Dear Colleagues,

Next Monday, March 3, is the deadline for both the 3rd Global symposium on Health Systems Research in Cape Town, and the 2014 Emerging Voices competition, linked to the symposium, for young aspiring researchers. If you know promising young health systems researchers, encourage them to take part (see the call). And if you think you are the next Julio Frenk, David Sanders or Tim Evans (not to mention the next Rob Yates), then be our guest.. You won’t regret it.  

The next health systems research & policy generation will have to delve even deeper into our increasingly complex and murky world, now that people realize the limits of a biomedical approach and the world faces existential and often interdependent challenges. This young generation might cheerfully hum Coldplay’s “We live in a beautiful wo-o-o-o-rld” but people tell me this is a very pragmatic generation nevertheless. They’ll need it. Just three illustrations from this week to make clear what I mean.

As you probably know by now, Ugandan president Museveni signed a law he really shouldn’t have signed earlier this week, while poking fun at homosexuals for failing to see the beauty of African women at the press conference. Whatever the reasons behind his decision, Ben Shepherd (Chatham House) said, correctly in my opinion: now donor countries find themselves in a “no-win” situation, at least in the medium term. This is obviously a minefield for the Global Fund, UNAIDS, the World Bank and many other donors.  Domestic politics played a role in Museveni’s decision, but clearly also a changing geopolitical constellation, as well as perhaps counterproductive advocacy in recent years (see this Foreign Policy viewpoint on the latter). Human rights might be universal, but not everybody seems to agree, not for the first time in history. We know it’s not up to them yet, but what would young health policy researchers recommend, faced with a conundrum like this, in an era of geopolitical shifts?  I have no idea what ‘smart health diplomacy’ would look like in this case, but John Kerry’s ‘megaphone diplomacy’ quote “this is like anti-Semitism in nazi-Germany” is probably not the right approach. So let the next Ilona Kickbush please step forward and enlighten us.

Ukraine offers another example. Deep dissatisfaction with domestic governance, business practices and widespread corruption led to protests on Maidan square and elsewhere. Many Ukrainians (but definitely not all) felt similar, and Europeans like me were somewhat puzzled to see how eager they were to join the EU, given our recent track record. Now, the ruling elite has been replaced in Kiev, after a bitter fight, but Pandora’s box is opened as well, as you can see if you follow the headlines in the news. For those of us who dream about cosmopolitan solutions and global citizenship, and even think they are inevitable in the age of climate change and other global challenges, you do have to wonder whether we won’t have to go first through an intermediary stage whereby a mix of nationalism and regional influence spheres will clash with global advocacy on certain causes. Other people think major cities will determine the fate of the planet. Anyway, it’s a potpourri, and “multi-level governance” doesn’t quite capture what’s going on. But it’s clear the choice will not just be one between isolationism and multilateralism. Young health researchers naturally think of global challenges, which require a global response. But are common people and decision makers ready to follow? And if not, how can we boost global citizenship for the causes that really – and urgently – require global solutions, so that we don’t come too late? Again, Emerging and other young Voices who are into governance have their work cut out in the coming decades. Or maybe we just need to clone Ilona Kickbusch?

Final example: this week, a Heinz branch closed in Belgium. If you have kids, you probably know Heinz’s core business. The factory will be moved to the UK by the end of the year. Reporters explained patiently that  the multinational Heinz was taken over by 3G Capital and Berkshire Hathaway last year. The latter belongs to Warren Buffett, also known for his support to Gates (including via ‘The Giving Pledge’). The Heinz CEO is just doing the ‘smart’ capitalist & cost-cutting thing here, moving a branch to a location where they can make even more profit (apparently the company in Belgium was making profit, but not as much as Heinz could make elsewhere), while coming up with the usual fairytale story of ‘getting closer to the customers’ etc. Even if you are a firm believer in the blessings and logic of capitalism, you can’t escape this question: if part of the money (earned by Berkshire Hathaway through cost-cutting like this) is subsequently used for a worthy global health cause, is Warren Buffett then off the hook? At the very least, investment consortia & funds would need to be taxed properly, so that philantropy like ‘The Giving Pledge’ is no longer needed, I’d say. An even better solution is a level playing field, in terms of social and ecological regulation, all around the world, instead of this race to the bottom. But that’s a long way off. But if it has been possible to globalize business and finance (including shadow banking) in recent decades, a global level playing field seems not just possible as well, but a necessity, just like a new paradigm of financial governance. For some great ideas on how to get to such a world, see this recent lecture by David Woodward, ‘Between the rack and a hot place: can we reconcile poverty eradication and tackling climate change?  Learn all about a ‘bubble up’ (instead of trickle down) economy – now we just need a scholar to define a ‘bubble butt’ economy – , dealing with ‘fiscal termites’, the need for a ‘global parliament’ (but not a global government) etc.   Meanwhile, we’ll start making 3D-prints of Ronald Labonté that will assist Emerging Voices in dealing with the global health philantropists of the future.

 

In this week’s guest editorial, Solomon Huruva (MPH, ITM), from Zimbabwe, discusses the latest “salary-gate” in his country and explores possible reasons for the scandal. 

 

Enjoy your reading.

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

 

Editorial

 

Yet another sorry tale from Zimbabwe; or an opportunity towards more accountability?

 

Solomon Huruva (MPH)

 

The year 2014 is one many Zimbabweans will not forget easily. The year started on a high note of expectations particularly for civil servants who were eagerly awaiting fulfilment of promises made before elections. This was going to be the first year they were going to get a salary increment since the introduction of the multi-currency system in 2009. In what seemed like a flash, the media was awash with cases of graft, abuse of public office by the most trusted of public servants. Revelations are showing that this is widespread. The scandal is now broadly termed “salary-gate”.

What shocked most civil servants was the “salary-gate” in the health insurance sector. According to the Herald, the top six executives of the biggest health insurance organisation PSMAS (Premier Service Medical Aid Society), were getting $1.1 million in basic salaries per month. The chief executive alone was taking home more than half a million US dollars a month. This is in the context where the majority of its members, civil servants (including those who retired), constitute more than 75% of membership. These members barely earn more than $400 per month and pensioners, widows who need medical care earn a good deal less.

PSMAS also owes service providers $38 million in unpaid fees. This scenario exposed the insured to high Out Of Pocket payments (OOPs) since many service providers were now demanding cash payments from those insured by PSMAS.

What are some of the possible causes of this scandal? Let us explore some options.

 

Governance

Since 2003, PSMAS is the second biggest provider of health services in Zimbabwe after the government, through its subsidiary Premier Service Medical Investments (PSMI). It has also been the biggest employer of doctors in Zimbabwe from 2012 on and contributed to internal brain drain and mal-distribution of this scarce resource. A problematic situation as it was both fund manager and provider of services. Reforms have long called for a provider-purchaser split particularly in the health sector; in this case, no one heeded that call. In 2010, long before the current crisis, stakeholders through theTraining and Research Support Centre (TARSC) platform called for enforcement of the law. The lack of capacity within the Ministry of Health (MOH) is one of the reasons behind the inability to enforce and regulate the sector.There was an inherent moral duty as a fund manager to provide services to clients, most of whom were its members (who did so to avoid paying OOP payments).

As a quasi-public sector enterprise, PSMAS fell under four ministries, respectively the Ministries of Finance, Health, Labour and the Public Service Commission. Although this makes sense, this made it rather difficult for anyone of them to ensure effective oversight and regulation of the organisation. The Ministry of Finance is the treasury of central government; the Ministry of Health should play the key oversight role, as it is responsible for regulation of the health sector, whereas the Labour and Public Service Commission are responsible for all workers in Zimbabwe and civil servants respectively. In reality, there was no effective ministerial or political control. This governance crisis could have led to the situation going unchecked for some time.

As mentioned, the MOH should have played a very critical stewardship and regulatory role because the main functions of PSMAS were health insurance & health services. However, the MOH failed to do so, and to make matters worse, MOH was the only ministry that did not have a representative on the governance boards of PSMAS. None of the four ministries has taken blame for what has transpired. In addition, MOH’s regulatory oversight role is post hoc i.e. it only approves or addresses issues after implementation and in many cases months later. The MOH therefore does not have meaningful blocking power to prevent ‘bad boy’ behaviour.

The CEO of PSMAS was also chair of 20 public companies in the country and within the region. Was he smart enough to sit on all those boards? Did we not have enough talent to go round?

 

Political motivations

In as much as this has been happening from around 2009, why expose this information now? One school of thought is this may be a political game.

After winning the July 31 2013 elections, the ZANU PF party (Mugabe’s party) wants to sanitise its image by ‘ seemingly being seen to fight corruption ‘. Most importantly regional groupings like the EU are considering lifting sanctions on Zimbabwe and this is a critical trade-off for the establishment. Corruption and rule of law had been high on the agenda as destructive vices that need attention if Zimbabwe had to entertain reengagement onto the international arena.

Closer to home the salary-gate could be a potential diversion from the pressing demands of restive civil servants who have been eagerly awaiting a salary increment.

 

A predatory, extractive type of institution?

Another school of thought focuses on the institutional arrangements within these health insurers. They are relics of our colonial past, and were created to extract resources from the people and have not transformed with the times, hence we should not expect less! Patients pay up to 70% in OOP expenditure and yet they are”insured”. In our National Health Accounts 2010 (still to be published), evidence showed that 58% of subscriptions by members went to transaction and administrative costs of running the health insurance firms.

Do we expect anything to change? Probably not; although we are a polarised nation, very few will take this opportunity and run with it. Nevertheless, maybe this is a good opportunity to reform the health insurance industry and have an alliance between health service providers and the insured to push for radical reforms. The key question is: can we make our leadership more accountable and responsible? Revelations from those well read show that this very CEO was earning three times more than a CEO of a global company whose GDP is ten times more than that of Zimbabwe. I do not want to make this a criminal case, but a moral one with the hope of invoking checks and balances. The biggest weakness in my opinion is that we did not have adequate checks and balances in place. Anyone in this position could have abused the system in seeking to satisfy his or her need.

The state institutions are to blame, since they did not protect the members from the predatory behaviour of public enterprises. The vulnerable expect the state to protect them, in the hope that the state has adequate technical competencies to oversee and regulate the market.

This is Zimbabwe, very little is done unless it is ordered from the top! The truth is we need a more accountable system, one that is responsive to the needs to poor, vulnerable communities of Zimbabwe.

 


 

 

UHC & post-2015

 

1.    BMC International Health and Human Rights – Is universal health coverage the practical expression of the right to health care?

Gorik Ooms et al.;

http://www.biomedcentral.com/1472-698X/14/3

Another Go4 Health output. If UHC would become the single overarching health goal, replacing the present health-related MDGs, would that be more consistent with the right to health? The authors of this paper used a comparative normative analysis to verify this contention and found that – to be a practical expression of the right to health – at least one element is missing in present authoritative definitions of universal health coverage: a straightforward confirmation that international assistance is essential, not optional.  But UHC is a ‘work in progress’.

 

2.    Chatham House Working paper – Development Assistance for Health: Quantitative Allocation Criteria and Contribution Norms

Trygve Ottersen et al.;

http://www.chathamhouse.org/publications/papers/view/197643

The general objective of this paper is to examine allocation criteria and contribution norms for Development Assistance for Health (DAH). More specifically, it reviews the allocation criteria stated by major institutions and estimates distributional implications related to different criteria; and reviews recognized contribution norms and, in the context of these, estimates total need and total available funds for DAH.

 

3.    Medact – Robert Yates on Public Financing – The Key to Universal Health Coverage

http://www.medact.org/blog/robert-yates-public-financing-key-universal-health-coverage/

This post dates from some time ago (and was posted on UHC forward first), but Medact republished it. It’s Rob Yates, so you probably know what he’s going to say, but he does it so convincingly that it’s worth re-reading.

 

4.    Global Health: Science and Practice – February issue

GH Science and practice;

The February issue of the “Global Health: Science and Practice” journal is now available online. It includes an article on cell phone use by community health workers, a commentary on WHO programming for postpartum family planning, and many other pieces.

 

We want to draw your attention more in particular to this article, ‘The imperative for health promotion in universal health coverage’ (by Gloria Coe et al). From the abstract: “Health promotion and disease prevention have huge impact on health, yet given low priority, risk being overlooked in universal health coverage efforts. To effectively prioritize promotion and prevention, strong cadres of personnel are needed with expertise in legislation and health policy, social and behavior change communication, prevention and community health, health journalism, environmental health, and multisectoral health promotion.”  (health staff in the future will need artificial intelligence, no doubt)

 

5.    European public health alliance (position paper) – Post-2015: The role of Global Health Research and Development (R&D) in the new development framework

http://www.epha.org/a/5956

This position paper, supported by 23 leading Global Health NGOs from both sides of the Atlantic, calls on both public and private stakeholders to ensure that R&D investment targets for poverty-related and neglected diseases (PRNDs) are guaranteed and strongly supported across the board. They call on governments, civil society and other stakeholders involved in the development of the post-2015 framework to ensure that the health goal encompasses R&D-specific targets related to the development of new, safe, effective, affordable and accessible health technologies to fight PRNDs.

 

6.    UHC Forward – Health 2015: A conversation with Davidson Gwatkin on Progressive Universalism

http://uhcforward.org/blog/2014/feb/26/health-2015-conversation-davidson-gwatkin-progressive-universalism

Cross-posted from Results 4 Development, second post in the post-2015 series (for the first one, a conversation with Helen Saxenian & Robert Hecht on 20 years in global health, from the 1993 WDR till Global Health 2035, see  here).  David Gwatkin discusses a bit more in detail a pro-poor pathway to achieving universal health coverage, termed ‘progressive universalism’, a term he invented in 2011.

 

By the way, PMAC 2015, in Bangkok (January 2015) will focus on global health post-2015: accelerating equity. Very timely.

 

7.    Lancet – Offline: Mindfulness—evidence, out of place

Richard Horton;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60271-3/fulltext

You might be forgiven for thinking that Horton’s reflection of this week is not that relevant for global health and the post-2015 era, but you would be wrong, as Horton really nails it here, discussing scientific research on mindfulness. (In the words of the Buddhist monk I occasionally visit on Saturday morning: politics, economy, science, … they all provide just one element of truth. Politics/policies and/or economy can never come up with all the answers, you also need to bring in spirituality (in a broad sense). Unfortunately, I usually forget his advice, probably because politics is ‘football for nerds’, as a Guardian columnist said earlier this week. The price we pay for overlooking spirituality is, however, cynicism.)

 

Infectious disease

 

8.    UCSF Global Health Group – Financing for malaria elimination

http://globalhealthsciences.ucsf.edu/sites/default/files/content/ghg/mei-financing-malaria-elimination.pdf

This document dates from December 2013. The UCSF Global Health Group and Cambridge Economic Policy Associates released a report and policy brief, titled “Financing for Malaria Elimination.” The report examines global and domestic resource allocation trends to malaria-eliminating countries and makes recommendations for new and additional funding sources.

 

For some of the latest scientific breakthroughs related to malaria control, see this Guardian global development professionals network article (on larval source management, …). Media sources also report on two recent studies in Genome Biology and Nature showing how the malaria parasite becomes resistant to insecticides and makes changes allowing it to infect humans.

 

9.    Global Public Health – special issue: HIV scale-up and the politics of global health

http://www.tandfonline.com/doi/full/10.1080/17441692.2014.880727#.UwxoXvl5OuI

We already covered most articles of this special issue in previous IHP newsletters, but it’s more than worth to go through the series, and also read this introductory Editorial (by Norah Kenworthy & Richard Parker).

 

Their final comments: “Writing during what appears to be the twilight hours of one of the most vast and resource-intensive health initiatives in world history, we take this issue as an opportunity to reflect on the politics of a passing era, while at the same time recognising that HIV scale-up has institutionalised political dynamics that will long outlive its period of prominence. In many ways, the transnational activism of, and consequent global response to, HIV created a lasting mould for subsequent initiatives that now make up what we collectively recognise as global health. In light of this, we trust that the articles included in this special double issue of Global Public Health do not simply provide a reflection on the scale-up of the response to HIV and AIDS over the past decades. They offer important insights into the transnational trends and politics of an unfolding global health paradigm – a still emergent history of the present whose lessons will hold relevance far beyond HIV and well into future decades of global public health.”

 

10. Vatican Radio – Conference Aims To Strengthen Role Of Faith-Based Organizations Against HIV/AIDS

Vatican Radio;

News on an international conference on stepping up the fight against HIV-AIDS opened in Rome, with participants focused on how to strengthen the role of faith based organisations. Jointly organised by UNAIDS and the global Catholic aid and development confederation Caritas Internationalis, the meeting reviews progress over the past three decades and pinpoints ways of expanding access to life saving anti-AIDS treatment.

 

11. Speaking of Medicine – Is Viral Load Testing for HIV a Realistic Strategy in Developing Countries?

http://blogs.plos.org/speakingofmedicine/2014/02/26/viral-load-testing-hiv-realistic-strategy-developing-countries/

Sara Gorman from Columbia University discusses viral load testing in resource-poor settings.

 

12. Science Speaks – As Ugandan nurse is tried in court and media, HIV treatment becomes prosecution evidence

http://sciencespeaksblog.org/2014/02/27/as-ugandan-nurse-is-tried-in-court-and-media-hiv-treatment-becomes-prosecution-evidence/

More on Uganda later in this newsletter, for obvious reasons, but this news on a Ugandan nurse was quite worrying too. Charged with a statute that HIV community and human rights advocates say hasn’t been put to use in half a century, Ugandan nurse Rosemary Namubiru will have to wait for a court to decide what happened when she tried to insert an intravenous needle into the arm of a two year old patient about two months ago.

 

13. Science Speaks – Hepatitis C and HIV co-infection highlight need for equitable treatment access, amfAR brief says

http://sciencespeaksblog.org/2014/02/27/hepatitis-c-and-hiv-co-infection-highlight-need-for-equitable-treatment-access-amfar-brief-says/

The new issue brief from amfAR highlights a peculiar global health conundrum –  people living with HIV, a disease for which no cure yet exists, survive with treatment only to die of a disease that can be cured. One example has long been TB. This brief puts the spotlight on Hepatitis C and HIV: Addressing the Dual Epidemic.

14. Scidev.net – Measles deaths decline but Africa’s 2020 goal in danger

SciDev.Net

Despite the global decline of deaths from measles, Africa must step up its control efforts, otherwise the continent is unlikely to achieve its target of eliminating the disease by 2020, says WHO in a recent report (see also the previous IHP newsletter).

15. NYT – Coping With Infectious Disease

New York Times

This NYT editorial comments on the launch of the Global Health Security Agenda, and why Congress should approve of the (so far little) money involved.

See also this JAMA article on GHS agenda demonstration projects in Vietnam and Uganda.

 

16. BMJ (Analysis) – Prevention is better than cure for emerging infectious diseases

David Heymann & Osman Dar;

http://www.bmj.com/content/348/bmj.g1499

Emerging infectious diseases have the potential to cause considerable morbidity, mortality, and economic damage. David Heymann and Osman Dar explain why we need to shift the emphasis from responding to emerging infections once they are detected to preventing them from occurring in the first place and describe one initiative that is working to achieve this.

 

17. East Asia Forum – Red flags in China’s disease control

Yanzhong Huang;

http://www.eastasiaforum.org/2014/02/18/red-flags-in-chinas-disease-control/

In comparison with the era of SARS, China is doing a lot better now. But a closer look at China’s response to the H7N9 outbreak still raises alarming questions on its ability to effectively manage a public health emergency of international concern, CFR’s Yanzhong Huang says. Meanwhile, Beijing is almost in the midst of a ‘nuclear winter’, with smog as never seen before.

 

Global Fund, GAVI & PEPFAR, …

 

A new Global Fund news flash focuses on the importance of country dialogue – “Country dialogue, with a high level of participation, has been made a fundamental requirement for any grant application in our new funding model, which is about to begin full implementation, in March 2014.”

 

18. Aidspan – The Global Fund releases eligibility list for 2014

Lauren Gelfand;

http://www.aidspan.org/gfo_article/global-fund-releases-eligibility-list-2014

The list of countries eligible to apply for Global Fund support for up to four components — HIV, TB, malaria and health system strengthening —  was released in February, timed to coincide with the imminent roll-out of the new funding model (NFM) allocating greater resources to those countries with high disease burdens and modest financial resources.

 

19. Aidspan – Call for proposals from France’s 5% initiative to improve gender representation and key population support under Global Fund grants

http://www.aidspan.org/gfo_article/call-proposals-france%E2%80%99s-5-initiative-improve-gender-representation-and-key-population-su

France’s 5% initiative has issued a call for proposals for ‘bold and innovative’ strategies to improve representation of key populations and women in the administration and governance of Global Fund grants. (I’m waiting for the first ‘bold and beautiful’ strategies).

 

20. JAIDS – The Politics and Epidemiology of Transition: PEPFAR and AIDS in South Africa

Matthew Kavanagh;

http://journals.lww.com/jaids/Fulltext/2014/03010/The_Politics_and_Epidemiology_of_Transition__.1.aspx

(We covered this article before in the newsletter, but it’s now in the new JAIDS issue.) PEPFAR is managing the largest “transition” of a global health program, withdrawing direct staff and funding for the treatment of hundreds of thousands of HIV-positive patients, as the South-African public sector takes over. Recent commentary has painted an optimistic picture of the transition and “country ownership” in SA. In important ways, however, the politics are outpacing effective health policy and the accelerated process is undermining the prospects for “getting to zero.” Thousands of patients and the health system have experienced significant disruption. PEPFAR should take urgent steps to ensure that the transition does not undermine hard-fought gains in SA. More broadly, the SA experience has important lessons for the future of aid to fight global HIV, argues Kavanagh.

21. Doing Well by Doing Good: The Impact of Foreign Aid on Foreign Public Opinion

Benjamin Goldsmith et al.;

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2361691

Does foreign aid extended by one country improve that country’s image among populations of recipient countries? Using a multinational survey, the authors show that PEPFAR substantially improves perceptions of the U.S. Their finding implies that in addition to its potential humanitarian benefits, foreign aid that is targeted, sustained, effective, and visible can serve an important strategic goal for those countries that give it: fostering positive perceptions among foreign publics. By doing good, a country can do well.   Tom Paulson discusses the implications of this paper on Humanosphere.

 

22. UNAIDS – Zero Discrimination Day to be celebrated 1 March 2014

http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/february/20140227zerodiscrimination/

UNAIDS Executive Director Michel Sidibé launched the Zero Discrimination Day on 27 February with a major event in Beijing, China supported by the China Red Ribbon Foundation, Hanergy Holding Group, Chinese government, civil society and celebrities. Similar events are planned for the days leading up to 1 March 2014 in countries around the world. Zero Discrimination Day is a call to people everywhere to promote and celebrate everyone’s right to live a full life with dignity—no matter what they look like, where they come from or whom they love. The day couldn’t come more timely …

 

23. Health Policy & Planning Debated – Sustainably graduating – so they don’t come home to live with us

Robert Steinglass;

https://blogs.lshtm.ac.uk/hppdebated/2014/02/18/sustainably-graduating-so-they-dont-come-home-to-live-with-us/

Excellent blog post on immunization sustainability – a must-read.

 

Homophobia

 

24. Reuters – Uganda’s Museveni signs anti-gay bill

Reuters;

If you read this newsletter, you probably know which bill Museveni signed, but just in case. See also Science Speaks.

 

Almost immediately, the media and the streets followed, see for example the publication of the names and pictures of 200 prominent gay people  in a tabloid. The clampdown is quite similar to what’s going on in Nigeria, by the way (see a New Internationalist article on the dire situation for LGTBs in Nigeria).

 

The increasingly dangerous situation for gays makes a mockery of the comforting words by the Ugandan health minister, who said homosexuals will not be discriminated against when accessing healthcare despite the introduction of a tough new anti-gay law.

 

Numerous individuals, donors and donor countries already reacted on the signing of the bill, worried and criticizing the bill, including Aids Alliance, the Global Fund, Desmond Tutu, John Kerry (who said, in addition to likening the situation to the nazi-era, that repealing the law is the only solution), and many others. The US said it is reviewing its relationship with Uganda’s government, including U.S. assistance programs that are heavily focused on fighting HIV/AIDS.  Some other (European) countries already announced aid cuts (see Euractiv for an overview).  More will follow, no doubt. See also the Guardian for an overview of donor reactions so far. The World Bank even reacted – it postponed a loan to Uganda -, in spite of its usual reluctance to interfere with domestic politics.

 

 

25. Foreign Policy – Unintended consequences: How clumsy foreign advocates unwittingly helped Uganda’s anti-gay bill become law

Elizabeth P Allen;

http://www.foreignpolicy.com/articles/2014/02/26/unintended_consequences_uganda_gay_law

Whether that’s a smart thing to do, cutting aid, that’s another question. This Foreign Policy viewpoint argues that international advocacy in recent years might, in fact, have been counterproductive. (must-read)

 

Meanwhile, Allafrica reported African countries didn’t react so much to Museveni’s decision … (unlike the West). This smoothly written article explains why.

 

26. Aidsfree world – Letter to Ban Ki Moon: UN Envoy for AIDS in Africa Must Go

http://aidsfreeworld.org/Newsroom/Press-Releases/2014/Letter-to-SG-re-envoy

In a letter to Ban Ki-moon, Paula Donovan and Stephen Lewis, co-directors of AIDS-Free World, state about UN Special Envoy for HIV/AIDS in Africa, Wandira-Kazibe,’s silence so far and apparent conflict of interest: “We write to you out of deep concern regarding Ms. Speciosa Wandira-Kazibwe, U.N. Special Envoy for HIV/AIDS in Africa. In the wake of Uganda’s passage of a law criminalizing homosexuality, Ms. Wandira-Kazibwe’s reprehensible silence, and her ongoing position as a senior adviser to President Museveni, threaten to undermine the credibility and independence of the United Nations. We urge you to terminate her position as Special Envoy and appoint an impartial advocate for the rights of all Africans. … Ms. Wandira-Kazibwe’s split loyalty presents an obvious conflict of interest that has damaged her credibility. Continued inaction by your office risks damaging yours as well”.

 

27. BMJ (blog) – Ugandan anti-homosexuality legislation: bad law, bad science

Julian Sheather;

bmj blog;

The proper defence of adult sexual behaviour is choice and consent, not biology, Sheather argues. The Ugandan law should be resisted because of its violation of fundamental adult liberties, not because of some uneasy medicalised reference to our genes. The state has no place in the bedrooms of consenting adults. “Yes bad science should be resisted wherever it emerges, but so should bad moralising. We know that like many demagogues, Museveni has had recourse to shoddy science. But the law in this area defines the scope of our fundamental private freedoms. And it should be resisted because it is a bad law, irrespective of what the science says.”

 

28. Chatham House – The Politics of Uganda’s Anti-Homosexuality Legislation

Ben Shepherd;

http://www.chathamhouse.org/media/comment/view/197622

Excellent analysis by Ben Shepherd, on the rationale behind Museveni’s decision & the catch-22 situation for donors.  (must-read)

29. Lancet (Correspondence) – Criminalising homosexuality threatens the fight against HIV/AIDS

Ashton Barnett-Vanes.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60403-7/fulltext

This Lancet letter presents the general picture. “The ambitious goals to tackle HIV by 2015 as outlined by UNAIDS, particularly to halve the number of countries with “punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses” cannot be achieved if we are going backwards and not forwards. If homosexual communities are further marginalised or isolated by national policies, the prospect of undoing progress in HIV/AIDS care is real. The international health community, together with those in law, human rights, and equality, can ill-afford to not make this case heard.”

 

 

NCDs

 

For the NCD researchers among you, eighteen recently published papers have been added to The Global Challenges of Noncommunicable Diseases collection in PLOS. This Collection brings together research and commentary published in PLOS Medicine that examines the challenges and opportunities for addressing NCDs around the world.

 

30. Economist – Cancer in the developing world: worse than AIDS

http://www.economist.com/news/international/21597962-burden-cancer-falling-increasingly-heavily-poor-worse-aids

This Economist article focuses on the increasing cancer burden in developing countries and the quick (and somewhat less quick) wins that are possible in the short/medium term.

 

31. Global Health Action – Language, culture, and task shifting – an emerging challenge for global mental health

Leslie Swartz et al.;

http://www.globalhealthaction.net/index.php/gha/article/view/23433

Language is at the heart of mental health care. Many high-income countries have sophisticated interpreter services, but in low- and middle-income countries there are not sufficient professional services, let alone interpreter services, and task shifting is used. In this article, the authors discuss this neglected issue in the context of LMICs, where task shifting has been suggested as a solution to the problem of scarce mental health resources.

 

NTDs

 

32. Lancet Global health (blog) – Opening up data to accelerate research for neglected diseases and global health

Belén Pedrique;

http://globalhealth.thelancet.com/2014/02/25/opening-data-accelerate-research-neglected-diseases-and-global-health

This DNDI (Drugs for Neglected Diseases Initiative) epidemiologist makes the case for data sharing.

 

Newborn, child, adolescent & maternal health

 

33. Lancet (Editorial) – Every newborn, every mother, every adolescent girl

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60388-3/fulltext

This Lancet editorial comes back on the launch of the new report by Save the Children this week. With the report, ‘Ending Newborn Deaths: Ensuring Every Baby Survives’, the momentum to achieve substantial reductions in neonatal mortality is accelerating. But “the “N” in the reproductive, maternal, neonatal, and child health (RMNCH) agenda needs to be more than just a letter.”  The editorial also asks for more attention to adolescent girls. It’s time to add the letter “A” to RMNCH.  See also The Guardian’s Sarah Boseley  on the new Save the Children report.

 

A Comment in this month’s (new) Lancet Global Health issue finds that socioeconomic inequalities in terms of neonatal mortality are falling, and tries to explain why.

 

34. Lancet Global Health – Is it a vaccine? Is it a drug? No, it’s SuperAmma!

Zoë Mullan;

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70184-6/fulltext

study of a handwashing intervention, published in the new March issue of The Lancet Global Health, shows that 6 months after the campaign was rolled out in in rural India, rates of handwashing with soap increased by 31%, compared to communities without the programme. This unique “SuperAmma” (Amma means mother) campaign shows that the benefits of using emotional motivators, such as feelings of disgust and nurture, rather than health messages, can result in long-lasting improvements in people’s handwashing behaviour, and could in turn help to reduce the risk of infectious diseases.

 

An accompanying Comment in the Lancet Global Health questions the impact of emotional drivers, rather than social norms.

 

As for me, I remember the old days when I went to the  ‘Hugging Mother’, somewhere deep down in Southern India. I wanted a hug from the hugging Amma. I never got a comforting hug from the Mother, though, as she had to leave on the very day I arrived, but the place left quite an impression on me, especially the western people I met there. Would be nice to invite her on the next Global HSR symposium, if she’s still alive.

 

35. UNICEF – UNICEF launches record $2.2 billion aid appeal to help children in emergencies

U.N. News Centre;

UNICEF launched record $2.2 billion aid appeal to help children in emergencies.
UNICEF’s ‘Humanitarian Action for Children 2014’ is the largest emergency appeal on record. It would aid 85 million people of whom 59 million are children.

 

36. Dipnote – Preventing Sexual Violence Is a National Security Imperative

John Kerry & William Hague;

http://blogs.state.gov/stories/2014/02/25/preventing-sexual-violence-national-security-imperative;

Preventing sexual violence in conflict isn’t about politics. It’s about our common humanity, and we all need to be united in action against it. That’s why the United Kingdom and the United States are working together to protect and empower vulnerable populations during conflict, humanitarian emergencies and peacetime.”

 

Kerry hosted a discussion on Tuesday on the U.S., U.N., and U.K. efforts to prevent and respond to sexual violence in conflict situations. According to the transcript, Kerry noted, “We’re going to ask governments to take practical steps to end sexual violence.”

 

37. Daily Times – Ban Ki-Moon Announces New Global Action To Support Women, Children’s Health

http://www.dailytimes.com.ng/article/ban-ki-moon-announces-new-global-action-support-women-children%E2%80%99s-health

UN Secretary-General Ban Ki-moon says a global action to improve the health of women and children will be enhanced through a new programme to share ideas and successes among developing countries, South-South collaboration in other words.

 

38. NEJM (Editorial) – New Diagnostics for Common Childhood Infections

http://www.nejm.org/doi/full/10.1056/NEJMe1316036?query=featured_home

As malaria is controlled in regions of sub-Saharan Africa, the causes of febrile illness are changing. In a new NEJM report on febrile children in Tanzania, a broad array of possible pathogens are identified and stratified by presenting syndrome. This Editorial comments on the article.

 

See also this VOA article, for some of the implications of this research.

 

 

39. Lancet Global Health – Networking to advance progress in children’s environmental health

Peter D Sly et al.;

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70004-X/fulltext

The aim of this Comment is to alert the global health community to the activities of a collaborative network that aims to provide a coordinated approach to address priority areas of children’s environmental health, and to invite participation from interested groups.

40. Lancet Global Health – The role of private providers in maternal health

Priya Agrawal et al.;

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70006-3/fulltext

The private sector’s potential contribution to address maternal mortality cannot be ignored. Growth of the private sector in health could be an important opportunity to tackle maternal mortality. To do so, the specialty needs to invest in expanding of the knowledge base for the role and effectiveness of private care to increase access to affordable high-quality maternal care. Global progress towards achievement of MDG 5 could depend on this effort.”  PA is the executive director of Merck for Mothers, and owns Merck stock or stock options.

 

41. The Tennessean – Gates Foundation, Former Sen. Frist To Cooperate On Maternal, Child Health Initiative

The Tennessean;

The Gates Foundation is teaming with a non-profit founded by former US Senator Bill Frist to promote women’s health in developing countries. Frist announced the partnership on Monday. The Gates Foundation will focus on a new initiative spearheaded by Frist’s Hope Through Healing Hands organization. That initiative, dubbed the Faith-Based Coalition for Healthy Mothers and Children Worldwide, will aim to encourage faith leaders to discuss health issues facing mothers, newborns and children.

 

42. Johns Hopkins – Eliminating Maternal Mortality In Developing Countries Could Extend Women’s Life Expectancy In Reproductive Ages

http://www.jhsph.edu/news/news-releases/2014/eliminating-maternal-mortality-in-developing-countries-could-extend-womens-life-expectancy-in-reproductive-ages-on-average-by-more-than-a-half-year.html

Maternal death rates represent the single largest health discrepancy between developed and developing populations, with nearly all – over 99% — maternal deaths worldwide occurring in developing countries and over half of them in sub-Saharan Africa countries. Eliminating maternal mortality would result in a gain of over a half year (0.6 years) in life expectancy worldwide, according to a new study in Plos One by researchers at Johns Hopkins Bloomberg School of Public Health.

 

 

Access to Medicine

 

43. BMJ (Feature) – From promises to policies: is big pharma delivering on transparency?

Peter Doshi;

http://www.bmj.com/content/348/bmj.g1615

As increasing numbers of pharmaceutical companies establish policies for granting third party access to their clinical trial data, the onus shifts to those ready to begin sifting through the data.

44. WHO Bulletin – International investment agreements and public health: neutralizing a threat through treaty drafting

Bryan Mercurio; http://www.who.int/bulletin/online_first/BLT.13.130955.pdf

This article does not argue against International Investment Agreements (IIAs). Instead, it seeks to demonstrate how more sophisticated treaty drafting can neutralize the threat to public health. In this regard, the article seeks to engage members of the public health community as campaigners not against IIAs but as advocates of better

treaty drafting to ensure that IIAs do not infringe upon the right of a nation to take

non-discriminatory measures for the promotion and protection of the health of

their populations. (Interesting read)

 

45. Nature – WHO plans for neglected diseases are wrong

Mary Moran;

http://www.nature.com/news/who-plans-for-neglected-diseases-are-wrong-1.14739

We covered this viewpoint already in last week’s IHP newsletter, but it’s also worth to check out the comments on the viewpoint, that are not exactly approving of the key messages of Ms Moran.

 

Human Resources for Health

 

46. IHP – Posting and Transfer in the Health Sector – The Bellagio Experience

Seye Abimbola & Aku Kwamie ;

http://archief.internationalhealthpolicies.org/archives/posting-transfer-health-sector-bellagio-experience/

In marvelous prose, Emerging Voices Seye and Aku report on their participation in a recent Bellagio workshop on posting & transfer in the health sector. As Kabir Sheikh mentioned in a tweet, we never thought one could write so lyrically about posting and transfer… or maybe they just didn’t want to be ‘transferred’ from Bellagio anymore? Probably good to have a few slots for ‘Emerging Poets’ in the next EV venture.

47. WHO Afro – Road Map for Scaling Up the Human Resources for Health for Improved Health Service Delivery in the African Region 2012–2025

http://www.afro.who.int/en/clusters-a-programmes/hss/human-resources-for-health/3999-scaling-up-hrh2012-2025

This Road map builds upon a number of national, subregional, regional and global HRH efforts. It has six strategic areas for achieving the objectives.

 

48. Humanosphere – West should compensate poor nations for trained health workers, say advocates |

Tom Murphy;

http://www.humanosphere.org/2014/02/west-compensate-poor-nations-trained-health-workers-say-advocates/

Humanosphere examines a new Health Poverty Action report on health workforce and capacity that says the West should compensate poor nations for the trained health workers it uses.

 

49. Lancet (World Report) – Southeast Asian countries to allow free flow of doctors

Chris McCall;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60391-3/fulltext

A new common market (ASEAN) agreement between several southeast Asian nations could transform health care in the region. But will it be for the better? Chris McCall reports.

 

Health Policy & Financing

 

 

50. Times of India – WHO criticised for not following policy on recognising NGOs

http://timesofindia.indiatimes.com/india/WHO-criticised-for-not-following-policy-on-recognising-NGOs/articleshow/29673286.cms?referral=PM

Civil society groups have expressed disappointment with the number of “industry groupings” that have “incorrectly gained NGO status” with the WHO.

According to the International Baby Food Action Network (IBFAN), a new entrant into this WHO list of NGOs, industry groups which have been recognized as NGOs by WHO include Croplife International (representing Monsanto, Syngenta, Bayer, CropScience, Dow Agrosciences, DuPont and other companies promoting GMO technologies ) the International Federation of Pharmaceutical Manufactures and Associations, International Life Sciences Institute (representing Nestle, Coca Cola, Kellogg, Pepsi, Monsanto, Ajinomoto, Danone, General Mills and others) and the Industry Council for Development (representing Nestle, Mars, Unilever and Ajinomoto). “All are guided by market profit-making logic (whose primary interest clashes with that of WHO). Their inclusion goes against WHO’s current NGO policy,” said a statement issued by IBFAN.”

 

(If these are NGOs, then I am a scientist.)

51. CGD – More Data Needed on USAID Global Health Supply Chain

Amanda Glassman et al.;

http://international.cgdev.org/blog/more-data-needed-usaid-global-health-supply-chain

Glassman applauds the USAID’s Global Health Supply Chain RFP data, but thinks there is still a lot room for improvement. For the Americans among you.

 

52. Journal of Epidemiology & Health (Editorial) – It is surely a great criticism of our profession…’ The next 20 years of equity-focused systematic reviews

M. Petticrew et al.;

http://jech.bmj.com/content/68/4/291.full

The Cochrane Collaboration has been celebrating 20 years of its existence throughout 2013. For 20 years it has aimed to support policymakers, practitioners and patients in making better-informed decisions about healthcare and public health. This Editorial looks ahead, and also tackles some of the common criticisms.

 

53. Health Financing in Africa – Africa Health Forum: investir, avec le secteur privé, dans la santé en Afrique

http://www.healthfinancingafrica.org/3/post/2014/02/africa-health-forum-investir-avec-le-secteur-priv-dans-la-sant-en-afrique.html

Interview with Agnes Soucat (in French), from the African Development Bank, about the Africa Health Forum, scheduled for 16-17 May in Geneva. This networking event is organized by the African Development Bank, together with ‘Jeune Afrique’.

 

 

54. Lancet (Correspondence) – Debates in medicine: global representation in medical discourse

Nicholas H. Neufeld,

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60396-2/fulltext

Lancet letter on the underrepresentation of researchers from the Global South, in Correspondence to the Lancet, NEJM, JAMA, based on research in 2013.

 

Global Health announcements

 

  • The African health economics and Policy association (AFHEA) holds its third international conference, from 11-13 March, in Nairobi. For the updated program, see here.

 

 

 

  • WHO and FAO announced the Second International Conference on Nutrition (ICN2) (see here). You can comment on the provisional political draft document.

 

  • The Lancet Commission for Global Surgery issued a call for comments.  The Commission on Global Surgery invites you to post a comment regarding topics pertaining to global surgery that you believe should be priorities for the Commission to address. By April 15.

 

 

  • First WHO Advanced Course on Health Financing for Universal Coverage for LMICs, 16-20 June 2014, in Nairobi, Kenya (see here).

 

Podcasts

 

If you only have one hour or so this weekend, we encourage you to watch the recent lecture by David Woodward (see the intro),  “Between the Rack and a Hot Place: Can we Reconcile Poverty Eradication and Tackling Climate Change?” (Sussex Development lecture) (on Youtube).

 

 

“By any reasonable definition, the majority of humanity is on the rack of poverty; and a major obstacle to its eradication is the growing threat of extreme and irreversible climate change.  The coexistence of a chronic crisis of serious under-consumption for most with an increasingly critical environmental crisis resulting from over-consumption in aggregate can only be explained by extreme inequality in the global distribution of income.  Resolving both simultaneously, as envisaged in the Post-2015 Agenda, requires a fundamental reconsideration of the nature and objectives of economic policy, and of the global economic system. The lecture discusses the extent and implications of global inequality, before building on a number of working hypotheses to outline an alternative model of economic development more conducive to the achievement of these two most fundamental global goals.”

 

 

Research

 

55. Plos – Data Access for the Open Access Literature: PLOS’s Data Policy

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001607;jsessionid=C198692C1E9DC86A2B5F27EFC51C2D65

The new PLOS Data Policy will require all submitting authors to include a data availability statement as of March 1, 2014. Read more about what this means and see the policy itself in this cross-PLOS Editorial from Theo Bloom and colleagues.

56. HP&P – Communicable disease control programmes and health systems: an analytical approach to sustainability

A Shigayeva & R Coker;

http://heapol.oxfordjournals.org/content/early/2014/02/21/heapol.czu005.short?rss=1

There is renewed concern over the sustainability of disease control programmes, and re-emergence of policy recommendations to integrate programmes with general health systems. However, the conceptualization of this issue has remarkably received little critical attention. Additionally, the study of programmatic sustainability presents methodological challenges. In this article, the authors propose a conceptual framework to support analyses of sustainability of communicable disease programmes. Through this work, they also aim to clarify a link between notions of integration and sustainability.

57. TMIH (Editorial) – The elusive effect of water and sanitation on the global burden of disease

Wolf-Peter Schmidt;

http://onlinelibrary.wiley.com/doi/10.1111/tmi.12286/full

Accepting the often fatal methodological flaws in quantifying health effects of water and sanitation may be an intellectual challenge, but perhaps a necessary step. We may at some point be forced to get out for a bit and walk through an urban slum during the wet season. The lack of high-quality trials on urban sanitation or rural water access should not stop us from opening our eyes – the oldest form of impact assessment. This may sound fantastical, but perhaps, only to the ears of a 21st century academic.”

 

58. SS&M – Supporting knowledge translation through collaborative translational research initiatives: ‘Bridging’ versus ‘blurring’ boundary-spanning approaches in the UK CLAHRC initiative

Sarah Evans et al.;

http://www.sciencedirect.com/science/article/pii/S0277953614000525

For the ones among you into knowledge translation. On the difference between bridging and blurring KT.

 

59. Alliance for Health Policy & Systems Research  Annual report 2013

http://www.who.int/alliance-hpsr/alliancehpsr_annualreport2013.pdf?ua=1

You might also want to check the Alliance’s annual report, focusing on capacity strengthening.

 

Miscellaneous

 

  • Great Chatham House paper ‘Stuck in transition: managing the political economy of low-carbon development’. (in HICs, MICs and LICs)

 

  • A thorough update from the political bickering around the SDGs – see  the Broker. It appears the ‘friendly phase’ of the post-2015 process is over. Now for the Putin-stage.

One Response to IHP news 260: Emerging Voices deadline – 3 March

  1. Jamie Uhrig says:

    41. The Tennessean – Gates Foundation, Former Sen. Frist To Cooperate On Maternal, Child Health Initiative

    I wonder if new Gates Foundation partner Frist is still praising Museveni who just signed the antigay legislation? https://tinyurl.com/lcpr2wl. He would then join UNAIDS Director Sidibe who just three months ago publicly praised the Musevenis for “their bold leadership”. https://tinyurl.com/kr4h6mc.

    ++++++++++++++++++

    Jamie Uhrig

    http://www.linkedin.com/in/jamieuhrig

    102 West 80th Street
    Apt 61
    New York NY
    10024

    +1 646 525 9945

    ++++++++++++++++++

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