Dear Colleagues,

This week, a global health lab discussion was held in London on the promising topic ‘what have economists ever done for global health?’.  The backdrop was, of course, Richard Horton’s diatribe on Twitter from a while ago (see this story in the Atlantic if you want to read it all over again). We didn’t attend the meeting, but have two things to add: (1)  at the very least, economists write great papers (and letters, and blog posts, etc).  (2) nevertheless, maybe it’s time for an equivalent of a Hippocratic Oath for (health) economists, as in ‘do no harm to health systems’, so that we don’t have to ask the same question in 30 years from now. See this IHP blog post for my own “late night” adaptation of the ancient Hippocratic Oath. Obviously it will require the brilliant mind of an economist to work out something more rigorous.   

Speaking of economists, in this week’s guest editorial, Charles Birungi (EV 2013) reflects on the AfHEA conference in Nairobi. He wonders why the “politics” of UHC were relatively absent. The next AfHEA conference will take place in Johannesburg, in 2016.

Enjoy your reading.

 

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

 

Editorial

 

Is universal health coverage in Africa post-2015 a myth or can it become reality?

Charles Birungi, EV2013

More than 250 experts  gathered in Nairobi between 11th and 13th March 2014. The occasion was the 3rd scientific conference of the Africa Health Economics and Policy Association (AfHEA), an association that promotes and strengthens health economics and policy thinking and analysis that contributes towards “better and equitable health for Africans”. This conference brought together economists, policy makers and analysts living or working in health economics and related fields in Africa to share information and exchange as well as foster healthy debate on opportunities and challenges for universal health coverage (UHC) post-2015 in Africa.

The choice of the venue could not have been better. The Kenyan health sector is at a crossroad, going through a historical change – moving towards devolved governance, in line with the 2010 Constitution. As a result, the topic of UHC has become central to the health and development policy discussions. The theme of this conference – “The Post-2015 African Health Agenda and UHC: Opportunities and Challenges” – is of particular interest to the citizenry, policy makers, academics and politicians, among others. Without unnecessarily claiming to be an extensive report of this conference, this blog reflects my personal impressions (and certainly the caveat that “the eye sees what it knows” holds!).

In the context of Africa, what does UHC mean? Cognisant that UHC is a means to an end and not an end in itself, it was variously argued that – in the context of Africa – adopting it as the sole post-2015 health goal would be simplistic. This is a view that has been emphasised by the report “Health in the post-2015 development agenda”. Also, various African analysts have argued so. Strikingly, from most of the conference presentations and the ensuing discussions, the participants felt UHC offers a strategic opportunity to improve health systems under each country’s own stewardship. Whereas most discussions largely dwelt on the importance of UHC and the technical and practical considerations needed to bring UHC closer to reality, I am of the view that there was little acknowledgement (and certainly guidance)  around the inextricable complexities of UHC’s political economy. Based on my experience as a policy analyst in Africa, I’m convinced that the politics and economics of UHC are very interconnected. Regrettably this reality received little recognition at the conference, which I believe is due to an inadvertent neglect of the “politics of UHC” by policy honchos in the analytical tools currently available. Or is politics too sensitive on the African continent to be incorporated into economic analysis?

Effectively utilising the various avenues for networking that the conference offered, I informally interacted with fellow Emerging Voices for Global Health and members of the Financial Access to Health Services Community of Practice, among others.  We engaged in passionate and powerful economic arguments making a plea for smart investments in global health. Drawing from these discussions, it is increasingly becoming clear that there is a big inclination to position market mechanisms and yardstick competition centre stage – as key policy levers for moving African countries towards UHC. These arguments, in my view, come at the expense of other values, those underpinning UHC (such as equity, which is sometimes presented as opposed to the efficiency objective). In my view, the work by Stéphane Verguet and colleagues at Disease Control Priorities (DCP3) that “extends” traditional cost-effectiveness health evaluations (through the so called Extended Cost Effectiveness Analysis (ECEA)) is groundbreaking by concurrently incorporating equity and financial protection considerations in economic evaluations. For UHC, this powerful tool offers an opportunity to understand the context in which an intervention is implemented and its effect on distinct groups of people.

In the pre-final plenary session, a couple of critical questions popped up, finally. Yes, we all agree that UHC is needed. But we also know – notably from a recent AfHEA/WHO-AFRO/Rockefeller Foundation study cited at the conference – that our financial and governance capacities are weak, that our human resources are of low quality and so are our health information systems, that we lack leadership, that we are bad at targeting and that good research in Africa is hard to find. So, how do we proceed? No conclusive answer was provided. Second, we were presented pros and cons of the omnipresent performance-based financing (PBF), but do we agree on any conclusion? One panel member gave it a try: we should consider PBF as one means among many others, not as a panacea.

As a way of conclusion, yes, UHC is a possibility in our lifetime. A number of African countries are on the move, in the right direction, towards UHC. Dr. Agnes Soucat of the African Development Bank (and one of the Lancet CIH Commissioners) noted, while presenting on the Global Health Convergence Agenda at the pre-conference, that “Universal health coverage is increasingly a major political issue in Africa”. The pressing issues facing African countries’ pathways to UHC require we utilise state of the art analytical tools that are alive to the realities of both the economics and politics of UHC. This way, the transition to UHC can be assured.

 


 

Post-2015 & UHC

 

1.    Lancet Correspondence – Investing in Health

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60473-6/fulltext

In this week’s Lancet issue, many people reacted to The Lancet Commission ‘Global health 2035: a world converging within a generation’. David Chiriboga et al. expressed their deep concern with ‘The Lancet Commission Global health 2035: a world converging within a generation’, “a re-run of the 1993 World Development Report, whose policies contributed to the shrinkage of government institutions and massive privatisation and fragmentation of health-care systems, effectively decreasing coverage and accessibility.”

 

Rob Yates et al are happy about what they call  “the new consensus on health financing: universal coverage can only be accomplished through public financing systems in which the state plays a leading part in raising revenues, pooling funds, and purchasing services.”   (it’s about time for a Michael Moore documentary on Rob Yates’ vital advocacy work, to be used in election campaigns all over the world)

 

Robert Fryatt  says, “With the new emphasis on the need for a “data revolution” in the post-2015 agenda, commissioners should not miss this opportunity to promote investment in health information to help a more efficient delivery of the “grand convergence” in health by 2035.”

 

2.    Lancet Correspondence (author’s reply) – Investing in Health

Gavin Yamey, Dean Jamison & Lawrence Summers;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60476-1/fulltext

The authors of the report react on the various Letters, in a crystal-clear way (as can be expected from top notch economists (see above)). Also: “We make no apologies for promoting policies that protect the poor.” Nevertheless, the last word on the Lancet Commission hasn’t been said.

 

Tom Paulson, for example (on Humanosphere), regrets the report is seldom mentioned (apart from in the Lancet, that is), after the first media commotion when the report came out, even by some within the global health and development community. He wonders why, and says the report perhaps awaits its “eureka” moment (as happened with the 1993 World Development report, when Bill Gates read it). Paulson reckons this new report makes an even stronger case for emphasizing health as a primary means of fighting poverty and inequity. So who will be this report’s Bill Gates? Or will Bill Gates again play the role of Bill Gates?

 

3.    Lancet (Correspondence) – What does UHC mean?

Raoul Bermejo, Jin Xu, Daniel Henao, Beverly Lorraine Ho, Isidore Sieleunou;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60477-3/fulltext

A number of Emerging Voices (from the Philippines, China, Brazil and Cameroon) say that in spite of some confusion on the concept of UHC (and many different interpretations in regions and countries around the world) countries are anyhow implementing UHC-related reforms, on their own terms. “UHC is powerful as an idea because it can resonate with many. A global dogma on UHC would be perilous, though.”

 

4.    Medical anthropology Quarterly – Playing the Numbers Game”: Evidence-Based Advocacy and the Technocratic Narrowing of the Safe Motherhood Initiative

Katherini T. Storeng et al.;

http://onlinelibrary.wiley.com/doi/10.1111/maq.12072/full

Brilliant paper. The authors of this paper provide a critical take on the rise of ‘evidence-based advocacy’ (EBA) in the competition for global health attention and resources, based on an ethnographic case study of the international maternal health field.  (if you only read one article this week, let it be this one – there are lessons in it, far beyond the maternal health community)

 

5.    CGD – Political Economy of UHC: Colombia Version

Amanda Glassman;

http://www.cgdev.org/blog/political-economy-uhc-colombia-version

Glassman draws attention to the importance of the political economy of UHC, based on her experience in Colombia. (see also Charles’ guest editorial, above, on the situation in SSA, and the relevance of politics and what is at stake for all actors, when UHC reforms are considered). Read also the interesting comments under this post, by Grant Rhodes, Pierre De Paepe and others.

 

Yet another example of the ‘political economy’ of UHC  is how the Congress Party in India now is more than likely to put  UHC in its manifesto for the elections. Whether that will the Party help win the elections, is another question, though. Timing is everything for a politician.

 

6.    Eastern Mediterranean Journal – Health in the post-2015 agenda: three considerations in moving forward

Sania Nishtar;

http://www.emro.who.int/emhj-vol-20-2014/volume-20-issue-2/health-in-the-post-2015-agenda-three-considerations-in-moving-forward.html

Despite the shortcomings, there are important lessons to be learnt from the experience with the MDGs, which should be factored into planning as the post-2015 health goals get cast. Nishtar lists three points (must-read).

7.    Paying for zero – Global Development Finance and the Post-2015 Agenda

Hiroto Arakawa, Sasja Beslik, Martin Dahinden, Michael Elliott, Helene Gayle, Thierry Geiger, Torgny Holmgren, Charles Kenny, Betty Maina, Simon Maxwell, John W McArthur, Mthuli Ncube, Ory Okolloh, Zainab Salbi, Mark Suzman, Virgilio Viana, and Jasmine Whitbread;

http://www3.weforum.org/docs/GAC/2014/WEF_GAC_PovertySustainableDevelopment_GlobalDevelopmentFinance_Paper_2014.pdf

(When you go through the list of names of authors of this paper, you know you have to read it.)

This paper was prepared as a group product by the listed co-authors who are convened by the 2013-2014 Global Agenda Council on Post-2015 Sustainable Development, organized by the World Economic Forum.  “Amidst a shifting terrain of post-2015 global development finance, this paper aims to distill core needs, challenges, and opportunities as a respectful contribution to the ongoing debates and deliberations. It does not aim to be comprehensive. Instead it aims to highlight some key parameters and opportunities that stakeholders might wish to consider.

Building on the work of the recent UN High-Level Panel of Eminent Persons on the post-2015 Development Agenda (2013), and also the ‘Getting to Zero: Finishing the Job the MDGs started’ paper prepared in 2012 by some of the co-authors of this paper, here we adopt the title ‘Paying 4 for Zero.’ The word ‘zero’ aims to signal a broad theme of transformation for sustainable development: eliminating extreme poverty, eliminating the pernicious forms of inequality and social exclusion, and eliminating unsustainable economic activities that place too high a burden on environmental assets. Zero is intended as a constructively provocative concept, if not absolute in technical terms.”

 

8.    Global Policy – The Donors’ Dilemma’ – A Manifesto for International Public Finance in the 21st Century

Jonathan Glennie;

http://www.globalpolicyjournal.com/blog/13/03/2014/donors%E2%80%99-dilemma-manifesto-international-public-finance-21st-century#.UyE-I1MBzt0.twitter

Another must-read on international public financing post-2015. Glennie argues for a five-fold paradigm shift, in the evolution from ‘aid’ to ‘international public financing’.

 

Global Fund, GAVI, PEPFAR …

 

Last week, the Global Fund had its 31st Board meeting in Jakarta, Indonesia.

 

You can read all about it in Issue 39 of the “Global Fund News Flash.” The issue features an article on the fund’s allocation amounts to countries for the period 2014-2016 and also features a video (of about five minutes) giving an overview of the new funding model.

 

9.    GFO newsletter – issue 239

http://www.aidspan.org/gfo_article/decision-points-approved-global-fund-board-during-31st-board-meeting

This newsletter provides all info on the Board meeting, including a point by point description of the decision points.  (must-read)

 

Ahead of the Board meeting, Tobias Luppe argued  in this AFGH blog post that NGOs had to keep up the pressure on the Fund, and distinguished between a conservative approach and a more ambitious approach.

 

10. GAVI – 1.5 million girls set to benefit from vaccine against cervical cancer

http://www.gavialliance.org/library/news/press-releases/2014/1-5-million-girls-set-to-benefit-from-vaccine-against-cervical-cancer/

The GAVI Alliance announced that it will support vaccination against human papillomavirus (HPV) for 1.5 million girls in Rwanda, Uganda, and Uzbekistan.

11. CGD – GAVI Moves on Better Data Verification

Victoria Fan & Kate McQueston;

http://www.cgdev.org/blog/gavi-moves-better-data-verification

Fan & Mc Queston are encouraged by the GAVI Alliance’s new application guidelines, which outline strengthened requirements for data verification of the immunization outcomes used for performance payments as part of its Health System Strengthening support.

12. Science Speaks – Birx appears in front of Senate Foreign Relations before confirmation vote

http://sciencespeaksblog.org/2014/03/07/birx-appears-in-front-of-senate-foreign-relations-before-confirmation-vote/

Deborah Birx appeared in front of the US Senate Foreign Relations Committee last week. Science Speaks reports on the meeting. Birx laid out four key areas she’ll focus on as the new global AIDS coordinator.

 

 

Infectious Disease

 

13. Huffington Post – Postcard From Vienna: Europe’s Stance on International Drug Policy

Michel Kazatchkine;

http://www.huffingtonpost.com/michel-d-kazatchkine/postcard-from-international-drug-policy_b_4936391.html

Europe needs to play a leadership role in the debate on international drug policy, as it has pioneered policies in the past and has now extensive experience and evidence showing that de jure or de facto decriminalization does not result in increased drug consumption and violence, but instead, ends the poisonous and dysfunctional conflict between public health and law enforcement, and increases users’ access to prevention and treatment services. Kazatchkine: “Europe is extremely well placed to provide some of the best evidence to support the switch from prohibition and law enforcement to a comprehensive set of human rights, social and public health-based policies that ensure access to prevention and treatment and involve “smarter” law enforcement that safeguards human rights and ensures citizen security.”

 

14. Lancet (World Report) – Polio eradication effort sees progress, but problems remain

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60452-9/fulltext

WHO looks set to declare its southeast Asia region polio-free at the end of this month. But progress is faltering in other regions with the remaining polio-endemic countries. John Maurice reports.

 

In one interesting development, though, in Pakistan, parents in Khyber Pakhtunkhwa province ( one of Pakistan‘s most troubled provinces) are to be paid to vaccinate their children against polio  (see  The Guardian ).

 

15. Science Speaks – Homophobic laws around the world block capacity to know, respond to HIV epidemics

http://sciencespeaksblog.org/2014/03/12/homophobic-laws-around-the-world-block-capacity-to-know-respond-to-hiv-epidemics/

On the continuing toll of homophobia, in places like Myanmar but now also Kenya (where the debate around homosexuality is also heating up now, sadly).

16. Reuters – Ugandans petition court over controversial anti-homosexuality law

http://news.yahoo.com/ugandans-petition-court-over-controversial-anti-homosexuality-law-124620441–sector.html

Ugandans opposed to a new anti-homosexuality law that punishes gay sex with long jail sentences have filed a constitutional petition alleging that the law violates fundamental rights.

 

UNAIDS, through Luiz Loures, deputy director of UNAIDS and assistant secretary general of the UN, said on Wednesday that UNAIDS is ready to join the lawsuit filed in a Ugandan court on Tuesday challenging the country’s Anti-Homosexuality Act.

 

Meanwhile, UNAIDS’  Protect the Goal campaign “kicked off” in South-Africa. Protect the Goal, which was first launched at the 2010 FIFA World Cup in South Africa, is a campaign to raise awareness around HIV prevention and encourage young people to get actively involved in both the national and global response to HIV. The official world tour kick-off event was held at the Soccer City Stadium, the largest stadium in Africa, during the South Africa-Brazil international friendly game. (Protecting the Goal didn’t work very well for the South-African team on this occasion, they lost 0-5 (with a hattrick from Neymar)).

 

17. FT – Vaccine breakthrough could help save millions

Peter Vanham;

http://blogs.ft.com/beyond-brics/2014/03/12/vaccine-breakthrough-could-help-millions/#axzz2vmk7AQlY

Earlier this week, The journal Vaccine published a study on delivering Meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in Benin. Vanham discusses the wider implications.

 

NCDs

 

18. Lancet – Chronic kidney disease and the ageing population

Marcello Tonelli et al.;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60155-0/fulltext?_eventId=login

March 13, 2014, the ninth World Kidney Day, focused on chronic kidney disease in elderly people. What are the key links between kidney function, age, health, and illness, and the implications of population ageing for the care of people with chronic kidney disease?

 

19. Lancet (Editorial) – Global elderly care in crisis

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60463-3/fulltext

The world’s population is ageing rapidly at an unprecedented rate. Population ageing has profound implications for the burden of disease and social and health-care systems. How well prepared are countries to cope with these changing demographics? Unfortunately, current elderly care systems worldwide are already unable to address the soaring demand from fast growing numbers of older people, even in higher-income countries.  (this is a sad reality, as many people with elderly parents can testify). Being aged might be even more problematic for people in LMICs. It’s time to do something about it.

20. Nature – Storm brewing over WHO sugar proposal

Brian Owens ;

http://www.nature.com/news/storm-brewing-over-who-sugar-proposal-1.14854

Scientists are gearing up for a battle with the food industry after WHO moved to halve its recommendation on sugar intake (see last week’s newsletter). Nutrition researchers fear a backlash similar to that seen in 2003, when the WHO released its current guidelines stating that no more than 10% of an adult’s daily calories should come from ‘free’ sugars.  (let’s see whether Michelle Obama is any different from George Bush)

21. Lancet (Editorial) – Hitting the target: a new framework for mental health trials

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60465-7/fulltext

The US National Institute for Mental Health (NIMH) has revised its policy for funding clinical trials. No longer will it be sufficient to establish whether or not an intervention is effective. All trials, pharmacological and psychosocial, now need to identify a target or mediator, and to show how it is affected by the intervention. … … NIMH is introducing stricter requirements for patient recruitment, trial registration, publication, and data sharing. People with mental health problems need and deserve innovative, effective treatments. The NIMH approach should facilitate the development of new therapies and greater knowledge of the biological, psychological, and social underpinnings of mental illness.”

 

Maternal health

 

22. Guardian – Women’s rights the focus as world leaders gather for New York talks

http://www.theguardian.com/global-development/2014/mar/10/womens-rights-world-leaders-new-york-gender-equality-csw

World leaders are meeting in New York for the annual Commission on the Status of Women (CSW), a two-week review of progress on women’s rights against the MDGs. They will also discuss how women’s empowerment can be accelerated under a new set of targets after 2015.  The conference focuses on development this year.

 

For some of the latest news on the CSW, see this Guardian article. The US, Russia and Caribbean states are trying to water down wording that calls for increased funding for women’s organisations in the draft document (hear, hear, there’s still something Obama and Putin agree on).

 

We also want to draw your attention the UN launch of the campaign ‘He for She’. The strategy behind the campaign, which began last Friday (linked to International Women’s Day)  is that men ought to stand up for the rights of the women of the world who are their mothers, sisters and daughters.

 

23. Speaking of Medicine – Forced to Flee: Humanitarian Disasters Leave Women at Higher Risk

Tane Luna Ramirez;

http://blogs.plos.org/speakingofmedicine/2014/03/07/forced-flee-humanitarian-disasters-leave-women-higher-risk/

Tane Luna Ramirez from MSF reflects on the challenges of providing care for pregnant women as well as the heightened risk of sexual violence in disaster settings.

 

24. Lancet – Offline: The laws of stupidity

Richard Horton;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60451-7/fulltext?_eventId=login

“In a meeting last week on the future of women’s and children’s health, one respected public health scientist warned about the population doubling time in Africa.  She estimated it to be around 20 years. … She argued that many of the gains in children’s health won over the past decade would be lost if this scenario of dramatic population expansion came to pass. Her view is widely held in the health community. And our solution—rapid scale-up of family planning services—has received endorsement and support from experts and donors alike. Family Planning 2020 is a movement to provide contraceptive services to an additional 120 million women worldwide. This momentum around family planning is welcome, especially if the definition of family planning covers a full range of reproductive health services. But is access to contraception really the answer to Africa’s—the world’s—demographic challenge? This simplistic technical approach illustrates so much of what is wrong with global health today.”  Horton explains what is wrong, drawing on some of the wisdom in Carlo Cipolla’s book The Economic History of World Population (1962). Cipolla was an Italian economist, apparently a lot smarter than Italian (former) cyclist Mario Cipollini.

 

Access to Medicines

 

25. Lancet (Early online) – Improving access to vaccines through tiered pricing

Seth Berkley;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62424-1/fulltext?_eventId=login

Sometimes, the title and the author provide enough information (to know that you have to read the viewpoint). This is obviously a case in point.

 

Meanwhile, Margaret Chan said earlier this week, during a keynote lecture on research for UHC during the Global Vaccine and Immunization Research Forum in Bethesda,   “some 22 million children are still being missed by vaccine campaigns and another one million lives could be saved annually if the children are reached.”

 

26. Lancet (Viewpoint) – Team science and the creation of a novel rotavirus vaccine in India: a new framework for vaccine development

Maharaj K  Bhan et al. ;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60191-4/fulltext?_eventId=login

Bhan et al comment on a new study in The Lancet (by Nita Bhandari and colleagues), showing the safety and efficacy of the 116E rotavirus vaccine against severe rotavirus gastroenteritis in Indian infants.  “The vaccine was not the product of a major multinational manufacturer, but rather, the result of work by team science, based in India.”  Development of this vaccine is a striking demonstration of the power of collaboration and team science and provides an alternative model for provision of low-cost vaccines by sharing the financial risks of development, they say.

 

For another Comment on the study, see Shabhir A Mahdi et al (also in the

The Lancet), focusing on this new sort of Alliance, as an alternative for GAVI innovations, in some instances. “…However, the sustainability of the GAVI process, in which countries are expected to take over ownership of funding for vaccine procurement once their gross national income per person exceeds GAVI’s eligibility threshold, remains a concern. One way to address this challenge is to explore approaches to development of low-cost, safe, and effective vaccines that are affordable for low-income countries. Within this framework, the development of 116E rotavirus vaccine provides a model of a successful tripartite alliance between donors, governmental institutions, and a willing private sector, to ensure that vaccines are developed at affordable prices.  …    …  Should the vaccine be prequalified by WHO, it will provide an additional affordable product to meet the large demand of the global market. The public—private sector partnership to develop and test the vaccine (somewhat similar to the approach used to develop a new meningitis vaccine, MenAfriVac, that is already realising a huge public health effect in Africa) provides an alternative model of risk and cost sharing to develop life-saving vaccines that are effective, safe, and affordable for use in low-income countries.”

 

27. Globalization & Health – Local production of pharmaceuticals in Africa and access to essential medicines: ‘urban bias’ in access to imported medicines in Tanzania and its policy implications

Phares GM Mujinja et al.;

http://www.globalizationandhealth.com/content/10/1/12/abstract

International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap.  The findings suggest that enhanced local production may improve rural access to medicines.

28. Live Mint – Cipla may put patent for new HIV drug in open access pool

http://www.livemint.com/Companies/32QhLDPXCEM6er6eAQkQfL/Cipla-may-put-patent-for-new-HIV-drug-in-open-access-pool.html

Cipla Ltd, which competed with multinational drug firms by cutting HIV treatment cost to a fraction of the prevailing rate, is hoping to make a similar impact with a new four-drug combination to treat HIV/AIDS in infants and children. The drug is in the advanced stage of development. The Indian firm led by Y.K. Hamied, which will own the intellectual property rights of the first-line antiretroviral (ARV) combination therapy, plans to put the technology in a free access patent pool, two company executives said, requesting anonimity.”

 

Health Policy & Financing

 

29. World Bank – Reprioritizing government spending on health : pushing an elephant up the stairs?

Tandon Ajay et al.;

http://documents.worldbank.org/curated/en/2014/01/19204376/reprioritizing-government-spending-health-pushing-elephant-up-stairs

This paper provides a global overview of health’s share of government spending and summarizes key theoretical and empirical perspectives on allocation of public resources to health vis-a-vis other sectors from the perspective of reprioritization, one of the modalities for realizing fiscal space for health. (must-read)  (we were particularly struck by the finding that ‘more women in public office are correlated with higher shares of public spending on health’).

 

30. Science Speaks – Homophobia’s costs to health, economies are subject of World Bank event

http://sciencespeaksblog.org/2014/03/13/homophobias-costs-to-health-economies-are-subject-of-world-bank-event/

Don’t ask me how they do it, but the World Bank can put a price on everything, and homophobia is not an exception. See this WB event earlier this week, on the economic cost of homophobia.

 

31. Humanosphere – Global health advocates deal with losing clout

Tom Paulson;

http://www.humanosphere.org/2014/03/global-health-advocates-deal-with-losing-clout/

For the first time in nearly 15 years, the US government is poised to reduce its investment in global health. (see Obama’s last budget request) This has disturbed many in the global health community who, for more than a decade, saw themselves as at the top of the aid and development hierarchy, Paulson says. He concludes: “But the Obama Administration proposal to reduce funding overall for global health while beefing up funding for other development assistance projects (like Power Africa, which some critics say is mostly subsidizing corporate investments in Africa as opposed to ‘empowering’ poor communities) means the global health community does have to make the case that improving health, fighting disease, is still one of the best ways to fight poverty.”

 

32. Global Health Council – Global Health Council’s Analysis of the President’s FY15 Budget Request

http://www.globalhealth.org/wp-content/uploads/GHC-Analysis-of-FY15-President-Request-Final.pdf

For the Global Health Council, “Overall the negatives outweigh the positives in the President’s FY15 budget Request”.  Read why.

 

33. KFF policy tracker – White House releases FY15 Budget Request

http://kff.org/policy-tracker/white-house-releases-fy15-budget-request/

With a detailed breakdown for global health programmes.

 

In other global health news from the US, Nils Daulaire will step down as Assistant Secretary Global Affairs at HHS – he will be replaced by Jimmy Kolker. (but this is just from the Twitter rumour mill)

 

34. Lancet (Correspondence) – On global health: stick to sovereignty

Wim De Ceukelaire (PHM) & Marc Johan Botenga ;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60478-5/fulltext

We are somewhat puzzled by this view. The authors react on Julio Frenk’s discussion of the concept of global health, whereby “he opposes sovereignty and solidarity arguing that a global society might be a substitute for state sovereignty”. De Ceukelaire et al, think, on the other hand, that defending sovereignty remains a safe bet. (Socialists of the 21st century are not like the ones from the 19th century, it appears. Or are they just as adaptive as capitalists?)

 

35. Plos – Building Research Capacity in Africa: Equity and Global Health Collaborations

Kathryn Chu et al.;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001612;jsessionid=5501DBFC3D810520A9C362561EA84F56

Kathryn Chu and colleagues discuss the impact of high-income country investigators conducting research in LMICs and explore lessons from the effective and equitable relationships that exist.

 

Yet, the opposite, that the North learns from the Global South, is also increasingly happening – for some recent examples of “reverse innovation” in Canada, see the National Post. Nevertheless, it’s not straightforward, there are often obstacles for implementation. “Experts say that “reverse innovation” – the use of healthcare practices and technologies from developing countries in developed ones – could transform healthcare in Canada, the U.S. and beyond. Low-cost medical procedures and techniques, created in response to a lack of resources and the needs of poor populations overseas, could help limit exploding healthcare costs, but medical administrators say Canada has systemic challenges to integrating such breakthroughs into the healthcare system.

 

36. CGD – The Health Financing Transition: Inevitable Change for the Better?

Bill Savedoff & Victoria Fan;

http://www.cgdev.org/blog/health-financing-transition-inevitable-change-better

Savedoff & Fan explain the health financing transition, as elaborated in their Social Science & Medicine article (and a CGD working paper). Great blog post.

37. Globalization & Health – Global health impacts of policies: lessons from the UK

Modi K Mwatsama et al.;

http://www.globalizationandhealth.com/content/10/1/13/abstract

This paper uses the initial stages of a study on global health impact assessments to pose the wider question of incentives for policy-makers to improve global health. It highlights three lessons for successful development and implementation of global health impact assessments in relation to stewardship, resources, and delivery mechanisms.

38. The Handbook of Global Health Policy

Garrett W Brown et al.;

http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0470674199.html#.Ux947Gx5olM.twitter

The Handbook of Global Health Policy provides a definitive source of the key areas in the field. It examines the ethical and practical dimensions of new and current policy models and their effect on the future development of global health and policy. You find a Table of Contents on this page, with all the contributors and chapters.

39. Harvard (book) – Global Health Law

Lawrence Gostin;

http://www.hup.harvard.edu/catalog.php?isbn=9780674728844

Human health lawyers among you (and others) might also want to read this book. In a book that systematically defines the burgeoning field of global health law, Lawrence Gostin drives home the need for effective global governance for health and offers a blueprint for reform, based on the principle that the opportunity to live a healthy life is a basic human right. Gostin shows how critical it is for institutions and international agreements to focus not only on illness but also on the essential conditions that enable people to stay healthy throughout their lifespan: nutrition, clean water, mosquito control, and tobacco reduction. Policies that shape agriculture, trade, and the environment have long-term impacts on health, and Gostin proposes major reforms of global health institutions and governments to ensure better coordination, more transparency, and accountability. He illustrates the power of global health law with case studies on AIDS, influenza, tobacco, and health worker migration.

 

 

Human Resources for Health

 

40. Future workforce matters (Comment) : A new era for human resources for health?

James Buchan & Jim Campbell;

http://www.horizonscanning.org.uk/publications/future-workforce-matters-issue-5/

In a guest piece for Future Workforce Matters, James Buchan and  Jim Campbell reflect on the health workforce policy and planning challenges being considered internationally and how recent events are spearheading new thinking. They discuss the follow-up of the HRH meeting in Brazil, including  the decision to put the Recife Declaration on the agenda at the World Health Assembly in May

2014,  as well as the establishment by Margaret Chan of an HRH advisory committee, at the Executive Board meeting in January. “The signs are that the health workforce issue is moving front and centre of the international health and development agenda.”

 

 

Research

 

41. HP&P – Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

Anne LaFond et al.;

http://heapol.oxfordjournals.org/content/early/2014/03/10/heapol.czu011.abstract

There is limited understanding of why routine immunization coverage improves in some settings in Africa and not in others. Using a grounded theory approach, the authors conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana).

42. Health Research Policy & Systems – National research for health systems in Latin America and the Caribbean: moving towards the right direction?

Francisco Becerra-Posada et al.;

http://www.health-policy-systems.com/content/12/1/13/abstract

National Research for Health Systems (NRfHS) in Latin America and the Caribbean (LAC) have shown growth and consolidation in the last few years. A structured, organized system will facilitate the development and implementation of strategies for research for health to grow and contribute towards people’s health and equity. The authors conducted a survey with the health managers from LAC countries that form part of the Ibero-American Ministerial Network for Health Education and Research.

 

43. Vaccine – Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012

Heidi J Larsson et al.;

http://www.sciencedirect.com/science/article/pii/S0264410X14001443

Vaccine “hesitancy” is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy.

 

Emerging Voices

 

44. Journal of Pakistan Medical Association – Stillbirth – a neglected priority: Understanding its social meaning in Pakistan

Saima Hamid et al.;

http://www.jpma.org.pk/full_article_text.php?article_id=6125

EV 2010 Asmat Malik was a co-author of this just published article in JPMA. Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a neglected priority in Pakistan. The authors review the evidence regarding social and biomedical understanding of stillbirths by both communities and healthcare providers.

 

45. Pan African Medical Journal – Relationship between multiple drug resistance and biofilm formation in Staphylococcus aureus isolated from medical and non-medical personnel in Yaounde, Cameroon

Agnes Bedie Eyoh et al;

http://www.panafrican-med-journal.com/content/article/17/186/full/

EV 2013 Henshaw Mandi was a co-author of this article. Monitoring the prevalence of nasal carriage of multiple drug resistance (MDR) Staphylococcus aureus (SA) strains in hospital personnel is essential. These strains when transmitted from hospital personnel to patients with already weakened immune states or in-built medical devices, may limit the latter’s treatment options. This study aimed at assessing the potential exposure of patients to these MDR SA in a resource-limited hospital setting by assessing the prevalence and relationship between antimicrobial susceptibility and biofilm forming capacity of SA isolates from hospital personnel.

 

Miscellaneous

 

  • Excellent blog post  by CGD’s Lant Pritchett, ‘An Homage to the Randomistas on the Occasion of the J-PAL 10th Anniversary: Development as a Faith-Based Activity’.

 

  • New ODI paper (by Gina Bergh et al): “What’s behind the demand for governance? An assessment of people’s views” (see  here).    This paper analyses emerging data from the United Nations’ “MY World survey” of people’s priorities for the future and how they have voted on governance-related issues. The authors compare this with a review of available evidence from global perception surveys and participatory research on people’s views and experiences relating to governance. Key findings include:  People across the world care deeply about governance, but some dimensions of governance emerge as more important to them than others. People’s top priority is for governments that are honest and effective and can deliver on their needs and expectations. Political freedoms are also important, but remain secondary to concerns about performance and the delivery of goods and services.

 

  • Thomas Piketty wrote a new book on inequality (for a Q&A with the author, see the NYT ).

 

 

  • OECD donors are considering pulling the plug on aid to richer developing countries  (see The Guardian ). See a DAC proposal paper for some more detail.

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