Dear Colleagues,


Some of you are on early Easter holidays, so we’ll try to keep this newsletter a bit shorter than usual. Other good reasons for keeping it brief, is that Richard Horton occasionally pops up in my dreams now (which I’d like to avoid), and that I have to pick up my son from a table tennis camp, later this afternoon.

In this newsletter we focus, among other issues, on the annual IHME report, ‘Financing Global Health 2013: Transition in an Age of Austerity’. Very nice report, apparently; on Twitter we learnt Chris Murray got a well-deserved “reception like a rock star”, when the report was launched. Unfortunately, the title is just plain wrong (granted, Bono himself gets it wrong on some issues too).  We don’t live in an “age of austerity”, that’s just the story the financial sector and many mainstream economists & decision makers want us to believe. The truth is that this is the age of global and national tax injustice, and it’s about time we do something about it. So let’s hope the next IHME report will have another title, for example: Financing Global Health 2015: Transition towards a fairer world. Maybe in an innovative Partnership with the People’s Health Movement?

Meanwhile, the World Bank (and the IMF) are holding their Spring Meetings in the US. The Lesotho story, based on an Oxfam report on a rather expensive health public-private partnership in the country, developed under the advice of the World Bank’s private sector investment arm (the International Finance Corporation), came no doubt as a nasty surprise to Jim Kim and his (restructured) staff. Especially after Kim’s encouraging words from last week “on how the Bank had been wrong and ideological” with respect to user fees, in the past. Kim already said he’ll look personally into this issue. Later today, at the  forum, “Towards UHC by 2030”, more questions can be asked to Kim and a star-studded bunch of global health panelists. They’ll no doubt promote UHC as a priority of sustainable development, and rightly so. Hepatitis C (medicine pricing) was also in the news this week, and chances are you also heard about the Tamiflu commotion. This week was also Health Workers Week, and Desmond Tutu ended the week by urging for an apartheid-style boycott of the fossil fuel industry. Now we’re talking!

In this week’s guest editorial, Alan Whiteside dwells on the importance of making sense of data, based on a few recent experiences. He sees a role for a commission to make sense of all the global health  information we get.


Enjoy your reading.


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




Making sense of data


by Alan Whiteside,  CIGI Chair in Global Health Policy, Balsillie School for International Affairs and Wilfrid Laurier University, Waterloo, Canada


We are bombarded with data and making sense of it is increasingly challenging. The same internet that brings the International Health Policies Newsletter barrages us with information: advertisements; offers to send money; raise libido and so on. With a few clicks of the mouse we can Google or find Wikipedia information, (although there is no guarantee of its quality). In this editorial I want to deconstruct three figures I have seen and used recently. These relate to money, HIV data, and life expectancy

Let me begin with money and the figure of $87 billion. Ahead of the replenishment meeting in December 2013, the Global Fund estimated US $87 billion was required to reach all vulnerable populations in eligible low and middle income countries over the period 2014 to 2016. This would provide essential services and bring HIV and AIDS, TB and Malaria under control. The estimated sources were: US$24 billion from international funding; an existing US $23 billion from domestic funding and a further US$14 billion to be found. The Fund hoped to raise US$15 billion but received roughly $12 billion. Clearly 24+23+14+12=73 and there is no certainty that additional domestic resources will be provided.

So is this a game of bluff? The reality is that we are reasonably certain of only $50 billion ($12 billion Global Fund, $24 billion international donors; and $14 billion domestic).  What does this mean for the response? There is a disconnect between absolutely having to have this money to reverse the epidemics, as the advocates so eloquently argued, and facing the reality of having just 66 percent of the 87 percent needed.

The second set of figures is HIV prevalence data. On the 1st April 2014 the Human Sciences Research Council in South Africa released the results of the 2012 South African National HIV Prevalence, Incidence and Behaviour  Survey.  This is mostly bad news. By mid-2012, there were an unbelievable 6.4 million people living with HIV in South Africa. Prevalence peaks at 36 percent among women aged 30-34 and at 28.8 percent among men in the 35 -39 cohort. The only ‘good’ news is that 2 million (31.2%) ‘were exposed to ART’, there was evidence to suggest they were on treatment.

These figures are shocking. Even more disturbing is the way we seem to have taken them into our stride. There should be research on the economic, social and political consequences of having this many people infected. Most are or will be dependent on state provided drugs. Why are we not looking at the social and psychological impact of this? Should we be rewriting the social contract between state and citizens?

The last set of data I want to highlight are from the  United Nations 2013 World Mortality Report.   The Department of Economic and Social Affairs of the United Nations Secretariat regard themselves as ‘a vital interface between global policies in the economic, social and environmental spheres and national action’. They compile, generate and analyse a wide range of economic, social and environmental data and information to review common problems and take stock of policy options. These reports are dense and require careful study.

Table three in the report gives the ten countries with the highest and lowest life expectancies at birth for the periods 1950 – 1955, 1990 – 1995, and 2010 – 2015. For people with basic economic and political literacy the data are generally not surprising. In 1950 – 1955 the highest life expectancy was Norway at 72.2 years; Japan took poll position in the second period (79.4 years) and remained there in 2010 -2015 at 83.5 years. For the most part the low life expectancies are also predictable surprising, in 1950 – 1955 Yemen at 25.3 leads the list followed by Mali. By the second period all ten countries are African. Worst was Rwanda, post genocide, where life expectancy was just 23.1 years. The real shock comes when looking at the data for 2010 to 2015. The country with the lowest expected life expectancy in the world is Sierra Leone (45.3 years). Next were Botswana (47.4), Swaziland (49.2) and Lesotho (49.5), then come nations such as the Democratic Republic of the Congo and the Central African Republic. Botswana, Lesotho and Swaziland are all middle income countries that, by most other measures, are doing well. How can these data be unremarked!

Issues for data were at the core of the 2010 report by the Commission on the Measurement of Economic Performance and Social Progress. This work was commissioned by French President Nicolas Sarkozy. It is a short but dense book, and the graphs, in particular, require considerable study. The Commission was written largely by and for social scientists, but was intended to reach out more broadly. There are only three chapters. The first looks at classical GDP issues; the second quality of life and the third, and probably most important, is on sustainable development and the environment.  I have always personally been deeply concerned about GDP particularly since it is used to place countries into income categories, which establishes what sort of support they are eligible for, and how they are viewed.

My take home message from the last few weeks of data overload is that figures are useful but we need to interrogate them and use carefully. However it is increasingly clear that in the health field we need a commission or at least an interest group to make sense of the information we are presented with. The life expectancy data from countries I know, that shaped my view of the world, and that I love has left me feeling depressed, but the real issue is that they have gone unremarked.



Global health financing


1.    IHME report – Financing Global Health 2013: Transition in an Age of Austerity

Financing Global Health 2013: Transition in an Age of Austerity, The Institute for Health Metrics and Evaluation (IHME)’s fifth annual report on global health expenditure, depicts financing trends that underline the resilience of development assistance for health. “This year’s updated estimates show that despite lackluster economic growth and fiscal cutbacks in many developed countries, total assistance remained steady, reaching an all-time high of $31.3 billion in 2013. While annual increases have leveled off since 2010, continued international funding is a sign of the international development community’s enduring support for global health.

The report also shows shifts in sources of financing. As funding from many bilateral donors and development banks has declined, growth in funding from GAVI, the Global Fund, NGOs, and the UK government is counteracting these cuts. Development assistance for different health issues is tracked up to 2011, revealing that the greatest increase in funding was for maternal, newborn, and child health.

New this year, IHME measured health funding for tobacco control for the first time and, using data from the Global Burden of Disease study, compared it to disease burden attributable to tobacco use. In general, the report found gaps between donor funding and disease burden in most regions, particularly with respect to non-communicable diseases; while these are a prominent and rising cause of health loss in the developing world, they are not a primary focus of development assistance for health. And many of the countries with the highest overall disease burdens do not receive the most development assistance for health.”


There’s also a nice visualization tool.  Tom Paulson gave his take on the new report on his Humanosphere  website, including a nice short summary of the key messages.


See also a Web-First article in Health Affairs by Joseph Dieleman (IHME whizzkid) et al.


2.    Action for Global Health – When will Europe’s biggest economies deliver to the world’s poorest? Latest OECD figures show EU member states share of aid to Africa continues to drop, despite highest-ever recorded increase in aid

The title of this week’s AFGH statement, responding to new OECD figures on aid, probably says enough. “New figures released earlier this week by the OECD show that the majority of donor countries, including EU member states, are still failing to meet their aid commitments to those who need it the most, despite the highest-ever recorded increase in ODA.” …  “We welcome governments’ efforts to step up their spending in foreign aid, particularly in the current economic climate,” said Tim Roosen, Coordinator, Action for Global Health. “But it is worrying that the real increase has been in the form of ‘non-grant’ ODA such as loans, which poor countries have to pay back – with interest – thereby accumulating even more debt.”


3.    Guardian – Foreign aid reaches record high

For a more general assessment of the new aid figures, see this Guardian article by Claire Provost. Foreign aid for development in poorer countries hit a record high last year, with large spending increases recorded by the UK, Iceland, Japan and the United Arab Emirates. Figures released by the OECD on Tuesday show ODA grew by 6.1% in 2013 to $134.8bn after falling for two years in a row in as donors grappled with austerity measures and increasingly divided public opinion in many countries. There are a number of downsides, though, to this encouraging news (see also above). (a downside for my French colleagues: apparently France cut its development aid even more than Greece).


4.    Oxfam – A Dangerous Diversion: Will the IFC’s flagship health PPP bankrupt Lesotho’s Ministry of Health?

Anna Marriott;

We already flagged this news in our intro. Marriott, the author of this new Oxfam report, summarizes: “The Queen Mamohato Memorial Hospital in Lesotho was built under a public–private partnership (PPP), which is the first of its kind in a low-income country and has been described as opening a new era for private sector involvement in healthcare in Africa. Instead, the Ministry of Health in one of the poorest and most unequal countries in the world is locked into an 18-year contract that already consumes more than half of its health budget. This is a dangerous diversion of scarce public funds from primary healthcare services in rural areas, where three-quarters of the population live.  The PPP was developed under the advice of the International Finance Corporation (IFC) and is seen as their flagship model to be replicated across Africa. Lesotho’s experience supports international evidence that health PPPs of this kind are high risk and costly, and fail to advance the goal of universal and equitable health coverage. Oxfam argues in this report that the IFC should be held to account for the poor quality of its advice to the Government of Lesotho and for marketing this health PPP as a success internationally, despite its unsustainable costs.”


For some coverage of the report, see  the Guardian.  Author Anna Marriott also provides summaries on Oxfam’s blog Global Health Check and in an Open Democracy article.


5.    JRSM – The effect of illicit financial flows on time to reach the fourth Millennium Development Goal in Sub-Saharan Africa: a quantitative analysis

Bernadette O’Hare et al.;

And to come back on the topic of a IHP guest editorial  from a few weeks ago (by Stephanie Topp et al), this new paper in in the Journal of the Royal Society of Medicine sets out to estimate the cost of illicit financial flows (IFF) in terms of the amount of time it could take to reach the fourth MDG in 34 African countries.


Post-2015 & UHC


6.    Lancet – Offline: The future for Africa

Richard Horton;

Africa is living on the edge of catastrophe, for a number of reasons. it is time to strengthen commitments to Africa as a major global priority for a new era of sustainable development, argues Horton. Some people might think he’s too pessimistic, especially with all this talk about a ‘rising Africa’, but I tend to agree with his (dire) assessment. But then again, I’m a “natural born pessimist”. And like Horton, I’m not on Gates’ payrollJ.


7.    Guardian – We need an apartheid-style boycott to save the planet

Desmond Tutu;

We must stop climate change. And we can, if we use the tactics that worked in South Africa against the worst carbon emitters, Desmond Tutu argues. See also here.  Richard Tol probably disagrees.



8.    Project Syndicate – The Grand Global Health Convergence

Gavin Yamey & Helen Saxenian;

Family planning is a crucial intervention to achieve a Grand Convergence.


9.    Joint Learning Network – Practitioner-to-practitioner learning helps countries move closer to UHC

Nkem Wellington;

This post provided  some info on the Joint Learning Network, on the occasion of World Health Day (7 April). “At this critical time when more countries will face the tough challenges of implementing reforms to achieve UHC there is growing demand for practical knowledge. The JLN fills this niche by blending technical assistance with practitioner-to-practitioner joint learning to harness the expertise of both global and local experts. This practical approach to addressing common challenges related to achieving UHC makes the JLN a strong compliment to other global efforts, and a unique, innovative model for facilitating South-South learning.

As already reported in a previous newsletter, the JLN will expand its footprint in 2014 by merging with UHC Forward – a global knowledge hub for information related to UHC – to expand the network’s audience, strengthen dissemination activities, and become a one-stop hub for UHC-related information. Additionally, to further enrich the learning experience they welcome new members to the ‘learning lab’ on a rolling basis. As the movement towards UHC accelerates around the globe and many countries simultaneously face the challenge of implementing UHC reforms, the JLN has decided to open its membership to countries with a demonstrated commitment to UHC. By expanding membership, the JLN seeks to increase its impact by equipping a diverse global audience with knowledge that can catalyze improvements to health system performance around the world. For the call (to become a member of the JLN), see here.

10. UHC campaign for regional task forces

This campaign urges WHO to set up ‘regional task forces’ that can accelerate and support the implementation of country-specific UHC around the world.  “The goal of this campaign is to collect a minimum of 10,000 signatures and to deliver a clear and robust message to the WHO that we, the people, support a regional task force approach as an important step in achieving equitable access to healthcare for all.” The petition will be delivered to the Directors of each World Health Organization Regional Office.

Another campaign focuses on UHC for older people.

In other UHC related news, IHP+ asked Guy A H Benissan, Regional Coordinator of REPAOC, Senegal and Bruno Rivalan from Global Health Advocates about how the UHC agenda links with effective aid and development cooperation. As you might remember, health CSOs from around the world met in Senegal in February 2014 to discuss UHC and the right to health; the civil society conference on UHC was organized by the network Action for Global Health.


11. World Bank – Universal health coverage: Time for an ambitious call for equity in health

Winnie Byanyima;

The executive director of Oxfam international says it’s time for UHC. “That UHC is needed is self-evident.  Now we need an ambitious plan to get there.” Moreover, it’s possible within 15 years, she says. “And to measure progresses towards UHC, there are three areas where the international community has to show the ambition needed to answer to what we – the people – want, and leave no one behind.”

12. Lancet (World Report) – Health gets greater attention in the 2014 Indian elections

Dinsa Sachan; Health has been a neglected issue in past Indian general elections. But this year, it has received more recognition by those vying to lead the world’s largest democracy. Dinsa Sachan reports.

See also a BMJ Feature article for the Indian political party manifestos for health: the Congress Party, BJP & the “Common Man” party.

13. ODI Briefing – Defining ‘aspirational yet attainable targets’ for new goals post-2015

Claire Melamed et al.; Apparently ‘aspirational yet attainable targets’ are in vogue among development wonks now. This briefing considers how ‘aspirational yet attainable targets’ could be defined for new post-2015 goals. The authors suggest a way to make goals nationally relevant, but without the complexity of country-by-country target setting. In this short note, Melamed et al apply this on the maternal mortality goal.

14. ChikaforAfrica – After 2015, then what? Africa in a post-MDGs era

Dr. Chika A. Ezeanya , a participant in the post 2015 Development Agenda for Africa meeting organized by the UNDP in Johannesburg, South Africa (February, 2013), reflects here on what the post-2015 agenda for Africa should involve:Africa’s future lies in the hands of authentic African thoughts, processes, and actions. The question of a 2015 agenda for Africa should be that of how and not what. The MDGs tried to address the question of what, that is, ‘hunger, poor health, poverty, environmental degradation, etc’. A post-MDGs agenda should focus on how to build Africans up in order for them to understand their unique challenges and address the same with indigenous resources and easily accessible homegrown tools. A post-2015 agenda ought not to warrant the flying– business-class of thousands of consultants from the Western world for stays in expensive hotels in order to write reports that often recommend for further studies to be conducted by their counterparts from the west.” Spot on.


15. Guardian – World Bank says growth alone can’t end poverty

More encouraging noises from Jim Kim et al. The World Bank has urged developing-world countries to fund social security programmes to lift the incomes of their poorest people, ending a reliance on growth to end poverty. In a report the bank said that while economic growth remains vital for reducing poverty, it has its limits. “Countries need to complement efforts to enhance growth with policies that allocate more resources to the extreme poor. These resources can be distributed through the growth process itself, by promoting more inclusive growth, or through government programmes, such as conditional and direct cash transfers.” But there was fierce criticism from, among others, the Bretton Woods Project and Oxfam’s Max Lawson.


Global Fund, PEPFAR & GAVI


16. IP Watch – Global Fund And Tiered Medicines Pricing Under Debate

Catherine Saez;

Late 2013, when Global Fund Executive Director Mark Dybul’s report to the 30th Board Meeting of the Fund (7-8 November) mentioned tiered pricing as a means to expand access, the discussion on tiered pricing gained further momentum.  This IP Watch article gives a nice overview of the debate in recent months, including on the controversial ‘new multi-agency initiative to help expand access to essential health commodities through a multi-tiered pricing framework’, geared towards MICs.     On 7-8 April, UNITAID and the WHO hosted an invite-only “2014 HIV Market Forum” in Geneva, in which one of the subjects was tiered pricing.

17. New York Times – New Global Aids Chief for U.S. Assumes Post

New York Times;
After the confirmation in the Senate last week, Deborah Birx, a former chief for global AIDS for the Centers for Disease Control and Prevention, was at last sworn in on Friday as the nation’s global AIDS coordinator. The post puts Dr. Birx in charge of PEPFAR and American participation in the Global Fund.

18. Global Fund – Innovative Investment in Indonesia Health Fund In an “innovative financing initiative”, code for ‘the business world pays peanuts in a halfhearted effort to improve its image’,  Dato Sri Dr. Tahir, Chairman of the Tahir Foundation in Indonesia, established a new Indonesia Health Fund with an initial investment of US$40 million from eight Indonesian business leaders in partnership with the Gates Foundation and the Global Fund. Bill Gates took part in a signing ceremony in Jakarta on 5 April with Dr. Tahir and the other philanthropists. The Gates Foundation will match the investment, which is for health programs in Indonesia.

19. Global Fund News Flash 41

In Issue 41 of its newsletter, the Global Fund News Flash has an article reporting from a regional meeting in Dakar focused on how gender, maternal and child health, and human rights should be integrated into the new funding model. But also in Namibia, Ecuador, Jamaica, … partners in the global effort to defeat AIDS, tuberculosis and malaria are busy this month holding consultations at regional meetings about the new funding model that is now being fully implemented by the Global Fund.

20. Save the Children – Recommendations for the GAVI 2016–2020 Strategy

This paper outlines Save the Children’s position on a number of issues they urge the Secretariat and the Board of GAVI to prioritise in the 2016-2020 strategy:

place equity at the centre of the new strategy; do more to strengthen health systems;

use purchasing power to increase competition and drive down vaccine prices; ensure immunisation gains are truly sustainable; revise eligibility and graduation criteria to promote equity; guarantee greater accountability to the global community; improve GAVI governance; support better data.


In other GAVI related news, Anuradha Gupta was appointed deputy CEO of the GAVI Alliance.


Infectious Disease


21. Lancet Global Health (blog) – Ebola in Guinea – people, patterns, and puzzles

Melissa Leach;

The ebola outbreak in Guinea raises intriguing patterns and puzzles that encourage us to ask new questions about zoonotic disease emergence in general, and what may be happening there in particular, Melissa Leach (IDS) argues.


22. BMJ – Fear spreads as number of Ebola cases in Guinea rises

Anne Gulland;

MSF has been forced to withdraw staff from a clinic in Guinea that was treating patients infected with the Ebola virus, after an angry crowd gathered. Precautions were also taken at the airport.


Meanwhile, WHO reported  the West Africa Ebola outbreak is among the ‘most challenging’ ever. It might take two to four months to contain, the WHO said on Tuesday.


23. NYT – Ebola Virus: A Grim, African Reality

David Quammen;

Quammen nails it: “Ebola in Guinea is not the Next Big One, an incipient pandemic destined to circle the world, as some anxious observers might imagine. It’s a very grim and local misery, visited upon a small group of unfortunate West Africans, toward whom we should bow in sympathy and continue sending help. It’s not about our fears and dreads. It’s about them.”


24. Allafrica – Ugandans Trading in Fake HIV Results

Yet another worrying trend. A BBC Africa investigation found that a growing number of Ugandans are easily buying fake “HIV-negative” test results.


25. AP – Pope presses anti-AIDS chastity strategy in Africa

Associated Press; Pope Francis has praised church workers in Africa who promote chastity as a key way to prevent the spread of HIV. Francis was speaking Monday at the Vatican to bishops from Tanzania.

26. IFRC report – Dengue: Turning up the volume on a silent disaster;

The International Federation of Red Cross and Red Crescent Societies (IFRC)  published a special report on dengue, titled “Dengue: Turning up the volume on a silent disaster.” In addition to raising attention for the disease, the IFRC also advocates for a shift in approach from responding to isolated outbreaks of dengue to investing in long-term, integrated programming including community initiatives leading to sustainable behavioral change.


27. Foreign Policy – The shots heard around the world

Laurie Garrett; There’s “a growing belief within Islamist circles that the polio-eradication effort is a secret CIA plot, designed to harm or contaminate Muslim children. … Among the imams were well-read scholars who drew their conclusions after perusing websites similar to those former South African President Thabo Mbeki used back in the day. Mbeki concluded that AIDS did not exist and that Western pharmaceutical companies invented false HIV claims in order to compel drug sales across Africa.”   Laurie is still angry with the US administration, for obvious reasons.

Meanwhile, a massive UNICEF polio vaccination campaign was launched in Iraq, Syria, and Egypt, aiming to vaccinate more than 20 million children.

28. WHO – WHO issues its first hepatitis C treatment guidelines

WHO has issued its first guidance for the treatment of hepatitis C, a chronic infection that affects an estimated 130 million to 150 million people and results in 350 000 to 500 000 deaths a year. The publication of the “WHO Guidelines for the screening, care and treatment of persons with hepatitis C infection” coincides with the availability of more effective and safer oral hepatitis medicines, along with the promise of even more new medicines in the next few years.


29. Lancet (Editorial) – A new direction for hepatitis C

This Lancet Editorial also zooms in on the new WHO guidelines.


30. Guardian – WHO calls for access to drugs for hepatitis C

Sarah Boseley;

New guidance on the diagnosis and treatment of hepatitis C worldwide strengthens the arm of campaigners who want pharmaceutical companies to slash the prices of new drugs that can cure most cases, argues Sarah Boseley.


See also an extensive IP Watch  article by Julia Fraser on the same issue, “WHO Guidelines May Help With Price Reductions For Hepatitis C Drugs”: The WHO guidelines themselves offer limited recommendation for reducing prices, she says, but may help in creating the conditions for price reduction by accruing demand and giving countries official backing in price negotiations.


While WHO wants a concerted effort  to drive down the cost of new hepatitis C drugs, Gilead Sciences aims to license its new hepatitis C drug to 3 or 4 Indian generic manufacturers to allow sales of the medicine at lower prices in about 60 developing nations (see Reuters).

31. NEJM (Perspective) – Treating Hepatitis C in Lower-Income Countries

Channa R. Jayasekera et al;

A bit more technical, but well worth a read.


Meanwhile, experts believe Hepatitis C could be virtually eliminated by 2030 (see this BMJ news article, quoting some people at a press briefing organised by the Hepatitis C Trust on the eve of the 2014 International Liver Congress in London. To be continued …


32. BMJ (Editorial) –The Tamiflu trials

This was big news yesterday. When the drugs don’t work … meaning neuraminidase inhibitors such as Tamiflu.   A number of articles in BMJ provide more detail.  From the final Cochrane Review, we now see a picture emerging of “a drug that is marginally useful in shortening a bout of flu by half a day, but does not prevent complications, keep people out of hospital or reduce the spread of infection and does have side-effects, some of which are worrying.” But this news has broader implications than just the effect or non-effect of drugs.   This BMJ blog post (which gives an overview of this week’s BMJ articles related to the inhibitors) puts it like this: “The BMJ is this week all about neuraminidase inhibitors and open data. Ten articles on the subject of anti-influenza drugs try to establish what we know. In sum: perhaps not enough to justify the huge expense governments worldwide have incurred in stockpiling these drugs, but perhaps enough in terms of improving transparency and providing researchers with all available data for independent scrutiny.”


See also Sarah Boseley for some coverage in the Guardian.


Andrew Jack nuances, and the article ‘Whether stockpiling pandemic flu drugs shrewd is or misguided’ in the New Scientist concludes: “Now is not the time to give up our antiviral stockpiles”.





33. Lancet Global Health (blog post) – Unsafe surgery: a question of gender and economics

Sarah Kessler;

As you know, there’s now a Lancet Commission on Global Surgery. It aims to make global access to safe surgery a reality “by embedding surgery within the global health agenda, catalysing political change, and defining scalable solutions for provision of quality surgical and anaesthesia care for all.” But guess what, there’s a gap in terms of economic evidence. Richard? “The clinical evidence for surgery is of course strong, but we’re also forced to acknowledge there’s a fixed budget. Current evidence on costs, cost-effectiveness, and financing of surgery is relatively small-scale and disparate. It’s hard to make your case for investment when you don’t have the data to support you.”


34. Lancet (Comment) – Nephrology in developing countries: the ISN’s story

John Feehally et al. ;

Since the 1980s, the International Society of Nephrology (ISN) has used its resources for education and training and, in doing so, advanced nephrology in LMICs worldwide through a portfolio of five outreach programmes. The authors conclude: “The ISN’s model and achievements provide a meaningful answer to how medical care in developing countries might be improved. We recommend our model to other professional medical societies and to individuals who want to help make a real and lasting difference in health care in developing regions of the world.”





35. Lancet (Editorial) – Neglected tropical diseases: becoming less neglected

On April 2, 2014, global health leaders gathered at the Institut Pasteur in Paris for the release of Uniting to Combat NTDs: Delivering on Promises and Driving Progress, a report assessing gains and setbacks towards reaching the 2020 NTD goals. This Lancet editorial assesses the NTD policy & financing situation, and argues, that in order to have a sufficient response: “This can only be achieved by countries committing to universal health coverage and anchoring NTDs in the post-2015 sustainable development goals (SDGs).”  NTDs as a sub-goal of the SDGs, in other words.


Maternal Health


36. Guardian global development – Drug to prevent excessive bleeding after childbirth could save thousands of lives

The trial of a new drug to prevent excessive bleeding in women after childbirth, which could potentially save thousands of lives annually, is to begin in 12 countries in June. The clinical study, which will be conducted by WHO, will include about 29,000 women in Argentina, Brazil, Egypt, India, Kenya, Nigeria, Pakistan, Singapore, South Africa, Thailand, the UK and Uganda. The trial, which is expected to last 18 months, will test the effectiveness of a new medicine developed by Ferring Pharmaceuticals, which can be stored at room temperature in hot and tropical locations, unlike oxytocin. If the WHO trial is successful, the agency will collaborate with Ferring and the pharmaceutical company Merck to explore how to make the medicine cheaply available to poorer countries.


37. Guardian – UN to measure women’s rights progress over past 20 years

Progress towards 20-year-old targets that sought to put women’s sexual and reproductive health and rights at the centre of development policy are assessed at a UN meeting in New York this week. The week-long Commission on Population and Development (CPD) began on Monday, and measures how far countries have come in meeting the action plan that emerged from the International Conference on Population and Development (ICPD), held in Cairo in 1994, and  will discuss ways to plug the gaps. It’s the 47th session of the Commission.

38. UNFPA – How Has the World Changed in the Last 20 Years?;

20 years after Cairo, this Global Review Report summarizes accomplishments & challenges.

Human Resources for Health


39. Joint World Health Worker Week Statement by the Frontline Health Workers Coalition, Global Health Workforce Alliance, Health Workforce Advocacy Initiative

It was World Health Day earlier this week – for an example of a blog post related to this year’s topic, see CSIS Katherine Bliss, Taking a bit out of vector-borne diseases.  But this short article is the Joint World Health Worker Week Statement by the Frontline Health Workers Coalition, Global Health Workforce Alliance, Health Workforce Advocacy Initiative. World Health Day is since two years the start of World Health Worker Week, a weeklong celebration of the inspiring health workers who make health care possible.


40. NZ Doctor – The future of nursing: STTI announces new global health initiative

The Honor Society of Nursing, Sigma Theta Tau International (STTI) announced the creation of the Global Advisory Panel on the Future of Nursing (GAPFON). The inaugural meeting of GAPFON — a panel of international nurse leaders — convened to establish a global voice and vision for the future of nursing that will advance global health. The panel is chaired by Johns Hopkins University School of Nursing Dean Emerita and Professor Dr. Martha N. Hill. The initial GAPFON meeting  took place in Basel, Switzerland, 27-29 March.


41. Humanosphere – Is global health about gizmos or people? |

Julia Robinson;


In a guest blog post, Julia Robinson discusses the “‘delivery bottleneck’ for new vaccines — a euphemistic way of describing the fact that Western innovations are piling up because the global south simply lacks the health care workforce and systems to deliver these new health technologies.” As already mentioned, this week is WHO’s World Health Worker Week, and Robinson emphasizes: “we need to make sure that along with creating Global Development Labs  (see last week’s IHP newsletter) that grow the private sector, we are also channeling resources towards the public sector and the governments whose responsibility it is to provide health care for their most vulnerable populations.” Human resources are key in this respect.


Access to Medicines


42. Unitaid – The Trans-Pacific Partnership Agreement: Implications for Access to Medicines and Public Health

We already discussed the Hepatitis C drugs access issue. But the trade agreements remain very much in the news. UNITAID commissioned this report to identify proposed TPPA provisions that are likely to have implications for public health and access to pharmaceutical products.


43. WHO Guidance – Principles and considerations for adding a vaccine to a national immunization programme: From decision to implementation and monitoring

This essential resource document reviews the principles and issues to be considered when making decisions about, planning, and implementing the introduction of a vaccine into a national immunization programme. Importantly, the document highlights ways to use the opportunity provided by the vaccine introduction to strengthen immunization and health systems. The comprehensive guidance also describes the latest references and tools related to vaccine decision-making, economic analyses, cold chain, integrated disease control and health promotion, vaccine safety, communications, monitoring, and more, and provides key URL links to many of these resources.

Orin Levine, director of vaccine delivery at the Gates Foundation, discusses this new document on the  blog “Impatient Optimists”.


Health Policy & Financing


44. Globalization & Health – Italy’s contribution to global health: the need for a paradigm shift

Eduardo Missoni et al;

This paper reviews Italian Development Assistance for Health and overall contribution to Global Health from 2001 to 2012. A paradigm shift is necessary. Meanwhile, Berlusconi is working on his own paradigm shift.


45. Reuters – Uganda arrests U.S.-funded health project staffer over gay law

Reuters ; A U.S.-funded health project in Uganda has suspended operations after police arrested a staff member on suspicion of promoting homosexuality, highlighting the mounting legal risks confronting the gay community in the east African state.

More of the latest news on the situation in Uganda and elsewhere in SSA you find on the Science Speaks blog, for example  here and here.


46. Economist – Right cause, wrong battle

Jim Kim, the president of the World Bank, wants it to promote gay rights. He has declared the “fight to eliminate all institutionalised discrimination” to be an “urgent task”. He recently put on hold a $90m loan to Uganda’s health sector after its government introduced one of Africa’s most draconian anti-gay laws. He has ordered an overhaul of the bank’s lending policies to make sure that no loan assists discrimination. At this week’s Spring Meetings in Washington, DC, he is convening discussions with gay activists on how best to do so.”  

The Economist says it shares Kim’s sentiment about bigotry… “Nonetheless, Mr Kim’s initiative is misguided. The World Bank is a technocratic development organisation, not a place for political advocacy. Setting up gay rights as a test of its lending decisions is likely to make the bank less effective at what Mr Kim himself has emphasised is its core job: tackling extreme poverty.  Mr Kim’s focus on gay rights is likely to be counterproductive in practice, for three reasons.”   And if you read the reasons the Economist lists, you can’t deny they have a strong case…

47. Lancet (Correspondence) – Founding of the Global Health Film initiative

Joseph R Fitchett et al. ;

The Global Health Film initiative is a partnership between the Gates Foundation, the Royal Society of Medicine, and the London School of Hygiene and Tropical Medicine. The primary objective of the Global Health Film initiative is to use film as a catalyst for discussion and for change in policy and practice for health worldwide. Interesting initiative. Read more about their plans.


Global health podcasts and videos


  • You find an overview of the London School’s “Global Health Labs” here (not all with podcasts though).
  • Global health videos: in order to promote papers published in Globalization and Health, video interviews will be made with authors. The first interview was with Alan Whiteside. See here.
  • And the (broader development) debate with Owen Barder & Bill Easterly, on the ‘Tyranny of Experts’, you find here.



Global Health announcements



  • An update on Health Systems Global and the preparations for the Symposium in Cape Town (see also the HS Global newsletter):


The programme for the Third Global Symposium on Health Systems Research is starting to come together. The programme working group is meeting this week in Cape Town. Almost 2000 individual abstracts have been received! Submitters will be notified by the end of April. The registration deadline for the early-bird registration is approaching. Register by 1 June 2014 to avoid paying a higher fee.




Coming up: the Health Systems Global blog, soon to be launched. This blog aims to catalyse discussions about a wide range of health systems research, policy and implementation issues, including research methodologies, teaching health systems, universal health coverage, medicines in health systems, the health systems of fragile and conflict-affected states, human resources for health, and the translation of evidence into action as well as people-centred health systems. HS Global invites guest bloggers to send contributions as a Word document (maximum 350 words, photos/figures welcome) to


Very soon Health Systems Global will also, in collaboration with the thematic working groups, launch a webinar series. Stay tuned for more information.



  • MSF Scientific Day 2014  Agenda  (May 23 ), in London.





48. Journal of the Royal Society of Medicine –  Knowledge systems in health in the WHO African Region: results of a questionnaire-based survey

Various papers presented in what looks like a JRSM supplement ( see early online articles )   describe the issues and challenges related to the availability and use of information in the African Region; the structure and function of the African Health Observatory and the national health observatories; and how they could be useful in addressing these issues and challenges. They propose a number of actions countries should consider taking for optimal leverage of national health observatories to improve country health systems.


This article for example (by Chris Zielinski et al) describes the mechanisms and systems of knowledge acquisition, creation, diffusion, application and improvement of knowledge in two layers of the health system: health policy formulation and the provision of clinical services. It is based on a questionnaire-based survey, in Health research institutions in 46 countries of the WHO African Region.


Check out also the Editorial, “The way forward – narrowing the knowledge gap in the WHO African Region to strengthen health systems”, and an article on “The African Health Observatory as a platform for strengthening health information systems”.


49. Global Public Health – HIV prevention: Making male circumcision the ‘right’ tool for the job

Kirsten Bell;

In recent years, HIV/AIDS programming has been transformed by an ostensibly ‘new’ procedure: male circumcision, Kirsten Bell argues. This article examines the rise of male circumcision as the ‘right’ HIV prevention tool. Treating this controversial topic as a ‘matter of concern’ rather than a ‘matter of fact’, she examines the reasons why male circumcision came to be seen as a partial solution to the problem of HIV transmission in the twenty-first century and to what effect. She concludes by stressing the need to expand the parameters of the debate beyond the current polarised landscape, which presents us with a problematic either/or scenario regarding the efficacy of male circumcision.


50. ODI Brief –  The technical is political – what does this mean in the health sector?

Daniel Harris et al. ;

It is now generally accepted that governance and political economy factors are key to the effective delivery of public goods and services in specific sectors. This brief, the fourth in a series, aims to help bridge the gap between governance and sector specialists by examining the politics and governance of the health sector through a ‘sector characteristics’ lens.


51. Dave Algoso – Zooming out from healthcare to systems thinking

Nice blog post. Dave Algoso distinguishes thinking about health care, thinking about health care systems, systems thinking about health care systems, and systems thinking about health.

52. Plos – Geographical Inequalities in Use of Improved Drinking Water Supply and Sanitation across Sub-Saharan Africa: Mapping and Spatial Analysis of Cross-sectional Survey Data

Rachel L Pullan et al.;;jsessionid=FABF56CD597ECC56098F5AB9EC9B8713

Using cross-sectional survey data, Rachel Pullan and colleagues map geographical inequalities in use of improved drinking water supply and sanitation across sub-Saharan Africa.

53. Lancet (Comment) – Should at-risk patients be paid to receive interventions?

A Thomas McLellan ;

Small financial incentives can dramatically increase the likelihood of people who inject drugs completing a course of hepatitis B virus (HBV) vaccination, according to research published in a new Lancet Article  (on the UK). McLellan comments. This article obviously also has potential implications for the Global South.


54. Health Policy & Planning – Tackling the tensions in evaluating capacity strengthening for health research in low- and middle-income countries

Imelda Bates et al.;

Strengthening research capacity in LMICs is one of the most effective ways of advancing their health and development but the complexity and heterogeneity of health research capacity strengthening (RCS) initiatives means it is difficult to evaluate their effectiveness. This study aimed to enhance understanding about these difficulties and to make recommendations about how to make health RCS evaluations more effective.

55. Globalization & Health (Commentary) – Open access: academic publishing and its implications for knowledge equity in Kenya

Duncan Mwangangi Matheka et al.;

Traditional, subscription-based scientific publishing has its limitations: often, articles are inaccessible to the majority of researchers in low- and middle-income countries (LMICs), where journal subscriptions or one-time access fees are cost-prohibitive. Open access (OA) publishing, in which journals provide online access to articles free of charge, breaks this barrier and allows unrestricted access to scientific and scholarly information to researchers all over the globe. At the same time, one major limitation to OA is a high publishing cost that is placed on authors. Following recent developments to OA publishing policies in the UK and even LMICs, this article highlights the current status and future challenges of OA in Africa. The authors place particular emphasis on Kenya, where multidisciplinary efforts to improve access have been established.




  • The Guardian:   “South Sudan and CAR are pilot countries for the new deal for engagement in fragile states , the landmark agreement endorsed by 44 countries and international organisations in Busan, Korea in 2011. The new deal sets out to effect fundamental change in the way the international community works in countries emerging from conflict or at risk of it, recognising that these states have been poorly served by aid approaches designed for non-fragile environments. Some have argued that, little more than two years after it was signed, the new deal is in crisis. As the development community gears up for the first high-level meeting of the Global Partnership for Effective Development Co-operation in Mexico next week – a meeting that will potentially shape the aid landscape for decades to come – now is a good time to reflect on where we have travelled since Busan, and how far we still have to go.


  • Tom Paulson wondered (on Humanosphere) why the humanitarian community remains so silent on the USAID-“Cuba Twitter” fiasco. He draws a comparison with the (huge) commotion around the CIA fake vaccination scheme in Pakistan.

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