Human rights day was celebrated appropriately this week as two global health milestones were reached – the Lancet’s 2010 Global Burden of Disease issue and the UN resolution on UHC in New York. And the week ain’t over yet in the US, if we can believe Laurie Garrett and the Twitter rumour mill. As Richard Horton mentioned in a tweet of his own, the big challenge is now how to use the Global Burden of Disease to accelerate progress towards UHC.
In this week’s guest editorial, our colleague Gorik Ooms reflects on the AIDS movement’s initial reaction when they heard about the UHC resolution, and on how the UHC and AIDS movements could get closer to each other.
We hope you also find the time to read a new BMJ Emerging Voices blog post. Especially the men among you 🙂 . Radhika Arora and other young female health systems researchers discuss the difficulties they experience to juggle their personal and professional lives.
Enjoy your reading.
Kristof Decoster, David Hercot, Ildikó Bokros, Peter Delobelle, Basile Keugoung &Wim Van Damme
Universal health coverage: a reason to maintain ‘AIDS exceptionality’ or a way to move towards ‘AIDS exemplarity’?
by Gorik Ooms
This week we celebrated Human Rights Day, on December 10. On December 12, the United Nations General Assembly adopted a resolution on universal health coverage, which you can find here. According to a WHO discussion paper, universal health coverage is “a practical expression of the concern for health equity and the right to health.” So one would expect the UNAIDS reference group on human rights, meeting in Geneva on December 12, to be very excited about this resolution. It was not. (Believe me, I’m one of them and I was there.) As I wrote in a previous editorial, the worlds of UNAIDS’ investment framework and WHO’s universal health coverage are two different worlds. Six months after the International AIDS Conference, nothing has changed in that respect.
UN resolution on UHC
1. Guardian – UN adopts ‘momentous’ resolution on universal healthcare
There’s no way the readers of this newsletter could have missed this wonderful news this week. Tran reports on the passing of the UN resolution on UHC. There was broad support for the resolution, somewhat unexpected. In an earlier article, Tran already provided some background on the UHC momentum. Now funding will be the issue, of course.
2. Report UN Special Rapporteur – Right of everyone to the enjoyment of the highest attainable standard of physical and mental health
Gorik already referred to this important document in his guest editorial, and UHC Forward also pays tribute to this note by the UN Special Rapporteur, Anand Grover, from a few months ago. It’s definitely worth to read it in full. Hopefully, the document will inspire the High-Level Panel in upcoming discussions on incorporating UHC in the post-MDG framework.
The report considers health financing in the context of the right to health. Full realization of the right to health is contingent upon the availability of adequate, equitable and sustainable financing for health, at both the domestic and international levels. The report thus discusses the obligation of states to ensure adequate, equitable and sustainable domestic funding for health. The report addresses three critical areas in health financing: how states ensure adequate funds are available for health and the sources from which they raise these funds; how these funds are pooled; and how funds and resources are allocated within health systems towards ensuring universal access to good quality health facilities, goods and services. The Special Rapporteur also explores a number of substantive issues in this regard, including taxation and international funding for health; pooling mechanisms, including social health insurance; and allocative concerns, such as allocation of health funds and resources between primary, secondary, and tertiary health care and the resource divide between rural, remote and urban areas.
Lancet Global Burden of Disease 2010
3. Lancet – Global Burden of disease study 2010
The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness. GBD 2010 consists of seven Articles, while accompanying Comments include reactions to the study’s publication from Margaret Chan, Jim Yong Kim, Richard Horton, Michel Sidibé and Peter Piot, Christopher Murray and many others. Read also the special report by Pamela Das et al. on the ‘story behind’ this almost super-human effort.
Excellent summaries and comments were already produced by Tom Paulson ( see Humanosphere – “the burden of a new global health agenda”, including some speculation on the political and advocacy fights the report might trigger ), Sanjay Basu ( on the Epi-analysis website – listing some highlights of GBD ), the Guardian (with a piece summarizing the key data). The Economist also pays quite some attention to this global health milestone in today’s issue: doctors will need some help to address the changing global health agenda, is their take home message… Finally, on Devex, Karl Hoffman considers the GBD as a gold standard moment for evidence-based decision making in global health.
GAVI and Global Fund
4. BMJ blog – Cost effective vaccines saving millions of lives around the world
In this blog post, Hollins summarizes last week’s GAVI Partners’ forum in Dar Es Salaam, Tanzania. The aim was “to foster greater political will and explore ways to accelerate results, innovation, sustainability, and equity in the field of immunisation. The meeting also highlighted and promoted the goals of the global vaccine access plan, a worldwide strategy for vaccination and immunisation programmes agreed at the World Health Assembly in May this year. Much of the focus for discussion was on securing the political will necessary from both donor and recipient countries to achieve the aims set out in this plan, but the forum also highlighted just how effective vaccines are in achieving global improvements in health.”
For summary documents of the sessions, which focused on four themes (results, innovation, sustainability, equity), see here.
You might also want to read an op-ed by Seth Berkeley on the CNN website – vaccines are good for economic growth, he argues. “But we know for a fact that vaccines — in addition to saving lives and improving health — are the cornerstone of a vibrant economy, fuel growth and serve as a magnet for foreign investment. Indeed, research has shown vaccines to be among the most cost-effective investments in global development. These academic papers, including one recently published that focuses on how to measure the economic benefits of the HPV vaccine, are getting noticed in African countries — not only by health ministers, but also by finance ministers and other officials.”
5. Global Fund Observer issue 206
Among other articles, the new GFO issue features an article on an Aidspan analysis of pledges and contributions to the Global Fund (you find the full report on the Aidspan website, including “GF donor scores” for each donor) and a commentary on gender transformative programs and the Global Fund.
Meanwhile, some African civil society organizations sent a letter to Mark Dybul, urging him and the Fund to provide a strategy to “once again” meaningfully engage civil society in the work of the Fund.
Human Rights Day
6. Science Speaks – Ugandan anti-homosexuality bill makes this International Human Rights Day a time to look at health impacts of homophobic landscapes
On Human rights day, Barton reflects on the health impact of homophobic landscapes in African countries such as Uganda, Nigeria and many other Commonwealth states.
7. Claudio Schuftan (PHM) – Health: not charity, not merchandise: a human right (part 2)
In this short article, Schuftan reflects on the difference between ‘the right to health’ and ‘health as a human right’, and WHO’s ambivalence, among other things.
Health Policy & Financing
8. 4th Global Summit of Schools of Public Health in Accra, Ghana
On December 9-10, 2012, the 4th Global Summit of Schools of Public Health was organized in Accra, Ghana, around the theme ‘Policy and Health Systems Research – The contribution of Schools of Public Health.’ The Summit, which was preceded by the third Annual General Meeting of the Association of Schools of Public Health in Africa (ASPHA), was launched in 2008 as a joint initiative of the Association of Schools of Public Health in Europe (ASPHER) and the Asia Pacific Academic Consortium of Public Health (APACPH), and later joined by the North American Association of Schools of Public Health (ASPH), the Alliance in South America (ALASAG), and the more recently established Association of Schools of Public Health in Africa.
During the Summit, a Declaration was signed by representatives of the European Academic Global Health Alliance (EAGHA), ASPH and ASPHA, marking the creation of a World Association of Schools of Public Health. The event, which follows the call for global governance among regional public health associations and intends to foster knowledge exchange among its member associations, was attended by representatives of over twenty public health schools in Africa who strategized around how to deepen collaboration among public health professionals towards improving health, reducing disease and alleviating poverty in Africa.
9. Ecohealth – Towards a Better Integration of Global Health and Biodiversity in the New Sustainable Development Goals Beyond Rio+20
Etienne V. Langlois;
An essay from a few months ago. The authors’ objective is to argue that discussions beyond Rio+20 and toward the adoption of SDGs offer a critical opportunity to re-assess the major challenges for global health and sustainable development. The way toward the post-2015 SDGs will likely be more effective if it highlights the full gamut of linkages between ecosystem processes, anthropogenic environmental changes (climate change, biodiversity loss, and land use), socio-economic changes, and global health. Negotiations beyond Rio+20 should strongly acknowledge the global health benefits of biodiversity protection and climate change mitigation and adaptation strategies, which reduce diseases of poverty and protect the health of the most vulnerable. Langlois et al. argue that health and ecosystems are inextricably linked to all development sectors and that health should remain a critical priority for the upcoming SDGs in the context of global environmental change.
10. HP&P – Operationalizing the One Health approach: the global governance challenges
Kelley Lee et al.;
“One Health” calls upon the human, animal and environmental health sectors to cross professional, disciplinary and institutional boundaries, and to work in a more integrated fashion. At the global level, this paper argues that this vision is hindered by dysfunctions characterizing current forms of global health governance, namely institutional proliferation, fragmentation, competition for scarce resources, lack of an overarching authority, and donor-driven vertical programmes. The papers also offers ways to remedy this.
11. Devex – In Africa’s malaria fight, a $3.6B funding gap
There is currently a $3.6 billion funding gap on malaria in Africa, according to the Roll Back Malaria Partnership, whose board concluded its 23rd meeting in Dakar, Senegal, on December 7. This could reverse recent gains in the fight against malaria in the continent.
12. Plos (Policy Forum) – Preventing Pandemics Via International Development: A Systems Approach
Tiffany L. Bogich et al.;
In a review of nearly 400 public health events of international concern, the authors found that a breakdown or absence of public health infrastructure was the driving factor in the largest fraction of infectious disease outbreaks. The relative roles of emergency response versus long-term development strategies to mitigate infectious disease threats are being debated within bilateral and intergovernmental aid agencies.
Bogich et al. propose a systems approach within development agencies to address pandemic prevention at the intersection of people and their environment where the risk of disease emergence is highest. To achieve this goal, mainstream development funding, rather than emergency funding, is required.
13. HP&P – Six concerns about the data in aid debates: applying an epidemiological perspective to the analysis of aid effectiveness in health and development
David Stuckler et al.;
Is aid helping, hindering, or having no effect on development and health? The answer to this question is highly contested, with proponents on all sides adhering strongly to their competing interpretations. The authors ask how it is possible for those who are often using the same data to hold such divergent views. Stuckler et al. employ an epidemiological perspective and find that, in many cases, the arguments are characterised by methodological weaknesses.
14. IPS – Brazil Enters New Era of Co-Production of Anti-AIDS Drugs
Last week, IPS reported that a new kind of public-private partnership will begin in 2013 in Brazil to produce an antiretroviral drug, through a technology transfer agreement that will be in effect until the patent expires in 2017. The productive development partnership is based on an agreement with drug maker Bristol-Myers Squibb, to produce atazanavir sulphate. The drug will be made by Farmanguinhos, a technical-scientific unit of the Oswaldo Cruz Foundation (Fiocruz) and the Health Ministry’s largest pharmaceutical laboratory. It will be distributed in the public health network as part of the ARV cocktail therapy that is provided free of charge to everyone who needs it in Brazil.
15. Results based financing for health – From Scheme to System—How can we better leverage RBF to strengthen health purchasing?
The RBF interagency working group gathers aid agencies interested in or already having operations with a RBF component. The group is connected to the HRITF Trust Fund of the World Bank. They meet around once a year to exchange experiences, information and to coordinate their vision. A recent meeting took place in Geneva. Cashin reports on some of the discussions there.
16. TMIH (Editorial) – Please, let not Western quackery replace traditional medicine in Africa
Cees N.M. Renckens et al.;
In May 2012, the first gathering of homeopaths was organised on African soil. Renckens et al. are worried about the rising use and popularity of Western homeopathy in Africa. Western homeopaths who have set up shop in Africa even suggest the potential of homeopathy in the treatment of HIV and malaria, inevitably with fatal consequences.
17. HP&P – Sector-wide approaches (SWAps) in health: what have we learned?
David H. Peters et al.;
Peters et al. reflect on what we have learned in the past few decades, since Sector-wide approaches (SWAps) in health were first developed in the early 1990s in response to widespread dissatisfaction with fragmented donor-sponsored projects and prescriptive adjustment lending. The authors also look at the future prospects of SWAps.
18. Globe and mail – Foreign aid partnership to boost research for maternal health
Canada’s foreign aid agency will work with Grand Challenges Canada in a bid to bring ideas for health innovation to the developing world, Canadian International Co-operation Minister Julian Fantino has said.
19. IPS (Op-ed) – Women out loud
Michelle Bachelet, Michel Sidibé and Jennifer Gatsi Mallet;
Global efforts to reach the “three zeros” for women and girls – zero new HIV infections, zero discrimination and zero AIDS-related deaths – are gaining momentum, Bachelet et al. argue. However, in spite of the gains made, our efforts for women and girls remain inadequate. The authors give some key messages of the new report “Women out loud”, launched by UNAIDS and UN Women earlier this week.
20. PNA – Economics of antiretroviral treatment vs. circumcision for HIV prevention
Till Barnighausen et al.;
In a study published online in the Proceedings of the National Academy of Sciences, Till Barnighausen, David Bloom, and Salal Humair of the Harvard School of Public Health examine whether HIV treatment as prevention (TasP) is indeed a game changer or if comparable benefits are obtainable at similar or lower cost by increasing coverage of medical male circumcision (MMC) and antiretroviral treatment (ART). They write: “The most cost-effective HIV prevention strategy is to expand MMC coverage and then scale up ART, but the most cost-effective HIV-mortality reduction strategy is to scale up MMC and ART jointly. TasP is cost effective by commonly used absolute benchmarks but it is far less cost effective than MMC and ART.”
21. HP&P – Studying the link between institutions and health system performance: a framework and an illustration with the analysis of two performance-based financing schemes inBurundi
Maria Bertone & Bruno Meessen;
Institutional arrangements of health systems and the incentives they set are increasingly recognized as critical to promote or hinder performance in the health sector. Looking at complex health system interventions from an institutional perspective may contribute to better understanding what are the paths and processes that lead to the results of such interventions. In this article, Bertone & Meessen propose an analytical framework drawing from new institutional economics. This framework suggests seven dimensions to look at: institutions, enforcement mechanisms, property rights, incentives, interactions between extrinsic and intrinsic sources of motivation, behavioural changes and organizational performance. They then apply the framework to the analysis of the institutional (re)arrangements of two PBF schemes in Burundi.
22. BMC Public Health – How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS
Françoise Jenniskens et al.;
Drawing on a study conducted in five African countries, this paper explores different stakeholders perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and health and how different stakeholders perceive this.
Global Health bits and pieces
- Check out a series of invited commentaries on health equity in ‘Australia & New Zealand Public Health Journal’.
- Ban Ki Moon announced a new initiative appealing for $2.2 billion over 10 years to fight cholera in Haiti and the Dominican Republic. There are already some concerns by some diplomats and U.N. observers that the funds necessary for the program would not be forthcoming from donors…
- A BMJ editorial by Veena Shatrugna on ‘the right to food security’ reflects on a recent report from the Right to Food and Nutrition Watch (October 2012) which considered the effects of globalised food policies on populations in the Third World. The report offered a different perspective on food insecurity than that provided by official UN/WB documents. The authors of the report considered food security in light of social determinants of nutrition, such as food availability, agricultural policy, land transactions, cropping patterns, and agricultural finance.
We already mentioned the new EV BMJ blog post by female EVs and EV organizers on the constraints they experienced so far in their professional and personal lives. It’s also cross-posted on the IHP website.
Isidore Sieleunou (Cameroon) – Do programs to reduce financial barriers and improve access to health care for the poorest work in Sub-Saharan Africa? Lessons from the user fees exemption program for the poorest in Benin
“In many developing countries, programs to improve the health of the population often fail to reach the poorest. Health care fee exemptions can be a financial mechanism to facilitate their access to health services. Our research intended to review the fee exemptions policy for the poorest implemented in Benin and draw lessons to improve the system. While Benin’s fee exemption policy improves access to health care of the poor in term of services’ utilization, contrary to expectations, it disproportionately benefits the less poor. The mechanism is not efficient in reducing financial barriers and improving access to care for the poorest, and needs to be redesigned.”
Prashanth NS (India) – How to study the capacity building of health managers
“Since the World Health Report of 2006 which focused on the health workforce, many have argued for understanding the aspects of skills and performance of health workers especially in LMICs. Human resource management interventions such as in-service training programmes are often called for. However, the lessons learnt from pilot programmes in human resource management are often difficult to translate into scaling up. There is a need to understand how individual, institutional and environmental conditions within which health workers function influence their performance. In my presentation, I describe a way of evaluating capacity-building interventions at the district level. I have applied a realist evaluation approach to evaluate a programme to build the management capacity of district and sub-district health managers in Tumkur district of Southern India. Realist evaluation is a theory-driven evaluation approach that begins by asking why a given programme/intervention worked for some and did not for others (as is often the case in health systems), thus trying to understand what works, for whom and under what conditions.”
23. Branko Milanovic (WB Working paper) – Global inequality by the numbers: in history and now
The paper presents an overview of calculations of global inequality, recently and over the long-run as well as main controversies and political and philosophical implications of the findings. It focuses in particular on the winners and losers of the most recent episode of globalization, from 1988 to 2008.
- The Guardian’s John Vidal gives his final assessment of the Doha climate conference outcomes – the key breakthrough was the agreement on the principle of ‘loss and damage” to compensate climate victims, he says.
- Finally, there was also some good news from the European parliament and the FTT.