We would like to remind all of you – and especially the young researchers among you – of the fast approaching deadline for Emerging Voices 2014 (3 March), which will be linked to the third Global Health Systems Research symposium in Cape Town. You find the call for EV 2014 here. As you probably know, the Emerging Voices programme aims at empowering young health researchers from the Global South by providing an intensive skills training and facilitating their participation in a global health conference. This year, the EV programme will be organized for the fourth time (after previous ventures linked to Montreux (2010), Beijing (2012) and Cape Town (Icasa, 2013) respectively). If you want to apply and are eligible, send a short CV, motivation letter and abstract (the same one as the one you submit for the real symposium) to firstname.lastname@example.org by March 3.
We’ll keep it short in this week’s intro as this was again a pretty important week for global health, as you’ll see, with the launch of The Lancet —University of Oslo Commission on Global Governance for Health, the final meeting in London of The UNAIDS/ Lancet Commission: Defeating AIDS — Advancing global health, and the launch of the Global Health Security agenda by the Obama administration. So plenty of news.
In this week’s guest editorial, our colleague Gorik Ooms comments on The Lancet/University of Oslo Global Governance for Health Commission published earlier this week. Gorik was a co-author of the report. And surprise, surprise, this time he argues for treading carefully. With good reason.
Enjoy your reading.
Kristof Decoster, Werner Soors, Peter Vermeiren, Basile Keugoung & Wim Van Damme
Global governance in times of distrust
Gorik Ooms (ITM)
Earlier this week, the report of The Lancet – University of Oslo Commission on Global Governance for Health was published.
I will not try to summarize the report here, as I hope you will read the entire report, not only the summaries and analyses that have started circulating. But it was a forceful analysis of the report that encouraged me to write this editorial: the one by Charles Clift at Chatham House.
Charles hits the nail on its head when he writes that “the analysis could have been briefer and its recommendations stronger”. Ouch!
You will forgive me for not writing an apology on behalf of the Commission – I’m not in a position to do that. Nor will I write an apology on behalf of myself – something like “if I had written this on my own, the recommendations would have been stronger”. I’d rather challenge you to formulate stronger recommendations, after considering the real life constraints as we faced them. If the report can achieve that, I’ll be very proud to have contributed my share to it.
We did spend a lot of time, in meetings and correspondence, analyzing the present reality, and the report reflects that. And it was depressing. Not global health governance in particular, although that was pretty sobering as well, but all of the global governance that affects people’s health. I remember thinking, after our meeting in Arusha: ‘Damn, perhaps Thomas Nagel was right after all.’
Most of you may not be familiar with Nagel’s work. Allow me to introduce you to one of his most famous papers, about The Problem of Global Justice. This is the first paragraph:
“We do not live in a just world. This may be the least controversial claim one could make in political theory. But it is much less clear what, if anything, justice on a world scale might mean, or what the hope for justice should lead us to want in the domain of international or global institutions, and in the policies of states that are in a position to affect the world order.”
Hopefully, you won’t get stuck on the ‘not clear what justice on a world scale might mean’ – that is the least convincing part; at least I can imagine what global justice might mean, simply by imagining what a global democratic government would do better than the global governance we have. We don’t really need to have a global democratic government to be able to imagine what it would do. But if we all agree on the improbability of a global democratic government in the near future – as I presume we do – it is far more difficult to express what we “want in the domain of international or global institutions, and in the policies of states that are in a position to affect the world order.”
After the sobering analysis of present global governance and its impact on health, it was difficult to imagine global institutions that would, at the same time, have the power to make states behave in ways other than they would without such institutions, and remain unaffected by the present power asymmetries.
Allow me to use a suggestion from the Youth Commission on Global Governance for Health to illustrate the dilemma we faced. In its comment, also published by The Lancet, the Youth Commission argues: “In an increasingly interdependent world, the Commission’s concern for diverging interests and power asymmetries requires a more ambitious response if we are to harness opportunities for shared responsibility and global solidarity for health among nation states and non-state actors.” In fairness, there is a recommendation in the report, about shared responsibility: “The Commission believes that there is an urgent need for a framework for international financing that is broader than what is currently defined as official development assistance to ensure the financing of a more universal agenda for socially sustainable development”. The report also mentions “global social protection”, which “would entail appropriate distribution of national and international responsibilities, with mechanisms to collect and redistribute transfers that are both duty-based and rights-based.” But that idea is followed by a kind of warning, not a straightforward recommendation: “these are important questions that need to be further explored and debated.”
Those of you who are familiar with my work know that I am strongly in favor of a global social protection regime. Nonetheless, I support the warning. Why?
About the two principal recommendations of the report – establishing a UN Multistakeholder Platform on Global Governance for Health and an Independent Scientific Monitoring Panel on Global Social and Political Determinants of Health – the Youth Commission argues that they are “likely to be influenced by the same diverging interests and power asymmetries described by the Commission.” Right. And a global social protection regime runs the same risk.
Allow me to return to Thomas Nagel. Here’s the final paragraph of his paper:
“… if we accept the political conception, the global scope of justice will expand only through developments that first increase the injustice of the world by introducing effective but illegitimate institutions to which the standards of justice apply, standards by which we may hope they will eventually be transformed. An example perhaps, of the cunning of history.”
Applied to the suggestion of the Youth Commission, what Thomas Nagel predicts is that any international institution that has the power to impose contributions for shared responsibility and global solidarity would be illegitimate at the start – with an overrepresentation of the most powerful states, and pursuing these countries’ interests first and foremost. Then, slowly, ‘standards of justice’ could be applied, to transform this institution into a legitimate institution. Perhaps the Global Fund to fight AIDS, Tuberculosis and Malaria fits this description: half of the votes of the board were given to ‘donors’, representing 1 out of 7 billion people; the other 6 billion people on this planet have only half of the votes. The Global Fund focuses on infectious disease control rather than on health, and it could be argued that infectious disease control serves the interests of the inhabitants of ‘donor’ countries more than efforts to improve health in a comprehensive way would. But maybe these shortcomings were unavoidable when the Global Fund was created, and because it now exists, standards of justice can be applied to it, and that would – in my opinion – require turning the Global Fund we have into a global fund for health, with a more representative board. This will take time, and more debate.
Charles Clift calls the central proposals of the report “a talking shop and a monitoring mechanism”. True, but I think we need more thinking, talking and monitoring, before states – and peoples – can move beyond their narrow short-term self-interests, towards a better understanding of the many dimensions of global interdependence; towards a global social protection regime, anchored in human rights, for example. Impatient we are, but carefully we must tread.
Lancet /University of Oslo Commission on Global Governance for Health
Despite large gains in health over the past few decades, the distribution of health risks worldwide remains unacceptably uneven. A new Commission from The Lancet and the University of Oslo examines how human health is affected by the current system of global decision-making (‘global governance’). The Commission identifies seven areas where political and economic injustices affect population health, and five key dysfunctions in global governance which are impeding improvements in health outcomes. The Commission launch was webcast earlier this week (you can watch it again here).
But do read the full report, it’s a very insightful read, as well as the Lancet editorial by Horton & Lo and the assessment by the Youth Commission. For a profile of the chair of the Commission, Ole Petter Ottersen, see here.
1. Chatham House – Tackling the Political Origins of Health Inequity
The Commission on Global Governance for Health was set the ambitious task of analysing how policies and actions outside the health sector impinge on health and proposing recommendations accordingly. Its report provides much food for thought, but the analysis could have been briefer and its recommendations stronger, argues C Clift. He was probably the first to analyze the Commission (but won’t be the last, we guess).
The UNAIDS and Lancet Commission: Defeating AIDS — Advancing global health
The UNAIDS and Lancet Commission: Defeating AIDS — Advancing global health convened for its second and final meeting in London (13-14 February). As you know, the Commission deliberates on strategies to ensure that the vision of the global AIDS movement, zero new HIV infections, zero discrimination and zero AIDS-related deaths, can be realised in the coming decades. The Commission also seeks to ensure that the principles and achievements of the AIDS response inform a more equitable, effective and sustainable global health agenda. The first meeting of the Commission was held in Lilongwe, Malawi on 28-29 June, 2013.
For the (not very informative) press release of the (first day of the) event in London, see here. What you need to know is basically: the recommendations will be published in The Lancet later this year, in a comprehensive report. But maybe there will be another press release, later today.
Global Health Security Agenda
2. Lancet (Comment) – Safer countries through global health security
Thomas R. Frieden et al.;
On Feb 13, 2014, the US Government launched a new global health security (GHS) agenda in partnership with WHO, the Food and Agricultural Organization of the United Nations, the World Organization for Animal Health, as well as with other (already 26) countries. The goal is to accelerate progress so that every country has an effective system to prevent, detect, and respond to health threats.
CDC also has a new Global Health Security website.
3. The Atlantic – Why Global Health Security Is Imperative
Thomas R Frieden;
Nice article by Frieden, for a broader (American) audience, explaining the purpose of the GHS agenda. “U.S. national health security depends on global health security, because a threat anywhere is a threat everywhere.” (sounds like a paranoid new initiative)
See also an article in Devex.
Other post-2015 news & UHC
4. Global Health Action – supplement: Facets of Global Health: Globalisation, Equity, Impact, and Action
We haven’t had time yet to go through this supplement, apart from the Preface and a quick glance at an article by Ilona “Mrs Global Governance for health” Kickbusch et al – ‘A new governance space for health’ (Kickbusch makes the governance & global health discussion even more complicated, but her distinction between ‘Global health governance’, ‘global governance for health’ and ‘governance for global health’ actually makes sense).
From the Preface: “The collection itself of articles in this special issue provides a broad overview on various facets of global health, and it attempts to establish the link between globalisation and its manifestation and impact on the regional and local levels. The idea for this collection was first conceived during the 13th World Congress on Public Health, held in Addis Ababa, Ethiopia, 23–27 April 2012, and evolved out of deliberations regarding the lack of comprehensive, dedicated and affordable textbooks for teaching global health. In the aftermath of the World Congress, a group was established to develop a first collection of articles for such textbooks. This special issue is the result of a collaboration that brought together representatives from the World Federation of Public Health Associations (WFPHA), the African Federation of Public Health Associations (AFPHA) and the Department of International Health at Maastricht University. This collection of articles focuses on aspects of governance, international relations and global health policies and on the role of health systems and health systems design including health system reform, primary care and the globalized health workforce. Further facets that are discussed include global health ethics and education. Other important aspects such as global health and global environmental change or global health and urbanisation have not been covered in this special issue but all articles intend to provide an up-to-date overview of the rapidly growing global health literature.”
5. WHO – Making fair choices on the path to universal health coverage – Final report of the WHO Consultative Group on Equity and Universal Health Coverage
Universal health coverage is at the center of current efforts to strengthen health systems and to improve the level and distribution of health and health services. This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage. The report addresses the key issues of fairness and equity (and trade- offs) that arise on the path to UHC. (Must-read).
6. Livemint – Towards a single health goal
K. Srinath Reddy;
This week, we organized a cluster meeting at ITM on UHC, with a number of invited speakers. See here for the presentation by Gorik Ooms for example, in which he assesses UHC on the (several) ‘right to health’ obligations. The broader question of the cluster meeting was to what extent UHC can be a unifying goal for the global health community post-2015; a unified agenda seems necessary, in view of the positioning of global health in the broader SDG agenda (otherwise global health risks to be sidelined/marginalized).
Srinath Reddy addresses the same question in this piece, and thinks UHC fits the bill.
7. HLSP update (February) – Health and development: global update
This excellent document gives an update of the last six months (with health & global development key events & activities).
8. NEJM (Perspective) – Beyond Repeal — A Republican Proposal for Health Care Reform
Timothy Stoltzfus Jost;
The author of this perspective sheds some light on a Republican proposal of late January, that goes beyond simply demanding repeal of ACA. Sophisticated Republicans exist, it appears.
9. Huffington Post – Dr. Brundtland’s Impact on Global Health; We Must Stay the Course
Yach is an admirer of former WHO director Brundtland and says we should follow her lead (she was (and probably is) a forceful advocate of PPPs).
10. Humanosphere – Study finds ‘free’ health care DOES improve health outcomes
Lovely article on an evergreen topic, after an earlier blog post by A Glassman on the question whether free care is good for health. Paulson’s conclusion goes like this: “Do financial barriers to health care make people less healthy? Seems like the evidence there is pretty strong, even if it can’t be proven to the satisfaction of some experts. Given the financial, political and logistical challenge of expanding access to health care worldwide, one may well wonder if these expert debates are advancing our knowledge or only serving the interests of inertia.” Looks like Paulson is getting increasingly fed up with some of the evergreen discussions in health financing.
In his blog post, he also refers to a seminar at IHME earlier this week (see
here for the webcast) on a new (not yet published ) study by Rodrigo Moreno-Serra (Imperial College), another influential expert in this debate. The study investigates empirically whether the population health benefits arising from progress toward UHC vary according to how equitable countries are in alternative domains, including access to care and socioeconomic conditions. The authors examined panel data covering 17 years and 160 countries through instrumental variable methods to get at the causal effects of pooled health financing and various equity proxies on under-5 mortality rates. Their estimations indicate that the benefits of an increased participation of pooled prepayment in health financing, in terms of reduced under-5 mortality, are generally larger in more equitable countries.
Global Fund & GAVI
11. GF news flash 37
You should read this GF news flash, as it provides info on Rwanda showing the way, ‘Willingness to Pay’ (A core feature of the new funding model is a “willingness to pay” policy that seeks to encourage additional government investments in national disease programs) , and the question who is eligible (for the 2014 list of eligible countries, see here).
As for Rwanda ‘showing the way’, the country and the Global Fund on 10 February announced the piloting of a new results-based financing approach with the material reprogramming of Phase 2 of an HIV grant. The RBF model is designed to streamline and encourage flexibility and eliminate bottlenecks in the financing of programs for countries with stronger capacities. (see also this Aidspan article). The grant amounts to $204 million.
12. HP&P – Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries
Helen Saxenian et al.;
Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond.
Homophobia around the world
You probably read a number of article on homophobia related to Sochi (see for example this one (by Richard Mole, on gay rights as the new front line in the culture clash between Russia and the West).
Related to homophobia in SSA, a New York Times editorial, ‘Demonizing Gays in Africa’ also raised the following question: “As acceptance of gays and lesbians has grown in the United States and Europe, intolerance and persecution has been rising in other parts of the world. African nations are leaders in this cruel and dehumanizing trend … … It is unlikely that any of these countries can reach their full economic potential because many foreign entities may find it too risky to invest in such hostile environments. These governments, in abusing their citizens, are moving in dangerous and destructive directions”. (The first time I saw not just a reference to possible donor implications, but also to broader Foreign Investment implications. )
But we also want to draw your attention to this paper (or rather a summary of an E-discussion):
13. UNDP – Summary of E-discussion – The Global Commission on HIV and the Law – Taking the Commission’s Recommendations Forward
A year and a half ago the Global Commission on HIV and the Law put out its report, HIV and the Law: Risks, Rights and Health with recommendations addressing the discriminatory practices that fuel HIV epidemics. Problems the report pointed to included overreaching patent protections and criminalization of HIV transmission, as well as abuses of people who use injecting drugs, men who have sex with men, prisoners, migrants, and people who work in commercial sex transactions. The time since — which has brought the passage of Nigeria’s and Uganda’s anti-gay bills, and India’s reinstatement of its colonial era law, a made-in-USA plan to undo South Africa’s patent reform draft, the Ukraine crackdown on NGOs, etc. — has been a regressive one for legislation, practice and progress addressing human rights among populations with the greatest exposure to HIV and the least access to HIV prevention, care and treatment. So this (new) report comes with recommendations to advance the recommendations, including outreach to Parliamentarians, rights-based training for law enforcement, work with media, community and religious leaders to identify and address stigma and discrimination, and more.
14. BMJ – WHO’s poor consultation with patients on HIV guidance has denied women choice in drug treatment
Criticisms abound among HIV activists about WHO guidelines, which include antiretroviral treatment for all children aged under 5 with HIV. Why does WHO not consult properly with those affected by the disease, asks Alice Welbourn. On the tricky questions around Option B+ etc.
In disturbing polio news, the Afghan capital of Kabul reported the first polio case since 2001.
15. Lancet Global Health – Chronic kidney disease in sub-Saharan Africa: a public health priority
Norberto Perico et al.;
In The Lancet Global Health, John Stanifer and colleagues assessed the largely sparse and anecdotal information about the epidemiology of Chronic Kidney Disease in sub-Saharan Africa in their systematic review and meta-analysis. Perico et al comment on the systematic review & meta-analysis.
16. BMJ – Tobacco companies are still determined to get children addicted
Companies have to keep recruiting new smokers to replace the millions who die each year after using their products. Gerard Hastings reflects on a new film that investigated marketing practices in the developing world that are now illegal elsewhere.
In case you want to know what the alcohol lobby is up to in Europe (in terms of influencing alcohol policy), read this Analysis in BMJ, ‘Europe under influence’.
Access to medicines
17. NYT – Poor Nations Seek New Hepatitis C Drug
Now that wealthy nations have a simple pill regimen that can cure hepatitis C, calls are mounting from representatives of poor nations for the same drugs. The Access Campaign of Doctors Without Borders has estimated that cocktails of sofosbuvir and similar drugs can be made for $250 or less, and it is lobbying to make that possible. It will ask WHO to put sofosbuvir on its list of drugs the agency tests for countries too poor to have their own drug regulatory agencies. And the campaign also plans to ask the three top funders of the war on AIDS — the Global Fund, PEPFAR and Unitaid — to agree to pay for hepatitis drugs too if the prices become affordable, which will let Doctors Without Borders start pilot treatment projects in several countries.
18. BMJ Feature – Drug patents cause fresh spat between South Africa and industry
An embarrassing leak of the drug industry’s lobbying plans against patent reforms has led to cries of “genocide” from South Africa’s health minister (see the IHP newsletter from last week and the week before). Andrew Jack reports from Cape Town.
For some of the latest news in this developing pharmagate, see this Science Speaks article.
19. BMJ (blog) – Drugs for the poor, drugs for the rich – why the current research and development model doesn’t deliver
Manica Balasegaram (executive director of the MSF Access Campaign);
Nice blog post, listing the recent troubles and pharma ‘gates’, which show again the current R&D model doesn’t work. (Must-read)
20. BMA – Trade disagreements: the transatlantic market and healthcare
Let’s go to one of the typical Global Governance for Health focal areas: trade agreements. Let’s first talk about the negotiations to create a more integrated marketplace to increase trade between the USA and the EU (TTIP – transatlantic trade and investment partnership). In this short article, the British Medical Association is warning of possible adverse consequences for healthcare (with focus on UK, obviously).
21. Social Europe journal – TTIP: It’s Not About Trade!
Dean Baker ;
Unlike what Karel De Gucht & co say, TTIP is not about trade or boosting economic growth, argues Dean Baker. “Instead, the real goal is the implementation of a new regulatory structure. The result: an international policing mechanism unlikely to have been approved via the normal political processes in each country. This is bad news for Europe.”
22. International Journal of Health Services – “Trade Creep” and Implications of the Transatlantic Trade and Investment Partnership Agreement for the United Kingdom National Health Service
Meri Koivusalo and Jonathan Tritter;
The ambitious and comprehensive Transatlantic Trade and Investment Partnership Agreement between the EU and US is now being negotiated and may have far-reaching consequences for health services. The agreement extends to government procurement, investment, and further regulatory cooperation. In this article, the authors focus on the UK National Health Service and how these negotiations can limit policy space to change policies and to regulate in relation to health services, pharmaceuticals, medical devices, and health industries. The negotiation of TTIP/TAFTA has the potential to “harmonize” more corporate-friendly regulation, resulting in higher costs and loss of policy space, an example of “trade creep” that potentially compromises health equity, public health, and safety concerns across the Atlantic. (and we thought the NHS was already fucked up)
23. Asian Journal of international law – Public Health and the Trans-Pacific Partnership Agreement
Andrew D. Mitchell et al.
Over to the Trans-Pacific Partnership Agreement then (TPP). Twelve-country negotiations towards the Trans-Pacific Partnership Agreement are drawing to a close. The TPP obligations have the potential to significantly restrict the ability of governments to regulate in the interests of public health. This article examines the impact that the TPP could have on two areas of public health regulation — tobacco control and access to medicines. It concludes that a number of legitimate concerns arise from the known content of the TPP, that the inclusion of a general health exception would be the preferable means of safeguarding the regulatory space of governments in relation to public health, and that United States proposals for stronger intellectual property protections that could restrict affordable access to medicines should be resisted.
24. Joint international NGO statement – USTR’s proposal for the Intellectual Property Chapter of the Trans-Pacific Partnership (TPP)
This is a joint NGO statement on the TPP IP chapter. Nancy Pelosi also disfavours fast-tracking the negotiations, we learnt this week.
25. End the Neglect –
In late January, the African Union’s (AU) 22nd Heads of State Summit launched 2014 as the Year of Agriculture and Food Security. Through increased dialogue, innovations, and advocacy, the AU is seeking to make lasting advances in improving nutrition, ending hunger, increasing gender equality and creating jobs. At the Summit, the AU also adopted the Continental Framework on the Control and Elimination of Neglected Tropical Diseases (NTDs) in Africa by 2020 called “Neglected Tropical Diseases in Africa, the End is Possible.” (one day I’ll write a blog post on all the “endgames” going on in global health – thank God the lingua franca in global health is not German )
Maternal, child & adolescent health
26. Lancet (Editorial) – Protecting children in conflict
Children need to be protected in conflict areas, we all agree. However, the reality is very different.
27. Huffington Post – Sad Faces, Sad Futures and a Recipe for Change
In this op-ed, Harry Leibowitz argues for a kind of Super fund for kids in conflict zones.
28. Lancet (Viewpoint) – Children growing up with HIV infection: the responsibility of success
Sarah Bernays et al. ;
An estimated 3·4 million children are living with HIV, more than 90% in sub-Saharan Africa. Those working in paediatric HIV care are now cautiously optimistic. Comparing the landscape with 10 years ago when HIV-infected infants faced inevitable death, those born with HIV now have access to antiretroviral therapy (ART) so that increasing numbers of children are surviving to adolescence and beyond. But this requires certain commitments. The drive to increase access to PMTCT interventions and ART obviously needs to continue, but policy makers and health-care providers should also focus beyond the goal of prolonging survival of HIV-infected children and concentrate on their broader health to ensure that they are able to achieve an optimum quality of life.
29. IPS – Doctors resist deadly vaccine
A spate of sudden infant deaths following vaccination in India has prompted leading paediatricians to call for stronger regulatory mechanisms to evaluate new vaccines for safety and efficacy before their acceptance into the national immunisation programme.
30. Lancet Global Health – The international charter on prevention of fetal alcohol spectrum disorder
Egon Jonnson et al.;
The first international conference on prevention of fetal alcohol spectrum disorders was held in Edmonton, AB, Canada, on Sept 23—25, 2013. The conference resulted in the production, endorsement, and adoption of the following international charter on the prevention of fetal alcohol spectrum disorder by more than 700 people from 35 countries worldwide, including senior government officials, scholars and policymakers, clinicians and other front-line service providers, parents, families, and indigenous people. It is presented to all concerned in the international community as a call for urgent action to prevent fetal alcohol spectrum disorder.
31. Guardian – Big gains made on women’s health, but access still unequal, says UN
A new UNFPA report lauds progress on health in the past 20 years, but condemns ongoing violence and discrimination against women.
32. Lancet Global Health – Family planning versus contraception: what’s in a name?
Maria I Rodriguez, Lale Say & Marleen Temmerman;
The 20-year anniversary of the 1994 International Conference of Population Development (ICPD) Programme of Action and the upcoming 15-year anniversary of the Millennium Development Goals provide an opportunity to think about the global development agenda, including progress made and any remaining challenges. A large amount of published work supports the fundamental role that sexual and reproductive health information and services have in the promotion of health, attainment of human rights, and sustainable development. However, poor sexual and reproductive health is a major component of global morbidity and mortality, and disturbing inequities exist in the burden of disability. Nearly 20 years after ICPD and 15 years after the Millennium Development Goals, the world lags far behind its objective of universal access to sexual and reproductive health information and services. A radical shift is needed to accelerate progress. The authors suggest to drop the term ‘family planning’ and talk about ‘contraception’ instead.
33. Lancet – Worldwide prevalence of non-partner sexual violence: a systematic review
Naeemah Abrahams et al. ;
Sexual violence against women is common worldwide, with endemic levels seen in some areas, although large variations between settings need to be interpreted with caution because of differences in data availability and levels of disclosure. Nevertheless, the author’s findings indicate a pressing health and human rights concern. Kathryn Yount comments on this systematic review, also in the Lancet.
Today is One Billion Rising – a campaign to end violence against women, with a global day of action and dancing. You can follow it on the website of the Guardian, for example.
34. The Broker – Midwives make a difference
Midwives play a vital role in development, especially with regard to the Millennium Development Goals. So what exactly do midwives do? (not sure the audience of this newsletter needs some explanation about this, but midwives are often neglected in the global health debate, we feel, especially at governance level)
Health Policy & Financing
35. New Left Review – 21st Century welfare
(Must-read) “How effective have Conditional Cash Transfers (CCTs) been in reducing poverty, and what have been their wider consequences for social provision in countries that have adopted them? The experience of Latin America, where the policy was developed and road-tested on populations from Mexico City to Santiago, from the Brazilian sertão to the Peruvian altiplano, offers the broadest range of case studies to date. The author traces the emergence and take-up of CCTs across the region, and examines the evidence on their outcomes.” And guess what, the picture is not as rosy as sometimes depicted.
36. Arab News – Riyadh, Dhaka to sign health pact
Saudi Arabia and Bangladesh will soon sign a Memorandum-of-Understanding to strengthen their mutual cooperation in various functions in the health sector.
37. Addis Standard – US, Ethiopia launch urban health program
USAID & Ethiopia’s Federal Ministry of Health launched the Strengthening Ethiopia’s Urban Health Program, which will promote greater health access and improved health status for more than 1.6 million households in 49 cities through high-quality health services.
38. Financing Health in Africa – Bamako initiative: some concluding thoughts
It will soon be 27 years that the Bamako Initiative was launched and community participation became a core component of health policy in Africa. Through eight interviews, one personal reflection, and many comments from readers of the series in French and English, what was once the “magic bullet” of community participation turned out to be a complex topic. Jean Benoît Falisse reflects on the series.
39. Lancet (Editorial) – Accelerating drug discovery
This editorial is perhaps more relevant for the North, at least for now. It discusses a new initiative by the National Institutes of Health (NIH), the Accelerating Medicines Partnership (AMP), bringing together government, non-profit, and industry stakeholders with the mission of overhauling the existing path of drug discovery.
40. Global Health Action – The global health concept of the German government: strengths, weaknesses, and opportunities
Recognising global health as a rapidly emerging policy field, the German federal government recently released a national concept note for global health politics (July 10, 2013). The authors of this article offer an initial appraisal of the strengths, weaknesses, and opportunities for development recognised in this document.
41. Imperial college – Climate change and health risks: new commission established
In 2009 a joint report between University College London and The Lancet stated, “Climate change is the biggest risk to global health of the 21st century”. Now a second UCL-Lancet commission is underway. Last month, UCL’s Institute of Global Health hosted a launch event for the report entitled ‘Climate crisis: emergency actions to protect human health’. You find a short summary of the event here. The Commission has five working groups.
42. Economist – Médecine avec frontières
Lovely title, and equally nice article. Medical tourism has taken off somewhat less than expected a while ago.
43. WHO Bulletin – Health system cost of delivering routine vaccination in low- and lower-middle-income countries: What is needed over the next decade?
Patrick Lydon et al.;
“On the eve of the 40th anniversary of launching of the Expanded Programme on
Immunization (EPI) in 1974, during the 27th World Health Assembly (WHA), fundamental questions about the level of financing needed to sustain achievements and scale up the EPI inlow- and lower-middle income countries continue to permeate the discourse on the economics of immunization. The answer to this question is all the more important in light of the fact that at the 65th WHA in 2012, ministers of health embraced the Global Vaccine Action Plan (GVAP) – a 10-year global strategic plan for immunization. But how much – and in what areas – are the investments needed for this decade?”
44. IHP – Health practicioners in post-Soviet countries: welcome or not really welcome?
Anar Ulikpan et al. ;
Anar Ulikpan (from Mongolia) and post-Soviet colleagues reflect on the relevance of a recent Alliance call on implementation research for countries like theirs. They raise a number of valid issues.
45. Social Science & Medicine – The health financing transition: A conceptual framework and empirical evidence
Victoria Fan et al.;
Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. The authors describe these trends as a “health financing transition” to provide a conceptual framework for understanding health markets and public policy. Using data over 1995–2009 from 126 countries, they examine the various explanations for changes in health spending and its composition with regressions in levels and first differences.
EV 2013 Stephanie Topp was quoted in this article on HIV in Zambian prisons (see
here). Check it out.
Global Health Announcements
HSR symposium organized sessions have been decided, and organizers are being notified as we write this down.
Global health podcasts
- For a nice presentation on global health crises by David McCoy, see
46. TMIH – Strengthening national health laboratories in sub-Saharan Africa: a decade of remarkable progress
GA Alemnji et al.;
Efforts to combat the HIV/AIDS pandemic have underscored the fragile and neglected nature of some national health laboratories in Africa. In response, national and international partners and various governments have worked collaboratively over the last several years to build sustainable laboratory capacities within the continent. Key accomplishments reflecting this successful partnership include the establishment of the African-based World Health Organization Regional Office for Africa (WHO-AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA); development of the Strengthening Laboratory Management Toward Accreditation (SLMTA) training programme; and launching of a Pan African-based institution, the African Society for Laboratory Medicine (ASLM). These platforms continue to serve as the foundations for national health laboratory infrastructure enhancement, capacity development and overall quality system improvement. Further targeted interventions should encourage countries to aim at integrated tiered referral networks, promote quality system improvement and accreditation, develop laboratory policies and strategic plans, enhance training and laboratory workforce development and a retention strategy, create career paths for laboratory professionals and establish public–private partnerships.
47. TMIH – Four-year retention and risk factors for attrition among members of community ART groups in Tete, Mozambique
Tom Decroo et al.;
Community ART groups (CAG), peer support groups involved in community ART distribution and mutual psychosocial support, were piloted to respond to staggering antiretroviral treatment attrition in Mozambique. To understand the impact of CAG on long-term retention, the authors estimated mortality and lost-to-follow-up (LTFU) rates and assessed predictors for attrition.
48. Global Public Health – Bringing the state back in: Understanding and validating measures of governments’ political commitment to HIV
Radhika J. Gore;
Analysis of the politics of HIV programme scale-up requires critical attention to the role of the state, since the state formulates HIV policies, provides resources for the HIV response and negotiates donor involvement in HIV programmes. However, conceptual and methodological approaches to analysing states’ responses to HIV remain underdeveloped. Research suggests that differences in states’ successes in HIV programme scale-up reflect their levels of ‘political commitment’ to responding to HIV. Few empirical measures of political commitment exist, and those that do, notably the AIDS Program Effort Index (API), employ ad hoc scoring approaches to combine information from different variables into an index of commitment. In this paper, the authors apply exploratory factor analysis to examine whether, and how, selected variables that comprise the API score reflect previously theorised dimensions of political commitment.
49. Global Public Health – Participation, decentralisation and déjà vu: Remaking democracy in response to AIDS?
Nora J. Kenworthy;
Participation, decentralisation and community partnership have served as prominent motives and driving philosophies in the global scale-up of HIV programming. Given the fraught histories of these ideas in development studies, it is surprising to encounter their broad appeal as benchmarks and moral practices in global health work. This paper examines three intertwined, government-endorsed projects to deepen democratic processes of HIV policy-making in Lesotho: (1) the ‘Gateway Approach’ for decentralising and coordinating local HIV responses; (2) the implementation of a community council-driven priority-setting process; and (3) the establishment of community AIDS councils. Taken together, these efforts are striking and well intentioned, but nonetheless struggle in the face of powerful global agendas to establish meaningful practices of participation and decentralisation. Examining these efforts shows that HIV scale-up conveys formidable lessons for citizens about the politics of global health and their place in the world.
- Check out this new World Bank Paper on why brain drain might actually benefit African countries (see here). Or a related article in The Atlantic.
- Devex reports on further changes at the World Bank.
- And former Australian PM Julia Gillard will be the Chair of the Board for the Global Partnership for Education (see Humanosphere ).