears – but the situation shouldn’t last too long. (And as we know, part of the Republican party is just downright wacko and prepared to anything, even when it comes to the debt ceiling. Having said that, the entire financial sector is a bit wacko now. But in the meantime, like American civil servants, we should perhaps all wonder for ourselves whether we are doing “essential” work or not … (starting with the people working for Goldman Sachs and JP Morgan Chase, for example – although admittedly, the latter now make a global health contribution, see last week’s press release on the new Global Health Investment Fund, hurray! ).
13. CGD – PEPFAR 3.0: The Easiest Decision for Congress This Week
Jenny Ottenhoff examines the PEPFAR Stewardship and Oversight Act of 2013 (S 1545/HR 3177), which aims to extend and modernize PEPFAR. “The bill isn’t a full reauthorization like in years past; it simply extends provisions in the current law that would otherwise expire on September 30 and updates PEPFAR’s annual reporting requirements to strengthen congressional oversight of the program.” She lists what the bill would do and wouldn’t do, and says that even in polarized times like these, this shouldn’t be too hard for Congress – given the bipartisan support for PEPFAR.
On Monday, The Senate Foreign Relations Committee on Monday night already passed a (slightly amended) version of the PEPFAR Stewardship and Oversight Act. (see also a Science Speaks article on this). For the latest on the PEPFAR bill in Congress, see again Science Speaks.
In other PEPFAR related news, in a meeting with top African and global health leaders on the sidelines of the U.N. General Assembly in New York last week, U.S. Secretary of State John Kerry announced the establishment of PEPFAR ‘Country Health Partnerships’. In the words of Eric Goosby: “Building on the success of PEPFAR’s 22 Partnership Frameworks, PEPFAR Country Health Partnerships will advance the principle of country ownership … by further empowering countries as they work to improve the health of their citizens and achieve an AIDS-free generation at home. PEPFAR Country Health Partnerships will involve an intensified commitment to shared responsibility and accountability, budget transparency, joint decision-making, and strategic investments based on improved data collection and analysis -– all of which will improve our collective ability to save lives and support sustainability. These partnerships represent the next step in a natural evolution that PEPFAR has undertaken in recent years to move from an emergency program to an enduring initiative. PEPFAR will initially formalize Country Health Partnerships with South Africa, Namibia, and Rwanda.” (see also a UNAIDS article on this).
14. GHTC blog – What’s ahead on the Hill: An update on the government shutdown and global health R&D programs
In a guest post on the Global Health Technologies Coalition’s “Breakthroughs” blog, Jenny Howell, senior policy and advocacy associate at PATH working with the GHTC, writes about how the government shutdown and budget negotiations in Congress will impact global health research and development programs across the federal government. She also provides an update on new legislation that would impact PEPFAR (see above) and summarizes how the government shutdown is affecting different agencies.
15. Aidspan – Board Decisions Made on Several Elements of the Allocation Methodology
“Several pieces have been added to the jigsaw puzzle of the Global Fund’s allocation methodology for the new funding model with the 3 October announcement of two Board decisions. These decisions covered the global disease split; TB-HIV collaboration; the split between indicative and incentive funding; graduated reductions for countries deemed to be over-allocated; and the disposition of additional resources that become available after the initial allocation is determined.” (must-read)
See also the Global Fund newsflash on these two Board decisions.
16. Plos (Policy Forum) – Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund’s Approach
David McCoy et al;
David McCoy and colleagues critique the dominance of “lives saved” models of assessing the impact of health programs using The Global Fund as a case study. (a must-read)
17. Plos (Perspective) – Saving Lives in Health: Global Estimates and Country Measurement
Daniel Low-Beer et al.;
Daniel Low-Beer and colleagues provide a response from The Global Fund on the critique of their lives saved assessment models. (again a must-read)
In other Global Fund news, Luxemburg made a new commitment (10.1 million US dollar for the next three years) which turns the country into one of the most generous countries (per capita).
18. CGD – Is The Global Fund Really Worth $5 Billion?
US politicians will need to decide whether the GF is worth 5 billion US dollar (as the US contribution to the Fund’s replenishment). Starting from the assumption that US politicians are rational people, Ben Leo gives the pros and cons. (very thoughtful piece)
PAHO meeting in Washington
19. PAHO press release – Health leaders from the Americas support UHC
Health leaders from the Pan American Health Organization (PAHO), WHO and PAHO/WHO Member States expressed support for UHC on the opening day of the 52nd session of the PAHO Directing Council. With quotes from Carissa Etienne, Margaret Chan, Nils Daulaire and others. The meeting took place from September 30 through October 4 in Washington, DC.
20. PHM on PAHO – Open letter to the distinguished delegates of the 52nd directing council/65th session of the regional committee of the WHO
PHM’s WHO Watch submitted some comments and suggestions on some of the items on the PAHO agenda in Washington. PHM watchers were following several items closely, throughout the four days, among others, Social Protection in Health, human Resources for Health, Cooperation for Health Development in the Americas and Health in the post-2015 development agenda.
21. Lancet Global Health – Effect of HIV prevention in key populations: evidence accumulates, time to implement
In The Lancet Global Health, Michael Pickles and colleagues show how Avahan, a large-scale prevention programme in India targeting female sex workers and men who have sex with men, is estimated to have averted about 202 000 HIV infections in its first 4 years and 606 000 infections over 10 years. Marie Laga (ITM) comments: ” This report should help to convince policy makers and programme managers worldwide to address this unfinished agenda of targeted HIV prevention. Investments in programmes for key populations and creation of a conducive environment for HIV prevention and human rights can make a great difference to the future course of the HIV epidemic. The evidence from India is overwhelming. The time for scaling up in the rest of the world is now.”
22. Science Speaks (blog) – Towards Zero Deaths: Roadmap for Childhood Tuberculosis builds on proven steps
WHO and partners released a report ‘Roadmap for Childhood TB: Towards Zero Deaths’. The document seeks to outline the activities that need to be implemented to accelerate progress toward the elimination of childhood TB. In that way the most vulnerable and invisible TB victims get into the picture.
23. NEJM (Review article) – Noncommunicable Diseases
David J. Hunter et al.;
The UN and WHO have called for a 25% reduction by 2025 in mortality from NCDs among persons between 30 and 70 years of age, in comparison with mortality in 2010, adopting the slogan “25 by 25.” The authors review the burden of NCDs and issues in prevention, detection, and treatment that must be addressed in order to meet this goal.
24. KFF – Report Calls For Cancer-Specific Global Fund To Curb Increasing Rates In Developing Countries
A global fund is needed to curb ballooning cancer rates in poor nations, where malignancies already kill more people than AIDS, tuberculosis and malaria combined, according to a report by a coalition of researchers presented at the European Cancer Congress in Amsterdam on Monday.
25. WHO Bulletin (early online) – Protecting policy space for public health nutrition in an era of international investment agreements
Anne Marie Thow et al.; http://www.who.int/bulletin/online_first/13-120543.pdf
Philip Morris has recently brought claims against Australia (2011) and Uruguay (2010) under international investment agreements (IIAs). The claims allege that Philip Morris is entitled to compensation following the introduction of innovative tobacco packaging regulations to reduce smoking and prevent non-communicable diseases (NCDs). Since tobacco control measures are often viewed as a model for public health nutrition measures, the claims raise the question of how investment law governs the latter. This paper tries to answer this question and to explain how governments can proactively protect policy space for public health nutrition in an era of expanding IIAs.
26. MSF Access – Governments in Trans-Pacific trade deal urged to reject political trade-offs harmful to access to medicines
As Asia-Pacific leaders prepare to meet in Bali for the APEC Summit, where the 12-country Trans-Pacific Partnership Agreement trade deal will be high on the agenda, MSF urged governments not to make political trade-offs during trade negotiations that will harm access to affordable medicines for millions of people. It appears the US may propose differential treatment for some countries, which would still block access to medicines for millions.
27. Euractiv – Food and drink firms urged to crack down on sugar ‘land grabs’
Coca-Cola, PepsiCo, Associated British Foods and other global food and beverage companies are being urged to establish a zero-tolerance policy on land grabs. In its report, Sugar Rush, published on Wednesday, Oxfam said sugar, along with soy and palm oil, was driving large-scale land acquisitions and land conflicts at the expense of small-scale food producers and their families.
28. Lancet (early online) – A global research network for non-communicable diseases
UnitedHealth Group/National Heart, Lung, and Blood Institute Centres of Excellence;
This Lancet Comment gives some info on the UnitedHealth Group/National Heart, Lung, and Blood Institute Centres of Excellence group, a global research network for NCDs.
29. Lancet (Viewpoint) – Addressing invisibility, inferiority, and powerlessness to achieve gains in maternal health for ultra-poor women
Zubia Mumtaz et al.;
Essential reading. The authors zoom in on their research in rural Punjab, Pakistan, in which they have documented an entrenched caste-based social hierarchy in which the lowest caste, the Kammis, experience chronic intergenerational poverty, social stigma, and poor health and nutrition. They suggest that such women can usefully be identified as “ultra-poor” in south Asia since the convergence of social stigma and economic poverty places them in a very marginalised position. Importantly, they noted low uptake of maternal health-care services and very high rates of maternal mortality in these ultra-poor, socially marginalised women. They regret that so far, the global maternal health community has paid very little attention to these stark realities, although there has been some improvement lately. They conclude:
“As the insights and recommendations from the meeting are taken forward, we challenge those charged with developing the post-2015 health and development agenda to place the unmet needs of ultra-poor people at centre stage. Without a resolute effort to emphasise, understand, and counter the deeply ingrained structures and processes—operating both within and beyond health-care systems—that perpetuate invisibility, inferiority, and powerlessness, progress towards equity in maternal health will remain elusive. Furthermore, in many parts of the world, continued neglect of the needs of these most marginalised women will also mean failure to achieve MDG 5.”
30. Plos – The Prevention of Postpartum Hemorrhage in the Community
In a cluster-randomized controlled trial in rural Ghana, Cynthia Stanton and colleagues assess whether oxytocin given by injection by community health officers at home births is a feasible and safe option in preventing postpartum hemorrhage. In this perspective, João Paulo Souza discusses implications of the study in low-income countries and outlines the remaining challenges.
31. Health Financing in Africa – Fee Exemption for Maternal Care in Sub-Saharan Africa: A Review of 11 Countries
Bouchra Assarag interviews Fabienne Richard (ITM) about a recent publication on fee exemption for maternal care (in Global Health Governance).
Health Policy & Financing
32. Lancet (Comment) – Economics: the biggest fraud ever perpetrated on the world?
It’s not often that Richard Horton is being attacked fiercely in his own journal. So if you’re an evil character like us, we presume you might want to read this nice piece of work. Starting point: Horton’s tweets on the multiple failings of economics and economists. (we figure sooner or later an economist might also want to talk about the multiple failings of medicine and doctors)
If you start feeling some empathy for health economists after this very balanced viewpoint, you might also want to read this short Comment by Bruce Hollingsworth in the Lancet Global Health on where we should focus on: cost, production, efficiency or effectiveness. The Comment is based on a paper he presented in a plenary session at the Global Health Metrics and Evaluation Conference in Seattle, in June.
33. Chatham House – Tackling Antibiotic Resistance for Greater Global Health Security
Gemma L. Buckland Merrett;
Antibiotic resistance is now recognized as a major global health security issue
that threatens a return to the pre-antibiotic era, with potentially catastrophic
economic, social and political ramifications. An extra burden is likely to hit
resource-poor countries. Integrated efforts involving academia, policy-makers, industry and interest groups will be required to produce a global political response with strong leadership, based on a coherent set of priorities and actions.
34. AFDB – Public-private partnerships promise a bright future for the African pharmaceutical industry
“The African pharmaceutical sector is expected to grow tremendously in the coming years. The opportunity is such that public-private synergies are key to the development of the industry.” These were the conclusions that emerged from the first African Pharmaceutical Summit, held on September 23 and 24 in Hammamet, Tunisia.
35. Plos NTDs – Advancing Sino-Indian Cooperation to Combat Tropical Diseases
Peter Hotez et al.;
In 2005 India, Nepal, and Bangladesh signed a landmark agreement to eliminate visceral leishmaniasis in South Asia. In this editorial, Peter Hotez, Sunit Singh and Xiao-Nong Zhou outline the exciting opportunity for India and China to also engage in international science diplomacy for controlling or eliminating the major neglected tropical diseases in their two countries, and thereby reduce the global NTD burden by up to 40%.
36. FAO report on undernutrition – The State of Food Insecurity in the World 2013
“The number of people who are chronically undernourished has fallen from an estimated 868 million in 2010-12 to 842 million in 2011-13, according to a U.N. report that celebrates progress made, but warns that ‘considerable and immediate additional efforts’ will be needed to meet global goals to reduce hunger by 2015,” The Guardian reports. “If current rates of progress continue, the report says, the prevalence of undernourishment in the developing world will approach 13 percent by 2015 — close to, but still above, the MDG target of 12 percent. “
Another Guardian Op-Ed (by Lawrence Haddad) says it’s time undernutrition is politicized as it’s far more than a health problem.
Meanwhile, “Food experts from around the world gathered for the first Global Food Security Conference in Noordwijkerhout, Holland, this week to discuss solutions for feeding a hungry planet,” Deutsche Welle reported. (they did so presumably in a fancy hotel)
37. Gulf Times – Stage set for summit of global health innovators
“A first of its kind ‘Global Innovation Diffusion Study’ was unveiled yesterday as the stage is set for the inaugural World Innovation Summit for Health (WISH) to be held at the Qatar National Convention Centre on December 10-11. Executive chair of WISH Prof Lord Darzi, who revealed the plan for the study at a press conference, explained that the study would assess eight countries comprising Qatar, Brazil, the UK, the US, Australia, Spain and South Africa, in terms of how their systems contribute toward transformative change – whether through innovation in technology, processes and business models.” (meanwhile, we hope Sepp Blatter and other FIFA bigwigs can induce some ‘transformative change’ in the way Nepalese workers are being treated in Qatar)
38. Foreign Policy – The World Hasn’t Tackled Syria’s Real WMD Nightmare
Leonard A Cole;
Assad’s bioweapons program should keep you awake at night.
Global health bits & pieces
- “India and the U.S. should expand their collaborations at a global level and work jointly together to address range of issues like poverty, child deaths, food security, conservation of natural resources and international peace,” Indian Prime Minister Manmohan Singh and U.S. President Barack Obama said in a joint statement following an hour-long meeting at the White House last week.
- Gates foundation and sanitation in India: “October 2, 2013, is the 144th birthday of Mahatma Gandhi and what better way for the Bill & Melinda Gates Foundation to celebrate this profound and inspirational leader than to announce our new partnership with the government of India in joint funding the Biotechnology Industry Research Assistance Council (BIRAC) to launch the Reinvent the Toilet Challenge – India,” said Girindre Beeharry & Carl Hensman (both from the Gates foundation), in a blog post. From his Hindu heaven, Mahatma probably smiles.
- On the ‘International Day of older persons’, AP reported: “The world is aging so fast that most countries are not prepared to support their swelling numbers of elderly people, according to a global study issued on Tuesday.”
- On disability: Inter Press Service has published a two-part series exploring disability’s place on (or rather its omission from) the international development agenda. (see here and here).
Global Health announcements
Open online course on global health in Geneva – see https://www.coursera.org/course/globalhealthoverview
The University of Geneva announces the launch of its 8 week Open Online Learning Course on ‘Global Health: An Interdisciplinary Overview,’ which commences on the 7th October, 2013. Anyone can register for this free online course via the following link: https://www.coursera.org/course/globalhealthoverview
The course presents a range of issues, trends, achievements and challenges for global health, from an interdisciplinary perspective. The course is based around the following themes:
Week 1. Introduction to global health concepts
Week 2. Emerging trends in global health: Infectious diseases
Week 3. Emerging trends in global health: Non-communicable diseases, mental disorders and disability
Week 4. Governance for global health, health systems and financing
Week 5. Foreign policy, trade and health
Week 6. Research, development, innovation and technology for global health
Week 7. The environment, sustainable development and health
The course includes video presentations by a range of 36 experts from the University of Geneva and other organisations, plus a course guide and interactive online discussion forum activities. Already 11,000 students from across the globe enrolled in this course.
39. BMC Health services research – Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation
Sophie Witter et al.;
PBF is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on LMICs. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. (a must-read)
40. WHO Bulletin – Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries
41. International Journal for Quality in care – Improving health system quality in low- and middle-income countries that are expanding health coverage: a framework for insurance
Kedar S. Mate et al.;
LMICs are increasingly pursuing health financing reforms aimed at achieving UHC. As these countries rapidly expand access to care, overburdened health systems may fail to deliver high-quality care, resulting in poor health outcomes. Public insurers responsible for financing coverage expansions have the financial leverage to influence the quality of care and can benefit from guidance to execute a cohesive health-care quality strategy. Following a literature review, the authors used a cascading expert consultation and validation process to develop a conceptual framework for insurance-driven quality improvements in health care.
42. Plos One – The Market Dynamics of Generic Medicines in the Private Sector of 19 Low and Middle Income Countries between 2001 and 2011: A Descriptive Time Series Analysis
Warren A. Kaplan et al.;
This observational study investigates the private sector, retail pharmaceutical market of 19 LMICs in Latin America, Asia and the Middle East/South Africa analyzing the relationships between volume market share of generic and originator medicines over a time series from 2001 to 2011.
Check out also the ‘Girl declaration’ (see here): “Girls were left out of the original Millennium Development Goals. The Girl Declaration has been written to make sure that doesn’t happen again. Bringing together the thinking of 508 girls living in poverty across the globe with the expertise of more than 25 of the world’s leading development organisations, the Girl Declaration is our tool to stop poverty before it starts.”
- A CGD fellow gave 12 take-aways from the IPCC report.
- CGD fellows Alan Gelb & Mead Over also discuss the new World Bank strategy (in a blog post ).
- Africa is not rising, a survey shows (in the Guardian).