Dear Colleagues,

 

While I’m putting together this newsletter, most of my department colleagues are enjoying a creative art workshop (annex teambuilding exercise) in Middelheim Park, Antwerp. The weather is great, so I hope they have a lovely time. Yesterday, on the first day of the annual departmental days, we did some strategic brainstorming, as we tend to do at gatherings like this. In a sign of the times, ‘wellbeing at the department’ was a discussion item, for the first time. Have we reached a tipping point? We know that probably sounds a bit odd if you’re trying to survive on a meagre income in a low-income country, but everything is connected with everything if you look carefully enough. Meanwhile, Richard Horton – or his Lancet global health alter ego – tweeted this week that if universities want to have some real influence on global health in the 21st century they will have to be more political and write (more) for policy makers. His analysis is spot on, but I’m not sure how that fits with the current trend towards ‘centres of academic excellence’.  

Meanwhile, it looks like it will be a hot summer again around the world. There’s “rumble in the jungle” in Vietnam (towards the Chinese), Ukraine, Brazil  (again riots ahead of the world cup), Turkey, Nigeria (see below), …. Many people are angry, and for good reason. Last but not least, whether you like it or not, it’s “Modi day” in India. We draw upon some Indian experts – we especially want to mention EV Radhika Arora – for a first assessment here. Radhika is rather balanced:

 “As Europe woke up this morning, the results from the biggest democratic elections held over the last two months in India poured in.  551 million people selected their candidate for Prime Minister for the next five years. And as widely expected the electoral landscape is awash in saffron as India’s Bharatiya Janata Party (BJP) led by Narendra Modi booked a landslide victory across the country. Results are not final as we write this, but it is already clear that the BJP has emerged as a genuinely national party.  Barring a few states, the votes indisputably position the BJP as the winner by a huge margin pan-India. Exit polls had indicated a loss for the Congress Party, but the degree of their defeat has been astounding – the party has been obliterated from the political map. Plagued by corruption, weak leadership and poor governance issues, the Congress seems to have dug its own grave.  Anyhow, the results could not be clearer, and for the first time since 1984 the country witnesses a clear win for a single party. Infamous for the communal violence between Hindus and Muslims that took place under his watch as Chief Minister of the Indian State of Gujarat in 2002, for many, Modi’s victory is met with mixed feelings. Depending on which side of the political spectrum your tribe belongs to, the social media is awash with a spectrum of emotions ranging from extreme despair to BJP-logo wearing selfies. What is evident is that the results, a reflection of a voter bank that represents a population with an average age of 27 years, express a strong desire for change, for a new social order that will usher in economic growth and stability (or so they hope). The BJP pledged economic growth, development, education, health and improved infrastructure, including toilets for every home. One can hope that the next five years usher in growth and development while ensuring a secular, liberal society. Final remark: it is rare to have a country as diverse as India to have such an almost homogeneous, unanimous vote for one party and candidate. Obviously, things were so wrong that the country preferred to vote for a candidate infamous for not preventing communal violence over voting for a party marred by decades of corruption and lack of a clear vision. Even the AAP came ahead of the Congress Party…

For another Indian insider (we let you guess who), with a far less balanced view: “It looks like Modi is going to be the next prime minister. Hurrah for industry and unbridled “development” and smaller government! It also seems like it will be a comfortable majority so that Modi is likely to be unrestrained by coalition politics. Some of his close confidants are very scary people to have in positions of responsibility. I hope that the ‘push’s and pulls’ of democracy and shrewd political sense that Modi has will keep him at the centre right.” 

We let you guess who we side with.

 

In this week’s guest editorial, two Nigerian Emerging Voices, Abubakar Kurfi and Seye Abimbola, reflect on the missing girls in northern Nigeria. A must-read.

 

 

Enjoy your reading.

 

The editorial team

 

 

Editorial

 

Reflections on the missing girls in northern Nigeria

 

Abubakar Kurfi & Seye Abimbola (EVs 2013 & 2010/12)

 

The history of Nigeria can be reduced to a long narrative on the theme of theft. The latest being the 15 April stealing of more than 200 girls from their dormitory in a secondary school in Borno state in northeast Nigeria by the Islamist group Boko Haram. In February, Boko Haram had stolen the lives of 59 boys in their school dormitory in neighbouring Yobe state also in northeast Nigeria. Ten days after the girls were abducted, Boko Haram killed 336 people in a village in Borno state, near the northeast Nigerian border with Cameroon.

On 14 April 2014, the day before the girls were kidnapped, two bombs exploded at a crowded bus station in a suburb of Abuja, Nigeria’s capital city, killing at least 88 people and injuring at least 200. Less than three weeks after, in the same suburb, a car bomb attack killed at least 19 people and injured 60 more. This year alone, Boko Haram has killed about 3,000 people, and since 2012, they have attacked about 300 schools. Their name Boko Haram translates loosely as “western education is forbidden.” Health workers have fled much of the worst affected Borno and Yobe states. In 2013, there were 53 recorded cases of polio in Nigeria, more than half of them were in Borno and Yobe.

While we commend the convergence of global voices against the evil of Boko Haram, the world needs to know that the single act of kidnapping the girls was the tipping point in a long series of atrocities committed by this group. This tipping point needs to be put within the context of ongoing killing, stealing and destruction that people in northern Nigeria have lived with for several years. Rather than reduce the narrative to saving Nigerian girls from Islamists gone wild, there is a need to appreciate the more complex narrative of the failure of the Nigerian state.

For that is what this really is: the failure of the Nigerian state to care for and protect its citizens. The Nigerian government had specific prior warning but did not take pre-emptive actions to protect school children who were taking a risk to sit their final high school exams. Boko Haram released a video few weeks before stealing the girls in which they indicated their intention to raid schools, advised students to leave their schools and threatened to abduct school girls who they would sell. The failure of the police and military to maintain order and security and protect Nigerians from Boko Haram is at least partly a result of corruption in the administration of funds meant for the Nigerian police and the military. In an area prone to attack, they were left without adequate security. In a territory that was supposed to be under emergency rule, they were transported for presumably hundreds of kilometres and they were not rescued.

The existence of Boko Haram itself is a result of a complex mix of factors which include many years of neglect of northern Nigeria where more than three quarters of people in several states live in extreme poverty. There is also a feudal culture which was preserved and reinforced by British indirect colonial rule: poor people survive on the crumbs that fall of the table of the rich, and many of the rich actually got wealthy by stealing funds meant for infrastructure, education and health services in their communities.

While these factors are common to northern Nigeria, they are worst in the northeast. Having a country with a place like northeast Nigeria is like sitting on the proverbial keg of gunpowder. In a setting where about 75% of the population is below the age of 35, majority of whom have no education, no jobs, no opportunities, no hope, and have never experienced a government that works, the emergence of a phenomenon such as Boko Haram seems inevitable. In such places, young people are a potential army of insurgents, a ready cannon fodder in the hands of fundamentalists.

Nigeria does not have a culture of protests. The ongoing protests to Bring Back Our Girls, represent the second time in recent times when Nigerians will come out en masse to make concerted and persistent demands of their government. The first was two years ago, when Nigerians took to the streets to protest the removal of fuel subsidy, the only way in which ordinary Nigerians benefit from living in a country which is the eighth largest exporter of crude oil in the world. The president reversed the removal of subsidy by 50%. It was a good exercise of democratic muscles.

The lesson of the Bring Back Our Girls protests is that Nigerians can kick a sleeping government and an indifferent world to action. This is another opportunity for Nigerians to exercise their democratic muscles, add strength, gain experience and gather confidence. That is the way of democracy. It happens through a long process of civic engagement, empowered by little successes here and there in holding leaders at every level accountable. There is a difference between such indigenous democratic process and the wave of global sentimentality which arose in response, which, good as it is, we know will not last. Enter the next headline elsewhere in the world and Boko Haram joins the ever growing list of forgotten global causes.

Boko Haram thrives on the breeding grounds of inequalities in northern Nigeria. These breeding grounds were fertilised over many years by entrenched greed and corruption. This anomaly cannot be righted by foreign intervention. We are even afraid that foreign intervention may worsen the situation because we know that foreigners fighting insurgents often leads to undesirable outcomes.    But the Nigerian government has long pretended to the outside world that it is capable of containing the menace of Boko Haram, while in reality it has not been able to do much, if anything. We wished for foreign support, we are happy it came and we hope that it helps bring back the girls alive.

Perhaps the worst thing the foreign intervention can do is take away from the success of ordinary Nigerians who came together to make an ignored evil into a global issue, people who succeeded at embarrassing their political leaders’ complacent inaction. The Nigerian government must sit up and read the handwriting on the wall. While we anxiously await the return of these girls to the comfort of their families, we urge you all to support this movement in any way you can. Mobilise support for the #BringBackOurGirls movement on social media, participate in the demonstrations in your various countries. What we must not cease to do is shine a light on the collective action of ordinary Nigerians, amplify it, and hope for more in the future. A new Nigeria might just emerge as a result.

 

 

Abubakar Kurfi is a public health physician who works with the National Health Insurance Scheme in Kaduna, Nigeria.

Seye Abimbola is a researcher at the National Primary Health Care Development Agency, Abuja, Nigeria and a PhD candidate at the School of Public Health, University of Sydney, Australia

 

 

 

Highlights of the week

 

1.    Preparing for the 67th World Health Assembly

As we now have Remco van de Pas on board, we would be rather dumb if we didn’t fully capitalize on his expertise. Remco is a seasoned WHO watcher and explains for us, ahead of the World Health Assembly, what are the key documents and comments to read (see the Section ‘World Health Assembly’, below ), as well as the meetings and side events to attend.

2.    WHO – WHO statement on the Fifth Meeting of the IHR Emergency Committee concerning MERS-CoV

http://www.who.int/mediacentre/news/statements/2014/mers-20140514/en/

MERS is fast becoming a household name, which is never a good sign. The fifth meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations concerning MERS-CoV was held by teleconference on Tuesday, 13 May 2014. As a result of their deliberations, the Committee concluded that the conditions for a Public Health Emergency of International Concern (PHEIC) have not yet been met. However, the Committee emphasized that its concern about the situation had significantly increased. See also Reuters on this.

3.    Health financing in Africa – PBF and community health workers: a new breakthrough in Rwanda

Bruno Meessen; http://www.healthfinancingafrica.org/3/post/2014/05/performance-based-financing-and-community-health-workers-a-new-breakthrough-in-rwanda.html

This blog post (in three languages!) by my colleague Bruno Meessen already caused quite some traffic on Twitter. Obviously, applying the PBF approach to community health workers, organized in associations or cooperatives, is receiving a lot of interest in the community of PBF experts and beyond. Looks like Rwanda is innovating once again.

4.    UNAIDS – International Day against Homophobia and Transphobia

http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/may/20140517idahot/

Conchita Wurst uttered last week, overwhelmed by emotions, the words“We’re unstoppable”. Unfortunately, the International Day against homophobia and transphobia is still very much needed. Check out Sidibé’s statement here, but more importantly, an excellent Humanosphere Op-Ed (by A Natif et al) on how African governments (like the Nigerian and Ugandan one)  exploit homophobia for Machiavellian political reasons.

For the latest example of this in Uganda: Ugandan lawmakers on Tuesday passed a bill criminalizing the ‘willful and intentional’ transmission of HIV’. Deborah Brix, US global AIDS coordinator, already reacted to this sorry news.

On the same issue, we also want to draw your attention to a new CSIS paper, ‘Revitalizing the fight against homophobia in Africa’ (by Richard Downie). We will need to rise like a phoenix, I presume.

 

5.    Lancet (Offline) – The case against global health

Richard Horton; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60797-2/fulltext

Richard did it again – he made the top 5 of this week. But his Offline piece is rather odd. Horton played the devil’s advocate at a recent debate, making the case in favour of the proposition that ‘global health investments benefit countries of the Global North more than those of the Global South’. He said he lost, but leaves us guessing about the arguments against this case, by Professor Nelson Sewankambo. So we hope for a sequel, next week.

 

Gearing up for the 67th World Health Assembly

 

For this section, we rely heavily on Remco’s input (as we mentioned in the section ‘Highlights of the week’). Remco is used to navigating the World Health Assembly (WHA) corridors. He will also report from the WHA.

When spring is in the air, temperatures are rising, birds are singing, new lovers get to know each other, and twitter is buzzing around the hashtag #WHA67, one knows it’s almost time for the World Health Assembly. Every year, at the week-long assembly of the World Health Organization in Geneva, country delegations debate and decide upon key global health policies. This year, the gathering takes place from 19-24 May. The Palais des Nations will be crowded again with diplomats, ministers of health and their “entourage”, different UN staff, NGO folks, some scholars and occasionally even Bill Gates himself! (We have a hunch he uses a lookalike for some of these global health gatherings, as he is a much wanted man these days, so better watch out, you might be talking to Conchita Wurst!).  On Twitter, global health pundits say Ministers of Finance (and even state leaders) should come too. But for that we’ll need a fancier hashtag, I think.

 

Anyway, if you plan to go, check out the agenda:

 

  • The provisional agenda of the 67th WHA.

 

  • The Journal of the 67th WHA with an updated schedule of the programme of the assembly, including all technical briefings and side events.

 

 

Some key policy debates and background documents include:

 

  • WHO Reform, framework of engagement with non-State actors:

http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_6-en.pdf

 

  • WHO reform,  Follow-up to the financing dialogue

http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_7-en.pdf

 

  • Prevention and control of NCDs:

http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_14-en.pdf

 

  • ToR for the global coordination mechanism on NCDs:

http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_14Add1-en.pdf

 

  • Maternal, infant and young child nutrition:

http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_15-en.pdf

 

  • Contributing to social and economic development: sustainable action across sectors to improve health and health equity:

http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_25-en.pdf

 

  • Antimicrobial drug resistance:

http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_39-en.pdf

 

 

On the issue of AMR, you might also want to read this CSIS Analysis (by J Christopher Daniels), ‘(Guarded) Optimism that the world will begin to deal with antimicrobial resistance in 2014’, concluding with: “With AMR’s appearance as a key item on both the Global Health Security Agenda and the agenda of this month’s World Health Assembly, 2014 may indeed be the year the world community finally begins to deal effectively with the natural consequences of interactions between microbes and antibiotics in a human host.”  For some more evidence of the rising prominence of AMR, see also this Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) progress report, just released.

 

 

Obviously, there’s much more on the WHA’s dense agenda. The WHO Watch of the People’s Health Movement is always a good source for comprehensive information and critical analysis (see  here ). The PHM preparatory workshop for WHO Watch started today in Geneva, Switzerland. Eight activists from around the world intensively discussed the agenda of the upcoming 67th World Health Assembly. Their commentary on various agenda items is already available on the WHO Watch website. News, reports and statements on important issues and concerns will be made available on a regular basis once the event starts  (see PHM commentary on the agenda items addressed at WHA67  ).

 

 

For the first time, statements by NGOs in official relations with WHO will be posted online, as to allow non-government actors also to have their position being made publicly available: https://apps.who.int/ngostatements/content/sixty-seventh-world-health-assembly-a671-0

 

 

Last but not least, there will be many side events and technical briefings in and outside the Palais des Nations (even more side events than people attending the assembly, it sometimes seems!). Some highlights include:

 

May, 19 :

  • NCD Countdown to 2025 – Measuring Progress, Accelerating Action.

http://ncdalliance.org/sites/default/files/rfiles/FINAL%20COUNTDOWN%20INVITATION.pdf

 

May, 20:

  • Monitoring progress towards UHC and NGO Session on Post-2015 Health Advocacy:

http://ncdalliance.org/sites/default/files/resource_files/UHC%20Briefing.pdf

 

  • How to preserve policy space for public health:

http://www.wemos.nl/news/?v=2&lid=2&id=308&cid=14

 

May 21: (!!!!!)

  • Launch of Chatham House Reports on Global Health Governance and Financing: WHO Reform and Sustainable Health Financing:

http://graduateinstitute.ch/globalhealth-event21may

 

May 22:

  • Framing a global strategy on Human Resources for Health

http://www.who.int/workforcealliance/media/HRHstrategy_WHAevent.pdf?ua=1

 

  • Overcoming the Challenges of Drug-Resistant Tuberculosis Today and Tomorrow

http://www.msfaccess.org/msf-67th-wha-tb-side-event

 

May 24:

  • Working towards Health for All: What’s the count? MMI mini-symposium and annual assembly:

http://www.medicusmundi.org/en/contributions/events/2014/global-health-whats-ahead

 

6.    Contemporary Politics – Reforming the World Health Organization: what influence do the BRICS wield?

Lara Gautier, Andrew Harmer, Fabrizio Tediosi,  & Eduardo Missoni;

http://www.tandfonline.com/doi/full/10.1080/.U3U5eMYe4ds

 

Excellent preparation for the politics inside the WHO (as well as jockeying around the WHO reform). In this paper, the results of a qualitative study – based on 21 key informant interviews – that seeks to better understand BRICS’ engagement in the WHO and the extent to which their action enables these countries to influence the reform process are presented.

 

7.    BMJ rapid response – Time to turn the tide: WHO’s engagement with non-State actors & the politics of stakeholder-governance and conflicts of interest.

Judith Richter.

http://www.bmj.com/content/343/bmj.d5012/rr/697686

Richter is “deeply concerned that WHO’s so-called reform will side-line those who work in the spirit of ‘Health for All’ and expand the influence of business corporations and venture philanthropies over global public health matters as well as reinforce the trend towards fragmented, plutocratic, global governance.”

8.    Plos Pathogens – Are We There Yet? The Smallpox Research Agenda Using Variola Virus

http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1004108

Another important debate for this year’s WHA. The World Health Assembly is set (May 19) to vote on whether to destroy the stocks of smallpox virus held at the U.S. Centers for Disease Control and Prevention, in Atlanta, and the State Research Centre of Virology and Biotechnology, in Koltsovo, Novosibirsk Oblast, in Russia.

 

In other WHO related news, the World Health Statistics 2014 report was released on Thursday. See the WHO press release. People everywhere are living longer, is the key message. Low-income countries have made the greatest progress, with an average increase in life expectancy by 9 years from 1990 to 2012.  (as for the Planet health statistics, we’re doing a bit worse)

 

Infectious Diseases

 

9.    Lancet (Seminar) – Current status of rabies and prospects for elimination

Anthony R Fooks et al.; http://www.thelancet.com/journals/laninf/article/PIIS0140-6736(13)62707-5/fulltext

It’s not often we cover this issue, but this one is for Omesh Bharti, EV from India, working on rabies. Rabies is one of the most deadly infectious diseases, with a case-fatality rate approaching 100%. The estimated annual figure of almost 60 000 human rabies fatalities is probably an underestimate. The most cost-effective approach to elimination of the global burden of human rabies is to control canine rabies rather than expansion of the availability of human prophylaxis. Mass vaccination campaigns with parenteral vaccines, and advances in oral vaccines for wildlife, have allowed the elimination of rabies in terrestrial carnivores in several countries worldwide. The subsequent reduction in cases of human rabies in such regions advocates the multidisciplinary One Health approach to rabies control through the mass vaccination of dogs and control of canine populations.

10.Plos Medicine – Communicating and Monitoring Surveillance and Response Activities for Malaria Elimination: China’s “1-3-7” Strategy

Qi Qao et al; http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001642;jsessionid=3046DA5E510505A72AEE5256B52230A5

Qi Gao and colleagues describe China’s 1-3-7 strategy for eliminating malaria: reporting of malaria cases within one day their confirmation, investigation within three days, and the appropriate public health response to prevent further transmission within seven days. Could provide some lessons for other countries too.

As a reminder, the Lancet now published in its print version the articleMalaria control in Africa: progress but still much to do’ (by Brian Greenwood et al).

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

Channa R. Jayasekera et al.; http://www.nejm.org/doi/full/10.1056/NEJMp1400160?query=featured_home

With costs that may exceed $90,000 per course, effective new hepatitis C treatments seem beyond the reach of LMICs. But the global rollout of HIV treatment teaches us that it’s possible to make these agents broadly available and affordable.

 

NCDs

 

12.WHO – High-level meeting of the UN General Assembly to undertake the comprehensive review and assessment of the 2011 Political Declaration on NCDs

http://www.who.int/nmh/events/2014/high-level-unga/en/

The UN General Assembly will convene a high-level meeting to undertake a comprehensive review and assessment on the prevention and control of NCDs on 10 and 11 July 2014 in New York. The high-level meeting shall take stock of shall take stock of the progress made in implementing the commitments in the 2011 Political Declaration on NCDs, identify and address gaps and reaffirm the political commitment in response to the challenge of NCDs.

13.WHO report – WHO calls on governments to do more to prevent alcohol-related deaths and diseases

WHO press release

Worldwide, 3.3 million deaths in 2012 were due to harmful use of alcohol, says a new WHO report. Alcohol consumption can not only lead to dependence but also increases people’s risk of developing more than 200 diseases including liver cirrhosis and some cancers. In addition, harmful drinking can lead to violence and injuries. The report also finds that harmful use of alcohol makes people more susceptible to infectious diseases such as tuberculosis and pneumonia.  (recommended reading for the part of the expat community that is into performance based drinking  – the same community might also want to read this week’s Lancet  editorial on the management of liver cirrhosis ).

 

14.Lancet (Editorial) – Prioritising palliative care

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60814-X/fulltextPalliative care is often a low priority in global cancer targets. However, the time has come for health professionals and health systems to consider palliative options seriously at the earliest stages of the cancer journey, and to enable a shared care model that involves palliative specialists in multidisciplinary treatment of patients.”

 

Maternal, child health & adolescent health

 

15.WHO (report) – Health for the world’s adolescents

http://www.who.int/mediacentre/news/releases/2014/focus-adolescent-health/en/

WHO’s ‘Health for the world’s adolescents’ report reveals that depression is the predominant cause of illness and disability for both boys and girls aged 10 to 19 years. The top three causes of adolescent deaths globally are road traffic injuries, HIV/AIDS, and suicide. (Timely report, sadly, in a week in which I read Norwegian Wood. Immersed in global health executive summaries and papers, I had forgotten about the power of novels. They convey so much more than stats).

16.Global Public Health – Investing in very young adolescents’ sexual and reproductive health

Susan M. Igras et al.; http://www.tandfonline.com/doi/full/10.1080/17441692.2014.908230#.U3M5Zfl_tz4

Very young adolescents (VYAs) between the ages of 10 and 14 represent about half of the 1.2 billion adolescents aged 10–19 in the world today. In LMICs, where most unwanted pregnancies, unsafe abortions, maternal deaths and sexually transmitted infections occur, investment in positive youth development to promote sexual and reproductive health (SRH) is increasing. Most interventions, though, focus on older adolescents, overlooking VYAs. They need to be complemented by targeted investment in VYAs.

17.ILO report – Maternity and paternity at work: Law and practice across the world

ILO; This new ILO report reviews maternity and paternity law and practice in 185 countries and territories. The review includes leave, benefits, employment protection, health protection, breastfeeding arrangements at work and childcare.

18.Guardian – ‘I decide’ campaign targets support of powerbrokers on sexual rights

http://www.theguardian.com/global-development/2014/may/13/i-decide-campaign-targets-powerbrokers-sexual-reproductive-rights-ippf

The International Planned Parenthood Federation launches a global push to have reproductive rights included in the new development goals.

19.Lancet (Comment) – Beyond expectations: 40 years of EPI

Margaret Chan; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60751-0/fulltext?_eventId=login

The Expanded Programme on Immunization (EPI) was established by the World Health Assembly in 1974 at a time of great optimism for public health,” Chan starts off this Comment in the Lancet. Later in the piece, she draws some lessons from the last 40 years. “Does EPI offer lessons of broader relevance as the world prepares for the post-2015 era?   … I see many signs that this desire to aim ever higher, with ambitious yet feasible goals, such as exceeding the Millennium Development Goal for reducing childhood mortality, eliminating a number of the neglected tropical diseases, and reducing tuberculosis deaths by 75%, will characterise the post-2015 era for public health. The future of global health can benefit from the pioneering work done by EPI in many respects—for example, finding new ways to secure and increase funding, fostering cooperation between multiple partners to work together with shared yet flexible strategies, stimulating industry innovation, and promoting country ownership through the streamlining of programmatic demands. Above all, EPI carved out pathways and strategies to achieve universal access to immunisation services.

20.Guardian – Faith leaders urge Obama to axe law restricting US abortion aid

http://www.theguardian.com/global-development/2014/may/15/barack-obama-us-abortion-aid-helms-amendment

More than 30 US faith-based groups are calling on Barack Obama to clarify then repeal a law that restricts aid funding for abortion services. Check out their Letter on how the Helms amendment should be interpreted. Encouraging, even if it doesn’t go far enough.

21.FemHealth (policy briefs) – Assessing the local health system effects of fee exemption policies for maternal services

http://www.abdn.ac.uk/femhealth/about/impact-and-dissemination/reports-policy-briefs/

(fyi:  The FEMHealth project was a three-year long research collaboration funded from the European Union. The research consortium was led by the University of Aberdeen and included eight partners in the UK, Belgium, Benin, Burkina Faso, Mali and Morocco, among which ITM)

With a little help from my (witty) colleague Bruno Marchal:

Most programme or policy evaluations aimed at improving maternal health assess the effects on the target group (mothers and newborns) or on services targeted by the policy, such as the workload or the quality of care of the maternity service or operating theatre. The Fee Exemption for Maternal Health (FEMHealth) project assessed the effects of user fee exemption policies for maternal care in Benin, Burkina Faso, Mali and Morocco on the local system, looking beyond the services directly targeted by the policy. First, an analytical framework was designed by adapting the WHO’s well-known health system model with its 6 core functions or “ building blocks “, placing the stewardship function at the heart of the health system. The assumption was that the different dynamics within the local health system, and in particular the effects of policy on the stewardship function (and inversely the effects of the stewardship function on the implementation of the policy), may have an influence on the impact of the policy on targeted and non-targeted services. Second, we carried out realist evaluation case studies to explore how policies are adopted (or not).

The study showed that dynamic models of the health system need to be used, which allow exploring the effect of the policy through the linkages between the different ‘building blocks’ and which put communities, providers and managers at the heart of the interaction (see POEM). The function of stewardship is key as it explains how resources are managed to produce socially beneficial outcomes (or not) and how actors are held accountable.  However, stewardship and how it can be supported is little studied in low and middle income settings. The FEMHealth research suggests that stewardship, understood as ensuring both integration and coordination of all local health actors, and accountability to the public, may explain variable performance of policies across different areas within each country, and brings some insights into mechanisms to support it.”

We specifically want to draw your attention to the following policy briefs (you find them on the FemHealth website):

  • POEM (Policy Effects Mapping tool) or how to assess the effects of a targeted policy on the local health system
  • Why and how fee exemption policies are adopted by district-level health managers: Methodological lessons from a series of realist case studies in Benin, Burkina Faso and Morocco

22.Health Policy & Planning debated – Abolition of user fees: do we (really) know enough?

Valéry Ridde et al.; http://blogs.lshtm.ac.uk/hppdebated/2014/05/12/abolition-of-user-fees-do-we-really-know-enough/?utm_content=buffer6b1e2&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Now that the effectiveness of user fees abolition has been demonstrated, we need to support decision-makers by supplying them with knowledge on the appropriate measures to take to fund abolition, implement it, improve its equity, adapt it to local contexts and healthcare systems, understand the roles of social actors, etc. “   Producing evidence on the complexity of user fees abolition interventions is crucial to support the implementation of UHC. So what are donors waiting for?    (Nice blog post.)

 

Health policy & financing

 

23.Seattle Globalist – Gates Foundation resists pressure to pull private prison investment

http://www.seattleglobalist.com/2014/05/08/gates-foundation-private-prison-investments-geo-nwdc/24430

You know us, we never miss a chance to say anything bad about the Gates foundation J. Check out this article.

24.Global Fund and Munich Re in Risk Management Partnership

http://www.theglobalfund.org/en/mediacenter/newsreleases/2014-05-09_Global_Fund_and_Munich_Re_in_Risk_Management_Partnership/

The Global Fund is further strengthening risk management in health programs that it supports worldwide, under an agreement signed with Munich Re, one of the world’s leading reinsurers. The partnership provides for the German company to contribute know-how in areas such as supply chain optimization, which can enhance program effectiveness when fighting the three diseases.”

25.International Nurses day – 2014 – Nurses: A Force for Change – A vital resource for health

http://www.icn.ch/publications/2014-nurses-a-force-for-change-a-vital-resource-for-health/

International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale’s birth. The International Council of Nurses commemorates this important day each year with the production and distribution of the International Nurses’ Day (IND) Kit. The IND Kit 2014 contains educational and public information materials, for use by nurses everywhere. The IND theme for 2014 is: “Nurses: A Force for Change – A vital resource for health.”   (and an underpaid one, if you ask us)

 

26.Lancet (World Report) – Concerns over mistreatment of migrant workers in Qatar

Sharmila Devi; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60818-7/fulltext

Worldwide attention is focusing on abuses migrant workers in Qatar have to face after injuries, illnesses, and deaths were reported in this group. Sharmila Devi investigates.

Many countries meeting this month at the UN Human Rights Council in Geneva have raised concerns about the exploitation of construction and domestic workers. Recent reports by Amnesty International and Human Rights Watch have highlighted their plight, including unsafe working conditions and great difficulty in accessing health care.

27.Guardian – China accuses British GlaxoSmithKline executive in bribery case

http://www.theguardian.com/business/2014/may/14/china-accuses-british-glaxosmithkline-executive-in-bribery-case

Was also in the news this week.

28.Lancet Global Health (blog)  – Exporting education: applying global health standards to educational partnerships

Julie Johnstone; http://globalhealth.thelancet.com/2014/05/15/exporting-education-applying-global-health-standards-educational-partnerships

“Capacity building through education can be an immensely powerful tool to build on existing infrastructure, develop local expertise and, consequently, improve health. Using a native educational structure, medical experts can effectively export education to almost any geography in the world. Accordingly, there is an emerging practice of global health medical education (GHMEd), where instructors from relatively resource-rich areas teach clinicians in resource-limited areas as part of a global health strategy to build knowledge. This knowledge is assumed to translate into improved health outcomes. There remain questions, however, as to how educators should approach teaching in a different medico-cultural contexts to ensure they are effective and do not cause harm.”

 

Research

 

29.Lancet (abstracts) – Consortium of Universities for Global Health, 5th annual conference

 

http://www.thelancet.com/abstracts/cugh2014/

The Consortium of Universities for Global Health (CUGH) is a young organisation—its 2014 conference is only its fifth annual meeting. But in this short time CUGH has established itself as a major venue for the presentation of the very best new work in global health. This year is no exception. More than 1400 individuals from around the world are attending the event. 550 abstracts were submitted and the 48 chosen as oral presentations are published here by The Lancet Global Health.”   Check out the abstracts here, as well as the introduction by Keith Martin, Zoë Mullan and Richard Horton, “An evolution in global health”.

 

 

30.Global Health Action – Why sub-Saharan African health workers migrate to European countries that do not actively recruit: a qualitative study post-migration

Annelien Poppe et al.;

http://www.globalhealthaction.net/index.php/gha/article/view/24071/html

 

Many studies have investigated the migration intentions of sub-Saharan African medical students and health professionals within the context of a legacy of active international recruitment by receiving countries. However, many health workers migrate outside of this recruitment paradigm. This paper aims to explore the reasons for migration of health workers from sub-Saharan Africa to Belgium and Austria; European countries without a history of active recruitment in sub-Saharan Africa.

31.CSIS (paper) – Sustainability and growth of university global health programs

Alistair I Matheson et al.;

http://csis.org/files/publication/140507_Matheson_UniversityEngagement_Web.pdf

Follow-up survey to document the progress of global health activities in North American universities since 2009, with a specific emphasis on the future trajectory and sustainability of the growth in university global health activities (yes, you read that right…).

 

32.Global Public health – Locating global health in social medicine

Seth M Holmes et al.;

http://www.tandfonline.com/doi/full/10.1080/17441692.2014.897361#.U3M5oPl_tz4

 

Global health’s goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. To respond to these complex biosocial problems, the authors propose the recent expansion of interest in the field of global health should look to the older field of social medicine, a shared domain of social and medical sciences that offers critical analytic and methodological tools to elucidate who gets sick, why and what we can do about it.

33.SS&M – Are Public-Private Partnerships a Healthy Option? A Systematic Literature Review of “Constructive” Partnerships between Public and Private Actors

 

Jens K Roehrich et al.; http://www.sciencedirect.com/science/article/pii/S0277953614002871

Governments around the world have increasingly used private sector involvement in developing, financing and providing public health infrastructure and service delivery through public-private partnerships (PPPs). Reasons for this uptake are manifold ranging from rising expenditures for refurbishing, maintaining and operating public assets, and increasing constraints on government budgets stifle, seeking innovation through private sector acumen and aiming for better risk management. Although PPPs have attracted practitioner and academic interest over the last two decades, there has been no attempt to integrate the general and health management literatures to provide a holistic view of PPPs in healthcare delivery. This study analyzes over 1,400 publications from a wide range of disciplines over a 20-year time period.

 

We also recommend an excellent (and balanced) blog post, by Serufusa Sekidde, on the same topic (PPPs) on the Global Health Hub website ( see here ).

 

34.Health Policy & Planning – Understanding the dynamic interactions driving Zambian health centre performance: a case-based health systems analysis

Stephanie M Topp et al.;

http://heapol.oxfordjournals.org/content/early/2014/05/14/heapol.czu029.short?rss=1

Yet another great paper from Emerging Voice 2013 Stephanie Topp. “Despite being central to achieving improved population health outcomes, primary health centres in LMIC settings continue to underperform. Little research exists to adequately explain how and why this is the case. This study aimed to test the relevance and usefulness of an adapted conceptual framework for improving our understanding of the mechanisms and causal pathways influencing primary health centre performance.”

 

35.Health Policy & Planning – Removing user fees for facility-based delivery services: a difference-in-differences evaluation from ten sub-Saharan African countries

Britt McKinnon et al.;

http://heapol.oxfordjournals.org/content/early/2014/05/10/heapol.czu027.short?rss=1&utm_content=bufferc0170&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Several countries in sub-Saharan Africa have recently adopted policies that remove user fees for facility-based delivery services. There is little rigorous evidence of the impact of these policies on utilization of delivery services and no evaluations have examined effects on neonatal mortality rates (NMR). In this article, the authors estimate the causal effect of removing user fees on the proportion of births delivered in facilities, the proportion of births delivered by Caesarean section, and NMR.

 

 

 

Miscellaneous

 

 

  • Check out the new EC Communication, “ A Stronger Role of the Private Sector in Achieving Inclusive and Sustainable Growth in Developing Countries”
  • (and Guardian coverage of the reactions).

 

Leave a Reply

Your email address will not be published. Required fields are marked *

Please fill in the below * Time limit is exhausted. Please reload the CAPTCHA.