Dear Colleagues,


Some people say irony is out, as we’re entering the New Sincerity era. If so, John Kerry is definitely in sync with the times, not mincing words but calling climate change ‘a weapon of mass destruction’. Now we’re talking. That should even wake up the North Korean leader Kim Jong-Un. And it obviously woke up WHO as well as the organization scheduled the first global conference on climate change and health (from 27 to 29 August 2014) at its headquarters in Geneva. Better late than never?

‘No nonsense Belgian’ Peter Piot went for some straight talking too recently, delivering a keynote speech on ‘10 myths about the AIDS response’. No, “the end is not near”, he said. And like it or not, “the reality is that many countries for many years will depend on international funding for their AIDS response”.  In this new sincerity era, we might as well immediately add that the bulk of this international money probably won’t come through traditional ODA. It is time for some truly innovative financing, in other words. So let’s occupy the ‘financial weapons of mass destruction’, aka tax havens, or bomb them altogether. Call it Global Defense for Health (GD4H). Not sure the Swiss can lead this particular global health initiative, but for sure The Lancet should launch a Commission on GD4H, now that Lancet Commissions seem to grow on trees.

Meanwhile, UHC is still hot in the post-2015 debates, either as a goal or as a means towards the post-MDG health goal (while Rob Yates probably wants both). However, some important people still have doubts about the concept – UHC is a bit too vague perhaps for a goal, Simon Bland said this week in the US, at a  GH2035 launch event. Nevertheless, more and more potential indicators for UHC are seeing the light, for example in the just published SDSN report, ‘Health in the framework of sustainable development’. In the new sincerity era, even if we admit this is supposed to be a technical report, this rather dull title should be improved. How about ‘Drowning together with the planet, but having a fun time nevertheless’? (we don’t recommend this title for UK readers)


For the suggested post-MDG health goal in the report, ‘Achieve Health and Wellbeing at all ages’, I guess we need the help from foul-mouthed rappers and hiphoppers like Kanye West, to sex it up for the masses. ‘Achieve health and wellbeing at all ages’ sounds too much like a “sanitized” goal, for the moment. More generally, I think the post-MDG debate needs a worldwide party to mobilize the global public. If Freddie Mercury got his farewell party in the early nineties live on tv, why not the planet, you might ask. So if Bono and others want to make themselves really useful, they should step up the global PR around the post-MDGs. The global health section of this MTV show could be a bit kinky, for example with a few greying  global health leaders twerking their asses off – health and wellbeing at all ages requires some exercise – and an enormous bonfire, lit by Margaret Chan, whereby she would throw all the capitalist evils of this world (tobacco, Jack Daniels, Coke bottles, botox, …) on a huge fire, while screaming ‘Yippie kay-yee-motherfuckers’. Corporate sponsors of the show would be delighted by this innovative way of fundraising for global health.

In spite of all these innovative financing options, a Global Fund for Health is probably out of the question for the foreseeable future, but who knows, in a few decades? Read the new Chatham House working paper by my colleagues Gorik Ooms & Rachel Hammonds to find out more about the political feasibility in the medium term. A rather blunt observer said some time ago, perhaps already anticipating the new sincerity era, about such a Global Fund for Health:  great idea, but we probably first need a third world war to have any chance of it happening. Enter Global Defense for Health !

In this week’s guest editorial, Dr Shubha Nagesh, from the Latika Roy Foundation talks about early intervention services geared towards children with special needs, in Uttarkhand, somewhere in the Indian Himalayas.

Last but not least, we want to remind you of a very important deadline – 3 March. Individual abstracts for the third Global Health Systems Research symposium in Cape Town need to be submitted by then!  


Enjoy your reading.

Kristof Decoster, Werner Soors, Peter Vermeiren, Basile Keugoung & Wim Van Damme




Engaging with special children: Early intervention services in the Indian Himalayas


Dr Shubha Nagesh, Director, Outreach, Latika Roy Foundation

The WHO disability report mentions that 5.1% of the world’s children live with moderate or severe disability and a prevalence of 0.4- 12.7% is reported in low- and middle- income countries. India is home to 25-35 million children with disability. Half or more of these children would not have access to any early intervention services.

Early intervention is the introduction of planned programming in order to alter the anticipated or projected course of development. Early intervention services are recognized as crucial in mitigating and sometimes preventing developmental disabilities, have a positive influence on the developmental outcome of children and families with disabilities and the effectiveness of community-based and family centered programs is proven. Services for early intervention are rare in India and non-existent in the rural areas. Affordable, accessible services are unavailable in most parts of Uttarakhand, the Himalayan state of India.

The Latika Roy Foundation is a voluntary organization in India, working with children and adults who have developmental and other disabilities. As a resource centre for people with special needs, the foundation provides early intervention services, education, livelihoods development, training and awareness.

The project elaborated in this paper follows on from Gubbara (Balloon in Hindi) an assessment center in a government hospital, to provide the local services parents are now demanding for their children. Gubbara is based at Doon Hospital, the state’s tertiary level health facility, and since three years has assessed almost 1000 children and provided them with home plans. Gubbara’s unique assessment program – free, comprehensive, high quality – is the state government’s first initiative in special needs. It has created a new demand for ongoing early intervention services in Uttarakhand. The project provides Early Childhood Care & Education (ECCE) to vulnerable children by training parents and area health workers, making their social/educational inclusion more feasible.

Following two successful years of Gubbara, the foundation initiated a comprehensive program for special children and their families in Dehradun district of Uttarakhand. The 18 month pilot project is funded by Sight Savers UK. The program identifies and assesses children in the area, at-risk for or having developmental delay and provides follow up services in the community. Recognizing that health personnel play a critical role in guiding the developmental aspects of the early intervention, training at all levels of health workers is underway. The community-based rehabilitation program includes home visits to provide early stimulation programs and training to parents and caregivers. The beneficiaries are the families of children with multiple disabilities who have attended Gubbara. They showed initiative in seeking out advice and attending a 5-day assessment program– now they are requesting follow-up services close to home. The approach was chosen bearing in mind families’ inability to travel any distance to avail of therapy for their children; as well as limited funding and acute scarcity of professionals.

A multi-disciplinary team consisting of a physiotherapist, a special educator, a child development aide (CDA) and an awareness coordinator visit the Community Health Centres (CHC) in the four target blocks within the district twice in a month. They provide follow up services for children assessed and identified to have a developmental disability or delay, identify new children from the area referred by field level health workers, and have meetings with parents to provide hands-on-training to manage their children better at home. Children are assessed for progress based on Gubbara evaluations and targets; parents are informed better about Gubbara-set goals and are trained in appropriate exercises and skills for their child’s needs.

Accredited Social Health Activists (ASHA) who form the backbone of India’s flagship health program, National Rural Health Mission (NRHM) were trained over four months in early intervention and became master trainers in the program. They in turn trained many more health workers in a cascade design and almost 900 filed level health workers were trained over a period of one year in the district. They helped identification of new children in the target areas and referral to Gubbara for assessment.

Most poor people don’t identify disability as a priority. Their concerns are water, livelihoods, fuel and fodder. Disability programs are seen as agency driven – some Good Samaritan’s idea. Our approach is parent-inspired, -sustained and -driven. Parents who have come to Gubbara for a one-week assessment are the entry point. The strengths- based approach builds on what parents already have: 1) the desire to do the best for their children and 2) first-hand knowledge about what makes their kids tick. The program works with them to determine their most pressing concerns and design programs to address them. They are trained – hands on! – to give their children the care, therapy and education they need and to set the goals they will pursue between visits.

Through these motivated parents, the project also engages with the established government network to intensively train health workers to supplement the parent-based therapy provision. Parents – the most concerned people in a child’s life – act as project monitors. Monitoring is the most difficult aspect of any large-scale initiative. The rights- based approach trains parents to understand that no one is doing their child a favor; access to services is their right and parents have a responsibility to see that they get it. Parents are trained to monitor health workers’ attendance, focus and skill delivery. They review their child’s therapy goals and progress with health workers. The child-monitoring booklet was developed to encourage a participatory monitoring of children’s progress by the trained health worker and the parent. Training to use the booklets was intensive and was repeated at each monthly meeting. Home visits were conducted to fine tune the process.

Children have happier, more fulfilling, and more productive lives through receiving appropriate therapy; parents are better able to cope with the challenges of raising their child; health care workers receive new skills, which also benefits the typical children in their caseloads.

At the recently held National Conference on Intellectual disabilities conducted by the Department of Disability Affairs the follow up project was greeted possibly as the only project in the country which provides services for children with special needs at the community level in government health facilities. The sheer numbers of new children identified and the eagerness of their families for services have been instructive and inspiring. Now when we make our case to government officials on the urgency of the problem and the desperate need for Early Intervention, we are more convincing; we are not arguing from a WHO report or from extrapolations: we have real-life stories, photos and data to share. We’ve seen the reality with our own eyes.

With the recently launched Rashtriyia Bal Suraksha Yojana (RBSK) program we hope to integrate with them at all levels including training, service provision, human resources, monitoring and streamlining health provision for children. By catering to the most marginalized and excluded children, the foundation believes that planning for the most vulnerable will make the world a better place for everyone. Early Childhood Care and Development (ECCD) is essential to achieving MDG 2 and improving access to health services for children with special needs could prevent and reduce child mortality and reduce social exclusion caused by stigma thereby helping positively towards attainment of MDG 4.




UHC & post-2015


1.    Chatham House – Financing Global Health Through a Global Fund for Health?

Gorik Ooms & Rachel Hammonds;

This paper analyses the desirability of a Global Fund for Health from a ‘political realism’ perspective, not from a normative one. In other words, the central question here is not whether the international community ought to create a Global Fund for Health, for ethical or human rights reasons. It is whether the international community would be willing to create such a fund and use it as the main channel for Development Assistance for Health (DAH) because of the impacts such an approach would have on certain qualities of DAH – some desirable, some undesirable. (must-read)


2.    SDSN – Health in the framework of sustainable development

This technical report looks at the current state of global health, and priorities for the post-2015 agenda. The document has been prepared by the ‘Health for All’ Thematic Group of the Sustainable  Development Solutions Network (SDSN) for submission to the UN Secretary General and the Open Working Group on Sustainable Development Goals. (must-read)


For the broader SDG picture, skim the just released draft report with an integrated framework of 100 indicators complementing the SDG goals and targets originally proposed.  As all indicators are at an early stage – some are in brackets – they are looking for comments and creativity to improve and complete them by March 14th 2014.


3.    Civil society conference on UHC in Dakar –  Global Civil Society Conference on Health concludes with a Joint Declaration on how to shape Universal Health Coverage to achieve the Right to Health


In previous post-2015 consultations, at a regional and global level, Civil Society Organisations and activists expressed the need to exchange views on global health and UHC by debating exclusively amongst civil society.  Together with The Western and Central African Regional Network of NGO Platforms (REPAOC), Action for Global Health hosted a workshop in Dakar, Senegal, solely for CSOs (17-19 February). The concept of the conference was to enable discussion at a grass-roots level on UHC and to obtain in-country experiences from different civil society representatives across the globe. You find the concept note on the website of AFGH. For the press release about the joint declaration, see here.


Meanwhile, Rob Yates reported on Twitter some early stress for Indonesia’s UHC scale-up. More government money is needed.


4.    CGD – New Initiative to Support Priority Setting for Universal Health Coverage

Amanda Glassman et al.;

Glassman and colleagues discuss a new platform — the international Decision Support Initiative (iDSI) – recently launched by NICE International to facilitate and support priority setting for UHC. The iDSI will support low and middle income governments, and perhaps donors, in making resource allocation decisions for healthcare. Specifically, the initiative will share experiences, showcase lessons learned and identify practical ways to scale technical support for more systematic, fair and evidence informed priority setting processes.


5.    Royal Statistical Society – Broader health coverage is good for the nation’s health: evidence from country level panel data

Rodrigo Moreno-Serra & Peter Smith;

(Research article, but set to become very influential in this UHC debate) Progress towards UHC involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. This paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. The authors use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. They employ various proxies for the coverage level in a health system. Their results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries.


6.    Comments on the Global Governance for Health report

The GG4H website lists all the Comments on the report so far, and also features all the video presentations from the launch.


In the intro, we also referred to another GH2035 launch event (different Lancet Commission, mind you!), this one in the United States: it’s like a rock group on a tour (but probably without groupies). Some very important panelists there, so you might want to have a look on Twitter (see here) to see what Tim Evans, Nils Daulaire & co said at the event. Apparently we’re now chasing the ‘Grand Unified Theory of global health’. Yes, that would probably chase groupies away…



  • The Lancet now published the viewpoint from Kent Buse et al, ‘ Health post-2015: evidence and power’ – was already online since September.
  • And as already mentioned in the intro, climate change is also rising on the global health agenda, together with the temperatures. Now WHO also changes to a higher gear: “WHO will host the first global conference on climate change and health from 27 to 29 August 2014 at its headquarters in Geneva. The three-day conference will bring together leading experts. The purpose is to develop a shared vision of how the health sector can best prepare for climate change, and to highlight the health benefits of climate actions. The outcomes will inform the UN Secretary-General’s Climate Summit in September 2014, as well as discussions on climate change and sustainable development taking place later this year.


Infectious disease


7.    Science Speaks – HIV response advocates to Senate Foreign Relations heads: Speed confirmation of next PEPFAR leader

Signers from 28 organizations advocating for global HIV responses called on US senators Robert Menendez and Robert Corker to schedule a confirmation hearing in the next week for Dr. Deborah Birx, nominated by the White House last month to serve as the next U.S. Global AIDS Coordinator and lead PEPFAR.

8.    Aids Alliance – Peter Piot: 10 myths about the AIDS response

Peter Piot dealt with 10 myths about the AIDS response, in a recent keynote speech to celebrate the 20th anniversary of the HIV/AIDS alliance. (must-read)


9.    HLSP – Investing in AIDS in Asia: transforming the policy agenda

Clare Dickinson et al.;

Despite intentions to intensify regional HIV responses (and growing evidence for what needs to be done) many Asian countries are struggling to refocus their resources and programmes to where it matters most, largely because of a legacy of outdated and inappropriate policy, programming and resourcing. Strategic investment approaches offer the possibility of improving the efficiency and effectiveness of existing and future resources, but success will require a reorientation of the ‘policy consensus’ and prevailing multi-sectoral architecture.


10. Lancet – The changing risk of Plasmodium falciparum malaria infection in Africa: 2000—10: a spatial and temporal analysis of transmission intensity

Abdisalan M. Noor et al;

An article published in The Lancet examines the change in malaria transmission intensity during the period 2000–10 in Africa. Researchers compiled data from 26 746 community-based surveys of parasite prevalence covering 3 575 418 person observations from 44 malaria-endemic countries and territories in Africa since 1980. Using model-based geostatistics the researchers found substantial reductions in malaria transmission in endemic countries in Africa from 2000 to 2010, but 57% of the population in 2010 continued to live in areas where transmission was greater than 10%.


Brian Greenwood et al commented on these findings. They conclude: “During the past few years, there has been an increasing focus on malaria elimination, which is commendable because the ultimate goal of all malaria control programmes must be interruption of malaria transmission. However, Noor and colleagues have shown that, during the past decade, the reductions in malaria transmission that have been achieved in much of sub-Saharan Africa, although encouraging, have been only modest. Also, these gains are threatened by emerging resistance to the pyrethroid group of insecticides and by the potential appearance of artemisinin-resistant malaria parasites in Africa. More could be done to improve malaria control in high-risk countries by increasing coverage with proven interventions such as insecticide-treated nets and chemoprevention. However, a focus on elimination must not result in a reduction in support for development of new methods (drugs, insecticides, vaccines, and new approaches to vector control), and improved delivery methods, which will be needed in large areas of sub-Saharan Africa before malaria transmission can be reduced to the level at which elimination becomes a credible prospect.”


11. Foreign Policy – The Taliban are winning the war on polio

Laurie Garrett;

Garrett comments on the reappearance of polio in Kabul.


In more encouraging polio news, there were pledges from the Ellison foundation and also Rotary international released about 36 million dollar to fight polio in Africa and Asia.





Most of the NCD action you find in the ‘Access to Medicines’ section – see below. Here we just refer to:

12. Guardian – Latin America leads the fight against junk food with the US on the sidelines

Countries like Chile and Mexico are fighting junk food directly with a slew of initiatives that are making the region an incubator for ideas that could be adopted elsewhere, including in the US.


13. The Conversation – Big Food lobbying: tip of the iceberg exposed

Gary Sacks;

On Big Food lobbying tactics in Australia and elsewhere.




14. Humanosphere – Visualizing the burden of neglected tropical diseases – NTDs

Katie Leach-Kemon;

Based on GBD data, Leach-Kemon visualized the burden of NTDs in the world. With focus on NTDs in SSA and also on Chagas disease.


15. BMJ – Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign

Diana Lockwood et al.;

Diana Lockwood and colleagues reflect on the global leprosy elimination programme and challenge the wisdom of WHO’s elimination strategies.


Maternal, child & adolescent health


16. Washington Post – Hillary Clinton launches global data project on women and girls

Washington Post;

Last week, Hillary Clinton launched a new partnership, ‘No Ceilings’, to measure and analyze the advancement of women and girls around the world. With the 20th anniversary approaching of a historic 1995 women’s conference, the Clinton Foundation is partnering with the Gates Foundation to gather and study data on the global progress of women and girls and the gaps that remain.


17. WHO – Ensuring Human Rights in the provision of contraceptive in formation and services – Guidance and recommendations

Unmet need for contraception remains a big challenge. WHO aims to to provide assistance to its Member States in achieving the goal of the highest attainable standard of health for all, including sexual and reproductive health. Among other interventions, the provision of high-quality contraceptive information and services is essential for

achieving this goal. It has been recognized that this cannot be done without  respecting, protecting and fulfilling the human rights of all individuals. In order to accelerate progress towards attainment of international development goals and targets in sexual and reproductive health, and in particular to contribute to meeting unmet need for contraceptive information and services, WHO has developed this guideline.

18. Huffington Post – Why Adolescent Health And Why Now?

Zulfiqar A. Bhutta & Stanley Zlotkin;

Bhutta et al make the case that the rise of adolescent health on the global agenda is a good thing.


In other maternal health news, the Lancet has a World Report on family planning in Indonesia (see here). “With a growing population that is worrying officials, Indonesia is reinvigorating its efforts in family planning provision. But the endeavour is no mean feat”. (Abby Seiff)


Global Fund & GAVI



Aidspan published a new issue of The Global Fund Observer, with among others an article on the lessons the conflict in Sudan could provide for the GF’s future response and work in fragile states, an article on the necessary integration of TB & HIV programs in countries with high rates of TB-HIV co-infection (and the challenges this raises), and an article reporting on a UNAIDS report from November about Asia & the Pacific.


GAVI has now opened its 2014 round of applications for new vaccines and health system strengthening support – See more  here.



19. Reuters – Museveni says he plans to sign anti-gay law after all

Ugandan President Yoweri Museveni said last Friday he would sign a controversial anti-gay bill into law. As for the so called “science” involved in this decision, see this Science Speaks article.


Obama reacted and said the anti-gay bill would be a step backward for Ugandans and might “complicate” the relationship between the two countries.


UNAIDS also expressed its deep concern.


20. Science Speaks – Anti-gay laws, rhetoric, impact, response: Good news, bad news and no news

Antigone Barton;

For some of the latest news on this issue, see this article. After urging by civil society leaders in South Africa and around the world, Ugandan-born physician and gay rights advocate Paul Semugoma has been ordered released from immigration officials’ custody, and will receive the work permit that will allow him to remain in South Africa (see also  the Guardian). So he won’t be deported to Uganda.

The article also features various reactions to Museveni’s decision, both from institutions, organisations, and donors asking him to change his decision, and from institutions and people supporting him.


By far the dumbest reaction came from the Gambian president, Yahya Jemmeh: he vowed to fight gay people “the same way we are fighting malaria-causing mosquitoes, if not more aggressively.”


Access to medicine


21. Nature – WHO plans for neglected diseases are wrong

Mary Moran;

(must-read) Research and development into diseases affecting the world’s poorest people will not benefit from WHO’s policy, warns Mary Moran. Devastating criticism of WHO’s R&D pilot projects. She makes a crucial distinction in this viewpoint.


22. BMJ (Feature) – Patent wars: affordable medicines versus intellectual property rights

Jacqui Wise;

India’s battle over patents is heating up, with campaigners fighting for access to affordable medicines pitted against the drug industry, which is fiercely protecting its intellectual property rights and profits. Jacqui Wise reports on how action there and in other developing countries is putting the whole patent system under scrutiny.


There’s plenty at stake, not just in India (although pharmaceutical sales in India alone are  set  to rise to 27 billion in 2016 according to a new Deloitte report). So it comes as no surprise that India is coming under increased scrutiny by American regulators for safety lapses, falsified drug test results and selling fake medicines. (see the NYT).


23. IP Watch – Battles Over Patents: Is India Changing The Rules Of The Game?

Great overview article (by somebody with an impossible name) on the ongoing patent battle (with India and South-Africa as some of the key battlegrounds). (must-read)


24. BMJ (news) – Two companies blocked from comparing their generic products to Herceptin in India

Sanjeet Bagcchi;

The drug company Roche has secured an injunction from the High Court of Delhi ordering two pharmaceutical companies—the Bangalore based Biocon and the US based Mylan—not to compare their generic versions of trastuzumab with Roche’s Herceptin.


25. Project Syndicate – Intellectual Property and Economic Development

Rod Hunter;

We also think about your entertainment, from time to time, so we’ve included this op-ed in the weekly selection. “The bottom line is that the ideas protected by IP rights are the dynamo of growth for developed and developing countries alike.”

26. Policy brief – The Trans Pacific Partnership Agreement Negotiations and the Health of Australians

It’s obvious there’s now anxiety about the Trans Pacific Partnership in pretty much all corners of the world including Australia, but also in New Zealand for example, or in Canada (see Ronald Labonté  in a blog post).


Australia was also the only developed country that stood with South-Africa at the recent WHO Executive Board meeting (see the Huffington Post).

But in very encouraging news about these trade negotiations, the (normally well-informed) Economist is getting desperate (always a good sign).

27. Chatham House (Working Group paper) – New Business Models for Sustainable Antibiotics

Kevin Outterson;

An antibiotic crisis is fast approaching. Owing to the long lead times for antibiotic research and development (R&D), society must act a decade before the need becomes immediately urgent, argues Outterson. Therefore an important task is to fix broken economic incentives. Any solution must overcome three obstacles simultaneously. They are:

•Inadequate market incentives for companies to invest in R&D and bring new products to market at the right time;

•Inadequate market incentives to protect these valuable resources from overuse and premature resistance; and

•Inadequate market incentives to ensure global access to life-saving antibiotics.


28. Gates Foundation – A report of the safety and surveillance working group


Drugs and vaccines are reaching unprecedented numbers of people in low- and middle-income countries (LMICs). These products have tremendous potential to save lives and reduce suffering, but many of the countries in which these products will be used do not have the capacity to effectively monitor their post-market safety. International initiatives have sought to address this gap, but have not attracted significant donor or industry support, or political capital and resources from LMIC governments. With new donor funding scarce in this weak global economy, substantial new resources for addressing post-market safety needs may not be forthcoming. Given limited resources and expanding post-market safety needs, a new strategy is needed. This report is the culmination of the seven-month effort of the Safety Surveillance Working Group (SSWG) to develop that strategy.” The Working Group went for a five-fold strategy.


Health Policy & Financing


29. Lancet – Offline: Madame Abe’s moment

Richard Horton;

Horton was very impressed with the Japanese first lady’s performance at the final meeting of the Lancet/UNAIDS joint Commission on Defeating AIDS, Advancing Global Health. She obviously struck a chord with Horton (and other global health watchers and institutions, including  UNAIDS). Horton also wonders (/laments) why some countries take a back seat in global health (like France, Germany, Russia, India and much of the Arab world), whereas other countries “energetically exert their soft power through global health—among them, the USA, UK, Norway, Sweden, Canada, Japan, and Brazil”. Debatable selection, I’d say – at least from the angle of GG4H.


30. Humanosphere – The Dark Heart of Global Health?

Johanna Crane;

(must-read), especially for all people who see global health as “a career”.


31. Nature – Vaccines endure African temperatures without damage

Declan Butler ;

Another key global health news item this week: an immunization campaign in West Africa has shown that vaccines can be delivered to remote areas without using ice boxes, and still remain viable. The finding challenges decades-old dogma that vaccines must be kept cool at every step of the chain from manufacture to use. The anti-meningitis campaign, carried out in Benin in December 2012 by the country’s health ministry and researchers from WHO and PATH tested delivering a vaccine against deadly meningococcal meningitis A that was stored at temperatures of up to 40 °C for up to four days. Its findings were published in Vaccine this week, and mark an unequivocal success, with only 9 of the more than 15,000 vials needing to be discarded, none of them for heat damage. See also the Guardian’s Sarah Boseley on this.


32. Globalization and Health (Short Report) – Regional variation in the allocation of development assistance for health

Michael Hanlon et al.;

The GBD 2010 Study has published DALY data at both regional and country levels from 1990 to 2010. Concurrently, IHME has published estimates of development assistance for health (DAH) at the country-disease level for this same period of time. The authors of this article used disease burden data from the GBD 2010 study and financing data from IHME to calculate ratios of DAH to DALYs across regions and diseases. They examine the magnitude of these ratios and how they have varied over time.


33. Project Syndicate – A Clear Case for Golden Rice

Peter Singer;

Readers of this newsletter might think some of us are George Bush “black or white” kind of people, and they’re probably right. But this article was a pleasant surprise, I’d have to say, so I guess I’d concur with Singer’s conclusion: “In some environmental circles, blanket opposition to GMOs is like taking a loyalty oath – dissidents are regarded as traitors in league with the evil biotech industry. It is time to move beyond such a narrowly ideological stance. Some GMOs may have a useful role to play in public health, and others in fighting the challenge of growing food in an era of climate change. We should consider the merits of each genetically modified plant on a case-by-case basis.”

34. Lancet (Book review) – People and their health: embracing a new path

Salmaan Keshavjee;

Book review of the important book, ‘When People Come First: Critical Studies in Global Health’. “The brave new world of global health in the 21st century requires that we do things differently, and not repeat the moral and delivery failures of the past.”


35. Smart Global Health – The Global Health Security Agenda: A Snowy Promising Start

J Stephen Morrison;

It ain’t April yet, so snow in Washington wasn’t perhaps that odd last week. But they had lots of it, and it proved a great backdrop for the start of the Global Health Security agenda. 26 Countries already joined. Now it’s time for some more money. Morrison also raises some other issues (and challenges to be dealt with).

36. Lancet Correspondence – Redefining global health-care delivery

Mahiben Maruthappu et al. ;

A few Lancet letters respond to Jim Kim’s ‘redefining global health care delivery’ viewpoint from a while ago. This one, by Maruthappu, but also one by  Elisabeth Glaser et al on the importance of nurses in this debate: “Meaningful inclusion of the largest professional health workforce, nurses, in policy design, model development, programme implementation, monitoring, and evaluation is essential for the success of value chains within countries and externally with non-governmental organisations that drive policy formation.”  (I’d say it’s time for quota)


37. Activist Post – Pharmaceutical drug trial industry in Kenya

Catherine Frompovich ;

Worrying blog post on the drug trial industry in Kenya (also based on a recent Wemos report). Frompovich wonders, among other things, whether trial participants are fully informed before they give their consent to participate in new pharmaceutical drug trials, which have become a flourishing industry in Kenya.


38. Global Health Promotion – Globalization and the rise of precarious employment: the new frontier for workplace health promotion

Sam Caldbick et al.;

Global market integration over the past three decades has led to labour market restructuring in most countries around the world. Employment flexibility has been emphasized as a way for employers to restructure their organizations to remain globally competitive. This flexibility has resulted in the growth of precarious employment, which has been exacerbated by the global financial crisis and resulting recession in 2007/2008, and the ongoing economic uncertainty throughout much of the world. Precarious employment may result in short and long-term health consequences for many workers. This presents a deeper and more structural determinant of health than what health promoters have traditionally considered. It calls for a different understanding of workplace health promotion research and intervention that goes beyond enabling healthier lifestyle choices or advocating safer workplace conditions to ensuring adequate social protection floors that provide people with sufficient resources to lead healthy lives, and for advocacy for taxation justice to finance such protection.





39. Globalization & Health – Health systems performance assessment in low-income countries: learning from international experiences

Christine Kirunga Tashobya et al.;

This study aimed at developing a set of attributes for a ‘good’ health system performance assessment (HSPA) framework from literature and experiences in different contexts and using the attributes for a structured approach to lesson learning for low-income countries (LICs).


40. NYT – Treating Tuberculosis and AIDS Together Saves Lives

Patients who have multi-drug-resistant TB and AIDS are more likely to live if they get simultaneous treatment for both diseases rather than waiting weeks to start the AIDS treatment, a small new (SA) study has found – the results are in line with three previous studies.

41. Plos – Living Systematic Reviews: An Emerging Opportunity to Narrow the Evidence-Practice Gap

Julian Elliot et al.;;jsessionid=D70F67622A40CB0386139C34D1841726

Julian Elliott and colleagues discuss how the current inability to keep systematic reviews up-to-date hampers the translation of knowledge into action. They propose living systematic reviews as a contribution to evidence synthesis to enhance the accuracy and utility of health evidence.


42. International journal for equity in health – Socioeconomic inequalities in HIV/AIDS prevalence in sub-Saharan African countries: evidence from the Demographic Health Surveys

Mohammad Hajizadeh et al.;

Existant studies universally document a positive gradient between socioeconomic status and health. A notable exception is the apparent concentration of HIV/AIDS among wealthier individuals. This paper uses data from the Demographic Health Surveys and AIDS Indicator Surveys to examine socioeconomic inequalities in HIV/AIDS prevalence in 24 sub-Saharan African (SSA) countries.


43. MSH – Ten Resources for Learning More about Universal Health Coverage as a Driver for Women’s Health

Ten useful resources for the maternal health community & UHC community.

44. BMC Public Health – Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa

Clara Aranda-Jan et al.;

Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa.



Check out this podcast on ‘Treatment as prevention in Africa’.


On the same topic, you might also want to read a Science Speaks article, reporting on a recently published Plos One article on HIV treatment as prevention in British Columbia, Canada. “The findings reflect similar findings showing population-wide impacts of HIV treatment as prevention, the authors say, noting ‘the magnitude of the impact of the expansion of HAART coverage on HIV transmission derived from our models is entirely consistent with the effect noted from the experience in Kwazulu-Natal.



Global Health announcements


As already mentioned, the Third Global Symposium on Health Systems Research in Cape Town is coming up – do send your abstract before it’s too late ( 3 March 2014 is the deadline).



Health Systems Global also shared some recent news in its newsletter.


  • There are two new Health Systems Global thematic working groups: Translating Evidence into Action and Supporting and Strengthening the Role of Community Health Workers in Health Systems Development, and another one in the making.
  • Registration for the Third Global Symposium is now open. Please visit the Symposium website to register. As a Health Systems Global member, you will pay a discounted registration rate. If not already a member, you can sign up to become a member or to renew when you register.





45. IPS – OECD in “Game-Changing” Move to Halt Tax Evasion

The OECD developed a new standard for automatic exchange of information. Already about 40 countries have agreed to adopt the standard. LICs are still left in the dark, though.


  • African nations (Mauritania, Mali, Niger, Chad, Burkina Faso) formed a  G5 to work on Sahel security & development.
  • The Guardian had a number of critical articles on the quite controversial G8 New Alliance for Food Security and Nutrition. New colonialism or not?
  • Scientists need to get more involved in the post-2015 negotiations (see  Also NYT columnist Nicholas Kristof said something similar about scientists, but then in general: “Professors, we need you!” He got Julio Frenk tweeting.



  • Two of the Buffett kids (Jennifer & Peter) wrote a nice piece on how philantropy can support the transformation of society (see here ).

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