Dear Colleagues,

Crimea and the mysteriously missing plane have been dominating the news for much of the past two weeks. On the plane we don’t have much to say,  unlike the Australian prime minister, the Sherlock Holmes of our times. The Crimean story is, however, great stuff for political watchers and would-be watchers like me.

For a start, we agree with some European diplomats that the West has lost the propaganda war with Putin, at least for now. Even if we agree with the Economist’s assessment of the danger of the current situation for international law and the world order, never before Western double standards have been so openly exposed, and Putin has made use of this opportunity in a trademark ruthless way ( Or maybe he just wanted to celebrate the 100th anniversary of the start of WW I in his very own way).

Not that it was very difficult for the Russian president to do so – many Europeans also don’t take the lofty human rights discourse from EU leaders very seriously anymore after witnessing the trojka policies’ carnage in southern European countries – with the right to health as just one of the victims of the overriding quest for “monetary stability” in the Eurozone in recent years. As for the human rights record of the US in the past decade, when we had our very own Putin (also known as a global health hero), you know the recent history. To put it differently, by all means, Putin is a thug, but we’ve had our share of thugs too in the recent past.

In addition, it’s been said many times in the past few weeks, but it rings true nevertheless. When you know how eager European banks, technocrats and business lawyers were to welcome shady Russian money (whether downright mafia money and money related to crime, or just money from tax evasion), it’s hard not to grin when you see the likes of Barroso, Van Rompuy and Cameron lecturing Putin on referendums (after some of them bullied Greece into cancelling its own referendum), democracy, international law etc.  A geopolitical “best buy” would be for some of our leaders with very little political capital left, to shut up in cases like these.  On one particular aspect, Putin can even claim to be a greater democrat than some of them, as he seems, unlike our European “merchant leaders”, prepared to sacrifice some of the big business interests of Russian tycoons for the sake of Mother Russia, while we are still busy calculating what the trade-offs are of meaningful economic sanctions.  In Putin land, politics rules the market, and not the other way around. Well, at least for a few weeks.

One of the best examples of the neoliberal turn of the EU since the early nineties is the European football competition, the Champions League. Like many others, I enjoy watching the brilliance of Messi, Hazard and Ronaldo on Tuesday or Wednesday evenings, but as soon as you hear the European hymn, you also see, very prominently displayed on your screen, ‘Gazprom: official sponsor of the Champions League’. Nuff said.

There are some among us who think it doesn’t matter how much Messi, Kompany, Hazard en co earn, it’s a free world after all, but they don’t just earn outrageous ‘Big Bang’ salaries, the money also has to come from somewhere. In Hazard’s case, quite a bit comes from Abramovich, Chelsea’s president. I remember Eto’o even went to Russia, for some time, to play somewhere in a very murky place in Russia where he got an astronomical salary.  

I don’t blame football stars  for cashing while they can, but nevertheless, in the run-up to the Brazil World Cup, I think it would be great if some of the more outspoken and visionary football players started a campaign on ‘where does the money from my handsome ‘incentive package’ actually come from?’ More transparency is needed, also in the football world, in other words, as everything is connected with everything. FIFA should fully support this campaign (yes, more grinning is allowed), to complement equally important campaigns about  HIV/AIDS, racism etc.  I think this age of increasing inequality within most countries requires nothing less from Drogba, Ribéry, Van Persie and many others. Global tax justice and transparency also needs to apply to sports stars  (see also this likeminded piece in the New Internationalist ).

But let’s not forget there are many other hotspots too, in the world, apart from Crimea. In this week’s guest editorial, Abubakar Kurfi, an EV 2013 who works with the National Health Insurance Scheme in the North of Nigeria zooms in on the very dire health care situation in this area. He argues the international community should do more – apparently, the Gates Foundation is already considering that

 

Enjoy your reading.

 

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

 

Editorial

 

More than just polio:  why the international community should pay more attention to the general health care situation in northern Nigeria

In recent years, there has been a global surge in both the intensity and range of insurgencies and terrorism globally, with northern Nigeria being its most recent addition.  The US Department of State reported recently that of some 15 countries surveyed for terrorism, Nigeria ranked 5th.  The insurgency in Nigeria which first came to light in 2009 presents Nigeria with its gravest domestic security challenge ever. There are fears that the insurgency which has affected every facet of our national life could lead to the collapse and ultimate disintegration of the state. It has so far affected all sectors of the country, be it education, health, agriculture or the economy. Especially  the North of the country has been hit hard.

Zooming in on the health sector, a sad case readily comes to mind. Yagana Goni, a 29 year old mother of 4, gave birth to her fourth child at home as usual. She however suffered post-partum hemorrhage and needed to be urgently transferred from one of the villages affected by the insurgency to the University of Maiduguri Teaching Hospital, a distance of about 120 km, to stop the bleeding. Although a commercial driver volunteered to transport her to the town after much delay, she suffered so much loss of blood that both the baby and the mother were lost.

Such is the fate of an average patient in the northern part of Nigeria, a region that has some of the worst infrastructural, health and socioeconomic indicators in the world. It is a region with a maternal mortality rate of 1,500/100,000 live births while the national average is 545/100,000, an infant mortality of 150/1000 live births while the national average is 75 / 1000 live births and a person living in that region has a life expectancy of 47 years which is 78% lower than the average national value and comparable only to that of war torn countries.

Complicating this picture further is the low level of health facilities utilization as a result of massive shortages of skilled man power like doctors, nurses and midwives, and their mass exodus to other neighboring states and countries that are considered safer.  A health worker  in one of  the states summarized the health system in his state thus, “The  health system is comatose, there are few hospitals with few drugs, inadequate and substandard technology and a lack of infrastructural support, including electricity, water and diagnostic laboratories resulting in misdiagnosis. Medical record keeping is rudimentary and diseases surveillance is very poor. We, the health workers, are so scared that the majority of us have left the state. The delivery of health care is now a personal affair and dependent on ability to pay, gradually we are becoming a state where there is no public service anymore.” Musa Babakura, a surgeon at the University of Maiduguri Teaching Hospital (UMTH) which is the only functioning University teaching hospital in the region, also described the health system as follows. “The whole healthcare system in northern Borno has collapsed and healthcare delivery is nil.  The situation is a “growing health crisis”, with the sick forced to trek vast distances to receive medical attention and vaccination.”

That is why up to today northern Nigeria is one of the most entrenched reservoirs of wild poliovirus (WPV) in the world, making Nigeria the only country with ongoing transmission of all 3 sero types: WPV1, 3 and circulating vaccine-derived poliovirus type 2. By 2012, Northern Nigeria had become a reservoir for WPV reintroduction to 25 polio-free countries.

Polio is obviously on the radar of the international community, but the bad polio situation in Northern Nigeria is just an example of the general predicament in the health sector. The very disturbing and horrendous statistics are further worsened by a weak and over stretched health system that has been affected by corruption; negative socio cultural practices; as well as poor political will, thereby maximizing the level of social and economic disconnect between the people and their leaders. The region  today has the highest number of young people on drugs in the country; the highest number of child beggars; the highest number of girl-children not progressing to secondary or tertiary education; the highest number of girl-children forced into early marriages, and the highest number of employable youth out of jobs.

The Nigeria Emergency Management Authority reports  that at least 470,000 people have been internally displaced from their homes while another 57,000 people have been displaced so far from that region into neighboring countries. This increasing displacement of people out of their homes has created an emergency situation in the region that is capable of spreading into other neighboring countries if nothing is done urgently.

In an interview I granted the Daily Trust newspaper, one of the major newspapers circulating in the region, I said: “The northern states need to come together and appreciate the gravity of their health care challenges and develop a comprehensive blue print for the revival of primary health care in the region. This should be backed by a very solid plan for ensuring accountability and transparency in health care expenditure in the region, because the pattern of morbidity and mortality as well as the socio-economic determinants of health and disease in the various geographical zones of the country are different. The provision of affordable and qualitative health care to the populace can be a very good tool for poverty reduction and empowerment.”

In addition, there is a need for the Federal Government of Nigeria to urgently deliver a comprehensive package of emergency medicines, vaccines and other logistics to provide much needed relief to those in need especially women and children. Also the States must devise means of retaining and motivating the available manpower remaining in the health sector by providing them extra security as well as better remuneration packages to ensure their motivation. A robust and efficient supply chain management should be in place and maintained to ensure the continuous flow of critical medicines, and other urgent logistics needed at a time like this. There is also a need for the rehabilitation of existing health facilities, vehicles and equipment to ensure prompt service delivery for those in critical need especially the vulnerable groups. Finally donor agencies need to be properly coordinated to ensure complementarity, maximization of benefit and limit waste of scarce resources. In view of the lackadaisical attitude of our government at the center, I say this is a time for more donors and donations to the north, and especially to the northeastern part of the country.

Unless, of course, nobody really cares about people like Yagana Goni.

 

Kurfi Abubakar (MD, MPH) is an emerging voice in global public health (2013) and works with the National Health Insurance Scheme, North West Zonal Office Kaduna, Nigeria

 


 

UHC & post-2015

 

1.    Chatham House (paper) – Fiscal Space for Domestic Funding of Health and Other Social Services

Di McIntyre and Filip Meheus;

http://www.chathamhouse.org/publications/papers/view/198263

There is a need to increase government expenditure on health and other social services in many countries in order to achieve UHC and promote inclusive social and economic development. Individual governments have an obligation to allocate the maximum available resources from domestic sources, and not simply rely on international assistance, in order to achieve the progressive realization of fundamental human rights. Ultimately, this requires adequate levels of government expenditure on a range of social services. … Conducted from the perspective of providing both financial protection and access to needed health services, an analysis of the relationship between government spending on health and various indicators related to the goal of UHC supports a target of domestic government spending on health of at least 5% of GDP  supplemented with a target of $86 per capita in low-income countries. Considerable development assistance for health (DAH) is required to supplement domestic public spending in low-income countries to meet this minimum per capita spending target.

 

2.    TMIH (Editorial) – Right to health and global public health research: from tensions to synergy?

Gorik Ooms & Rachel Hammonds;

http://onlinelibrary.wiley.com/enhanced/doi/10.1111/tmi.12287/

While I draft populist intros for this newsletter and ‘economist bashing’ blogs, my colleagues write full blown peer reviewed articles and viewpoints… it’s just incredible.   In this (fascinating) viewpoint, Ooms & Hammonds describe the natural tension between public health and international human rights law, using a number of historical examples at the global level. They also explore the possible implications for UHC if public health researchers and right to health scholars work together.

 

You might also want to read a blog post on the site Global Health Governance, on financing the health MDGs (by Courtney Page & Yanzhong Huang). Especially the last paragraph is interesting: “ Last September, UN Special Envoy for financing of the health related MDGs, Ray Chambers announced the mobilization of $1.15 billion to reach MDGs 4 and 5, which was the largest amount ever committed for those goals.  These funds, in concert with the $2.6 billion from the London FP Summit in 2012 and pending $15 billion Global Fund replenishment, amount to more than $18 billion, a number that demonstrated a sense of global responsibility and commitment to make the world a healthier and safer place.  They represent the new frontier of global health financing. The unique alliances between governments, financial institutions, and the private sector can be the key to successfully funding the critical health services of today for the health of tomorrow’s generation.

 

But some are already saying that now, instead of the billions for MDGs, trillions will be needed for the SDGs … (see below).

 

3.    UNAIDS – Parliamentarians call for AIDS as priority in the post-2015 agenda

http://www.unaids.org/en/resources/presscentre/featurestories/2014/march/20140318parliamentarians/

The importance of prioritizing AIDS in the post-2015 development agenda was discussed during a key note debate at the Joint Parliamentary Assembly of the African, Caribbean and Pacific States and the European Union in Strasbourg, France on 18 March. The debate was introduced by UNAIDS Executive Director, Michel Sidibé.  So the conclusion is perhaps not that surprising.

 

4.    CGD – Does Health Aid Reach the Poor?

Victoria Fan;

http://www.cgdev.org/blog/does-health-aid-reach-poor

Yet another must-read from CGD’s Victoria Fan. She discusses the new WHO report that argues that the poor should be prioritized under UHC. She argues, among others, that policies to coordinate and pool information are crucial, as a minimum, before pooling money.

 

5.    The Hindu – For an all-party manifesto on health

Vinod Paul K. & Srinath Reddy;

http://www.thehindu.com/todays-paper/tp-opinion/for-an-allparty-manifesto-on-health/article5798249.ece

The upcoming election in India should set a benchmark and transform the landscape of healthcare in India, no matter who comes to power, the authors of this viewpoint argue. “To begin with, parties must make healthcare a core priority for the next decade, to enable transformation of the healthcare system, while promoting pro-health policies in other sectors.” Paul & Reddy list five principles to form the core national agenda on health. They should be embraced by all the parties.

 

In other UHC related news, ‘UHC forward’ will merge with the ‘Joint Learning Network’ to make information on the global movement towards universal health coverage more accessible.

 

6.    PSI Impact issue on global health best buys

http://psiimpact.com/

This was also the week of the global health ‘best buys’. PSI Impact dedicated an issue to this, and there was also a ‘best-buys in global health’ event  in the US (see here for the full webcast). The event convened experts from implementing agencies, governments, researcher institutions, and the private sector to discuss and debate what makes a “best buy” in global health. The panelists also drew upon a survey conducted to identify these best buys   (see here for the main survey results).

 

Some stuff we found interesting: health systems strengthening (HSS) was identified as a global health best buy (!) – see also Tom Paulson on this ‘finding’ (see below). Tobacco taxes are rising on the international agenda, or at least Amanda Glassman would like them to rise much more, …

 

See also this viewpoint from Karl Hoffman in the  Huffington Post, ‘The Best Buys in Global Health: Striking the Effective Balance’.

 

7.    Humanosphere – Back to the fuzzy future in global health

Tom Paulson;

http://www.humanosphere.org/2014/03/back-fuzzy-future-global-health/

The global health community seems at a loss these days, as indicated by two conferences yesterday I web-participated in devoted to coming up with a future game plan for the field.” Paulson doesn’t deny HSS is indeed important and a global health ‘best buy’, but it’s not exactly a very new idea, he argues. And he continues: “ I vote for sticking with simple and clear global health goals first. These grander and fuzzier goals should also be on the list, but further down – at least until we actually pick all the obvious, low-hanging fruit still out there”   …  (read this blog post!)

 

8.    World Economic Forum (blog) – A new global vision for sustainable development

John McArthur;

http://forumblog.org/2014/03/paying-sustainable-development/

Today, as the MDGs approach their 2015 deadline and the world negotiates a new global vision for sustainable development, the time has come to shift mindsets from “B” to “T”, since the next frontier is talking about trillions of dollars in required investment throughout the global economy.” (must-read from this WEF Young Global Leader). He discusses the report, ‘Paying for Zero: Global Development Finance and the Post-2015 Agenda’.

 

Trillions … time to get Goldman Sachs involved.

 

9.    Stockholm Environment institute – Cross-sectoral integration in the Sustainable Development Goals: a nexus approach

http://www.sei-international.org/publications?pid=2474

For some of the latest developments in the SDG debate, see this piece on the importance of a “nexus” approach. (see also here). And for a more general overview of the Open Working Group’s work so far, see this website – it includes a progress report). When looking at the health section, it indeed seems to go for pretty much everything possible in the global health universe. (instead of MDG+, I’d call it MDG2)

 

10. Plos – Health in Jeopardy: the Corporate Influence on Climate Negotiations

Alicia Pawluk;

http://blogs.plos.org/speakingofmedicine/2014/03/14/health-jeopardy-corporate-influence-climate-negotiations/

Alicia Pawluk argues that fossil-fuel producers have too much influence over U.N. climate negotiations. She says UN climate policymakers should learn from the WHO Framework Convention on Tobacco Control and diminish the influence of fossil-fuel producers in climate talks.

 

But that’s not the only problem: activist and advocacy organizations increasingly look and act like multinational corporations (‘corporatization’) (see this piece in

Open Democracy), a trend which is also “empowering” Big Business…

 

11. The Conversation – 1000 insatiable leaders, tackling the world’s biggest challenges, unite in an African capital

Alessandro Demaio;

https://theconversation.com/1000-insatiable-leaders-tackling-the-worlds-biggest-challenges-unite-in-an-african-capital-23902

Demaio was in Tunisia to speak at the global conference of the International Federation of Medical Student Associations (IFMSA).  Some 1000 young emerging visionaries from all over the planet came to a small, seaside town outside of Tunis to discuss humanity’s greatest challenges, and connect to form a powerful new cohort of change and develop effective solutions for a healthier tomorrow. Demaio drew 4 lessons from these ‘can do’ emerging leaders.  The Tunis meeting also inspired the  Hammamet declaration.

 

12. Translational Global Health – Public health vs business thinking: a case study from the Hult Prize Competition

Kremlin Wickramasinghe;

http://blogs.plos.org/globalhealth/2014/03/hult-blog/

On Demaio’s blog, Kremlin Wickramasinghe (that’s not a name you want these days) writes about the nexus of public health and business thinking – as well as some reflections on the global Hult Prize. Very nice blog post. “Do public health academics and entrepreneurs think along the same lines? What would happen if we asked them to identify solutions to a problem that both groups care about? Would solutions be the same or drastically different? I had an opportunity to find some answers to these questions at the Hult Prize regional finals. The Hult Prize is funded by the Clinton Global Initiative to provide start-up funding (one million dollars) for the young social entrepreneurs who come up with the most compelling ideas to solve a problem faced by billions of the world’s population.”

13. Lancet – Offline: What have economists ever done for global health?

Richard Horton;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60491-8/fulltext

Very nice overview of the discussion at the London School last week, the Global Health Lab on ‘what have economists ever done for global health?’. “The medical community owes economists a great deal. But although we might be kind to economists, perhaps we should be tougher on the discipline of economics itself. For economics has much to answer for. “ … “Anne Mills fervently argued the case in favour of economists. It was they who contributed to understanding the idea of “best-buys” in global health. It was economists who challenged user fees. And it was economists who made the connection between health and economic growth, providing one of the most compelling political arguments for taking health seriously. Some economists might adore markets. But not health economists, she said. … “Clare Chandler, a medical anthropologist (also from the London School), took a different view. She asked, what has neoliberal economics ever done for global health? Her answer, in one word, was “inequality”. …  (to be continued, I guess)

 

14. Lancet (Correspondence) – Not everyone is ignoring social chaos

David Miliband;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60509-2/fulltext

Richard Horton contended in January that key global stakeholders have not only failed to discuss the impact of social chaos on health, but have actively stymied the conversation. David Miliband – you probably know him – welcomes Horton’s focus on a topic that has not received the attention or action it deserves, but says “Horton fails to account for the considerable work done by NGOs, advocacy groups, and others to document social chaos and its effects on health, and hold the people in a position to improve the situation responsibly.”   He concludes his letter like this, pointing out the importance of bringing in local voices: “These local voices, we know from experience, will, when allowed to, bring the focus back to the social and political issues that, as Horton correctly infers, underlie so much of the global health disparities in evidence today. And, most importantly, they will bring the discussion back to where it needs to go: practical solutions.

 

World TB day

 

15. Lancet (Editorial) – A new brand for tuberculosis

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60502-X/fulltext

The Lancet received an interesting email last week—an invitation to participate in the research stage of a new Stop TB Partnership initiative to build a brand for tuberculosis from Siegel+Gale, a London-based branding agency who have been commissioned to undertake the work. The aim of the project is to develop an iconic and lasting identity for tuberculosis. The goal is to create a brand that will raise the profile of the disease, influence high-level decision makers, attract necessary resources, and amplify the voice of the tuberculosis community.”  Is this really what is needed, this Lancet editorial wonders.

 

16. Lancet (Comment) – World TB Day 2014: finding the missing 3 million

Nick Herbert et al. ;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60422-0/fulltext?_eventId=login

On April 23, 1993, WHO declared tuberculosis a global health emergency. Tuberculosis is now about to come of age as a global emergency—April, 2014 marks the 21st anniversary of that declaration.  In this Comment, ahead of World TB Day on March 24, A Zumla and colleagues note two essential requirements for rapid progress: commitment at the highest political level and the necessary resources. “To achieve unity for these aims, on World Tuberculosis Day, March 24, 2014, the UK All Party Parliamentary Group on Global Tuberculosis has joined with parliamentarians from the Group of Eight countries to call for coordinated global action on tuberculosis.”  (I thought the G8 didn’t exist anymore, as of this week?)

 

Earlier this week, The Lancet also published a Comment on TB control in China, which included some lessons for TB control post-2015. “This study is important for the present discussion about the post-2015 global tuberculosis control and elimination agenda: the new tuberculosis targets likely to be considered by the 2014 World Health Assembly include a 50% reduction in tuberculosis prevalence between 2015 and 2025. Achieving such a target would be an important milestone toward tuberculosis elimination. The results from China show the feasibility of achieving such a target by aggressively scaling up the basic programmatic elements of tuberculosis control both within and outside the public sector.

17. WHO – Progress in diagnosing multidrug-resistant tuberculosis

http://www.who.int/mediacentre/news/releases/2014/tb-day/en/

A WHO news release, ahead of World TB Day, announces progress made by a new project that helped to triple the number of MDR-TB cases diagnosed in participating countries. The project is called ‘EXPAND-TB’ (Expanding Access to New Diagnostics for TB), and is financed by UNITAID.

 

18. MSF Briefing paper – The new face of an old disease: Urgent action needed to tackle global Drug-Resistant TB threat

http://www.msf.org/article/new-face-old-disease-urgent-action-needed-tackle-global-drug-resistant-tb-threat

 

MSF released a new briefing paper on Monday which outlines why the alarming spread of deadly strains of drug-resistant tuberculosis (DR-TB) is one of the biggest global health threats we face today.  The organization calls on governments, pharmaceutical companies, and researchers to mobilize urgently to save more lives and find new treatments to stem the virulent disease.

 

Check out also the MSF drug-resistant TB manifesto.

 

Meanwhile, in the US, global TB funding was cut ( see  Science Speaks) in Obama’s budget request – see also previous IHP newsletters).

 

 

Global Fund & GAVI

 

19. Aidspan – Meaningful change or more of the same rhetoric? The Global Fund’s new funding model and the politics of HIV scale-up

A Kapilashrami & J Hanefeld;

http://www.aidspan.org/gfo_article/meaningful-change-or-more-same-rhetoric-global-fund%E2%80%99s-new-funding-model-and-politics-hiv

This was a week where the commotion around the Global Fund’s New Funding Model gained momentum, for obvious reasons. This Analysis by Kapilashrami, A. and Hanefeld, J., based on their recent paper in Global Public Health, is a must-read.

 

But do read the whole new issue of the Global Fund Observer, as it contains plenty of info, and early reactions of countries to the NFM allocations. There’s also some info on the idea of an ‘African Bureau’, which is getting closer – a regional bureau so as to better influence the decision-making process at the Global Fund Board. And the Global Fund Observer also started a French newsletter.

 

20. GF news flash – issue 40

http://us5.campaign-archive1.com/?u=8a32f13900b342bdc0291e17c&id=176a8834c6&e=fcb7eaf0a2

This news flash also zooms in on the NFM, as the Fund launched full implementation of its new funding model this month. “At its core is a shift from a blanketing “one size fits all” approach to a more targeted approach, so that greater impact can be achieved globally and more people can actually be reached. Many countries that were informed on 12 March about their allocation amount for 2014-2016 are understandably now quite interested to know how those allocation amounts were determined. Many are asking: What was the allocation formula? The Global Fund has prepared and published an explanation. It’s called “Overview of the Allocation Methodology” and it is pretty comprehensive and detailed. It can be found on the Global Fund website” (see  here).

 

21. GAVI – Lions Clubs, GAVI Alliance celebrate partnership at Capitol Hill reception

http://www.gavialliance.org/library/news/press-releases/2014/lions-clubs-gavi-alliance-celebrate-partnership-at-capitol-hill-reception/

Not much GAVI related news this week, apart from the celebration of the partnership between Lions clubs & GAVI, at Capitol Hill. Lions Clubs International has reaffirmed its commitment to protect children from measles and rubella in the world’s poorest countries with a US$ 7.5 million initial donation to the GAVI Alliance to help fund measles-rubella programmes. (a whopping donation, in other words – can’t they work together with Burger King too?)

 

 

Other Infectious diseases news

 

22. Global Bioethics blog – Truvada: the political pill

Stuart Rennie;

http://globalbioethics.blogspot.be/2014/03/truvada-political-pill.html

There is some political commotion around Truvada, a recent HIV prevention pill (PrEP).

23. Science Speaks – Uganda anti-homosexuality law: As USAID, “partners” disagree, next steps unclear

http://sciencespeaksblog.org/2014/03/19/uganda-anti-homosexuality-law-as-partners-disagree-usaid-pauses-to-consider-ribbon-cuttings/

This blog post discusses the implications of Uganda’s anti-homosexuality law on USAID’s ability to carry out its programs in country.

 

In other ‘gay rights & HIV’ news, the Guardian has a  piece on the also very difficult situation in Myanmar.

 

24. Critical Public Health – Culture and behaviour in mass health interventions: lessons from the global polio eradication initiative

Sebastian Taylor;

http://www.tandfonline.com/doi/abs/10.1080/09581596.2014.895799#.UygTYPl5OuI

Then there’s polio. Here’s the abstract of a new article in Critical Public Health: “Success in the Polio Eradication Initiative now hinges on a very few endemic countries. Maximising household vaccination in these places is key. Evidence suggests that while vaccinator performance generally, and physical access related to security, create blockages in the vaccination supply-side, unwillingness to be vaccinated by small groups of households and communities constitutes the principal demand-side barrier. The question is why. Culture has been treated as a dominant factor determining resistance to vaccination in the global programme. Resistance, often occurring in areas with substantial Muslim population, has been associated with fear and rumour fuelled by ignorance, and religious objection – problematically merged in a religio-cultural interpretation of resistance as a kind of Islamic obscurantism. Yet attitudes to the polio programme appear to vary substantially within small geographic areas. Rather than being a matter of common belief, public orientation appears to be shaped by a combination of religio-cultural and more localised socio-economic and political factors – in particular, the potentially aggressive nature of mass vaccination, and the perceived under-supply of other development goods. Interpreting resistance to vaccination as essentially religio-cultural marginalises an understanding of resistance as the rational and strategic response by households and communities to systematic conditions of inequity and exclusion.

 

Meanwhile, polio transmission continues in Cameroon; in Iraq a polio case was identified too, spreading from Syria refugees, Laurie Garrett tweeted.

 

And in more encouraging news, Pakistan and Afghanistan  agreed  on a joint anti-polio strategy. Also, WHO will certify the South-East Asia region (that comprises of 11 countries including India) as polio free on 27 March.

 

 

25. Lancet Respiratory Medicine – Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data

A large meta-analysis of individual patient data involving more than 29 000 patients from 38 countries published in The Lancet Respiratory Medicine showed that adults hospitalised with H1N1 influenza during the 2009–2010 pandemic were 25% less likely to die from the disease if they were given antiviral drugs called neuraminidase inhibitors such as Tamiflu. The findings also indicate that treatment within 2 days of flu symptoms developing halved the risk of death compared with later treatment or no treatment. News outlets also reported on this (see Reuters for example).

 

So it appears Tamiflu did save lives after all…

 

World Water Day

 

For some reason, whenever World Water Day is approaching (22 March), I have to think of Kevin Costner.

 

  • Speaking of Medicine features  a number of the articles PLOS Medicine, PLOS Neglected Tropical Diseases, and PLOS Pathogens have published in the past on the importance of clean water to human health.
  • Also in anticipation of World Water Day, a UNICEF blog underlines the need to continue focusing on water and sanitation needs of children, and describes some of the programs taking place in the world’s poorest areas.

 

26. Plos (Editorial) – PLOS Medicine and Water, Sanitation, and Hygiene: A Committed Relationship

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001614;jsessionid=E3DE3B0336E5E9738BD61BE8F8A4A4D0

The PLOS Medicine editors discuss the importance of water sanitation and hygiene (WASH) and confirm PLOS Medicine’s commitment to continuing to publish WASH-related research.

 

27. Guardian – Growing global thirst for energy threatens water supplies

Claire Provost;

http://www.theguardian.com/global-development/2014/mar/21/global-thirst-energy-threatens-water-supplies

Growing demand for energy will put increasing pressure on the world’s already strained water resources, particularly in developing and emerging economies, the UN has warned. “There is an increasing potential for serious conflict between power generation, other water users and environmental considerations,” it says in the world water development report, published on the eve of world water day on Saturday.

 

NCDs

 

28. Plos – Representation and Misrepresentation of Scientific Evidence in Contemporary Tobacco Regulation: A Review of Tobacco Industry Submissions to the UK Government Consultation on Standardised Packaging

Selda Ulucanlar et al.;

http://www.plos.org/wp-content/uploads/2014/03/plme-11-03-Ulucanlar.pdf

To coincide with the report from the Chantler review of standardized packaging for tobacco products in the UK, PLOS Medicine provides a pre-publication version of the upcoming research article “Representation and Misrepresentation of Scientific Evidence in Contemporary Tobacco Regulation: A Review of Tobacco Industry Submissions to the UK Government Consultation on Standardised Packaging” by Selda Ulucanlar and colleagues at the University of Bath and the UK Centre for Alcohol and Tobacco Studies.

 

Read also George Monbiot (in The Guardian), on ‘How Big Tobacco’s lobbyists get what they want from the media’ (including the BBC).

 

In more encouraging tobacco news ,  six African countries gathered to improve Tobacco counter marketing: “Health Ministry Representatives from Botswana, Kenya, Nigeria, Rwanda, South Africa and Uganda joined a regional workshop to improve warnings on cigarette packs and anti-tobacco public education campaigns.”

 

29. WHO –  WHO tools to prevent and control noncommunicable diseases

http://www.who.int/nmh/ncd-tools/en/

This section provides links to WHO tools for the prevention and control of noncommunicable diseases – from setting national targets and developing national multisectoral policies and plans to measuring results. The list of tools is not exhaustive but is intended to provide information and guidance on effectiveness and cost-effectiveness of evidence-based interventions, taking into account the “Global NCD action plan 2013-2020”.

 

 

HRH

 

30. Human Resources for Health blog – Challenges and research on posting and transfer in the health sector

Seye Abimbola & Aku Kwamie;

http://blogs.biomedcentral.com/hrhblog/2014/03/14/challenges-and-research-on-posting-and-transfer-in-the-health-sector/

The prolific Seye Abimbola & Aku Kwamie (both EVs) wrote another blog post on ‘posting and transfer’ this week,  related to the recent Bellagio meeting. (see also BMJ blog).

 

Access to medicine

 

31. Guardian – New hepatitis C drugs must be affordable worldwide, say campaigners

Sarah Boseley;

http://www.theguardian.com/society/sarah-boseley-global-health

On one of the key new battlegrounds in the global access to medicine fight,  Hepititis C. In a new MSF report, it is argued that we must learn from the HIV epidemic and ensure that affordable prices are in place so that the millions with hepatitis C infection can get new drugs that appear to be a cure. You find the MSF report, ‘New Treatments for Hepatitis C Virus: Strategies for Achieving Universal Access’, here.

 

See also Science Speaks on this issue.

 

 

Maternal and child health

 

  • For some of the latest information on the ‘Commission on the Status of the Women’ conference in New York, read the following two Guardian articles ( see here and here ), on indicators for women’s empowerment post-2015, the decreasing influence of the Holy See, etc. More in general, Bloomberg reports that  women diplomats have now reached a critical mass. “More female diplomats at the negotiating table could introduce a perspective their male counterparts may not share, especially when ‘grappling with policies having to do with war and peace that affect women…

 

32. International Health (Editorial)  – Keeping rotavirus vaccines on the international agenda

Rebecca F. Grais et al.;

http://inthealth.oxfordjournals.org/content/6/1/1.full

Rotaviruses are the leading cause of severe dehydrating diarrhea in children under 5 years globally, with low-income countries estimated to account for almost all rotavirus-related deaths.

33. Lancet (Editorial) – Syria: 3 years of suffering

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60503-1/fulltext

While the conflict in Syria shows no end in sight, two reports released this week describe the intolerable effect Syria’s 3 year war has had on children. UNICEF’s report Under Siegethe devastating impact on children of three years of conflict in Syria and  Save the Children’s report A Devastating Toll: the impact of three years of war on the health of Syria’s children which examines Syria’s ravaged health system and what this means for children and their mothers.

 

 

WHO

 

 

  • The first preparatory documents for the World Health Assembly 2014 have now been released – see here.

 

 

  • And World Health Day (April 7) is coming up – see here. The theme is: “Protect yourself from vector-borne diseases”. More than half of the world’s population is at risk from vector-borne diseases such as malaria and dengue. Yet, we can protect ourselves and our families by taking simple preventive measures, including vaccination.

 

 

Health Policy & Financing

 

 

34. KFF – The U.S. Global Health Budget: Analysis of the Fiscal Year 2015 Budget Request

kff analysis

In-depth analysis of Obama’s Global Health Budget.

 

35. Business Day live – Breakthrough scheme unlocks aid donor funds

http://www.bdlive.co.za/business/2014/03/16/breakthrough-scheme-unlocks-aid-donor-funds

Development consultancy Dalberg and some innovative South African companies are shaking up traditional approaches to development by merging corporate finance and donor aid.”  On malaria bonds etc.  (for the “social entrepreneurs” and other innovators among you)

 

36. Lancet (World Report) – Breaking the cycle: drought and hunger in Kenya

Sam Loewenberg;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60492-X/fulltext

Aid to Kenya responds to the country’s recurrent food crises but it fails to address the underlying infrastructure problems that could prevent such emergencies. Sam Loewenberg reports.

 

37. Journal of Medical Internet research (Viewpoint) – Health Domains for sale: the need for Global Health internet Governance

Tim Ken Mackey et al.;

http://www.jmir.org/2014/3/e62/

A debate on Internet governance for health, or “eHealth governance”, is emerging with the impending award of a new dot-health (.health) generic top-level domain name (gTLD) along with a host of other health-related domains. This development is critical as it will shape the future of the health Internet, allowing largely unrestricted use of .health second-level domain names by future registrants, raising concerns about the potential for privacy, use and marketing of health-related information, credibility of online health content, and potential for Internet fraud and abuse.

 

Emerging Voices

 

38. BMC Health Services – Performance evaluation of a  health insurance in Nigeria using optimal resource use: health care providers perspectives

Mohammed Shafiu et al.;

http://www.biomedcentral.com/1472-6963/14/127

Performance measures are often neglected during the transition period of national health insurance scheme implementation in many LMICs. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme in Nigeria, using optimal resource use domains and examines possible factors that influence each domain, according to providers’ perspectives.

 

Research

 

39. Health Systems – A bioethical framework for health systems activity: a conceptual exploration applying ‘systems thinking’

Carleigh B Krubiner & and Adnan A Hyder;

http://www.palgrave-journals.com/hs/journal/vaop/ncurrent/abs/hs20141a.html

Recognizing that the health system is a complex and dynamic network of actors and activities, this paper seeks to push the field of bioethics to develop a more holistic approach from the health systems perspective. Expanding upon the work of existing public health frameworks and drawing upon concepts from related areas such as governance, human rights, and organizational ethics, the authors’ provisional list of ethical considerations for health systems fall under the following categories: Holism, Sustainability, Evidence & Effectiveness, Efficiency, Public Engagement & Transparency, Accountability & Feedback, Equity & Empowerment, Justice & Fairness, Responsiveness, Collaboration, and Quality. By outlining these key domains, they hope to stimulate global discussion and further development of an ethics framework that will help guide ongoing work to strengthen health systems. This will be particularly important for LMICs where resources are highly constrained and health systems efforts have scaled-up dramatically in the past decade.

40. World Bank – Private health sector assessment in Tanzania

James White et al.;

http://documents.worldbank.org/curated/en/2013/09/18273242/private-health-sector-assessment-tanzania

Tanzania exemplifies the developing world’s struggle to achieve ‘middle-income’ country status while confronting widespread poverty and substantial health challenges-such as persistently high child and maternal mortality, HIV/AIDS, TB, and malaria. In this context, Tanzania’s National Public Private Partnership (PPP) policy and second Health Sector Strategic Plan (HSSP) included a call for a private health sector assessment. Accordingly, following a regional technical exchange in Mombasa, Kenya, Tanzania’s PPP Technical Working Group (TWG) requested that the Health in Africa (HIA) initiative of the International Finance Corporation (IFC) conduct an assessment of the private health sector in mainland Tanzania.

41. HP&P – Contextual factors as a key to understanding the heterogeneity of effects of a maternal health policy in Burkina Faso?

Loubna Belaid & Valéry Ridde;

http://heapol.oxfordjournals.org/content/early/2014/03/14/heapol.czu012.short?rss=1

Burkina Faso implemented a national subsidy for emergency obstetric and neonatal care (EmONC) covering 80% of the cost of normal childbirth in public health facilities. The objective was to increase coverage of facility-based deliveries. After implementation of the EmONC policy, coverage increased across the country, but disparities were observed between districts and between primary healthcare centres (PHC). To understand the variation in coverage, the authors assessed the contextual factors and the implementation of EmONC in six PHCs in a district.

42. HP&P – Price subsidies increase the use of private sector ACTs: evidence from a systematic review

Alexandra Morris et al.;

http://heapol.oxfordjournals.org/content/early/2014/03/14/heapol.czu013.short?rss=1

Although artemisinin combination therapies are the recommended first-line treatment for uncomplicated malaria in most endemic countries, they have been prohibitively expensive in the retail sector where many suspected malaria cases purchase treatment. ACT subsidies seek to stimulate consumer demand for the drugs over cheaper but often ineffective alternatives by reducing their prices. A systematic literature review was conducted to identify reports of experimental or programmatic ACT subsidies to assess the impact of subsidies on consumer use.

 

43. TMIH (Systematic review)– Informed consent comprehension in African research settings

Muhammed Afulabobi et al.;

http://onlinelibrary.wiley.com/doi/10.1111/tmi.12288/abstract

Previous reviews on participants’ comprehension of informed consent information have focused on developed countries. Experience has shown that ethical standards developed on Western values may not be appropriate for African settings where research concepts are unfamiliar. The authors undertook this review to describe how informed consent comprehension is defined and measured in African research settings.

44. Health Research Policy and systems – Evaluation of the international forum on evidence informed health policymaking: Addis Ababa, Ethiopia – 27 to 31 August 2012

Justin Neves, John Lavis et al.;

http://www.health-policy-systems.com/content/12/1/14/abstract

Meetings and conferences are often used as a tool to disseminate information, network with colleagues, and/or set direction for a field of study, but there is little evidence to support whether such events achieve their objectives. This study evaluates the International Forum on Evidence Informed Health Policymaking (EIHP), a three-day meeting held in Addis Ababa, Ethiopia, in 2012, to determine the success of the meeting based on pre-determined objectives.

45. Health Policy & Planning – 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.full?keytype=ref&ijkey=1LZ7T1zFIWxv5mP

In 2011, the Africa Routine Immunization System Essentials (ARISE) project conducted in-depth case studies in three countries (Cameroon, Ethiopia, and Ghana) to explore and describe the factors underlying performance improvement in routine immunization in Africa.  Funded by the Gates Foundation, the studies aimed to define the pathways through which specific drivers improved Routine Immunization (RI) system performance by investigating the experience of 12 districts.

 

Global Health announcements

 

  • The Cape Town HSR symposium is coming up, and many of you are involved in the review of individual abstracts (deadline 26 March!)
  • For the next (Fourth)  Global Symposium on HSR, the call for proposals is out. Please feel free to share around and send queries and complete proposals to healthsystemsresearch@cphiv.dk by 1 June 2014. For more information click here.
  • When tweeting about the Third Global Symposium in CapeTown, please use the hashtag #HSR2014.

 

  • 21 March (today) – Meeting in Geneva on antimicrobial resistance:  Organised by the Global Health Programme at the Graduate Institute, Geneva, in cooperation with the Centre on Global Health Security at Chatham House, London, the seminar focuses on the problem of antimicrobial resistance, specifically its national/regional and international context: for more info, see here.

 

Miscellaneous

 

  • Bill Easterly has a new book out, ‘The Tyranny of Experts: Economists, Dictators and the Forgotten Rights of the Poor”, and you should probably read it (see  The Guardian  for a review, and Humanosphere for a Q&A with Bill). We assume he considers Bill Gates one of the main “Tyrannosaurus Rex”s in this respect.

 

  • The NYT had an interesting article on the increasing influence of billionaires in the US on American science. (see  here )

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