Dear Colleagues,

This week Obama visited my country, or ‘Brave Little Belgium’ as he called it. Not sure about the first adjective, but the second one is obviously spot on. Apparently the Belgian media thought this was still 2008, as Obama-mania was everywhere. The Belgian press framed the story pretty much like a Jason Bourne movie, and few hard questions were asked. Fair enough, you can’t deny the mesmerizing US president has far more glamour than the average EU technocrat, so we were all easily carried away (at least for a day).

The key aim of his visit was to sit together with the European leaders, among others on TTIP and Crimea, but most of the attention went to his speech in Bozar (a cultural centre in Brussels), in the evening. His speech was dedicated to Crimea and Russia, and Obama talked among other issues about his belief in our ‘universal ideals, principles and values that will ultimately prevail’ – Americans will always be Americans. A lot of the people in the audience were young people, and his message for them was, basically, that the fight for democracy and rule of law is never over. Every generation has to fight for these values and principles as can be seen in Crimea and the Ukraine  for the moment, he implied. But these ideals will be irresistible, in the end, he assured us, at least if we show the same commitment as previous generations.  Vintage Obama.

Although we like the guy, there are, however, a few problems with this grand vision. His claim that these ideals and values are universal is true (at least to some extent), however, what about the young generations in Southern European countries who feel that their very own leaders have betrayed them as well as these ‘universal principles’, sacrificing them on the altar of the euro and the banks? It’s not just in Maidan or ‘Tunis, Cairo & Tripoli’ that young people have demonstrated, just last week there was a big manifestation in Madrid against austerity policies in Spain, with a few million people taking to the streets (admittedly, only 50.000 according to official figures, but the truth probably lies somewhere in between). Or how about the Golden Visas  in Portugal, whereby rich people from elsewhere in the world can get a European visa, if they’re rich enough – apparently quite a few shady people have already applied for these visas, recently, including people from Chinese triads. This contrasts enormously with the zeal with which Europe fights immigration from ordinary and poor people they consider less ‘needed’ at its borders (see Lampedusa). What’s more, Golden visas are now being granted in southern European countries where a big part of the population is suffering under austerity. Not sure how this matches with the rhetoric about universal values of the American president. Perhaps we should call it the ‘rule of law’, EU style?

The rather optimistic picture Obama sketched of the merits of capitalism, democracy and the free market, also contrasts with the picture of the last three (neoliberal) decades – and it’s probably good to read his speech together with recent work from Thomas Piketty (see the New Yorker  for example). And let’s not forget about TTIP itself…

But yes, these universal ideals are worth fighting for. Yet, when Western (American & European leaders) don’t respect these ideals, or are perceived to pay only lip service to them, they become very vulnerable for criticism, including by their own populations. Quite a few of our emperors have no clothes anymore. Granted, Obama didn’t deny the West hasn’t always lived up to its own ideals and values. But where does political realism end and hypocrisy begin? I can’t speak for America, but in Europe, many people feel our leaders have failed us, big time. Enter populist authoritarians like Putin, who don’t hesitate to exploit this.

Which is why it’s probably good to prepare for a plan B – if these universal values and principles can’t be implemented globally, at least in the medium term, if only because Western ‘soft power’ has diminished for a number of reasons, including the fact that many people feel the West hasn’t lived up to its own values and principles, then probably we should prepare for a multi-polar world in which some of these values and principles will not be shared, at least for the next few decades. The global health community should prepare for such a multi-polar world too – not because we like it – we don’t, and I agree many of these aspirations and ideals are universal – but because it seems to happen in front of our eyes. I argued this in a recent blog post, ‘Is global health ready for a multi-polar world?’, which you may want to read in case you have nothing else to do this weekend.

In this week’s guest editorial, Stephanie Topp, Abubakar Kurfi, Charles Birungi and Natalie Eggermont (all EVs) wrote about the need for the mainstream global health community to fully confront the political economy issues around ‘ownership’, a concept Bill Gates, Mark Dybul and many others in the global health & larger development community seem to be very fond of. If they’re serious about ownership, they should pay much more attention to the (global) political and structural conditions that are required for meaningful ‘ownership’. If they fail to do so, they, too, might one day be perceived to pay only lip service to a nice principle.


Enjoy your reading.


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




When will the global health community confront the political economy of ‘country ownership’?


Over the past half century the global health elite has excelled in setting lofty goals and making aspirational comments, as part of a broad – if often ill-defined – movement towards global improvements in disease prevention, diagnosis and treatment.  Some of these goals have been met (notably small-pox eradication and substantial reductions in child mortality), while others have been less successful.   None have been so grand and so vigorously pursued as those relating to HIV and AIDS.  Indeed, with new HIV infections at their lowest levels since the early 1990s and a 21% fall in AIDS-related deaths globally in the past decade the UN catch-cry ‘Zero New Infections, Zero Stigma and discrimination and Zero AIDS related deaths’ reflects an increasing focus amongst global health activists and policy makers on achieving an AIDS-free generation and bringing about ‘the end of AIDS’.

While aspirational statements can play a role in helping to galvanise policy makers, funders and health workers to further action, they can also serve as a distraction by encouraging an over-simplistic assessment of the challenge(s) at hand.  Within the global health and HIV/AIDS communities, for example, the need for strong health systems and strengthened national ownership of HIV/AIDS responses is now widely recognized (and correctly so), and yet comparatively little attention is being paid to the political and structural conditions that are required to enable such ‘ownership’ to evolve.

The global political economy has a significant, and not always positive effect on the structure and impact of domestic policy-making and investment in health.  Evidence from one recent report – Illicit Financial Flows from Developing Countries – demonstrates that for every dollar of official development assistance (ODA) coming into sub-Saharan Africa in 2010, ten dollars exited the region via the illicit financial flows of a global ‘shadow economy,’ comprising tax havens, secret jurisdictions, disguised corporations, trade mispricing and money laundering.  A growing body of literature (see: Oxfam’s Working for the Few’ / Aidwatch’s Global financial flows, aid and development) and various commentators (e.g. Alex Cobham / J. Ball) suggest that ODA may help to mask the effects of illegal financial flows by unintentionally crowding out domestic spending, weakening the need or resolve of local governments to invest in human services, or, by propping up service sectors undermined by corrupt officials or governments.  These assertions are supported by the work of Lu et al, amongst others, who demonstrate that in many sub-Saharan African countries, health-specific development assistance provided direct to governments, has had a significant negative effect on domestic government spending on health (a reduction of between $0.43 to $1.14 in government health expenditure from domestic resources, for every US$1 of health-specific development assistance disbursed).
So why do global health donors not simply pack up their bags and leave?
ODA has been an almost permanent feature of the post-independence landscape of sub-Saharan Africa and many assume that a withdrawal of aid would result in widespread collapse of institutions that provide basic services.  Providing a counterpoint to this assumption, a recent study on Somaliland – which seceded from Somalia in 1991 and as a result has been largely ineligible for international aid – provides an example of how ineligibility for aid may actually facilitate the development of more accountable political institutions and the re-emergence (albeit gradual) of a local service sector.  Although clearly describing a specific context, the study shows how in the absence of external funding the Somaliland government had to turn to its citizens, especially the business community, for revenue by means of taxation.  This provided a source of financing but also a critical mechanism of government accountability, with negotiation over government spending of those taxes an essential part of the social contract.

The debate surrounding the potential negative impact of ODA is not new and the Somaliland example remains an isolated one.  Nonetheless, in the context of a debate on strengthening country ownership of the HIV/AIDS response, this case, combined with the data on illicit financial flows, help to focus attention on the importance of not how much money is spent, but who controls it and how accountability is institutionalized.  Recent debates in Davos and the declarations coming out of the G8 and G20 meetings similarly demonstrate a growing international recognition of the need to support LMICs to strengthen the social contract and institutionalize government accountability.

Within the global health community, however, there remains a disconnect.  The rhetoric of improved governance and accountability is not matched by any genuine commitment to shift from the neoliberal status quo that underpins the global shadow economy (see for example Microsoft’s Tax record) or (as demonstrated during recent Global Fund replenishment discussions) away from traditional forms of ODA that may actually undermine, instead of strengthening the social contract.  To be fair, there has been a shift within some sections of the global health community with growing momentum towards Universal Health Coverage  (UHC) and an associated emphasis on public financing.  Nonetheless, progress is slow; too slow, with many global health experts seemingly hardwired to consider ‘value for money’ (e.g. twitter hashtag: #BestBuys4GH) while ignoring fundamental structural and political issues.

As the post-2015 discussions continue, key questions that should be considered include whether the global health community can truly contribute to strengthened ownership of the HIV/AIDS response, or indeed, UHC, given its strong preference for global health financing strategies that (even as they advocate for increased domestic inputs) tend to ignore the underlying and systemic inequity of the global political economy.  The Lancet Governance for Global Health Commission represents a recent and welcome exception to this selective blindness although some remain skeptical as to its capacity to truly influence the real financial players in this domain.



** The views expressed in this editorial are those of the authors and not their respective affiliated organizations.  You can follow any of the authors on twitter at:  @globalstopp / @abukurfi / @C_Birungi / @neggermont.



Authors & Affiliations


  1. Stephanie M. Topp,

Affiliation: Centre for Infectious Disease Research in Zambia and Divisions of Infectious Disease, University of Alabama at Birmingham.


  1. Kurfi Abubakar Muhammed

Affiliation: National Health Insurance Scheme, Nigeria.


  1. Charles Birungi

Affiliation: School of Accounting, Economics and Finance, University of KwaZulu-Natal, South Africa


  1. Natalie Eggermont

Affiliation: Institute of Tropical Medicine, Antwerp




World TB day and other TB news


1.    Lancet Series on TB

To mark the Stop TB Partnerships’ World TB Day on Monday 24 March 2014, The Lancet journals published a special new collection of Reviews, Comment, and Articles to cast light, and the world’s attention, on tuberculosis, in the hope of raising this disease higher up the agendas of international communities. The new publications discuss topics ranging from extremely drug-resistant tuberculosis, to the role of advocacy in tuberculosis, and new anti-tuberculosis drugs, highlighting the key areas and challenges to be met if inroads are to be made into winning the battle against tuberculosis.


Among others, there is a Comment  on the theme of this year’s World TB Day, ‘Finding the missing 3 million’. “Every year about 3 million people with active tuberculosis are not diagnosed and continue to spread the disease in the community, with many dying. Other patients are diagnosed but not officially reported, eluding public health systems. The consequences of failing to diagnose and properly treat these 3 million people will impede gains made in tuberculosis control.”


2.    Lancet (early online ) – Quantifying the tuberculosis disease burden in children

Ben J. Marais;

Marais comments on a new study in the Lancet by Helen Jenkins and colleagues which estimates the number of incident tuberculosis and multidrug-resistant tuberculosis cases in children by WHO region.


3.    Lancet Viewpoint – Importance of tuberculosis control to address child survival

Stephen M Graham et al.;

Tuberculosis commonly affects young children (<5 years) in countries that have high rates of child mortality. The global public health focus to control tuberculosis has traditionally aimed to reduce transmission through early case-finding and effective treatment of the most infectious cases. Young children have historically been excluded from this focus, since their contribution to tuberculosis transmission is believed to be small. In the past decade, national tuberculosis programmes in high-burden settings have given increased attention to the challenges of childhood tuberculosis. In 2012, World TB Day focused on children for the first time. This attention is likely to increase further as the WHO Global Tuberculosis Programme’s ambitious post-2015 tuberculosis control strategy seeks to engage the entire health sector, including maternal and child health.”

4.    Lancet Global Health – Tuberculosis control needs a complete and patient-centric solution

Madhukar Pai et al.;

Whether it is mobile phone service or vacation travel, good businesses know that success depends on providing a complete and customer-centric solution. Should patients with tuberculosis not be offered a complete solution that is patient-centred? After all, millions are affected and a large market at the base-of-the-pyramid remains unserved. A complete and patient-centric solution will not only include care that meets the International Standards for Tuberculosis Care, but also be delivered with dignity and compassion, grounded in the reality of patients’ lives as they navigate the long pathway from symptoms to cure. Such solution-based innovation requires a systems-thinking approach that must place patients at the centre of design strategies, recognise their clinical and psychosocial needs, and be cost-effective.” This article provides some recent promising models.


5.    FT – special report on TB

This annual FT supplement on TB is always worth reading (but you need eyes like a pilot).


6.    Lancet Global Health blog –

Aaron Oxley;

This World TB Day, parliamentarians from all G7 countries signed on to an impressive call to action. That they do so is right, and timely, Aaron Oxley argues. But are these countries doing all they should in fighting the disease? He gives some suggestions on what they could do more, with a focus on ‘finding the missing 3 million’, this year’s theme, and ‘TB Reach’.


On World Tuberculosis Day, UNAIDS made an urgent call for global efforts to be stepped up to ensure earlier testing and treatment of TB and HIV.


You might also want to read a number of blog posts on TB, on the Speaking of Medicine website. Speaking of Medicine offered  three perspectives on tuberculosis research and treatment.


7.    Lancet Global Health (Correspondence) – Zero tuberculosis at the latest International AIDS Congress in Asia and the Pacific?

Petros Isaakidis et al.;

The authors of this short article recently attended the 11th International Congress on AIDS in Asia and the Pacific (ICAAP) in Bangkok, Thailand. ICAAP is the largest forum on HIV/AIDS held in the Asia—Pacific region and globally one of the largest AIDS conferences. During the 5 days of the conference, they hardly heard the words tuberculosis, TB, multidrug-resistant tuberculosis, or MDR-TB being used by either speakers, delegates, or community representatives. They wonder why the community at this AIDS conference was not discussing tuberculosis when it is undeniably an issue of high importance.


8.    Humanosphere – If only TB was as sexy as Ebola

Tom Paulson;

Xi Jinping probably thinks sometimes ‘I’m too sexy for my land, but if only I was as sexy as Obama’. Tom Paulson says, based on media coverage this week, that the same is true for TB. Ebola got most of the media attention this week, in spite of the fact that on Monday, World TB day was celebrated.


PBF toolkit



  • The PBF toolkit was officially released at the Results and Impact Evaluation workshop for Results Based Financing, organized annually by the World Bank. This time the workshop took place in Buenos Aires, Argentina. The event gathered around 200 experts from countries implementing RBF with WB support (and many WB experts). It’s a major knowledge event for the WB, of which the health sector is today largely dominated by the PBF strategy.   (Participants visited the field yesterday and were impressed by Argentina’s SUMAR plan: nationwide Results Based financing with an impressive impact.)


The toolkit was created by practitioners for practitioners and embodies decades of field testing to help them implement PBF in their own context. Guidance on the process, the planning, the design, and the implementation of PBF schemes is shared by authors who have experimented with various methods and who have designed, implemented, witnessed, and evaluated its effects. The toolkit addresses why PBF is used to finance health services in lower- and lower-middle-income countries and how practitioners can introduce PBF in their country. It provides tools and explanations to help the practitioner accomplish many tasks, and is meant to be a one-stop shop for the forms, tools, spreadsheets, contracts, terms of reference, performance frameworks, and so on that have been designed for successful PBF approaches in Asia and Africa.


It also contains lessons learned and experiential knowledge for starting PBF approaches and for scaling up these approaches nationwide. The toolkit contains what the authors (see below), as implementers, would have liked to know when they first started designing such approaches.


  • On the blog Financing Health in Africa, you can find an interview with the main architect of the toolkit, Gyuri Fritsche (see  here ). He compiled it together with two other policy entrepreneurs, Bruno Meessen and Robert Soeters. It wasn’t an easy journey, apparently…



UHC & post-2015


9.    AFGH – Realising the right to health for all: UHC and water, sanitation and hygiene (WASH)

Linked to World Water Day, this discussion paper explores why Water, Sanitation and Hygiene (WASH) must be included in a comprehensive definition of UHC and how this can be done.


10. WSJ  (blog) – After Polio, What’s Next on India’s Health Agenda

K. Srinath Reddy;

On March 27, India was officially certified polio-free. Reddy wonders what will come next – the answer, he says, is UHC, although the journey will be tough.


11.  Economist – Uphill all the way

Talking about difficult journeys, how’s Obamacare faring? It’s been a while since we reported on Obamacare, and this week’s Economist piece on Obamacare provides a good update. Check out also the related piece in the Economist (on the Supreme Court & Obamacare) (see here).


12. Humanosphere – Time to move from pruning trees in global health to forest management

Dave Algoso;

Algoso comments on the recent event on ‘best buys in global health’, hosted by the CGD along with Population Services International (PSI), PATH, Devex, and Merck for Mothers. As you might remember, apparently health systems strengthening is now very much considered a ‘best buy’ – or in the words of Algoso: “Participants tried to shoe-horn points about systems strengthening into the “best buys” rhetoric”. (Very nice blog post)



In a separate blog post, Amanda Glassman (CGD) also comes back on the Best Buys-event. (see here). ‘The key is in delivery’. She and her co-author give some takeaways from panelists.


13. UHC forward – UHC Forward will merge with the Joint Learning Network to make information on the global movement towards universal health coverage more accessible

Many countries are pursuing UHC to increase access to quality essential health care without financial hardship. For countries to achieve progress, it is critical that they have access to evidence about what works and how other countries are making progress. To address this critical challenge, in July 2014 the Joint Learning Network for Universal Health Coverage (JLN) and UHC Forward will merge web platforms and launch a new website under the JLN brand to serve as a one-stop portal for practical guides and tools that focus on the ‘how to’ of achieving UHC as well as information related to the global movement towards UHC.


14. Global Dashboard – Sustainable development goals, targets and…clusters?

Molly Elgin-Cossart;

The UN’s Open Working Group on Sustainable Development Goals (OWG) meets next week to discuss potential goals and targets to replace the MDGs, which expire in 2015. The OWG co-Chairs have attempted to reduce a long list of development priorities into 8 “clusters” for discussion (issued last week), following reactions to the 19 “focus areas” they released last month.  The logic behind the clusters is not that clear, though. You find the clusters here (health is part of cluster 2).


15. Guardian – Campaigners welcome ‘milestone’ agreement at UN gender equality talks

UN Member states have agreed that gender equality and women’s rights must be prioritised in future discussions on what should be included in the next set of sustainable development goals. After two weeks of negotiations in New York, the Commission on the Status of Women (CSW) ended in the early hours of Saturday morning with an agreement that called for the acceleration of progress towards achieving the millennium development goals, and confirming the need for a stand-alone goal on gender equality and women’s empowerment in the set of international targets that will be introduced once they expire in 2015. The agreement also said gender equality must underpin all other goals.”  Overall a pretty good outcome of the two weeks.  See also an analysis in the Huffington Post.


In other post-2015 news, some of the ‘Who’s who’ in global health were in London this week, for a two-day event at the Royal Society of Medicine, ‘Generating knowledge for health: the post-2015 challenge’. See here for the program.



And Richard Horton will be very pleased with the news that the Copenhagen Consensus guys intend to do ‘cost-benefit’ analyses on the post-2015 goals. (see



16. CGD – A “Data Revolution” of the People, by the People, and for the People – Not Just for Advocates

Mead Over;

Mead Over explains what a real ‘data revolution’ would look like, post-2015, which benefits not (only) post-MDG & SDG advocates, but the people at large.

17. UNAIDS – African Parliamentarians call ending AIDS to be priority in the post-2015 agenda

UNAIDS reports  on a roundtable at the Pan-African Parliament in Midrand, South Africa (25-26 March). The meeting was organized by the African Union Commission (AUC) in collaboration with the NEPAD Agency, and in partnership with the Pan-African Parliament (PAP) with support from UNAIDS and Global Fund   The special role of parliamentarians in advancing the AIDS response now and beyond 2015 was discussed there. (The aim of the dialogue was to create awareness and build the capacity of parliamentarians on the agreed 2013 Abuja actions toward the elimination of AIDS, TB & Malaria in Africa by 2030, the Roadmap on shared responsibility and global solidarity for HIV/AIDS, TB and Malaria, and the AU Manufacturing Plan for Africa (PMPA) including the African medicine regulatory harmonization (AMRH) initiative.)


18. Devex – We must seize the opportunity of the First High-Level Meeting of the Global Partnership for Effective Development Cooperation

Ngozi Okonjo-Iweala ;

In less than a month’s time, the Global Partnership for Effective Development Cooperation will hold its first high-level meeting in Mexico City. The Partnership was conceived at the Fourth High-Level Forum on Aid Effectiveness in Busan, Korea, in 2011 and helps nations, business and organizations work better together to end poverty. The Mexico meeting, set for April 15-16, marks a major milestone in the fight against poverty and in the run-up to the MDG target year of 2015.  Okonjo-Iweala provides some focal issues.


Global Fund


19. Globalization & Health – Implementing Global Fund programs: a survey of opinions and experiences of the Principal Recipients across 69 countries

Francis Wafula, Charles Marwa & David McCoy;

Principal Recipients (PRs) receive money from the Global to manage and implement programs. However, little research has gone into understanding their opinions and experiences. This survey set out to describe these, thereby providing a baseline against which changes in PR opinions and experiences can be assessed as the recently introduced new funding model is rolled out. An internet based questionnaire was administered to 315 PRs. A total of 115 responded from 69 countries in Africa, Asia, Eastern Europe and Latin America. The study was conducted between September and December 2012.


In other GF related news, Japan paid its 2014 contribution.


Other infectious disease


20. Reuters – West African nations scramble to prevent spread of Ebola deaths


The Ebola outbreak story is rapidly evolving. This was a report from earlier this week. To be continued, obviously. See also a WHO update from 26 March.


21. Reuters – Sanofi faces make-or-break verdict on big dengue vaccine bet


Sanofi expects final clinical results for its vaccine against dengue by late September. The company has already gambled on starting production despite some disappointing early trials data.


22. Guardian – UN brands polio outbreak in Syria and Iraq ‘most challenging in history’

There was good polio news this week, with the official declaration of the SE Asian region of WHO as polio free. But the news from the Middle East is very worrying.




23. WHO – 7 million premature deaths annually linked to air pollution

This was big news all over the world. Earlier this week, WHO reported, using new estimates, that in 2012 around 7 million people died – one in eight of total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save millions of lives.


See also the  Guardian.


24. Globalization & Health (Debate) – mHealth and global mental health: still waiting for the mH2 wedding?

Conor Farrington et al.;

The conjunction of high levels of mental illness and high levels of mobile phone usage in poorer countries highlights the potential for “mH2” interventions – i.e. mHealth (mobile technology-based) mental health interventions – to tackle global mental health challenges. However, global mental health movements and initiatives have yet to engage fully with this potential, partly because of scepticism towards technological solutions in general and partly because existing mH2 projects in mental health have often taken place in a fragmented, narrowly-focused, and small-scale manner. The authors argue for a deeper and more sustained engagement with mobile phone technology in the global mental health context, and outline the possible shape of an integrated mH2 platform for the diagnosis, treatment, and monitoring of mental health.

25. World Bank – The seven salvos of sin (taxes)

Jim Brumby;

Recently, the representatives of ministries of finance and ministries of health, as well as a host of civil society organizations and international organizations, met in Manila to consider lessons to be drawn from the international experience surrounding so-called sin taxes. Brimby sees seven lessons. Now we just have to wait for the movie with Kevin Spacey.


In other tobacco related news, the Lancet features the first systematic review and meta-analysis this week, examining the effect of smoke-free legislation on child health. It shows that rates of both preterm births and hospital attendance for asthma were reduced by 10% within a year of smoke-free laws coming into effect. The analysis of 11 studies done in North America and Europe, involved more than 2.5 million births, and nearly 250 000 asthma exacerbations. Has obvious lessons also for LMICs. Currently only 16% of the world’s population is covered by comprehensive smoke-free laws, and 40% of children worldwide are regularly exposed to second-hand smoke.

26. Lancet (Editorial) – Towards a better life with Alzheimer’s disease

Much needs to be done to help the growing population with Alzheimer’s disease around the world. A good life with dementia, a report published by the UK Alzheimer’s Society on March 19, focuses on care for people with dementia and recognises the serious challenges that exist, whether patients are living in the community or in care facilities. The report describes six domains—respect for identity, remembering life experiences, sustaining relationships, enabling happiness, protecting people from risks, and maintaining health—to preserve a good quality of life for people with Alzheimer’s disease and other forms of dementia, and for their families. According to the report, timely diagnosis, increased public awareness, and greater flexibility of care would help to address the challenges. A better life with Alzheimer’s disease should not be an exception, but the norm across societies.”  Hope the whole world pays attention.

27. Plos Translational global health – An Epidemic of Trauma on the Road

Christopher Tedeschi, Assistant Professor of Medicine at Columbia University and a practicing emergency physician, explores the global and local epidemic of road traffic accidents. From personal close-call, to big-picture epidemiology.  (must-read about an issue that should be higher on the international health agenda)



Access to medicine


28. Commons – The Transatlantic Trade and Investment Partnership (TTIP): A Civil Society Response to the Big Pharma wish list

The analysis of the 5 most worrying proposals of the pharmaceutical industry’s wish list for the EU-US trade agreement reveals a real threat to European public health systems and democracy. A report by the Commons Network and civil society partners shows that the pharmaceutical industry’s wish list for the TTIP is detrimental for public health, will increase the cost of medicines and undermines democratic processes.


29. BMJ (news) – Trade talks between US and EU could increase cost of drugs, new report says

Deborah Cohen:

This BMJ news article gives a summary of the Commons report (see above). “Ongoing free trade negotiations between the European Union and the United States will lead to agreements that will “limit transparency of clinical trials” and “increase the cost of medicines” if the drug industry has its way, a coalition of public health groups has said in a report.”


30. Global health Europe – Summary: Last week’s EU Global Health Policy Forum in Brussels – Access to Medicines

Last week on March 20th, the EU Global Health Policy Forum took place at the premises of the European Economic and Social Committee in Brussels. Approximately 60 stakeholders from academia, civil society, industry and policy came together to discuss in an open environment the issue of ‘Access to medicines’ in countries outside the EU.  Presentations were given by representatives from WHO, the European Generic Medicines Association (EGA), MSF, the Medicines Patent Pool (MPP) and the European Federation of Pharmaceutical Industries and Associations (EFPIA). The presentation slides can be found here. All in all, an extensive discussion emerged with stakeholders on the issues of barriers and facilitators to access to medicines, intellectual property rights, quality and safety of medicines – and EU strategies and activities on how to improve access.”


31. Reuters – Australia demands opponents stop stalling WTO tobacco case

Australia asked five countries challenging its tobacco policies on Wednesday to stop delaying the progress of their cases at the World Trade Organization and took the unusual step of speeding up one of the complaints against itself. … Australia hopes the stringent packaging laws will reduce smoking and improve public health, and other countries around the world have said they may follow suit, based on the WTO case, raising the stakes for a speedy resolution…”  (Indonesia, Ukraine, Cuba, Honduras and Dominican Republic have all launched complaints at the world trade body to try to overturn Australia’s “plain packaging” laws on tobacco.)  For some more detail, see an IP Watch article.


32. Nature – WHO: Steering plans for neglected diseases

Bernard Pécoul & Manica Balasegaram;

The authors (resp. from the Drugs for Neglected Diseases initiative & MSF) respond to the rather blunt viewpoint in Nature from a while ago by Mary Moran (who criticized plans by WHO for tackling neglected diseases in the developing world).

Maternal & Child health


33. Guardian – Family planning groups in developing countries set for Bloomberg boost

Grassroots organisations are to share in a multi-million dollar project to improve family planning and reproductive health services for women and girls in Africa and Latin America. Groups in Uganda, Burkina Faso, Senegal and Nicaragua will be able to apply for advocacy grants as part of a three-pillar, $50m package to support family planning services. The scheme was announced on Thursday by Bloomberg Philanthropies, set up by Michael Bloomberg, the former mayor of New York.


34. WHO Bulletin (early online) – Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

Ellen Van de Poel et al.;

This study aimed to evaluate the effect of vouchers for maternity care in public health-care facilities on the utilization of maternal health-care services in Cambodia. Voucher schemes increased deliveries in health centres and, to a lesser extent, improved antenatal and postnatal care. However, schemes that targeted poorer women did not appear to be efficient since these women were more likely than less poor women to be encouraged to give birth in a public health-care facility, even with universal voucher schemes.


35. Lancet Global Health – Why are economic growth and reductions in child undernutrition so weakly correlated—and what can public policy do?

Abhijeet Singh et al.;

From the new (April) Lancet Global Health issue. Singh comments on the new analysis in The Lancet Global Health by Sebastian Vollmer and colleagues who assess the (often implicit) claim that economic growth will automatically lead to declines in child undernutrition: if poor nutritional outcomes are a manifestation of the poverty of nations, then surely economic growth would offer a remedy? Marshalling individual-level data from 121 Demographic and Health Surveys, Vollmer and colleagues document at best a weak, and often absent, association between economic growth and reductions in stunting, underweight, or wasting.


36. World Bank – Integrated Community Case Management: How Can We Ensure Its Sustainability?

Patricio V Marquez;

Marquez was recently part of a panel at an international symposium on Integrated Community Case Management (iCCM) held in Accra, Ghana, and hosted by UNICEF and other organizations, including WHO, USAID, Gates Foundation and Save the Children. The goal of the panel was to consider the role of partners in sustaining iCCM, in particular in supporting countries and their governments to scale up, deliver and fund iCCM, looking forward to the post-2015 MDG period.


World Health Assembly


More preparatory documents for the next WHA are now available – see


37. Infobabymilkaction – Opening the door to Business lobbying – what’s wrong with the new WHO policy proposals

A while ago, WHO published a draft proposal for a Framework and set of policies to address its engagement with Non State Actors (NSAs). Member States are being invited to discuss these proposals at WHO’s HQ in Geneva on 27th and 28th March. Public Interest NGOs are not invited.   IBFAN  (International Baby Food Action Network)  has been following the process closely and finds serious flaws, inconsistencies and contradictions in the proposals.

38. IPWatch – WHO Members Discuss Engagement With Non-State Actors This Week

Still on the same meeting in Geneva, the informal consultation with member states on WHO’s engagement with “non-state actors.” The meeting follows a request by member states at the January WHO Executive Board to pursue discussions on a framework for the organisation’s engagement with non-state actors, which has been changing in recent years. This article has all the detail.


In other WHO related news, we learnt on Twitter (via R Horton) that Chris Dye is to start as WHO’s new Director of Strategy on Monday. He will put science at heart of WHO, according to Horton.



Health Policy & Financing


39. Lancet Global Health (April issue)

Zoë Mullan gives an overview of the content of April’s Lancet Global Health issue in her editorial.


We especially want to draw your attention, in addition to articles already mentioned above, to an article on expanding access to mental health care in LMICs (see here), and an article on disseminating research in sub-Saharan Africa through journal partnerships.


40. Lancet Global Health (blog) – ‘Wonder’ drug attracts global health award

Andy Crump;

Satoshi Omura, of the Kitasato Institute in Japan, was awarded the 2014 Gairdner Global Health Award for his work on the origin and discovery of ivermectin. Millions of people, mostly in poor rural communities throughout the tropics, are taking ivermectin annually to cure or eliminate some of the world’s most disfiguring, stigmatising, and socioeconomically devastating diseases.

41. BMJ (blog) – The science of climate denialism

David McCoy;

McCoy distinguishes between all kinds of climate denialism, among others between ‘epistemic scepticism” (where people doubt the reality or causes or climate change) and “response scepticism” (where people dispute the efficacy of acting to tackle the problem). He says the key battle is to overcome response scepticism (rather than epistemic scepticism), and the health community should be at the forefront of this. Totally agree. So let’s start (with my own response scepticism, I’m afraid …).


42. BMJ (editorial) – Climate change and human survival

David McCoy et al;

The IPCC report shows the need for “radical and transformative change”, McCoy et al argue. “If we are to avoid catastrophic climate change and bequeath a sustainable planet worth living on, we must push, as individuals and as a profession, for a transformed, sustainable, and fair world.” He also lists what health professionals can do.


43. Lancet (World Report) – Doctors criticise UN’s approach to global drugs control

Ed Holt;

A high-level UN meeting on international drug policy came to a close last week with doctors lamenting the lack of progress on health issues. Ed Holt reports from Vienna.

Growing numbers of doctors are calling for a health-based approach to be adopted as a cornerstone of global drugs policy as a high-level UN conference highlights what critics say are continued failings in international bodies’ strategies for dealing with global drug problems. The High-Level Review at the latest annual session of the UN Commission on Narcotic Drugs (CND)—the chief policy-making body for international drug control—in Vienna earlier this month assessed how the UN is meeting goals for dealing with the global drug problem ahead of a UN General Assembly Special Session on Drugs in 2016.”


44. CGD – PEPFAR and MCC Partner to Promote Country Ownership

Jenny Ottenhoff;

Last week, PEPFAR signed a three-year agreement with the Millennium Challenge Corporation (MCC) to support efforts to promote greater host-country responsibility and ownership in the US global AIDS program. See also a PEPFAR

press release and a Devex article. In this blog post, Ottenhoff mentions that the MCC model includes three features that could be extremely useful in moving PEPFAR toward a more country-owned approach.


45. Science Speaks – Uganda anti-homosexuality law ramifications and consequences unfold in “complicated” relationship with US

Science speaks;

Two responses to human rights violations are not mutually exclusive, a U.S. State Department spokesperson said, referring to the (aid) response to Museveni’s signing of the law but also the decision to send increased United States military support to Uganda to track down human rights violator and warlord Joseph Kony.


See also Buzzfeed on the memo by USAID Mission Director Leslie Reed entitled, “U.S. Government Response to enactment of the Anti-Homosexuality Bill.” (from end of February).


In other news on Uganda, reports Uganda’s anti-gay law may threaten its research.


46. Associated Press – Ethiopian lawmakers to pass bill deemed anti-gay


Tu quoque, Ethiopia? Legislation is proposed in Ethiopia that would make homosexuality a “non-pardonable” offense.


47. – We can create a sharp global picture of health research

Robert Terry;

Obtaining a reliable global picture of health research will make it possible to spot gaps and encourage greater collaboration in the development of new drugs, diagnostics and vaccines. The WHO is now developing the Global Health Observatory, a platform that will eventually produce the picture we need. But some challenges still need to be overcome, Terry argues.

48. Devex – US global health research funding falls short of innovation rhetoric — NGOs–ngos-83155

Despite the Obama administration’s emphasis on science, technology, and innovation for international development, United States funding for global health research and development is not what it could or should be, according to an advocacy coalition of 30 global health nongovernmental organizations. On Thursday, the Global Health Technologies Coalition made a case on Capitol Hill in a Senate briefing aimed at convincing lawmakers that American global leadership demands funding for U.S. global health technologies and products — including low-cost vaccines, drugs, diagnostics, and devices that can combat diseases endemic to the developing world.”




49. BMC Public Health – Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework

Sandra Mounier-Jack, …, & Bruno Marchal;

The WHO health systems Building Blocks framework has become ubiquitous in health systems research. However, it was not developed as a research instrument, but rather to facilitate investments of resources in health systems. In this paper, the authors reflect on the advantages and limitations of using the framework in applied research, as experienced in three empirical vaccine studies we have undertaken.




Emerging Voices



50. Revue Santé publique – Les difficultés d’accès aux soins de santé des indigents vivant dans des ménages non pauvres

Kadidiatou Kadio, Valéry Ridde et al.;

To increase the financial access to health care for indigents, action research was conducted in Burkina Faso. Based on a community approach, village committees identified indigents who were exempt from payment of health care fees. Quantitative analysis of the food expenditure of selected households (to assess the efficacy of the community-based selection) showed that some of the indigents selected came from households with a high economic level. This research was designed to explain why these people were identified by the Village Selection Committees (VSC).



51. ODI (paper) – Zero poverty… think again: the impact of climate change on development efforts

Climate change will affect the achievability of any future development goals through its impacts on areas such as agriculture, water and health, and through its many indirect impacts. This paper reviews what is known about the impacts of climate change on potential post-2015 development goal areas and shows that it is essential for climate change to be addressed in order not to compromise development efforts.

It concludes that however climate action and adaptation are incorporated into the post-2015 agreements, it is vital that the final result is coordinated and sufficient because without it, progress on human development, and reaching a world with zero poverty, will be severely impacted.


Check out also:


  • Great article and great title (on Open Democracy) – “My environmentalism will be intersectional or it will be bullshit.” (by Adam Ramsay – not the football player, I presume)


  • New CGD   working paper on ‘Does development reduce migration?’ (by Michael Clemens)

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