Dear Colleagues,

Plenty of news this week, as usual: Ebola, World Health Day  coming up, the second IPCC report, even more disturbing than all the previous ones, the EU-Africa summit, Deborah Birx finally confirmed for PEPFAR, a number of new publications and articles around post-2015, 20 years after the genocide in Rwanda, Jim Kim admitting the World Bank was ‘wrong and ideological’ with respect to user fees,… so we’ll keep it short in this week’s intro.

Nevertheless, it’s good to reflect briefly on the mysterious ‘laws of the media’, now that Belgium was visited by Obama, Xi Jinping and 80 African leaders, all within one week. Last week, “Obama-mania” turned professional journalists in my country into near-groupies; Xi Jinping, who arrived a few days later, didn’t quite have the same effect, but he still got quite some attention (and the same was true for his wife and the two pandas offered as a gift to Belgium some time ago; the Xi’s visited the pandas – believe it or not, by now we have managed to turn Hao Hao and Xing Hui into a communitarian issue in Belgium, dividing the North and the South – and no, this is not an April’s fool joke). 

The 80 African leaders who arrived in Brussels earlier this week got far less visibility, at least in Belgian newspapers. They weren’t totally ignored, but whereas nobody could escape Obama’s blitz-visit, and we learnt all about Air Force One, the Beast and the draconic security measures taken (in less than a day), coverage of the EU-African Union summit mainly focused on content issues (maybe because Angelina Jolie wasn’t there?), such as the horror in the Central African Republic, the migration issue, etc. Overall, attention was rather limited, at least when I compare with the 3rd China-Africa cooperation forum in Beijing in 2006, for example, when I happened to be around in the Chinese capital. Or if you compare with the funeral of Mandela a few months ago… (you might want to imagine now the ‘end-of-episode’ voiceover of “Desperate Housewives”, trying to draw a pseudo-wise lesson from all this, but I’ll spare you thatJ)   

In this week’s guest editorial, Shishir Dahal, Emerging Voice from Nepal, dwells on the exploitation of Nepali migrants which started long ago but continues till today, albeit in different forms. From ex-Gurkhas over Fifa-construction workers in the Gulf to women and girls suffering in Indian brothels, the fate of poor Nepali people should get far more attention. Tell our media.


Enjoy your reading.


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




Country of slaves

Shishir Dahal (EV 2010)

Immigration has a long history in Nepal. Many people living in the Nepali hills migrate due to a lack of agricultural land and poor infrastructure for industry. In other words, migration to improve one’s livelihood is an obligation rather than a choice for many Nepalese. The 21st century is not much different from previous centuries in that respect.

Before India was colonized by the British, major cities in India were a popular destination for Nepalese migrant workers. They were recruited for the work local populations were unwilling to do,  like washing dishes, cleaning, cooking,  … You name it.

In the history of Nepalese migrant workers, the 1815 Anglo-Nepalese war was  a turning point. In that war a well-equipped British army was defeated by the (comparatively small but ferocious) army of the Gurkha kingdom. Impressed by the bravery of Gurkha soldiers, the British started to recruit Nepalese soldiers establishing a separate “Brigade of Gurkhas”  in their army, first – under a clause of the peace and friendship treaty with the Nepali king- in the East India Company’s arm. This was the start of a long military alliance between the British and the Gurkhas which lasts till today. Since then the British army has set up (annual) recruitment camps in the Himalayan foothills of Nepal, recruiting thousands of young Nepalese for the army. In every war the British fought over the past two centuries, the “Brigade of Gurkhas” has played a significant role. Sadly, often these poor Nepalese are intentionally portrayed as  ruthless mercenaries and even cannibals  (see here or  here for some recent examples of biased media coverage of the Gurkhas). Less known perhaps is that many former Gurkhas are fighting against the British government, asking politicians to do something about the discrimination they face(d) while in service and after their retirement. Till this day, this struggle continues for many of them, even if the British government has taken a few measures recently.

Unlike Gurkha “migration”, mass migration towards the Persian Gulf countries started only two decades ago. Political instability in Nepal due to the Maoist insurgency, combined with the need for cheap labour in the booming economies of many Gulf countries led to a massive outflow of migrant workers. Nepalese workers are mostly unskilled or semi-skilled and typically recruited for construction work. When Qatar was selected to host the 2022 World Cup football, the demand for Nepalese workers increased even more, as they are considered obedient, hardworking and honest workers. And cheap, of course. Unfortunately, these workers have to work under the notorious Kafala system. The kafala system (‘sponsorship system’) is a system used to monitor construction laborers in Persian Gulf states. The system requires all unskilled laborers to have an in-country sponsor, usually their employer, who is responsible for their visa and legal status. The harsh system allows the confiscation of passports and (illegal) charging of exorbitant agent fees. Qatar has an exit visa system so these migrant workers cannot leave the country without their sponsor’s permission. Many of them thus find themselves trapped in a Gulf country with unpaid wages, working under inhumane working conditions.

To give you an idea, 44 Nepalese workers died between 4 June and 8 August last year, in about two months in other words. Without major improvements, the International Trade Union Federation (ITUC)  estimates that 4,000 workers are likely to die before the first ball is kicked in 2022. Back in Nepal more coffins will be arriving with a “Natural Death “ tag on them, more poor families will be mourning beloved ones and more Nepali hearts will break. When the tournament finally kicks off in 2022, these victims of the so called ‘beautiful game’ will be forgotten. “Collateral damage”, so to speak. FIFA officials along with the Qatari Emir will then be sitting on plush seats in air-conditioned stadiums, made on a pile of dead bodies of these unfortunate labourers. Together with thousands of other “fans”, they’ll be cheering on  “million dollar” boys & men, chasing a ball. Everyone is talking about the likely impact of Qatar’s extreme heat on a few hundred (let’s not forget, ridiculously overpaid) football players, some even want the tournament to take place in a less hot season. Poor Rooney, Ronaldo and Kompany… Football pundits are already wondering how English fans will support their team without bottles of beer, if alcohol is not allowed around the stadiums…

Both groups of Nepali migrants, the  “Gurkhas’ and “FIFA workers” were compelled to work and often die  in  foreign lands,  serving their masters  in the hope that they would be able to send at least some of the money they earn(ed) to their impoverished beloved ones back home. Time and again both groups have been and are being discriminated against, abused and humiliated (and we didn’t even mention the numerous poor Nepali girls and women illegally trafficked across the border with India, to work in brothels in places like Delhi, Mumbai and Kolkata, a sad story which requires an editorial in itself).

Recently, a reputed British newspaper came up with a series of articles exploring the plight of “FIFA Construction workers”. Ironically, far less is being said in British media about their fellow service men, “The Gurkhas”…

So misfortune continues and slavery never ends for poor  Nepalese.  They are raped and tortured in the brothels of Kolkata, enslaved in the stadiums of Doha and humiliated in the barracks of London.






1.    Globalization & Health – How can health remain central post-2015 in a sustainable development paradigm?

Peter S Hill, Kent Buse, Claire E Brolan & Gorik Ooms;

Health did well out of the MDG process, but the global context and framing of the new (SDG) agenda is substantially different, and health advocates cannot automatically assume the same prominence. This paper argues that to remain central to continuing negotiations and the future implementation, 4 strategic shifts are urgently required. Advocates need to reframe health from the poverty reduction focus of the MDGs to embrace the social sustainability paradigm that underpins the new goals. Second, health advocates need to speak–and listen–to the whole SD agenda, and assert health in every theme and every relevant policy, something that is not yet happening in current thematic debates. Third, we need to construct goals that will be truly “universal”, that will engage every nation–a significant re-orientation from the focus on low-income countries of the MDGs. And finally, health advocates need to overtly explore what global governance structures will be needed to finance and implement these universal SDGs.


2.    Globalization & health – Back to the future: what would the post-2015 global development goals look like if we replicated methods used to construct the millennium development goals?

Claire E Brolan et al.;

The MDGs were ‘top-down’ goals formulated by policy elites drawing from targets within UN summits and conferences in the 1990s. Contemporary processes shaping the new post-2015 development agenda are more collaborative and participatory, markedly different to the pre-MDG era. This study examines what would the outcome be if a methodology similar to that used for the MDGs were applied to the formulation of the post-2015 development goals (Post-2015DGs), identifying those targets arising from UN summits and conferences since the declaration of the MDGs, and aggregating them into goals.


3.    Placing Healthy Women and children at the Heart of the Post 2015 sustainable development framework

The Partnership for Maternal, Newborn and Child Health (PMNCH) policy brief on “Placing Healthy Women and Children at the Heart of the Post 2015 Sustainable Development Framework” is now open for consultation until 21 April 2014. “With negotiations by the UN Open Working Group currently underway in New York for what will be the next iteration of the MDGs, The Partnership, through its Post 2015 Working Group has issued this brief, to inform member states and Post 2015 advocates on critical women’s and children’s health issues and how these could be integrated into the Post 2015 development agenda.”


Speaking of this UN Open Working group, the Co-Chairs of the Open Working Group on SDGs have released a number of documents in preparation for its 10th session which took place from 31 March till today at the UN headquarters in NY.  This included a revised  focus areas document. Check out focus area three: health and population dynamics, which includes virtually everything the global health community cares about…


4.    New Security Beat – For Maternal Health, What Role Will Universal Health Coverage Play In a Post-MDG World?

Katrina Braxton;

Braxton (Katrina, not Toni) reports on a panel of experts at the Wilson center (February 20) who contemplated what role UHC could play for the global maternal health agenda. This agenda has been largely defined by the MDGs for the last decade and half, but what will happen after they expire in 2015? What kind of framework is needed to continue the momentum towards eliminating preventable maternal deaths and morbidities? The panel of experts (including Jonathan Quick – see also his recent Plos  essay on the same issue) reckoned UHC is a powerful mechanism that may be crucial to finishing the job.  (the article also features a link to the video of the panel session)


5. – Health Research re-orients to the post-2015 agenda ;

Two articles report on last week’s conference at the UK’s Royal Society of Medicine, ‘Generating knowledge for health: the post-2015 agenda’.  (see also

this one). Both are well-worth reading.


6.    Beyond 2015 – Beyond 2015 builds potential targets for a post-2015 framework

Since 2012, part of the focus of “Beyond 2015”, a global civil society campaign pushing for a strong and legitimate successor framework to the MDGs,  has been the conceptual foundations of the post-2015 agenda: the vision; the purpose and the values behind any framework, as well as criteria by which to judge potential goals, targets and indicators.


Two documents were produced recently in Pretoria, namely:

  1. a Beyond 2015 Think piece on the post-2015 agenda:  “The think piece highlights the key challenges of our time, including the persistence of extreme poverty, rising inequality, social injustice, accelerating climate change, unsustainable use of natural resources and  conflict, violence and insecurity. It highlights the opportunity we currently have to build “an equitable and sustainable world where every person is safe, resilient, lives well, and enjoys their human rights, and where political and economic systems deliver well-being for all people within the limits of our planet’s resources”, and the role of the post-2015 framework in doing so.”
  2. Beyond 2015 Values and targets for the post-2015 framework. “The ‘Values and Targets’ document builds on the work of the various Thematic Task Forces, and provide a list of 40 targets which cut across the agreed values (Environmental Sustainability, Human Rights, Poverty Eradication, Well-being, Peace and security, Equity, Global Responsibility). These targets will be a key advocacy tool for the whole campaign throughout the intergovernmental negotiations around the post-2015 agenda.


7.    IHP+ Civil Society Consultative Group: position paper April 2014 – Aid effectiveness in the health sector beyond 2015

Members of the IHP+ Civil Society Consultative Group (CSCG) met in December 2013 and identified priorities for the coming year. They agreed that the post-2015 development agenda presents an opportunity to secure more ambitious global health commitments, and for aid and other forms of development co-operation to be delivered in a more effective transparent and accountable way.  CSCG members have developed this position paper on Aid Effectiveness in the Health Sector Beyond 2015. They argue that health must be central to any post-2015 development framework and that the IHP+ already offers a set of tools and ways of working that can support governments and development partners to implement any future health goal(s) in line with the principles agreed in the Busan Partnership for Effective Development Co-operation, Accra Agenda for Action and Paris Declaration.


8.    IPS – Donors Repeatedly Postpone Major Aid Effectiveness Report

Major foreign assistance donors have again delayed the release of a report meant to measure transparency, accountability and cooperation of aid effectiveness. The repeated delay of the voluntary U.N.-guided report, which was originally slated for release in January but was bumped for at least a second time last week, has prompted some aid groups to question donor countries’ commitment to aid transparency.” The report would be the first of its kind. The “Global Partnership for Effective Development Cooperation”, established in Busan in 2011, emphasizes the “ownership” of aid recipients over development strategies alongside strengthened transparency and accountability for aid programming. The global monitoring framework on aid effectiveness would assess and track progress on the agreements made in Busan, and was slated for release in early 2014, but it has been postponed several times.


9.    Global Health Action – How might global health master deadly sins and strive for greater virtues?

Cathérine Panter-Brick et al.;

As a former Catholic, I love it when global health scholars use Catholic metaphors and concepts (like “deadly sins”, 4 “main temptations”, etc) to talk about global health issues and governance. The authors of this paper examine how the field of global health might surmount current challenges and prioritize its ethical mandate, namely to achieve, for all people, equity in health. They use the parlance of mastering deadly sins and striving for greater virtues in an effort to review what is needed to transform global health action. Global health falls prey to four “main temptations”: coveting silo gains, lusting for technological solutions, leaving broad promises largely unfulfilled, and boasting of narrow successes. This necessitates a change of heart: to keep faith with the promise it made, global health requires a realignment of core values and a sharper focus on the primacy of relationships with the communities it serves. Based on the literature to date, they highlight six steps to re-orienting global health action.  (looking forward to the muslim & Buddhist version of this article)




10. Summary report of a meeting in Bellagio, 11-13 March 2014: Monitoring UHC

As you might recall, the joint WHO/World Bank paper “Monitoring progress towards universal health coverage at country and global levels: a framework” was launched in December 6, 2013 and available on the web for consultation through mid-February 2014.  Approximately seventy comments on the WHO/WB framework were received from UN agencies and World Bank, bilateral development partners, civil society organizations, academics and others. These were used as a starting point for recent meeting discussions in Bellagio. The discussions were organized in five areas:

1. General issues related to the M&E framework; 2. Monitoring financial risk protection; 3. Monitoring intervention coverage; 4. Equity and targets; 5. Research and measurement needs; communication.


11. World Bank Health (blog) – Universal health coverage: Measuring the path to progress

Ashis Kumar Das;

Built-in and ongoing collection and tracking of quantitative and qualitative data may be suitable for country-specific UHC measurement. Though tracking process and qualitative indicators is context-specific, it would be efficient to design a set of global measures to track countries embarking on UHC. Building capacities of the National Health Research Unit for UHC measurement could be a potential idea in the medium- to long-term for several low- and middle-income countries.”


We also hope many of you will watch the WB event on UHC, on April 11, ‘Toward Universal Health Coverage by 2030’, with the likes of Margaret Chan, Jim Kim, Ngozi Okonjo-Iweala, Bloomberg, Lawrence Summers, …  and many more people.  This is one of the live broadcast sessions during the WB’s biannual Spring meeting. “Co-sponsored by the World Bank Group and WHO, this half-day high-level event will identify ways in which countries can accelerate achievement of the MDGs and emerging post-2015 targets with aligned support from the global development community  around UHC.”


12. Coming up: 1st  African Ministers of Health meeting jointly convened by the AUC and WHO


The first meeting of African Ministers of Health jointly organized by the World Health Organization and  the African Union Commission is scheduled for 14 to 17 April 2014 in Luanda, Angola. Delegates to the four-day meeting are  expected to: identify key actions needed to accelerate progress towards Universal Health Coverage, agree on key milestones  for the establishment of an African Medicines Agency, as well as on mechanisms for addressing risk factors for NCDs. The meeting is also expected to  agree on 2 crucial processes: one  for the establishment of an African Centre for Disease Prevention and Control, and the other for joint accountability mechanisms for implementing Declarations and Commitments agreed by the continent’s health ministers. A review of the status of Africa’s plan for the ending preventable maternal and child deaths also features on the agenda of the meeting.  You find the provisional agenda & some background docs on the site (including the document : “UHC in Africa: from concept to action”).


13. NEJM – The Legality of Delaying Key Elements of the ACA

Nicholas Bagley;

For the lawyers among you: NEJM features two pieces (see also this one ) on the legality of delaying some elements of Obama’s Affordable Care Act.


14. Oxfam Briefing paper – Working for the Many: Public services fight inequality

Emma Seery;

Free public services, such as health and education, are one of the strongest weapons in the fight against inequality. They benefit everyone in society, but the poorest most of all. They mitigate the impact of skewed income distribution, and redistribute revenue by putting ‘virtual income’ into the pockets of the poorest women and men.

Across OECD countries public services already provide the poorest people with the equivalent of 76% of their post-tax income. Oxfam is calling on governments to urgently reform tax systems and increase public spending on free public services, such as health and education, to tackle inequality and prevent us being tipped irrevocably into a world that works for the few and not the many.”


For a summarizing blog post by Emma Seery, see here.



And yes, as already mentioned in the intro, Jim Kim now publicly said  the WB was “wrong and ideological”, with regards to user fees in LICs.  Let’s all drink champagne tonight.



IPCC report & climate change


15. Global Climate & Health Alliance – Climate change: health impacts and opportunities – a summary and discussion of the latest IPCC working group 2 report

However, perhaps we should leave the drinks in the fridge for the moment. The IPCC released yet another report earlier this week – you probably noticed J. The most recent report from Working Group 2 of the Intergovernmental Panel on Climate Change, “Climate Change 2014: Impacts, Adaptation and Vulnerability”, describes in worrying detail, the current and future impacts of climate change; as well as the

challenges we face in mitigating further climate change and adapting to its impacts.   This report by the Global Climate & Health Alliance summarizes this report, and also  suggests recommendations to health professionals on what they can do to address the profound impacts of climate change on human health and social wellbeing.

16. Lancet (Comment) –  Climate change and health: on the latest IPCC report

Alistair Woodward et al.;

The IPCC released its fifth report on March 31. In a Comment in The Lancet, Alistair Woodward and other contributors to the report discuss its assessment of the anticipated effects of climate change on health. Although some reduction in morbidity and mortality related to cold weather is possible, for example, it is expected that risks of injuries, disease, and deaths will be exacerbated by hot weather. Action to reduce air pollution and improve reproductive health services is called for.


BMJ also pays some attention to the report, for example in the Editorial, ‘Climate change is a health emergency’.  Tell me something new.  (I’m a little bit baffled by the many viewpoints  I’ve been reading recently on the supposedly very important role health professionals can play in tackling this enormous challenge. Yes, they have a role to play, but not a much more important role than economists, ordinary citizens, politicians, communications people, activists, etc. In order to learn to live within planetary boundaries, we will need everyone. And as far as I can see, many health professionals, at least in developed countries, happily take part in our dead-end consumerist lifestyle )


Other remark: this week we had demographer John May in Antwerp for a lecture at ITM. He provided us with some of the latest demographic trend projections for the world and sub-Saharan Africa more specifically, and the potential for reaping a demographic dividend. It made me wonder whether we shouldn’t link the population/fertility issue in some SSA countries with climate change negotiations. For example, in the – no doubt very toxic – grand bargain: “If you guys do something about your fertility rates, we will do something about our unsustainable consumption patterns in the North”  (not May’s idea, just a wacko suggestion of mine).  There won’t be many takers, on both sides, I guess, but that doesn’t mean it shouldn’t be put on the table. In any case, it would be a beneficial agenda for both sides, as well as for the planet.


17. Guardian – Climate change will ‘lead to battles for food’, says head of World Bank

Jim Kim was interviewed ahead of the biannual World Bank meeting. Among other issues, he urged campaigners and scientists to work together to form a coherent plan in the fight against climate change, as has been done for HIV in the past. So far, this plan is still lacking. Time is running out.


EU-Africa summit in Brussels


18. IPWatch – Africa-EU Businesses, International Organisations Send Recommendations On Health To Leaders

Representatives of private sector, international organisations and others from Europe and Africa this week delivered a set of recommendations on health and pharmaceuticals to the two regions’ leaders ahead of their summit taking place earlier this week. The list of recommendations, which includes commitments on substandard and counterfeit medicines, emerged from a roundtable on health and pharmaceuticals held at the 5th EU-Africa Business Forum, which took place from 31 March to 1 April in Brussels. The list was passed on to heads of state meeting at the IV EU-Africa Summit on 2-3 April in Brussels.


For some great analysis of the EU-Africa summit itself, see this Chatham House expert view (by Alex Vines) and an Euractiv article on the ‘elephant in the room’, illicit capital flows.



World health Day


19. WHO – World Health Day 2014: reventing vector-borne diseases – “Small bite, big threat”

More than half the world’s population is at risk from diseases such as malaria, dengue, leishmaniasis, Lyme disease, schistosomiasis, and yellow fever, carried by mosquitoes, flies, ticks, water snails and other vectors. Every year, more than one billion people are infected and more than one million die from vector-borne diseases. This World Health Day – 7 April – WHO is highlighting the serious and increasing threat of vector-borne diseases, with the slogan “Small bite, big threat”. The Organization also emphasizes that these diseases are entirely preventable. Newly published “A global brief on vector-borne diseases” outlines steps that governments, community groups and families can all take to protect people from infection.


As some of these vector-borne diseases are re-emerging in the North, you could say they have their very own interpretation of ITM’s mantra ‘Switching the poles’


20. Huffington Post – World health day

Peter Hotez;

The WHO is recommending we use this World Health Day to remember the devastating impact of vector-borne diseases, especially on the world’s poor. The good news is that there is cause for optimism that through new technologies we might one day dramatically improve global health through disease control and elimination”, argues Peter Hotez, “Mister NTDs”.



Global Fund


21. IIGG working paper – The Global Fund’s China Legacy

Yanzhong Huang & Jia Ping;

Over the past decade, the Global Fund’s presence in China has left behind a deeply mixed legacy. Although the Fund’s money has made important contributions to China’s fight against AIDS, TB, and malaria, as well as its domestic health governance in ideational, institutional, and policy domains, it is associated with uneven progress in grant performance, low value for money, unintended effects on civil society–building, and enduring challenges to scaling-up and sustainability.

In this International Institutions and Global Governance program Working Paper, CFR Senior Fellow Yanzhong Huang and Jia Ping, chief executive director of the Health Governance Initiative, argue that the mixed legacy has important implications for global health governance, the Fund’s future financing model, and China’s handling of its own public health challenges.


In other Global Fund news related to China, it was announced that the GF is deepening its partnership with China by tapping the expertise of Chinese pharmaceutical companies to develop and market drugs that will help defeat AIDS, tuberculosis and malaria all over the world.


22. Global Fund observer – new issue 241

In this issue, we especially want to draw your attention to Bernard Rivers’ Commentary on the necessity of reform in the Governance of the Global Fund. Some of the suggestions in this article are excerpted from a paper entitled “Options for Reforming the Global Fund Board” newly published by Aidspan.


In other GF news, the Global Fund Board approved $147.76 million in interim and renewal funding (at its latest Board meeting end of February), and the Fund also released  a comprehensive database of country-specific information on the 2014-2016 allocations under the new funding model (NFM), following the 12 March announcement of country allocations.



Infectious disease


23. Lancet (World Report) – West Africa struggles to contain Ebola outbreak


Andrew Green;

Health workers in west Africa are trying to control an Ebola outbreak that started in Guinea and has already spread to neighbouring Liberia. Andrew Green reports.

24. Foreign Policy – Don’t kiss the cadaver;

Laurie Garrett;

Laurie Garrett argues that Africa has reported over 2,000 cases of Ebola since 1976 and that thus some valuable lessons have been learned over the last 30 years. It’s now up to Guinea (and neighbouring countries) to remember them.

25. BMJ (news) – Polio virus spreads from Syria to Iraq

Sophie Arie;

As already covered in a previous IHP letter, Iraq has reported its first case of poliomyelitis for 14 years, amid concern that the disease cannot be prevented from spreading beyond Syria and throughout the Middle East.

26. Humanosphere – Global health advocates celebrate polio milestone despite disease resurgence |

Tom Paulson;

Last week, the World Health Organization certified that India and Southeast Asia was ‘polio free.’ Significant progress has been made against this crippling disease, with 80 percent of the planet now free from polio thanks to an aggressive global vaccination campaign largely led for decades by WHO, UNICEF, Rotary International and more recently supported – both financially and from the bully pulpit – by the Bill & Melinda Gates Foundation. There is indeed cause for celebration, but also for alarm’, argues Tom Paulson.


27. Guardian Global Development – Malaria in Mozambique: trialling payment by results

Malaria is a prime target for applying development impact bonds (Dibs), a new way of attracting funding for development issues (such as malaria). “A coalition of public and private groups (including government, corporates, and public donors) is working to make malaria control in Mozambique the focus of one of the first development impact bonds soon to be issued. The Mozambique malaria performance bond (MMPB) is designed to increase funding for, and the efficiency of, malaria interventions. Over 10 years, the MMPB aims to protect up to 8 million people in Mozambique from infection and reduce malaria prevalence in the targeted areas by up to 75%.”


28. NEJM (Global health review article) – Pandemic Preparedness and Response — Lessons from the H1N1 Influenza of 2009

Harvey Fineberg;

The most recent global pandemic was caused by the influenza A (H1N1) strain. This event prompted the first activation of provisions under the 2005 International Health Regulations (IHR), which went into effect in 2007. In this article, Fineberg focuses on lessons from the global response to the 2009 H1N1 pandemic. He identifies some of the key successes and shortcomings in the global response, on the basis of the findings and conclusions of the review committee. The article concludes by pointing to steps that can improve global readiness to deal with future pandemics.



29. WB (report) – Transport for health: the global burden of disease for motorized road transport

Safer and cleaner road transport is critical for achieving health and development goals around the world, according to a new WB report that –for the first time–assesses the global health loss from the combined impact of road injuries and pollution that can be attributed to motorized transport. The report was prepared by the World Bank-led Global Road Safety Facility and the Institute for Health Metrics and Evaluation at the University of Washington, along with contributions from authors of other institutions.  Findings of the report were discussed earlier this week in London at an event hosted by ODI.


30. BMJ (Feature) – Does it work to pay people to live healthier lives?


Sarah Strickland;

With chronic diseases placing an ever growing burden on health services, governments are increasingly offering financial incentives to encourage healthier lifestyles. Sarah Strickland looks at the trends and the evidence.


31. Globalization & Health – Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need

Ahmed Hassan Amara et al.;

With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic NCDs. However, with few exceptions, the local and international communities prioritise communicable diseases. The aim of this study is to review the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries.


The Lancet also has a few Letters in today’s issue on the burden of stroke estimates (see here ).


Access to medicine


32. Reuters – Drugmaker GSK to invest $200 million in African factories, R&D

GlaxoSmithKline plans to invest up to $216 million in Africa over the next five years as chronic diseases become more common among the continent’s swelling urban middle classes. The decision reflects the draw for the pharmaceutical industry of the region’s rapid economic growth and rising demand for treatments for NCDs like heart and lung disorders, diabetes and cancer.


GSK’s ViiV unit also added a new HIV drug to the AIDS patent pool, dolutegravir.



33. UNAIDS – Cooperation for the local manufacturing of pharmaceuticals in Africa intensifies

African leaders and key multilateral organizations are strengthening and broadening support for the local production of essential medicines on the continent. This was one of the key outcomes of the Seventh Joint African Union (AU) Conference of Ministers of Economy and Finance and the Economic Commission for Africa (ECA) Conference of African Ministers of Finance, Planning and Economic Development held in Abuja, Nigeria, from 25 to 30 March. On the sidelines of the annual conferences, the AU, UNAIDS, UNECA and UNIDO held a high-level meeting, ‘Local Manufacture of Pharmaceuticals: an Untapped Opportunity for Inclusive and Sustainable Industrial Development in Africa’, with African ministers of finance and economic planning. The event highlighted the opportunities for developing a high-quality pharmaceutical industry in Africa, which will bring important health and economic development benefits.






34. Guardian – Bill Gates: world must step up fight against neglected tropical diseases

Sarah Boseley;

Sarah Boseley had an interview with Bill Gates in Paris,  where he was taking part in a meeting to look at the progress made against 10 neglected tropical diseases in the last two years. He’s happy with the progress so far, but more needs to be done. More money was also announced in Paris, including $50m more from the Gates Foundation, $50m from the Children’s Investment Fund Foundation and $120m from the World Bank.


In the article, Boseley also reports: “Julien Potet, neglected diseases adviser of the Médecins Sans Frontières access campaign, said that while they were glad the campaign was attracting attention to some neglected diseases, others were still forgotten – such as yaws, which can lead to disfigurement and disability, yet can be cured with a single dose of the antibiotic azithromycin. WHO had struggled to get donations from a major drug company. Potet said: “Another example is snake bite, which is listed as very neglected by WHO.  Sanofi has done a good job of donations for sleeping sickness but have told us they were looking at stopping production of anti-venom for Africa.”  Donations, in MSF’s view, are not always the best way forward, he added, particularly as small drug companies cannot always afford to make them.”


For some more detail on Potet’s view, see this Lancet Global Health blog post by him:  “Neglected tropical diseases and access to medicines: time to think beyond drug donations”.

35. Lancet Global Health (blog) – Yaws eradication: gaining momentum, but a bumpy road ahead

Andrea Rinaldi;

Even if it still doesn’t get the attention needed (see above), yaws is slowly getting back on the global health agenda. WHO is gearing up to wipe the disease off the face of the earth by 2020, but is this target feasible? Andrea Rinaldi reports from the Third WHO Consultation on Yaws Eradication, March 24-25, 2014.


See also IS Global  on the same issue.


Maternal & Child health


36. Guardian – Jolie to seek end to sexual violence as war weapon at London summit

Angelina Jolie has said she hopes a global summit on sexual violence she will co-host in London with the UK government will bring lasting change to global peacekeeping and war crimes prosecutions, deterring the use of mass rape as a weapon in future conflicts. The four-day summit will begin on 10 June and will bring together governments from 141 countries to discuss how to improve and standardise the investigation of large scale sexual violence in wartime, to bring an end a culture of impunity that has severely limited prosecutions up to now.


37. WHO Bulletin – April issue

The new  April issue has, among other articles, an editorial on the lack of progress in reducing anaemia among women, yet another “inconvenient truth”.



World Health Assembly



  • Preliminary PHM comments on some of the agenda points of the upcoming World Health Assembly are available, see   (must-read)



  • Meanwhile, KEI reports Member States of the World Health

Organisation (WHO) are unable to agree on a draft framework and policy on

the organisation’s engagement with “non-State” actors. A two-day informal consultation that took place in Geneva on 27-28 March 2014 concluded with an understanding to entrust the WHO Secretariat to submit a new version of the policy, taking into consideration the comments from Member States, to the World Health Assembly (WHA) through the Program Budget and Administrative Committee.



Health Policy & Financing


38. Science Speaks – Birx confirmed as PEPFAR leader by voice vote

The US Senate confirmed the nomination of Dr. Deborah Birx – she’ll be the US AIDS coordinator & PEPFAR boss. Advocates applauded her confirmation; now the question remains when she’ll be sworn in to assume PEPFAR’s leadership.


39. CGD – Meeting the Challenge of Drug Resistant Diseases in Developing Countries

Victoria Fan & Amanda Glassman;

The US has an untapped opportunity to offer global leadership against drug resistance through the major global health programs it already supports, namely PEPFAR, the Global Fund, and the Presidents Malaria Imitative. In this memo, Victoria Fan and Amanda Glassman highlight considerations for Congress with respect to oversight of these key channels of US development assistance for health that greatly affect drug resistance. The memo draws from a 2010 CGD working group report on The Race Against Drug Resistance, and was submitted to members of the House Foreign Affairs subcommittee on African and Global Health in advance of a 2013 hearing on drug-resistance in developing countries.

40. Jakarta Globe – Bill Gates to Visit Jakarta for New Health Fund  “Microsoft founder Bill Gates will visit Jakarta on April 5 to sign a memorandum of understanding with the Indonesian government to launch the Indonesia Health Fund, a five-year charitable pool to which philanthropists can contribute in order to expand health care access to some of the country’s poorest people”.

41. AJPHA (Editorial) – Resurrecting “International” and “Public” in Global Health: Has the Pendulum Swung Too Far?

Anne Sebert Kuhlmann et al.;

Nice read. The authors wonder whether the ‘global’ in global health is as global as normally conceived. They make a crucial distinction. Not sure I completely agree with them, though.


42. Lancet – Offline: What is the World Health Summit for?


Richard Hortonn;

The second regional meeting of the World Health Summit convenes this week at the Medical School of the University of São Paulo (April 6—8). It follows a successful regional conference held in Singapore a year ago. In 2015, the Summit will move to Kyoto, Japan. The Brazilian hosts at this year’s meeting are celebrating Latin American learning in five areas—healthy life expectancy, urban health, universal health coverage, health education, and research capacity. Region-focused global health events are rare. They matter because they provide an opportunity for global lessons to be drawn from local experiences.” The Lancet has been a strong supporter of the idea of a World Health Summit since its inception in 2009. “But, as a critical friend, one must question its current value and direction. There is a sense among some partners that the Summit is drifting (and indeed diminishing) from year-to-year without evident achievement or advantage. Does the world need a World Health Summit?”  Horton offers two small suggestions to reinvigorate the World Health Summit.


43. Lancet (Editorial) – Condemning the death penalty


Amnesty International’s report Death Sentences and Executions 2013, published on March 27, noted a 14% increase in executions in 2013. This is very concerning.


This Lancet editorial argues that, as a first step towards abolition, greater transparency is needed, particularly from China and countries in the Arab world. But “The death penalty is an outmoded practice and focus should be on its eradication.”


44. Lancet (Editorial) – Rwanda: looking to the future

Ahead of the International Day of Reflection on the Genocide in Rwanda on April 7, this editorial reflects on the last 20 years in Rwanda. The Lancet also published (early online) a Public Health paper by Rwanda’s minister of health Agnes Binagwaho and colleagues, which charts the extraordinary transformation of the country’s health system over the past 20 years. “Two decades ago, the genocide against the Tutsis in Rwanda led to the deaths of 1 million people, and the displacement of millions more. Injury and trauma were followed by the effects of a devastated health system and economy. In the years that followed, a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda’s health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.


45. BMJ (Feature) – Expert views: what the next Indian government should do for health and healthcare

Jeetha D’Silva;

As the population prepares for the polls in India, Jeetha D’Silva asked some “movers and shakers” for their thoughts on the key health and healthcare issues that politicians should be focusing on.

46. Irin (Briefing) – Punitive aid cuts disrupts health care in Uganda;

Since the enactment of a draconian anti-homosexuality bill in Uganda just over a month ago, donors have been slashing or suspending aid to the country in protest. This IRIN article gives an overview of cuts and measures taken. They are already having a major (and dire) impact on healthcare services, particularly for HIV/AIDS patients.


As for the EU position (or at least one of the many “EU positions”), “Imprisoning gays and lesbians for their sexuality is a “disgrace” that should disqualify offending countries from EU aid, the president of the European Parliament, Martin Schulz, told a joint summit with MPs from the Pan-African Parliament yesterday (31 March), sparking a row.” (see Euractiv).



Meanwhile, the Ugandan government has appeared unfazed by the donor cuts, with President Museveni speaking at a “thanksgiving” parade to celebrate the Anti-Homosexuality Act (AHA) organized by religious leaders on 31 March and describing donor cuts at “contemptuous”. He also said, at this rally of religious leaders, politicians and thousands of supporters on Monday, that Uganda could very well live without aid that Western donors suspended or diverted in protest at an anti-gay bill that became law in February. He also backed a new (domestic) special Fund for HIV/AIDS.


Foreign investors also don’t seem too troubled (see Reuters), for the time being.


47. Humanosphere – Ugandan researcher cites western roots of Africa’s anti-gay movement

Tom Paulson;

Very nice article. Stella Nyanzi, an anthropologist who studies gender and sexuality issues in Uganda, at Makerere University in Kampala, discusses the origins of  Africa’s anti-gay movement. The picture is much more complex than just American evangelicals fanning the flames. She will be the keynote speaker at a Seattle conference focused on sexuality, health and human rights, this weekend.


48. CSIS (paper) – US – Russia health engagement: still on the agenda

Judyth L Twigg;

In spite of the current troubles in the Ukraine & Crimea, the US should continue to engage with Russia (in terms of health collaboration). The potential pay-off is worth the effort and the risk, Twigg argues.


49. CFR –  Health-care Provision and Health-care Reform in Post-Mao China

Yanzhong Huang;

An effective strategy to engage China’s health-care sector requires the U.S. government to continue promoting business opportunities for U.S. biopharmaceutical firms, hospital groups, and insurance companies, CFR Senior Fellow for Global Health Yanzhong Huang tells the U.S.-China Economic and Security Review Commission. In the meantime, it is also important for the U.S. government and companies to demonstrate the willingness to work with China in addressing health issues of their immediate concern.


50. WSJ (blog) –  Why People Who Influence Reseach Are Popular in Pharma Boardrooms

A new research paper (in JAMA) found that nearly 40 percent of drug makers worldwide – and nearly every U.S. pharmaceutical manufacturer – had at least one board member who simultaneously served in a leadership position at such centers in 2012.


51. Devex – USAID, Hillary Clinton launch Global Development Lab for game-changing innovations

USAID unveiled its new Global Development Lab, “which it hopes will bring greater innovation to meeting the goal of ending extreme poverty and “take game-changing solutions to more than 200 million people.”  The lab launches with 32 “cornerstone partners” in place, including multinational corporations with very reassuring names such as Coca-Cola, Nike, Microsoft, and Wal-Mart; civil society organizations and foundations including Catholic Relief Services and the Skoll Foundation; The University of California at Berkeley, Massachusetts Institute of Technology and other institutions of higher learning; and Sweden, the only other bilateral donor that has so far committed to supporting the initiative.


See also coverage by The Guardian.


52. Rollcall – As Food and Drug Imports Increase, FDA Focuses on Becoming Global Health Organization


The Food and Drug Administration is tasked with overseeing the safety and quality of most of the food, medical devices, drugs, biological products, vaccines, and cosmetics in the United States. But every year, more and more of those products come into the country from other nations. … This growth of imported products has been rapid and is expected to continue to increase. That is why FDA Commissioner Margaret Hamburg says the agency must transform itself into a global health organization…”


53. CGD – A NICE Idea for Priority Setting in Global Health – Amanda Glassman

In a CGD wonkcast, Amanda Glassman argues for the creation of a new institution that draws upon medical and scientific literature to support low- and middle-income governments and donors in resource allocation decisions for healthcare.  Amanda gave some encouraging news concerning international progress on health care priority setting: ”We learned that the Bill and Melinda Gates Foundation and the UK aid agency have funded an International Decisions Support Initiative (IDSI) at NICE International,“ a branch of the UK’s National Institute for Health and Care Excellence.”


54. GH Watch – Nutrition Agenda on the International Strategies: Ongoing Initiatives, Challenges and Proposals

End of November 2014, the Second International Conference on Nutrition (ICN2) will be held in Rome. This event is jointly organized by the FAO and the WHO and is occurring 22 years after the first conference, performed in 1992. This new background paper gives a very nice overview of what is wrong with current global food policy initiatives and lists five key principles to be realised.  (must-read)




55. Globalization & Health – Economic impacts of health shocks on households in low and middle income countries: a review of the literature

Kurshid Alam et al.;

Poor health is a source of impoverishment among households in low -and middle- income countries (LMICs) and a subject of voluminous literature in recent years. This paper reviews recent empirical literature on measuring the economic impacts of health shocks on households.


56. BMC Pregnancy & Health – Stakeholder views on the incorporation of traditional birth attendants into the formal health systems of low-and middle-income countries: a qualitative analysis of the HIFA2015 and CHILD2015 email discussion forums

Onikepe Oluwadamilola Owolabi et al.;


Health workforce shortages are key obstacles to the achievement of the health-related MDGs. Task shifting is seen as a way to improve access to pregnancy and childbirth care. However, the role of traditional birth attendants (TBAs) within task shifting initiatives remains contested. The objective of this study was to explore stakeholder views and justifications regarding the incorporation of TBAs into formal health systems. Data were drawn from messages submitted to the HIFA2015 and CHILD2015 email discussion forums. The forums focus on the healthcare information needs of frontline health workers and citizens in low – and middle-income countries, and how these needs can be met, and also include discussion of diverse aspects of health systems. Messages about TBAs submitted between 2007-2011 were analysed thematically.



Emerging Voices


57. Globalization & Health – “In the driver’s seat”: the health sector strategic master plan as an instrument for aid coordination in Mongolia

Anar Ulikpan et al.; In 2005, the Ministry of Health (MoH) in Mongolia initiated the process of developing its Health Sector Strategic Master Plan (HSSMP), using a wide-ranging consultative process, driven by the MoH, and requiring participation from all levels of health facilities, other ministries, donor agencies and NGOs. Among other objectives, the MoH sought to coordinate the disparate inputs from key donors through the HSSMP, aligning them with the Plan’s structure. This research explores the extent to which the HSSMP process served as a mechanism for effective aid coordination while promoting ownership and capacity building and the lessons learned for the wider international development community.


Global health podcasts

Here you find a link to the (by now notorious) Global Health Lab on ‘what have economists ever done for global health’, at the London School of Hygiene & Tropical Medicine.





  • Center for Economic and social rights:  Financing sustainable development: the right partnerships for a better world (see here). (Not that anything like these suggestions will happen, but they’re very true nevertheless.)
  • Duncan Green looks ahead to the next World Bank Development Report on mind & culture (see here ).
  • A Guardian op-ed on a new report on IMF, with the lovely title ‘Conditionally yours’. (see here).
  • Nature: “ Policy: The art of science advice to government” (see here) : Peter Gluckman, New Zealand’s chief science adviser, offers his ten principles for building trust, influence, engagement and independence.
  • And the IMF-World Bank Spring meetings are coming up – many events will be webcast (check it out here ).

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