It’s 2014 now, and to start with the important news, Lionel Messi is back! Should be good for the health of many people around the world. Almost as important though, we also want to remind you of this year’s – 2014 – Emerging Voices Venture, which will be linked to the third Global Health systems research symposium in Cape Town. You find the call here (deadline is March 3 for submitting the three required documents), but you can already express your intention to apply here and of course nobody says you can’t send us the documents earlier than the deadline. Having just spent some days in Cape Town, we can definitely recommend the (stunning) setting (and the programme of course!). We hope Emerging Voices will shine in Cape Town the way Messi, Neymar and our very own Kompany & Hazard will no doubt shine at the World Cup in Brazil earlier in the summer.
It was the week of the ‘polar vortex’ and ‘Chiberia’ in the US – where are the pictures of a bare-chested Obama taking on the many wolves in Washington, by the way ? -, and of course let’s not forget the stranded people on the Antarctic, obviously all great fun for Fox. But whether you believe in global warming or global cooling, it should be clear by now that not greed but green is good for all of us and we would thus do well to take care of our own habitat. Meanwhile, Richard Horton and Anthony Costello are having none of it, and think (like many of us, including me) that climate change is still the biggest global health threat of this century, so a new Lancet Commission on Emergency Actions to Protect Human Health was set up to respond to the health emergency of climate change. For a Commission event on Thursday 16 January in London, see here.
This week, Patrick Stewart from CFR wrote a nice essay on ‘good enough global governance’ for Foreign Affairs which you should definitely read, if only for his description of the difficult transition of the G20 from a short term crisis manager to a longer term steering group for the global economy – similarities with the Global Fund are just a coincidence.
As for the increasing homophobic backlash in countries as diverse as Uganda, Russia, India, … (for an insightful UNAIDS infographic, see here) it is not clear how the global health community (and donors and international organisations in general) should react. Many are divided as well on the issue, it appears. My own piece of advice: I think they would be far less vulnerable to vitriolic attacks and criticism – as in “this is a Western imposed and imperialist agenda, propagated in sync with a broader neoliberal globalization agenda”, if organizations like WHO, the World Bank, Rockefeller, etc. and individuals like Cameron or Branson also took a clearer stance on other important social issues, affected by globalization. Like the right to decent work, for example. Can you imagine Cameron not just criticizing homophobic laws in recipient countries but also saying something like this: ”Workers in Cambodia and Bangladesh need to have a decent salary, just like in the UK (oops).” Or to take another example, as long as USAID is cheerfully relishing its partnership with Walmart, without taking a clear stance on the company’s social record in the US and elsewhere, it seems more in line with Davos thinking than with global justice. Encouragingly, the Clinton Initiative seems to be paying more and more attention to youth unemployment in Greece, for example. A trailblazer for others?
After the ‘coming out’ of a German gay football international this week, I also dream of a global team of football stars, from countries around the world, all of them proudly gay. Can you imagine the adverts on our tv screens? FIFA has been very vocal in terms of promoting racial tolerance, perhaps it’s time to also focus more on sexual identity – after all, football can’t be a western imperialist agenda, no matter hard we try – although arguably, the Champions & Premier Leagues are neoliberal toys.
Well, the year is still fresh, so dreaming is still allowed.
In this week’s guest editorial, Swati Srivastava talks about the ‘new guy’ in India, Arvind Kejrival, from the ‘Common Man Party’ which made a blast in Delhi elections just before the end of the year.
Enjoy your reading.
Kristof Decoster, Basile Keugoung & Wim Van Damme
Aam Aadmi Party: sweeping clean the corridors of power in Delhi?
By Swati Srivastava (Research Associate Public Health Foundation of India, currently studying at ITM)
Last December Delhi, and the whole of India, witnessed something special. The concept was too much of a fairy tale to be plausible: a new political party, founded on the principle of a “war against corruption” and rooted in a movement for reform took on the grand old dame of Indian politics, the 128 year old Indian National Congress party in a state which it had ruled unopposed for ten years, and emerged (albeit semi-) victorious. The Aam Aadmi Party (AAP, Common Man Party) made a spectacular debut in the Delhi Assembly elections, emerging as the second largest party and its leader, Arvind Kejriwal, a former civil servant, pulled off a remarkable win over the outgoing septuagenarian chief minister.
However, politics makes for strange bedfellows, and early January saw the AAP come to power in the Delhi Assembly with the Congress’ support. On January 2 Kejriwal and Co., backed up by the Congress to meet the requisite majority, took oath as ministers, an event that was a bit of an irony considering the AAP wanted to sweep clean Delhi’s corridors of power and VIP culture with its veritable broom (the party’s rather apt symbol). Still, Kejriwal and the youngest-ever Delhi cabinet ministers taking the Delhi Metro (instead of the ubiquitous fear-inducing and traffic-halting Ambassador cars fitted with red and blue beacons so preferred by Indian politicians) to commute on their first (and hopefully subsequent) days at work was welcome, though it had the opposition crying hoarse populism.
This aside, the AAP has some lofty ideas on where they are trying to go. What is not so clear is how they are going to get there. The Delhi elections were contested around the themes of the passage of the Jan Lokpal Bill, which seeks appointment of an independent anti-corruption body to investigate corruption cases; swaraj or self governance/rule, in which people will take decisions directly in local meetings; reduction of electricity tariffs and audit of power distribution companies; water supply and distribution; safety and equality for women, and human development focused on health and education. Vis a vis health, AAP is also making all the right noises. Improving quality of government facilities, increasing the number of facilities, filling staff vacancies, making private hospitals accountable for and fulfilling their public obligations in return for public subsidies, and management of dispensaries and primary hospitals by village committees all feature prominently on their agenda. AAP also promised to open 500 government schools, improve existing schools, and regularize and appoint teachers for vacant posts. Where the money for all of this will come from is, of course, a rhetorical question.
The few days that AAP has been in power have been replete with populist promises that have left a lot of people bewildered. The first of these included providing 700 litres of free water per day to each household with a regular water connection (a move criticized for both its inability to bring water to those who need it most i.e. a fifth of Delhi residing in slums/ localities without metered connections; as well as a scant regard for water distribution and losses). This was followed by a tariff cut of 50% on electricity. On the economic front, the AAP’s committee on economic policy is yet to come up with its recommendations. Some economic stances include simplifying value added tax for traders and opposing foreign direct investment in retail. A party strategist recently stated “the party is socialist, not silly”; and will seek to increase the number of quotas for “lower” castes and women, a move that has traditionally not been welcomed by AAPs middle-class supporters. A prominent left-wing politician remarked that the lack of a clear-cut program and policy perspective means that AAP represents all things to all people. Other critiques include the presence of only three top party positions, which is rather contradictory for a party focused on decentralization.
The AAP must be appreciated for its stance on corruption. The party was formed as a break-away faction from the Anna Hazare movement, seeking to politicize the Jan Lokpal demand. They also fielded no candidates with criminal proceedings against them, which sadly cannot be said for other parties. AAP also sought feedback from voters post announcement of election results on government formation, and received nearly 450,000 SMSs, phone calls and emails. Wednesday saw the launch of an anti-corruption helpline in Delhi.
The AAP is high on ambition, and has captured the fancy of the generally politically apathetic Indian middle classes. It remains to be seen how they can sustain this momentum, and how ambition translates into substance. Delhi is different from other states, where an election based on the platform of corruption could garner the public’s support. Corruption may not be a game changer in other states, where it still may be more important for the aam aadmi (common man) to vote along caste, religious, or ideological lines. Previous experiences have also shown that populist measures to please electorates have never appealed on a long term basis with Indian voters. Trying to balance their people-centered governance while co-opting diverse groups alongside the empowered middle class and negotiating the minefield that is the Indian political spectrum may help AAP to usher in a politics of hope for India.
Lancet series on increasing value and reducing waste in research
A new Lancet Series focuses on increasing value and reducing waste in research. The Series documents waste in research from five principal sources — ranging from waste in deciding what research to do, through to waste because of unusable reports of research. In these papers they set out some of the most pressing issues, recommend how to increase value and reduce waste in biomedical research, and propose metrics for stakeholders to monitor the implementation of these recommendations.
Dakar “Harare + 25” conference report
You can find the English report on the ‘Harare + 25’ conference in Dakar (from October 2013) here: ‘Renewing health districts for advancing UHC in Africa: Report of the regional conference “Health districts in Africa: progress and perspectives 25 years after the Harare Declaration” . (There’s also a French version (see here).)
Bruno Meessen (ITM) introduces the report and puts it in perspective in this blog post on the ‘Health 4 Africa’ blog.
Post-MDGs & UHC
1. Le Monde Diplomatique – supplement on UHC : Health coverage : a universal struggle
Le Monde Diplomatic has a supplement on UHC this month, with a number of interesting articles. For the French version, see here.
2. Lancet – Offline: Social chaos—the ignored tragedy in global health
Social chaos is systematically ignored on the global health agenda, Horton claims. Matters of armed conﬂict, internal displacement, and fragile situations are never seriously discussed in global health for a. This needs to change – Social
chaos should be a more central concern for global health.
3. Plos Medicine – Improving Women’s Health through Universal Health Coverage
Jonathan Quick et al.;
Jonathan Quick and colleagues discuss how women’s health world-wide can be improved through universal health coverage.
- Yesterday (January 9), a two-day WB/UNAIDS/… conference started, on how to reframe the HIV response in the global agenda: “Social Drivers to End AIDS and Extreme Poverty”.
From the website: “As 2014 kicks off, global health and development leaders are increasingly engaged in discussion of the post-2015 development agenda and strategies to end extreme poverty and AIDS. This discussion included how to reframe the AIDS response so that it is comprehensive, in the context of broader global development goals. On Jan. 9-10, 2014, the World Bank Group, UNAIDS and other partners host a conference to address intersectoral approaches to merge global development and HIV responses with broader goals for equitable and sustainable progress. The conference report served as a companion document to a future special issue of The Lancet, which will report outcomes of the UNAIDS and Lancet Commission on AIDS and Health.” The opening session was live broadcast.
4. Science Speaks – PEPFAR leader: CDC Global HIV/AIDS director named to succeed Ambassador Goosby
The White House has nominated a physician scientist, Dr. Deborah Brix, whose career began three decades ago with a focus on immunology, vaccine research, and global health, to succeed Global AIDS Coordinator Ambassador Dr. Eric Goosby. She still needs to be confirmed by the Senate.
5. Science Speaks – USAID, Population Council agreement for non-antiretroviral microbicide quest looks to expand prevention toolbox
“An agreement between the United States Agency for International Development and the Population Council announced Monday for the development of a non-antiretroviral-based compound to block HIV and other sexually transmitted infections could yield a low-risk, easy access product for women in low resource settings in as few as a dozen years, if a promising new compound performs as hoped.” The agreement is a $20 million five year initiative. Plans are aiming at beginning clinical trials in 2016, initially for a gel-based product. A best case scenario could make a product available by about 2026.
6. Science Speaks – HIV success ratings are in the eye of the beholder
Science Speaks examines the Afrobarometer research project’s recent cross-continent survey, released in December ( overall, the HIV response is perceived quite well, when compared to other government service delivery tasks), and a supplement from the Journal of the International AIDS Society that discusses progress and challenges in efforts addressing HIV/AIDS in Africa.
7. Aidspan – African HIV programming failing to respond to acute needs of sexual minorities
Global Fund efforts to target key affected populations including sexual minorities in the fight against HIV may continue to face an uphill battle in sub-Saharan Africa, new studies have shown, because of prevailing stigma and marginalization even within existing programming.
8. IRIN – Life-saving hepatitis C drug approved, but cost is high
An article from a few weeks ago (Dec 23): “Following approvals in the US and Europe this month of a new drug to treat hepatitis C, activists are pushing for the medication to be made available in poor countries, a development reminiscent of the activism that forced down HIV/AIDS drug prices a decade ago in Brazil, South Africa and Thailand.” Nice overview by Irin.
9. Globalization & Health – “To patent or not to patent? the case of Novartis’ cancer drug Glivec in India”
Ravinder Gabble et al.;
The ‘Novartis case’ illuminates how India is interpreting international law to fit domestic public health needs. “The Novartis case arguably sets an important precedent for the global pharmaceutical industry and ideally will help improve access to lifesaving medicines in the developing world by demanding that patient health needs supersede commercial interests. The Supreme Court of India’s decision may affect the interpretation of the article of the TRIPS Agreement, which states members shall be free to determine the appropriate method of implementing the provisions of this Agreement within their own legal system and practice.”
10. Fierce Pharma – China pulls J&J trademark on OneTouch diabetes products
Some more evidence that Big Pharma patents and trademarks are under siege in emerging markets: China removed Johnson & Johnson’s OneTouch trademark rights, allowing competitors to sell their diabetes-monitoring products under the same name. J&J is appealing the decision.
11. Guardian – War on tobacco far from won
New figures from the Seattle-based Institute for Health Metrics and Evaluation show smoking rates have dropped over the past 30 years but the actual numbers of people using cigarettes have risen. See the study in JAMA.
For some IHME visualisation tools, see here.
12. Public Health – China’s position in negotiating the Framework Convention on Tobacco Control and the revised International Health Regulations
This paper examines China’s position in the negotiations of the Framework Convention on Tobacco Control and the revised International Health Regulations. In particular, it explores three sets of factors shaping China’s attitudes and actions in the negotiations: the aspiration to be a responsible power; concerns about sovereignty; and domestic political economy.
13. Plos – Averting Obesity and Type 2 Diabetes in India through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study
Sanjay Basu et al.;
In this modeling study, Sanjay Basu and colleagues estimate the potential health effects of a sugar-sweetened beverage taxation among various sub-populations in India over the period 2014 to 2023. In a linked Perspective, Tony Blakely and colleagues discuss the real-world implications of this type of modeling study.
14. Duncan Green – Obesity, Diabetes, Cancer: welcome to a new generation of ‘development issues’
Oxfam’s Duncan Green, a development policy expert, talks about the rise of the ‘North in the South’ on health – or what he calls “Cinderella Issues”. “Things like road traffic accidents, the illegal drug trade, smoking or alcohol that do huge (and growing) damage in developing countries, but are relegated to the margins of the development debate. If my New Year reading is anything to go by, that won’t last for long.” In fact, the shift is already happening.
15. WHO – Framework of engagement with non-State actors: report by the Secretariat
This is the Framework of WHO engagement with non-State actors, as put forward by the Secretariat. Will be discussed at the 134 Executive Board meeting, together with many other agenda items (see here for all the background docs).
16. Nature – Projects set to tackle neglected diseases
Erika Check Hayden; http://www.nature.com/news/projects-set-to-tackle-neglected-diseases-1.14474?utm_campaign=KFF%253A%2520Global%2520Health%2520Report&utm_source=hs_email&utm_medium=email&utm_content=11597564&_hsenc=p2ANqtz-9qoL1X4cDW0rwES7Dl4CUDHFrD4Vo6bGEEiADtVdVTUtc1-mqA-in-ZlT1i5veSd4GzJSbwfW7hMLf60g-0oPG62TL2w&_hsmi=11597564
Nice overview of the R&D funding for neglected diseases discussion (and the pilot projects), which will also be an item at the EB.
17. Lancet (Correspondence) – Webcast the World Health Assembly
Amir Attaran et al.;
To borrow a phrase that is common in global health circles, “the time is now” to webcast the World Health Assembly! (not sure the sessions will be watched as much as reality tv though)
18. GF newsflash issue 35 – Funding Application Materials Now Available
http://www.theglobalfund.org/en/blog/2014-01-08_Global_Fund_News_Flash_Issue_35/ As reported in a previous IHP newsletter, on 20 December 2013, the Global Fund made available a new funding application template, called a concept note, to enable applicants to prepare requests for funding in 2014. The submission of a concept note begins the process of applying for a grant. In March, the Global Fund will launch the full implementation of its NFM. The new funding application documents, posted in the ‘new funding model’ section of the Global Fund website (see here ) include a template for the Standard Concept Note for HIV, tuberculosis and malaria, as well as core tables and instructions. The Global Fund plans to publish all application materials by the end of January 2014. These will include Non-Standard Concept Notes (for example, for joint HIV/tuberculosis applications and for health systems strengthening) along with an optional “Expression of Interest” template to be used for regional applications.
19. GFO (new issue)
Aidspan published Issue 234 of its Global Fund Observer. The issue includes an article on the approval of more than $250 million for the renewal of 16 grants for 13 applicants; a news story on the 2013 ICASA conference in Cape Town and a commentary (by Njihia Mbitiru) on why the private sector should contribute more to the Global Fund. (As you might have guessed, we thoroughly enjoyed this article in particular – after all, the GF is supposed to be a “public-private partnership”.)
In related news, you might want to read this nice article by Robert Bourgoing, on whether organisations like Aidspan should be ‘watchdogs’ or ‘critical friends’. He reports on a recent meeting in Nairobi with the representatives of about 30 organizations from Eastern and Southern Africa involved in the monitoring of global health programs. The meeting was hosted by Aidspan. (PS: real friends never shy away from constructive criticism, so ‘critical friends’ is perhaps not an appropriate term)
Health Policy & Financing
20. Global Fund – A New Development Framework
Mark Dybul & Julio Frenk;
It’s time for a Monterrey Consensus 2.0, argue Dybul & Frenk (in a Huffington Post op-ed). Emerging countries have to be much more involved in development (and for example also in the Global Fund). Let’s see whether there are any takers.
21. Health Financing in Africa – Scaling up results-based financing for faster progress towards the health MDGs: reflections on a recent donor meeting in Oslo
Bruno Meessen and Olivier Basenya (MoH, Burundi) report on a recent donor meeting hosted by the Ministry of Foreign Affairs of Norway dedicated to developing a road map for RBF, in Oslo 11-12 December. Check out also the numerous responses below the blog post. Hot topic, obviously.
22. CSIS – Global Health within a domestic agency: The transformation of the office of global affairs at the HHS
In 2011, the US department of Health and Human Services (HSS) introduced a global health strategy, the first of its kind for what traditionally has been seen as an agency with primarily domestic responsibilities. Since then, global health has become more and more important within the department’s mandate. Bliss gives the picture of the last few years.
23. Equinet January newsletter
The new issue of the Equinet newsletter includes, among other articles, an editorial by Barbara Kaim: ‘Equitable health systems listen to people.’ ( a bit like smart politicians do)
24. Project Syndicate – The Emerging World’s Vaccine Pioneers
Decent week for Bill – with this op-ed in Project Syndicate, in which he points out the growing role of emerging-country vaccine suppliers – , but also with this fairly critical article (by Ian Birrell) in the Guardian (to Gates’ credit, it also appeared on the Guardian’s Poverty Matters site, which is subsidized by the Gates Foundation). Birrell questions the tax practices of Microsoft. (Microsoft is not alone in this, obviously. Nevertheless, if Gates really wants to be a “secular saint”, he should take the lead on this key global health issue as well: there’s is no global health without proper taxation. For example, by a public announcement in Davos?)
25. Globalization & Health – The global financial crisis and health equity: Early experiences from Canada
Arne Ruckert & Ronald Labonté;
Health equity (in Canada) is primarily impacted through two main pathways related to the global financial crisis: austerity budgets and associated program cutbacks in areas crucial to addressing the inequitable distribution of social determinants of health, including social assistance, housing, and education; and the qualitative transformation of labor markets, with precarious forms of employment expanding rapidly in the aftermath of the global financial crisis.
26. Guardian Global Development Professionals network –
Disabilities caused by neglected tropical diseases are often overlooked in prevention efforts. Media coverage and health programmes must also focus on side-effects and care options, the author of this article – listening to the lovely name of Emelie Filou – argues, not just on MDA.
27. USAID – USAID Announces new award to prevent and repair obstetric fistula
USAID announced the award of the Fistula Care Plus Project to EngenderHealth and its institutional partner, the Population Council. Fistula Care Plus is a five-year cooperative agreement with a ceiling of almost $75M. The overall objective of the project is to strengthen health system capacity for fistula prevention, detection, treatment and reintegration in Sub-Saharan Africa and South Asia. Activities will begin immediately in Bangladesh, Democratic Republic of Congo, Sierra Leone, Niger, Nigeria, and Uganda.
28. CFR – Guaranteeing That Our Medicines Are Safe: Building a Global Coalition of Regulators
Patrick Stewart & Jeffrey Wright;
To help devise strategies and examine best options for medicines regulators to coordinate multilateral cooperation in the sphere of safe medicines, CFR’s International Institutions and Global Governance program convened a workshop in Washington, in September last year called, “Ensuring the Safety and Quality of the Global Supply Chain for Medicines: Regulatory Challenges and Lessons From Other Sectors.” The event convened heads of medicines agencies from ten countries and the EU to glean insight from transnational regulation in twelve other international spheres.
29. Social Science & Medicine – Do sector-wide approaches for health aid delivery lead to donor-flight?
Rohan Sweeney et al. ;
This paper utilises a dataset of 46 low-income countries over 1990-2009 and a variety of panel data regression models to estimate the impact of health SWAp implementation on levels of health aid. Results suggest that amongst 16 especially poor low-income countries, SWAp implementation is associated with significant decreases in health aid levels compared with non-implementers. This suggests donors are not indifferent to how their contributions are allocated by recipients, and that low-income countries considering a SWAp may need to weigh the benefits of greater control of aid allocations against the possibility of reduced aid income.
30. Lancet (Editorial) – Health care in the USA: turning the corner
The year has just started, and Obama got some bad news again this week – with among others, the fierce criticism from Gates (Robert, that is) on his foreign policy. However, as far as the implementation of ACA is concerned, things seem to improve. There are still plenty of challenges, though, this Lancet editorial argues. See also the Lancet World Report on the same issue (by S. Jaffe).
31. Project Syndicate – Trading away human rights
Olivier de Schutter & Kaitlin Cordes;
One Belgian we’re really proud of: Oliver De Schutter. In this op-ed for Project Syndicate, he argues together with Kaitlin Cordes that a human-rights impact assessment must be conducted before any Trans-Pacific Partnership (TPP) deal is signed.
- ICASA 2013 EV venture: You can find some “Icasa” EV2013 videos & presentations here; for interviews with EVs, see here or on Youtube.
32. Journal of multidisciplinary health care – Job satisfaction among nurses working in the private and public sectors: a qualitative study in tertiary care hospitals in Pakistan
Asmat Malik et al.;
Asmat Malik, EV2010 & 2012, recently got an award award from the Rockefeller Foundation. He also just published this qualitative study. Using narrative analysis a study was undertaken in public and private tertiary care hospitals in Pakistan to examine and compare job satisfaction among nurses and understand the factors affecting their work climate.
Global health bits & pieces
- Canadian health officials reported North America’s first known case of H5N1 avian influenza infection in an Alberta woman who died last week.
- The World Bank approved $500 million to improve rural water supply and sanitation services in four Indian states (see here )
Podcasts & Videos
You can find four global health related TED talks here (by people like Vikram Patel, Ben Goldacre, Richard Wilkinson, …)
33. BMC Medicine – Using verbal autopsy to measure causes of death: the comparative performance of existing methods
Christopher Murray et al.;
Physician review of verbal autopsy questionnaires is less accurate than automated methods in determining both individual and population causes of death.
34. Global Public Health – Up-scaling expectations among Pakistan’s HIV bureaucrats: Entrepreneurs of the self and job precariousness post-scale-up
One year’s ethnographic fieldwork was conducted by the author among AIDS control officials in Pakistan at a moment of rolling back a WB-financed Enhanced Programme. In 2003, the Bank convinced the Musharraf regime to scale up the HIV response, offering a multimillion dollar soft loan package. Qureshi explores how the Enhanced Programme initiated government employees into a new transient work culture and turned the AIDS control programmes into a hybrid bureaucracy. However, the donor money did not last long and individuals’ entrepreneurial abilities were tested in a time of crisis engendered by dependence on aid, leaving them precariously exposed to job insecurity, and undermining the continuity of AIDS prevention and treatment in the country. Qureshi offers an ”ethnographic critique of the transnational HIV apparatus and its neoliberal underpinning”. He suggests that this Pakistan-derived analysis is more widely relevant in the post-scale-up decade.
- 8 Twitter tips for people tweeting from global health conferences: see here.
- CGD Brief (by Charles Kenny & William Savedoff): Results based payments reduce the real costs of corruption in foreign aid
- And yes, Sachs & Easterly are enjoying the latest episode in their epic battle – see T Murphy on this (on Humanosphere). One day they should have their own sitcom.