In this week’s newsletter, we pay quite some attention to the 132nd WHO Executive Board meeting, one with an unprecedented workload as well as a conspicuous role for Margaret Chan. Meanwhile, rumour has it that WHO’s post-MDG goal of preference, Universal Health Coverage, is encountering some serious opposition, not the least in influential political circles. Conversely, healthy life expectancy seems to be gaining momentum. But 2015 is still far away.
Tim Evans was appointed as the World Bank’s director for Health, Nutrition and Population, and will make up a “Dream Team” with Jim Kim, according to a colleague of ours. Which begs the question: who is then Michael “Air” Jordan and who would be “Magic” Johnson? (in a world with increasing BRICs influence, we need Yao Ming too, but maybe he’s already secretly on board 🙂 ). Hopefully the new Bank dream team can also put some pressure on world leaders to do something about the horrific Syrian health crisis. Encouragingly, the international community just pledged 1.5 billion at a fundraising conference for Syria.
Many columnists reflected on Davos’ meaning earlier this week, including Gideon Rachman (Financial Times), Ian Bremmer (Foreign Policy) and Schumpeter (Economist). Focusing more on global health, Humanosphere’s Tom Paulson reckons Davos still matters: “A number of major global health and poverty mitigation schemes have been launched at Davos over the years. The message Gates brings every year is that the rich and powerful are obligated to look upon the problems of the poor, and to take action. It’s a message that seems to be sinking in.” Let’s hope so. On the bright (?) side, bankers seem to increasingly like the African continent. This week, Bill Gates also released his annual letter, focusing on the importance of data and measurement. Adam Wagstaff no doubt agrees.
In this week’s guest editorial, EV 2010 Joarder Taufique, currently a doctoral student at Johns Hopkins, makes a case for intersectoral action for health. He recently wrote an editorial on this topic for Global Health Promotion.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Intersectoral action for health: searching for a more inclusive approach
by Taufique Joarder, EV 2010 from Bangladesh, doctoral student at Johns Hopkins
In our medical curriculum in Bangladesh there is a subject called ‘Community Medicine’, which is an abridged version of Public Health. Our aspiring future doctors, occupied with the overly optimistic dream of becoming accomplished clinicians in the near future, often neglect this subject as this is only distantly related to their aspirations. Discouraging the tendency of delving into Community Medicine text books by some students, our senior colleagues used to say: ‘Just memorize the chapter on Primary Health Care (PHC) and the Alma Ata Declaration. Teachers never fail a student in Community Medicine, and if someone accidentally tends to fall into the ditch, they (the teachers) as a lifeline ask the definition of PHC, its eight components, and a few principles of the Alma Ata Declaration.’
Read the rest here
1. IP Watch – WHO Executive Board Concludes After ‘Unpredecented’ Workload
This article provides a neat (and relatively short) overview of the 132nd EB meeting, including the respective agenda items and Chan’s role – she “alternately explained, sang, and cried” during the week. You can find another nice summary, produced by the NCD Alliance, here. If you want some more detail, GH Watch produced documents with highlights of the consecutive days.
2. Intellectual Property Watch – Debate erupts at WHO over ‘consensus’ on financing R&D for the poor
The issue of financing and coordinating R&S for neglected tropical diseases continued to stir emotions, as illustrated by this joint letter sent by civil society organizations to WHO EB delegates on follow-up of the report of the Consultative Expert Working Group on R&D (CEWG), which recommended developing a legally binding global convention to address the unmet R&D needs of developing countries. The recommendation resulted in a draft resolution that failed to be finalized at the EB and was hence referred to the WHA for further negotiation.
The recommendation, which revolves around the de-linkage of the cost of R&D from the price of health technologies to replace the current system of patent monopolies, is perceived to be at odds with the viability of the mostly in developed countries based and research-driven pharmaceutical industry, thereby resulting in a crisis of conscience at WHO that could clearly hamper its Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA).
We hope you also find the time to read some other articles and blog posts on various other agenda items, new WHO priorities, WHO reform items, etc. :
- Global Post reports on a new action plan for mental health which could be a turning point.
- Some say the benefits of a decentralized WHO outweigh the challenges.
- IHP blog post (by Kristof Decoster): Is WHO ready for a rising Africa ? (with a focus on AFRO and a notorious Twitter afficionado)
3. Lancet – WHO and the future of disease control programmes
Christopher Dye et al.;
In a changing global health landscape, national programmes for the control of HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases must be reinforced and adapted for three reasons: the global burden of these communicable diseases remains enormous, disease control programmes have an integral and supporting role in developing health systems, and the health benefits of these control programmes go beyond the containment of specific infections. WHO’s traditional role in promoting communicable disease control programmes must also adapt to new circumstances.
The Lancet features also a few World Reports this week, somehow linked to WHO:
- Alleged links between the International Agency for Research on Cancer (IARC) and the asbestos industry have been condemned on the eve of a crucial UN conference. David Holmes reports. (apparently the asbestos industry learned some tactics from the tobacco industry)
- Another World Report zooms in on the mercury treaty, on which we already reported last week.
4. WHO Bulletin (editorial) – Human resources for universal health coverage: a call for papers
Mubashar Sheikh et al.;
The new WHO Bulletin issue just came out. This is one of the three editorials. The Bulletin will publish a theme issue on HRH and UHC to provide an opportunity to identify the changes in HRH investment, production, deployment and retention required to achieve UHC. Its publication will coincide with the Third Global Forum on Human Resources for Health, to be held in Recife, Brazil, on 10–13 November 2013.
Bill Gates’ Annual Letter
5. WSJ – Bill Gates: My Plan to Fix The World’s Biggest Problems
In the WSJ, Bill gave a sneak preview to his annual letter. (A few days later, the WSJ was attacked by Chinese hackersJ too, although Bill didn’t even mention the smog in Beijing!). Good measurement and a commitment to “follow the data” are key to improving the human condition. Melinda Gates also chipped in, in Foreign Policy, in the context of maternal health. But somehow the powerful story she told on Sebsebila Nassir, an Ethiopian mother, impressed us most. Uplifting stories and data complement each other.
Polio remains the Foundation’s top priority, and Gates is fairly optimistic about polio eradication – he called for a detailed plan to eradicate polio by 2018. Meanwhile, a new study came out in NEJM which seemed to prove that “A partial dose of polio vaccine was as good as a full one in providing a basic level of immunity against the crippling disease”. Poor countries will no doubt pay attention.
A number of people commented on Gates’ annual letter, including Tom Paulson and Ed Carr – the latter is stressing that the aid community also needs to get rid of its failure-averse institutional culture.
In case you want to read another critical piece on Gates this weekend, there’s always the Guardian. Gates happens to be the principal shareholder in Republic Services – the second-largest waste management company in America. And guess how workers are treated there.
BRICS & Global Health
6. Global Health Governance – Can (MICs) governments make the global R&D system work for all?
Global Health Governance has a few nice blog posts this week. Check out this one by Suerie Moon for example, in which she asks some pertinent questions about BRICs countries in the context of the Consultative Expert Working Group on Research and Development (CEWG) debate. “Much has been made of the rise of the BRICS – or MICs more generally – and their growing financial, diplomatic, and normative influence in global health. Unfortunately, we’ve seen too little evidence that the MICs are ready and willing to fill the potential leadership vacuum arising from this power shift.”
Other GHG blog posts dwell on how the Obama administration could integrate global health into its so called “pivot strategy” towards Asia (by Yanzhong Huang, also on CFR Asia Unbound), and one on how Brazil outpaced other BRICs countries in its response to epidemics, mainly by capitalizing on its civil society.
7. Rockefeller foundation – Top trends: Impacting the next 100 years of global health
Yet another global health event took place in Beijing last week, “Dreaming the future of health”. (a slightly cynical event, given the fact that Beijing smog was reaching Olympic levels last weekend ). In advance of the convening, The Rockefeller Foundation asked select attendees and other experts to identify ten trends that may dominate the global landscape into the future. This list is the result of that “crowd-sourcing” exercise. (we heard an innovative Beijing business man is already selling ‘fresh air’ in Coke cans).
8. BMJ – After aid: the NHS can also learn from India and China
A recent debate in the BMJ asked whether rich countries should stop sending development aid to India. This debate is set against a backdrop of a changing world order. This author argues that relationships between the UK and India and the UK and China have matured into partnerships of equals, creating new opportunities for mutual learning and benefit. He wonders what may have shaped these changing relationships, and what gains the three countries can anticipate. (how about swapping political leaders too ? Wouldn’t it be nice if Xi Jinping had to run the UK for one year and David Cameron had to do the same with the People’s Republic ? )
Maternal and Women’s Health
KFF reports that at the African Union summit in Addis Ababa, Ethiopia, heads of African states gathered at a side event to renew their commitment to reducing the maternal mortality rate on the continent. They noted the 2009 launch of CARMMA, the Campaign for Accelerated Reduction of Maternal Mortality in Africa, by the African Union and UNFPA, which aims to move Africa closer to achieving MDG 5. It was reported that African Union Commissioner of Social Affairs, Dr. Mustapha Kaloko, “is not convinced Africa will reach the set goal by 2015 but he does believe CARMMA has the capacity to accelerate the reduction.” The day after, UNFPA Executive Director spoke about the necessity of family planning services. Dr. Babatunde Osotimehin stated that “ensuring availability of family planning […] would improve the health of mothers and children in Africa, besides saving health care systems unnecessary expenditure.”
- In a post on the Gates Foundation’s Impatient Optimists blog three experts talk about the increasing momentum in Arusha to create a Maternal Health Movement. As you know by now, the meeting resulted in a manifesto which was presented by an omnipresent global health editor and is now being finalized.
- As we already mentioned, in a post on Foreign Policy, Melinda Gates discussed the content of Bill Gates’ annual letter in the context of maternal mortality: “Measurement in the field of maternal health will continue to be a massive challenge. … If we invest in better measurement, we will get a lot more impact out of all that courageous effort.”
The White House released a Presidential Memorandum on Wednesday on the “coordination of policies and programs to promote gender equality and empower women and girls globally.” This will entail the appointment of an “Ambassador at Large,” who will lead the Office of Global Women’s Issues at the State Department, ensure that the Senior Coordinator for Gender Equality and Women’s Empowerment at USAID will provide guidance to the USAID Administrator on priorities for U.S. development assistance, and establish an interagency working group on international gender issues, chaired by the National Security Advisor. Let’s see what the long term effects of this can be, internationally, especially now that Hillary Clinton has been replaced by John Kerry.
Still on women’s health and gender issues:
- An interesting SciDev opinion piece focuses on the potential role for mHealth in tackling sexual violence. Henrietta Miers, an expert in gender policy who has worked across Africa and Asia as a Gender and Social Development Consultant, argues (on the basis of two articles published in Plos recently, see here and here) that research is needed into how mobile phones could be used to provide information and counseling after sexual attacks.
9. Lancet (Editorial) – Hunger: enough is enough
Couldn’t agree more. This Lancet editorial reflects on the “Enough food for everyone IF campaign” which targets the G8.
10. Lancet (Comment) – Prediction of immunisation performance
Celina M. Hanson et al.;
Increased immunisation efforts can bring us closer to reaching the MDG 4 target of reducing child mortality by two-thirds. But greater efforts are needed on two fronts: acceleration of the uptake of underused and newly available vaccines, and strengthening of the immunisation system to improve overall routine immunisation coverage. The GAVI Alliance has been successful in accelerating the uptake of underused and newly available vaccines, these authors argue, “but have we identified effective ways to tackle the strengthening of the immunisation system? What are the factors that affect immunisation performance in low-resource settings? Are poor countries inevitably worse off when it comes to delivery of life-saving vaccines to the entire population?” Not necessarily.
11. AllAfrica.com – Africa: ‘Decade of Vaccines’ Blueprint Ignores High Vaccine Prices and Lacks Ambition
After this GAVI pep talk, probably also good to read about the concerns that MSF has about the ‘Decade of Vaccines’ blueprint: “The cost of vaccinating a child has risen by 2,700 per cent over the last decade, so it is puzzling that the vaccines blueprint for the next decade does not have a goal to bring prices down,” said Dr Manica Balasegaram, Executive Director of the MSF Access Campaign.
12. Lancet (Comment) – Acute lower respiratory infections in developing countries
Michael S. Niederman et al.;
In this comment on a systematic analysis of the global and regional burden of hospital admissions for severe acute lower respiratory infections in young children, the authors offer some recommendations to address the important burden of severe childhood pneumonia in developing countries, through improved access to effective prevention, diagnosis and treatment.
13. GFO newsletter – Issue 208
Aidspan published Issue 208 of its “Global Fund Observer” earlier this week. Among others, the issue contains two stories on the new funding model (NFM), which will normally be launched by the end of February. Presumably, community involvement will still be central in the GF new funding model.
Meanwhile, African countries are increasingly adopting innovative financing to bridge gaps in AIDS funding. This GFO news article gives some examples.
14. GAP – Whistleblower Fired by Global Fund Board Files Lawsuits
Government Accountability Project (GAP) has learned that Laurence Fauth, an attorney retained by John Parsons, the former Inspector General of the Global Fund who was dismissed from his post on 15 November 2012 for alleged “unsatisfactory performance”, filed an appeal of the decision before the International Labour Organization Administrative Tribunal (ILOAT) in Geneva, Switzerland earlier this month. Fauth also filed a defamation claim on Parsons’ behalf before the ILOAT for the pejorative public news release issued by the GF Board on the same date. This could have financial ramifications, the article argues. (By the way, we urgently need another word for whistleblower ).
Health Policy & Financing
15. Lancet (Editorial) – What is the purpose of medical research?
The Lancet editors lament the purpose of medical research in recent decades, and offer suggestions to do something about it.
16. UHC forward – Life after the MDGs
Julian Schweitzer ;
UHC is out, healthy life expectancy in ? Is that it ? Tweets from Horton also seemed to imply this week that UHC faces stiff opposition in high level policy circles close to David C.
17. Malaria matters – Have we reached a funding plateau for malaria?
Bill Briegel ;
Briegel reflects on the worrying ‘flattening out’ trend of malaria financing.
18. Washington Post – Make climate change a priority
The WB president gets it. If we don’t do something about climate change, we might jeopardize all development progress made in recent decades. Worryingly, climate change was not very high on the Davos agenda. Kim offers a few urgent priorities. (Not yet a slam dunk for the dream team).
19. Plos – Tackling Non-Communicable Diseases In Low- and Middle-Income Countries: Is the Evidence from High-Income Countries All We Need?
Shah Ebrahim et al.;
Shah Ebrahim and colleagues argue that more research on NCDs in both high-income countries and low- and middle-income countries can result in mutual benefits and will help better address the growing burden of NCDs.
20. IHP – Access to medicines and quality of medicines: always together!
Raffaella Ravinetto & Christophe Luyckx;
The universal availability of essential quality medicines, at affordable prices and with appropriate quality standards, is a fundamental prerequisite to ensure universal access to health, these ITM authors argue. In their viewpoint, they focus on the new ‘Member State mechanism’ approved in a resolution at the 65th WHA in 2012, proposing international collaboration on ‘substandard, spurious, falsely-labelled, falsified or counterfeit (SSFFC) medical products’. (one of the authors handed IHP an appropriately dodgy picture of himself to boost his case)
Global Health bits & pieces
- Representatives from Ministries of Finance and Health, national health insurance authorities and development partners, as well as experts and practitioners from Asia and Africa are to meet in Centurion, South Africa, next month at a forum (March 11-14) on the role of health insurance in achieving UHC and social health protection. The forum, entitled “Achieving Universal Coverage Through Health Financing Reform”, is organized by the African Development Bank, in collaboration with GTZ, ILO and WHO, in close consultation with the Government of the Republic of South Africa. The forum aims to facilitate knowledge exchange between African and Asian countries on building coherent and sustainable health financing systems that are geared to achieving universal health coverage.
- Check out this interesting article on Devex, in which the author argues the private sector is a critical but often misused partner in PPPs.
- The Prince Mahidol Conference 2013 is going on, in Bangkok – see the PMAC 2013 website. The theme is ‘One health’.
Emerging Voices videos
Joseph Zulu (Zambia) – Improving priority setting in health systems at district level in Kenya, Tanzania and Zambia
Priority setting is an essential component of every health system as it helps governments to focus on key health needs. But how can health systems develop fair priority setting processes? This is the question that this presentation tries to address. It attempts to answer it by discussing the results of an evaluation of a EU funded project that was implemented at the district level in the health sector in Kenya, Tanzania and Zambia aiming to strengthen fair priority setting processes. Increased stakeholder involvement and improved systems for publicizing priorities were some of the indicators of fairness that emerged at the end of the project. This project could provide lessons to health systems in other LMICs on strategies for strengthening fair priority setting processes.
Woldekidan Kifle Amde (Ethiopia) – Engaging with complexity of capacity development: Reflections from a multi-country intervention to strengthen leadership for health workforce development in Africa
Consensus prevails about lack of capacity in sub Saharan Africa, its impact in realization of development goals, and thus the need for capacity development in the region. However, agreement has yet to be reached on what constitutes capacity and how best to develop it. This presentation is a reflection on a collaborative capacity development intervention implemented by four public health academic institutions in sub Saharan Africa to strengthen leadership for health workforce development. The presentation highlights the complex nature of challenges faced in the course of implementation, how partners needed to be flexible and responsive to navigate the challenges, and the importance of engaging in systematic learning. The learning process is guided by a systems perspective that conceptualizes capacity and its translation to performance and change as being mediated not just by external intervention but also by a set of other interdependent factors. The interrogation particularly focuses on exploring how and why capacity development is mediated by interactions with multiple actors and context.
World Bank (Policy Research Working Paper) – The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries A Systematic Review
Arnab Acharya et al.;
This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries.
HP&P (Systematic Review) – Impact of user fees on maternal health service utilization and related health outcomes: a systematic review
Susie Dzakpasu et al.;
This systematic review aims to assess the evidence of the impact of user fees on maternal health service utilization and related health outcomes in low- and middle-income countries, as well as their impact on inequalities in these outcomes.
HP&P – Estimates of performance in the rate of decline of under-five mortality for 113 low- and middle-income countries, 1970–2010
Stéphane Verguet & Dean Jamison;
Measuring country performance in health has focused on assessing predicted versus observed levels of outcomes, an indicator that varies slowly over time. An alternative is to measure performance in terms of the rate of change in how a selected outcome compares to what would be expected given contextual determinants. Rates of change in health indicators can prove more sensitive than levels to changes in social, intersectoral or health policy context, the authors of this paper argue. It is thus similar to the growth rate of GDP in the economic context. They assess performance in the rate of change (decline) of under-five mortality for 113 low- and middle-income countries.
- The Global Journal has a lengthy article on the long history of NGOs.
- Read about Labour’s “social contract without borders”, in the Guardian.
- The High-Level panel is gathering again, this time in Liberia; see also here for the latest. Meanwhile, you find the first (and very preliminary) results of the post-2015 “My World” survey here.
- The jury is still out on whether Africa is rising or not – we don’t really know, this Foreign Policy piece argues, as good data are lacking. (but who needs data, eurozone austerity proponents would argue, if the course is right?)
- Even if Africa is rising, aid will still be necessary, this WB blog post emphasizes, but the aid will be less about money and more about knowledge exchange.
- Hillary Clinton’s legacy for foreign aid and development is summarized in a long Devex article.
- Finally, a new ODI paper was published on MDG 8: “Recasting MDG 8: global policies for inclusive growth”.