Richard Horton and Lancet co-editors get it right today in the Lancet’s post-2015 Manifesto for the world we want. There is plenty of unfinished business in global health – enter World Aids day. They see five key areas of global health for improvement as we move towards an era of sustainable development, as well as some crosscutting issues that need to be addressed. But let there be no mistake, there is one key objective for all of us, they conclude: “Confronting the escalating threat to human health, even to human survival, from climate change. The era of sustainable development is perhaps the last opportunity our species has to engage with this catastrophic danger—solving the challenge of climate change is the most important foundation for our planet’s sustainability, bar none.”
The global health community is still not totally convinced of this overriding global health objective, including in my own institution. Yet, time is running out, and the “theatre of the absurd” in Doha, as the Economist called COP18 in an article this week, will probably not do much about it. Nature is equally scathing. The challenge is daunting, but we have not much choice, have we? You can’t discuss UHC or other health post-MDGs and happily ignore the big elephant in the room, runaway climate change.
However, this week’s global health news is, obviously, dominated by HIV/AIDS – and not just because some nude protesters stormed House Speaker John Boehner’s office in the US congress, protesting possible cuts in Aids funding linked to the fiscal cliff negotiations. In this week’s guest editorial, we invited Antoinette Awaga, a GF program manager from Togo, to comment on the recent Global Fund board meeting and the new funding model. She is quite optimistic and wishes Mark Dybul all the best.
Enjoy your reading.
Kristof Decoster, David Hercot, Ildikó Bokros, Peter Delobelle, Basile Keugoung &Wim Van Damme
The Global Fund on the road to health system strengthening ?
By Antoinette E.D. Awaga, GFATM Program management Unit Coordinator, Togo
After 10 years of existence, the GFATM appointed a new director, Dr Dybul, and approved a new funding model (NFM) at the 28th Board of Directors held on 14 and 15 November2012 inGeneva,Switzerland. The first business model with round calls for proposals and two phases had shown its limits in recent years. Enter the new funding model. The NFM will remain demand driven but allows for more flexible processes. It will also provide – in a more effective way – strategic direction to the Fund’s portfolio and increase the ability of the Fund to support national robust programs with a focus on countries with the highest needs and the least ability to pay, while remaining global. The length of each allocation period will be three years, and this will be aligned with the Fund’s three year replenishment cycle. At the beginning of an allocation period, the Fund will determine how much funding is available for the entire period. Applicants may apply for this funding at any time during the period. The length of a grant under the new model will be three years with some flexibility to shorten or extend the length. Countries will be assigned to one of the four bands on the basis of their ability to pay and disease burden. Ability to pay will be measured by gross national income per capita.
World Aids Day
1. Science Speaks –Clintonlaunches Blueprint for AIDS-free generation: “Now we have to deliver”
U.S. Secretary of State Hillary Clinton unveiled the PEPFAR Blueprint yesterday, a blueprint for an AIDS-free generation. The blueprint lays out four “roadmaps” — for expanding treatment and prevention interventions, reaching populations of greatest risk and promoting sustainability, creating a shared response, and using science to guide the efforts. The blueprint also pays attention to TB, setting a course for coordinated treatment efforts that would address both diseases. The immediate aim, to reach the “tipping point” at which numbers of new infections is surpassed by the numbers put on life-saving and preventive treatment, will be the first step towards achieving an AIDS-free generation,Clinton said. The blueprint has been masterminded by Eric Goosby and Michel Sidibé.
2. CGD – World AIDS day 2012: getting to the beginning of the end
Amanda Glassman & Denizhan Duran;
One question remains, according to CGD fellows Glassman & Duran: is this really “the beginning of the end of AIDS”? To answer this question, we have to define what the “end” is. There are currently two visions on that (with ONE’s definition, in its rather gloomy report of this week, on one side, and Mead Over on the other). Yet, by either definition, we haven’t yet reached the beginning of the end, Glassman & Duran argue. There is undeniable progress though. So, how do we capitalize on these gains and truly reach the beginning of the end? That will require (1) more money and (2) more value for money.
Sarah Boseley and Tom Murphy also commented, respectively, on the inspiring PEPFAR blueprint and rather pessimistic ONE report (at least as compared to last week’s UNAIDS report), both in the Guardian.
3. Aidstar – Emerging Issues in Today’s HIV Response: Debate 7 : AIDS Funding in a Resource-Constrained World
Earlier this year, on Monday, July 23, the World Bank, PEPFAR, USAID, and The Lancet jointly presented the seventh and last in a series of debates on emerging issues in the global response to HIV, to coincide with the 2012 International AIDS Conference. In this debate, global aids funding was discussed – with on the one side Jeffrey Sachs & Michel Sidibé, on the other side Mead Over and Roger England. Debate 7 discussed the proposition, “Continued AIDS investment by donors and governments is a sound investment, even in a resource-constrained environment.” This document gives the overview of this session.
4. Smart global health – A new funding model for the Global Fund
Summers provides some core attributes of the new funding model: enhanced flexibility, more focused, faster reviews.
A CSIS report also draws some (strategic) lessons from the 2012 AIDS conference.
Other HIV related news:
- Two new World Bank studies urge governments and their development partners to provide better prevention, care, and treatment services for sex workers and people who inject drugs as an important step toward ensuring a world free of AIDS.
- Global Fund Observer just published a new issue, with news onZambia,Uganda,Zimbabwe, auditing, …
- CEOs urge countries to lift HIV travel restrictions: in a joint initiative, a number of CEOs have signed a pledge urging 45 countries to repeal policies and laws restricting travel for people living with HIV. Forty-five countries, including key hubs for international business, still deny entry, stay, residence or work visas for people living with HIV. That is discriminatory and bad for the bottom line, not necessarily in that order.
- In a few Lancet letters, the sustainability of task shifting for ART is being discussed.
Post-2015 & UHC
5. Lancet (Editorial) – A manifesto for the world we want
What are the health priorities post 2015? What lessons can be learned from the health MDGs? The Lancet looks to the future, and highlights five key areas of global health for improvement as we all move towards an era of sustainable development – or total ecological disaster.
Global Health Action has a supplement on climate & mortality: it shows how retrospective, longitudinal, population-based health data from several resource poor settings in Africa andAsia can enhance the understanding of the impact of the variability extremes of weather on mortality.
We also want to draw your attention to a Chathamhouse report (by Bob Dewar) onAfrica & climate change. He sketches a gloomy picture but also some of the opportunities forAfrica.
6. Impatient optimists – We have the power to change the rules
Joe Brewer et al.;
No, this is not an Occupy manifesto, but a strong message voiced on the Gates foundation ‘Impatient Optimists’ blog. Some people at the Gates foundation are getting really “impatient”, it appears. Too early to talk of a ‘paradigm shift’ at the Foundation, obviously, but yet more evidence of some Gates staff getting more political. For the busy ones among you, this is what they have in mind: “This month, we are launching a new platform called /The Rules, to help promote accurate narratives around poverty, and collaborate with people around the world to challenge and change the rules – the most basic drivers of inequality and poverty. We have a special focus on organising with people and grassroots movements in countries such as Brazil, India, Kenya and South Africa. We are creating new ways for people to speak up and organise themselves using simple, cheap technologies like basic mobile phones. The first campaign for /The Rules will target the system of offshore tax havens, starting with one of the biggest and most connected of them all, the City of London. Tax havens are allowing a tiny global elite to extract trillions of dollars from rich and poor countries alike, starving our nations’ treasuries and choking off funds essential for schools, health facilities, social programs and infrastructure.”
Excellent idea, and very much in line with Martin Kirk’s view on how to make development communication more effective, earlier this week, in the Guardian Global Development Professionals Network, a platform just launched. As Kirk says, it’s time to ‘drop the passive’ when discussing poverty.
And now that the Gates Foundation is at last getting in the mood for some stuff you’d rather expect from the People’s Health Movement, let us suggest some more targets: Walmart (with the strike last week), McDonald’s and Burger King (with staff in New York demonstrating for union recognition today), the global textile industry that is still ignoring social and ecological externalities (see Bangladesh, Zara, …), the fossil fuel lobbies, hell-bent on destroying our planet,… Plenty of choice there. It’s going to be a brave new world for the PR guys at the Foundation… Besides a Giving Tuesday, the US and the world also urgently need a Union or a “Kick some Corporate Ass” Tuesday!
7. Global Health Governance (blog) – Healthy development in the post-2015 era
In this blog post, CFR fellow Yanzhong Huang reflects on a workshop entitled “Sustaining Healthy Development: A Workshop on the Post-MDGs Agenda for Global Health.” It was organized on November 19, by the Council on Foreign Relations Global Health Program.
8. ChathamHouse – Workshop summary: Moving towards universal coverage: identifying sustainable methods for improving global health security and access to health care
In the first half of 2012 the Chatham House Centre on Global Health Security established two high-level Working Groups led by internationally prominent chairs and comprising some of the leading actors in the field of global health. The first meeting of the Working Groups was held at Chatham House on 8 and 9 October 2012. The two working groups focus on ‘WHO and the international system’ and ‘commitments to sustainable financing: need for a new model?’ respectively. This document gives the overview of the first meeting.
Some more UHC related news: check out Claudio Schuftan (PHM) ’s concerns about the calls for Universal Health Coverage. “The calls we now often hear for Universal Health Coverage are mostly very vague. Calls for universal coverage are confused with calls for universal access. The former, often part of an insurance scheme, may not give access to all services so that we cannot speak of universal access.”
9. Global Policy – Global governance of health and the requirements of human rights
Gorik Ooms & Rachel Hammonds;
The authors (and colleagues of ours) explore two areas in which new mechanisms of global governance of health have emerged in the first decade of the 21st century: firstly, international assistance to finance healthcare and the Global Fund; and secondly, the Social Protection Floor which aims to ensure basic social guarantees for all. They argue that human rights can help to combine and strengthen these mechanisms, serving as a guide for a true partnership between people across borders, rather than merely a set of norms imposed upon states.
10. WHO – WHO’s arrangements for hosting health partnerships and proposals for harmonizing WHO’s work with hosted partnerships – Report by the Secretariat
This document prepares for the report to the Executive Board at its 132nd session on WHO’s hosting arrangements for health partnerships (like the Alliance, Roll Back Malaria, Stop TB, …) and proposals for harmonizing work with hosted partnerships. The report contains: (i) an overview of the partnerships currently hosted by WHO; (ii) an outline of the contributions made by hosted partnerships to global public health and to WHO’s work and opportunities generated by them; (iii) a description of what hosting a partnership entails and the rationale for such hosting; (iv) challenges emanating from the hosting relationship; and (v) suggested courses of action for improving harmonization between WHO and hosted partnerships.
The WHO just released a newsletter on the WHO reform. “Change@WHO follows the developments of WHO reform; each issue will report on the three strands of programmes and priority setting, governance and managerial reform. Change@WHO will be published three times per year.”
11. IP Watch – WHO Members Agree On “Strategic Work Plan” On Health R&D – But No Convention
Rachel M. Hermann;
After three days and two nights of tough negotiations to address the global gap in research and development for neglected diseases at the WHO, member states agreed to endorse a strategic work plan that includes proposals on the coordination, financing, and monitoring of R&D expenditures separately, but not to advance the idea of an overarching framework. The recommendation for a global R&D convention proved divisive to the very end of the negotiations. Progress will be reviewed again at the WHA in 2016…
For an in-depth analysis, see also Knowledge ecology international, “WHO negotiators propose putting off R&D treaty discussions until2016”. Developing countries were confronted with stiff opposition from theUS and the EU, it appears.
12. KFF – UNAIDS, Stop TB Partnership Sign Memo To Work Together To Halve TB Deaths By 2015
UNAIDS and the Stop TB Partnership on Tuesday launched an initiative aimed at reducing HIV deaths caused by TB by half by 2015. The memorandum of understanding signed by the groups states they will “take action … to strategically address the intolerable burden of TB mortality borne by people living with HIV. The two organizations are developing a detailed work plan and have committed to collaboration to achieve three main objectives within the next three years: increase political commitment and resource mobilization for TB/HIV; strengthen knowledge, capacity and engagement of civil society organizations, affected communities and the private sector; and help most-affected countries integrate TB/HIV services.” ( this seems in line with the PEPFAR blueprint’s focus on TB, see above)
Check out also a nice interview with Mario Raviglione, director of the WHO Stop TB department, by Daniele Dionisio (GESPAM).
13. KFF – Global Polio Eradication Initiative IMB Report Optimistic But Warns Of Possible Polio Resurgence In 2013
Though there is “significant risk” of a resurgence of polio in 2013, anew report from the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) is optimistic about the eradication of the disease, noting that 99.9 percent of polio has been stopped worldwide, with 175 cases reported so far in 2012 compared with 350,000 reported in 1988. Though the IMB’s “target of stopping global polio transmission by the end of the year will clearly not be achieved,” only four countries — Afghanistan, Nigeria, Pakistan, and Chad – reported cases in 2012 and India was declared polio-free in January, marking a milestone taking it off the list of endemic countries. The report concludes there is a ‘magic formula’ that is still missing in the affected countries, which it calls ‘absolute ownership’: this means parents demanding the vaccine for their children and local leaders grasping the challenge of wiping polio from their area. However, quite disturbingly, the report also suggests countries should bar entry to travellers from nations still plagued by polio unless they have proof they have been vaccinated.
In encouraging polio news, Nigeria’sKanoState government, the Dangote Group, and the Gates Foundation on Monday signed a multi-year memorandum of understanding geared towards the eradication of polio in Kano State. A statement from the Gates Foundation said the public-private partnership aims to “improve routine immunization and primary health care in Kano State with a goal of reaching 80 percent coverage with basic vaccines by 2015.
Health Policy & Financing
14. Lancet (Editorial) – Zoonoses uncaged
This editorial introduces a Lancet series on Zoonoses. In this series, leading experts discuss the ecology, drivers and dynamics of zoonoses, while also addressing how we might predict the next zoonotic pandemic, and reduce the potentially catastrophic human and economic cost of such an outbreak.
15. Lancet (Comment) – Progress and changes in the South African health sector
In a new Lancet review article, Bongani Mayosi and colleagues report on the progress and changes made toSouth Africa’s health systems since the 2009 Lancet Health in South Africa Series. In this Comment, Aaron Motsoaledi, South-Africa’s Minister of Health, gives his view.
16. Guardian – Big Pharma ups its game in providing drugs to people in poor countries
Pharmaceutical companies are showing greater accountability in the boardroom today over access to medicines, with more openness, targets and investment in drugs relevant to the poor, but they show no evidence that they adequately supervise the conduct of outsourced clinical drug trials, according to a new analysis released on Wednesday. Published every two years, the ‘Access to Medicine Index’ ranks the world’s 20 biggest drug companies. GlaxoSmithKline remains at the top of the index, followed closely by Johnson & Johnson and Sanofi. As for drug development, the focus continued to be on respiratory and diarrheal diseases, HIV, and malaria, but some neglected tropical diseases are gaining attention. In addition, more companies were found to be running ‘tiered pricing’ schemes, in which medicines are cheaper for targeted countries or populations.
17. TMIH (Editorial) – Malaria mortality estimates: need for agreeable approach
Yazoume Ye et al.;
The purpose of this commentary is to shed light on ways to ensure that we do not continue to have this dichotomy in malaria mortality estimates in the future, as evidenced by the recent – different – IHME and WHO malaria mortality estimates. Verbal autopsy could be the way forward.
18. Globalization and health – Crossing the quality chasm in resource-limited settings
Duncan Smith-Rohrberg Maru et al.;
This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.
19. Global Public Health – HIV testing for pregnant women: A rights-based analysis of national policies
Elizabeth J. King et al.;
Ethical and human rights concerns have been expressed regarding the global shift in policies on HIV testing of pregnant women. The main purpose of this research was to conduct a policy analysis using a human rights-based approach of national policies for HIV testing of pregnant women. The authors collected HIV testing policies from 19 countries. Results highlight the need for more attention to issues of pregnant women’s autonomy in consenting to HIV testing, confidentiality in antenatal care settings and provision of counselling and care services. The authors conclude with a discussion about potential implications of the current testing policies and provide recommendations for ways that HIV testing policies can more effectively uphold the human rights of pregnant women.
Emerging Voices videos
Godson Eze (Nigeria): Enhancing routine immunization performance using innovative technology in an urban area of Nigeria (presentation also given at a parallel session inBeijing)
The study was done inNigeriawhere routine immunisation coverage has been erratic in most areas and once controlled vaccine preventable diseases are beginning to re-emerge. Also, the traditional home-visit system has been unsustainable. So SMS messages were sent to mothers in a reminder-recall system to bring their babies for routine vaccination. As per coverage and timeliness, children of mothers who received reminders were significantly better than the ones from the control group who did not.
Beverly Ho (Philippines): How did the introduction of a maternity care benefit package contribute to the attainment of Millennium Development Goal (MDG) 5?
The rate of decline in maternal mortality ratio (MMR) in thePhilippinesis slow. A complex web of factors – structures, inputs, processes – have been identified to affect maternal mortality. Optimizing intrapartum care appears to be the single most important intervention for reducing maternal mortality in both high and middle/low-income countries However, financial access to intrapartum care remains a major barrier. The Philippine Health Insurance Corporation (PhilHealth) made available the Maternity Care Package and Normal Spontaneous Delivery Packages for its members and qualified dependents. Analysis of hard and soft data has shown how a health insurance benefit package designed to cover normal deliveries has increased demand for quality maternal health services among pregnant women and led to improved supply of services.
20. ODI – Climate Finance fundamentals
This series of short, introductory briefing on various aspects of climate finance are designed for readers new to the debate on global climate change financing. In light of the fast pace of developments in climate finance, the briefs allow the reader to gain a better understanding of the quantity and quality of financial flows going to developing countries. The briefs outline the principles of public climate finance; the emerging global climate finance architecture; and address the instruments, needs and actual funding amounts in the action areas of adaptation, mitigation and forest protection (reducing emissions from deforestation and forest degradation, REDD-plus). Several look specifically at the climate funding situation for specific regions of the world.
- The UK stops aid to Rwanda: “… In a defining moment for UK aid policy to Rwanda, the international development secretary, Justine Greening, announced on Friday that £21m of budget support – money that goes directly to the Kigali government – due to be handed over next month will not now be released.” This is one very obvious example of what Tom Murphy calls the changing aid landscape since Busan (very nice blog post, by the way).
- Mark Tran reckons this was pretty much a lost year for aid effectiveness reform, in the EU (in the Guardian).
- The Canadian federal government signalled a radical shift in its foreign aid, not exactly for the better. See here and here. Canada’s international development agency will align itself more closely with the private sector – including the mining sector (!) – and work more explicitly to promote Canada’s interests abroad. (Gates Foundation: we have another target for you guys!)
- Francehas survived the introduction of the financial transaction tax so far. Its financial sector is doing just fine.
- As already mentioned, the Guardian launched a Global Development Professionals network. Interesting articles from Owen Barder, Justine Greening (on aid transparency, the new priority in theUK) and others.
- A WEF report on population growth, and why it matters.