Dear Colleagues,

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This week the Lancet launches its “Malaria elimination series“. Indeed, there is growing consensus that it is timely and urgent to accelerate the “big push” in malaria control. In 2007 Bill Gates called for “eradication” and was cheered by many, for a variety of reasons … Others tried to correct the (blunt) language, and now the global malaria community has settled for “malaria elimination”, with a progressive “shrinking of the malaria map”. There are certainly opportunities to decrease malaria considerably, and this fits well in the ‘quick win’ approach to reaching the MDGs. However, lessons from previous attempts have learnt that if this is done exclusively in “campaign mode” then there is a big risk of “resurgence” and “rebound”  (not unlike what happened in the US this week). This could lead to a backlash and hangover symptoms… To prevent this from happening (again!), long-term malaria control needs to be planned from the start, involving comprehensive health systems strengthening to use the drive and energy generated for wider health goals. But that is a tall order.


We would also like to draw your attention to a new issue in the ITM SHSO&P series, by Josefien Van Olmen and colleagues. The attention for Health Systems Strengthening (HSS) has by now resulted in an overwhelming amount of articles with HSS in the title. Most of these only add to the cacophony around the topic, unfortunately; few publications really add to the debate. The recent excellent article of Shakarishvili in Health Policy & Planning was an exception. The monograph by Van Olmen and colleagues also aims to contribute to and spice up the debate, by giving overviews, clarifications and visions. The authors outline a framework that is primarily meant for analysis of individual health systems, but can be adapted and used for analyzing specific problems modelling of effects of future interventions. The framework goes beyond the WHO building blocks approach by stressing four additional issues: (1) a focus on outcomes and goals; (2) the importance of underlying values and principles; (3) service delivery as the core building block, which needs unpacking; & (4) health systems interactions with the population and with the specific contexts in which they are embedded.


Enjoy your reading.


< ?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />David Hercot, Kristof Decoster, Josefien Van Olmen, Basile Keugong & Wim Van Damme

Global Health

1. Lancet Series – Malaria elimination series

In a Lancet series, malaria elimination is put under the microscope: what are the technical, operational, and financial challenges that confront malaria-eliminating countries? 

Das & Horton comment on the series: malaria elimination is worthy, challenging and – only just – possible. But an effective vaccine would still come in handy.

In another comment, Feachem et al. set some priorities for malaria elimination for malaria-endemic countries, WHO, the GF, the research community, the pharmaceutical industry and the private sector. The time horizon? 2050.

A Lancet article dwells on the global health career of Richard Feachem, former boss of the GF. Feachem does not only have a very clear vision on malaria elimination, he is also very explicit about the role the GF should play.

Earlier this week, Sarah Boseley also commented on the Lancet series in the Guardian. In some countries, control might be the best policy.

2. BMJ (news) – Countries’ long term progress in health isn’t related to economic growth, report finds

Peter Moszynski;

The twentieth UN Human development report (PDF, 11 MB) was released a few days ago. BMJ columnist Moszynski looks at it from a health perspective. Most developing countries made dramatic yet often underestimated progress in health (as well as education and basic living standards) in recent decades. Many of the poorest countries saw the greatest gains.


Three new indicators have been included in the report. A particularly timely one is an indicator about inequalities within countries. A Guardian piece zooms in on this new measure.


Next week, South Korea will host the G20 meeting. So far not a word has been uttered about global health, maybe because emerging countries don’t perceive global health and the UN the same way donor countries do. A new Seoul consensus does not seem to include global health, at least for now.

Health systems

3. SHSO&P 27 – Analysing Health Systems To Make Them Stronger

Josefien Van Olmen et al.; or

As stated in the introduction, the authors outline a framework that is primarily meant for the analysis of individual health systems, but can be adapted and used for analyzing specific problems modelling of effects of future interventions. The framework expands on the WHO building blocks approach by stressing four additional issues.

4. Global Public Health – Using global health initiatives to strengthen health systems : a civil society perspective

Jennifer Cohn; Asia Russell; Brook Baker; Alice Kayongo; Esther Wanjiku; Paul Davis;

In this interesting article, the authors fill a knowledge gap by providing the civil society’s perspective regarding the effect of PEPFAR and the GF on country health systems and the added value of civil society interacting with GHIs to strengthen health systems.

5. TMIH (viewpoint) – Why do we need a point-of-care CD4 test for low-income countries?

R. Zachariah, S. D. Reid, P. Chaillet, M. Massaquoi, E. J. Schouten, A. D. Harries

In this viewpoint, the authors discuss the reasons why a point-of-care CD4 test is urgent. It is high-time that CD4 technology is simplified and adapted for wider use in low-income countries to change the current paradigm of restricted access.

Health Financing

6. The East African – Why the private sector must join the fight against AIDS, malaria and tuberculosis

Jeannette Kagame & Aigboje Aig-Imoukhuede;

The authors (including the first Lady of Rwanda) of this opinion piece are members of the board of Global Fund friends Africa. They call upon the private sector to contribute to the fight against the three diseases as this would amount to a win-win strategy for the African industry.

7. CGD (paper) – Where Have All the Donors Gone? Scarce Donor Funding for Non-Communicable Diseases Working Paper 228

Rachel Nugent & Andrea B. Feigl;

CGD released an analysis of ODA money allocated to non communicable diseases. Despite major increases over the years, the picture remains bleak..

8. AIDSSPAN – OIG Finds Serious Deficiencies in Performance of All Four PRs in Zambia

The GF story in Zambia has been a bitter one recently. An audit report made clear that principal recipients have shown evidence of significant financial management and control weaknesses, episodes of misappropriation and fraud, and losses of grant funds.


Last week, Andrew Harmer already commented on this disturbing news.

9. WHO Bulletin – Examining health-care volunteerism in a food- and financially-insecure world

Kenneth Maes;

In this viewpoint, Maes analyses the volunteerism that is often promoted by community level programmes. Something is indeed wrong when volunteers cannot meet their basic needs.

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