Dear Colleagues,



Several global health conferences/meetings took place this week or are still ongoing: the global newborn health conference in Johannesburg; the Africa health forum in Washington, hosted by the WB; a  Global summit on civil registration and vital statistics (in Bangkok), organized by the Health Metrics Network and WHO, a conference on UHC and ethical dilemmas (in Boston, apparently the place (not) to be this week, and especially not this morning ) (hashtag #UHCEthics), …  and we probably forget a few more. Anyhow, this newsletter pays quite some attention to all abovementioned events. Most of these events are also “covered” on Twitter. We also selected some reflections on the new Global Fund momentum and there is also some vaccine related news in advance of next week’s World Immunization Week (and the upcoming Global Vaccine summit).  


Speaking of global health events, we already want to flag a few other (global or regional) events coming up (as well as deadlines for calls for abstracts):


  • A regional conference on the health district strategy, “ Health district in Africa: Progress and Prospects 25 years after the Harare Declaration”  will be organized by the Community of Practice Health Service Delivery,  in conjunction with Harmonization for Health in Africa (HHA) agencies and Be-Cause Health. The event will take place in October 21 – 23, 2013 in Saly, Senegal. The abstract submission deadline is  May 15.  You can submit your proposals to:  (for some reason the ‘cop’ thing reminds me of an old Bodycount song today – must be this morning’s disturbing Boston headlines)


  • The Third International conference on Family planning will be held from 12-15 November 2013, in Addis Ababa, and will be hosted by the Federal Ministry of Health of Ethiopia and the Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health. Deadline for abstracts is the 1st of May.


Our guest editorialist of this week, Karina Widowati, zooms in on the journey towards UHC in her country, Indonesia. The deadline there is 2019.



Enjoy your reading.


Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme






Indonesia aims for universal health coverage by 2019


By Karina Widowati ( MPH, Health Specialist UNICEF Country Office Jakarta, Indonesia)

In 2004, Law No. 40/2004 was issued in Indonesia, several days before President Megawati resigned from her position.  The law mandated the establishment of a National Social Protection System (Sistem Jaminan Sosial Nasional   (SJSN)) and was sparked by the severe economic crisis in 1999 which had wreaked havoc in the Indonesian society (and in the wider region).  The social security law aimed to protect all citizens from economic risk due to illness, injury, old age and death.  For its progressive implementation, five years of transition were foreseen for the four state-owned insurance companies[1] (Perseroan Terbatas (PT)) to adapt to the requirements and become a single non-profit Social Protection Agency. However, implementation proved more difficult than anticipated. Lack of political commitment to implement the Social Security Act from the first government directly elected by the people, the government led by president Susilo Bambang Yudhoyono, during its first term (2004-2009), was probably the main cause of the slow implementation in the years immediately following the law, but there were plenty of other implementation challenges.

Political commitment  became somewhat more visible with the formation of a new National Social Security Council (DJSN) on June 24, 2008, nearly four years after the Social Security Act was passed. The implementation of the law really started to gain momentum during the presidential election campaign in 2009 under pressure from labour organizations, universities and the former chief of the SJSN team.  The national parliament drafted legislation for the establishment of a National Social Security Agency (Badan Penyelenggara Jaminan Social,  or BPJS) and urged the central government to review it. The year 2010 was filled with debate on the institutional form of this agency. The parliament wanted to merge the four state insurance companies into one non-profit social protection agency, whilst the government, represented by the Ministry of State Owned Enterprises, insisted to keep the separate agencies that are currently profit oriented and obligated to reimburse dividends to the central government. Legislation on BPJS was finally enacted on 24 November 2011 (Law No 24/2011) with the establishment of two national agencies, BPJS I for health insurance and BPJS II  for employment benefits (including injury, retirement, pension and death). The state-owned insurance companies are required to hand over their beneficiaries to these two administering bodies by 2029 (at least according to the law; this seems a bit late, though, taking into account the proclaimed aim of UHC by 2019). The 2011 law calls for the merger and unification of Jamkesmas, the government-financed health insurance programme for the poor and near-poor (which was started in 2005), with all other existing health insurance programs (Askes, Jamsostek, mostly, but also a number of local health insurance schemes (Jamkesda). This integration should kick off in January 2014. According to the plan, the current (for-profit) administrator for the civil servants insurance program, PT Askes, would be converted into BPJS I, a not-for-profit agency which is, from then on, meant to administer all social health insurance programs in the country.

Meanwhile, the Ministry of Health in collaboration with health practitioners, universities, and other related ministries developed a road map to National Health Insurance – INA Medicare 2012 -2019. This document will serve as a platform for the implementation of the health insurance part of the social security (SJSN) law. In the road map, MoH predicted that when BJPS I begins operating at the beginning of 2014, it will cover 121.6 million people.  This figure  would include 96.4 million people from Jamkesmas, the health insurance programme  for the poor and near poor (however, there seems to be a huge issue of mistargeting and leakage to the nonpoor, an issue for which the local Jamkesda to some extent try to compensate), 17.2 million people from PT Askes (for civil servants), 5.5 million from PT Jamsostek (for private sector employees) and an additional 2.5 million people from a subnational scheme. 50 Million people would have some form of insurance from another scheme (local schemes mostly) (and would thus not yet be managed by BJPS I)  and  73.8 million people would remain un-insured at the beginning of 2014, according to this projection. Recent World Bank figures are less optimistic. Total coverage would be achieved by 2019 (Indonesia’s population will be 257.5 million then), after the harmonisation of existing schemes and the expansion of coverage to currently uninsured people. The transition towards UHC would thus be achieved in stages, but the deadline –  2019 – is clear. The target seems quite ambitious for a low-middle income country like Indonesia if you keep in mind that a country like South Korea needed around 12 years to achieve full health insurance coverage.

The benefit package will be “comprehensive” in that all illness caused by natural disease will be covered. Beneficiaries for which the premium is paid by the government (the poor and near poor) will be entitled to use a third class room in the hospital; people who pay a (mandatory) contribution will be entitled to a first or second class room, depending on the scheme they choose. Provider payment options will be based on a combination of capitation and diagnostic-related groups, it seems, but lots of challenges remain with respect to the unification of provider payment mechanisms, different benefits packages, premium rates,  etc. The picture is still a bit fuzzy and this will probably remain so for a while.

With more than 20 billion USD to manage (not including the pension fund), resistance is still high regarding the institutional form of BPJS I, mainly because the government gets a  marginal profit  from current state insurance companies but also because the reform will involve large-scale organizational restructuring.  Recent headlines pointed out that the Finance Minister agrees to allocate only 1.5 USD/month/person instead of 2 USD for the premium. This amount would allocate for 84.6 million poor (and near-poor) people (instead of the proposed 96.4 million). Even with an average economic growth of 6.1 % in the last decade, it remains unclear whether the government can afford to pay out subsidized premiums that will cost them 5 billion USD per year. The mandatory insurance contribution has been decided (at 5% of the income or salary), but there is still debate on the proportion of the contribution that should be paid by the employer and employee. An additional challenge is how to collect the premium, should it be embedded in the current tax system or transferred directly to the national agencies by the employer?

It’s clear that on the road to UHC, Indonesia still has a long way to go.  2019 is not very far away and implementation challenges are enormous.  The current fragmentation will need to be overcome and strategic choices will then have to be made in order to improve the coverage especially with regards to informal labour (workers in the informal sector now account for 70% of the total amount of workers). In a country where the ratio of formal and informal workers is 30:70, setting up a social security system is anything but straightforward. Other challenges on the path towards UHC are to ensure that services are available in line with benefit packages – see for example the huge gap between the theoretical benefits package offered by Jamkesmas and the actual availability, especially in remote, rural locations and in a dispersed archipelago of more than 17000 islands – and to eliminate the barriers to access these services, not only geographically but also socially.

Different packages based on different premiums should be avoided not only to minimize cost sharing but also to avoid discrimination. The challenge ahead is to define adequate remuneration packages for providers that reflect health service costs based on benefit packages, and to close the gap between providers’ and the public interest. We will also need a strong political commitment from our Finance Minister to increase the budget allocation for health. Instead of the current 2.2 % of total government expenditure going to health, up to 5% is needed ( the 2009 Law on National Health also mandates this figure) to ensure the wellbeing of Indonesia citizens.

Everyone has the right to health, in Indonesia and elsewhere. Our constitution states that it’s the job of the state to protect this right, and common people in Indonesia are increasingly aware of this.   No doubt it will be hard work to achieve UHC by the end of the decade, but I’m sure we can do it.



Africa health forum 2013 in Washington

1.    Health Forum – info on event & background papers

During the 2013 World Bank-IMF Spring Meetings, African Ministers of Finance and Ministers of Health and development partners participate in the Africa Health Forum 2013: Finance and Capacity for Results. (hashtag: #africahealth ) (18-19 April). The Forum is co-hosted by the World Bank and the U.S. State Department Office of Global Health Diplomacy, in collaboration with Harmonization for Health in Africa. The event can be watched on livestream and there’s also a video library. You can also find a number of short background papers on the site. The first day (18 April) was for the ministers  (and included a final speech by Jim Kim at the end of the day); technical discussions follow today.


The initiation note provided the background and the objectives of the meeting:


The proposed Africa Health Forum 2013 builds on the Tunis declaration and it is a rapid response to the call from African leaders. The Forum, which has a theme of “finance and capacity for results,” and a cross cutting focus on country level institution building, has the following objectives:


To learn from Ministers of Finance and Ministers of Health and to explore policy options to ensure that investments in health produce sustainable systems and results, with more reliance on domestic funds.   Proposed themes for dialogue:

a1.       Policies to achieve results and lasting impact, taking into account the following:  trends in health outputs and outcomes, improvement in quality of services, and diversity of results across countries.

a2.       Innovative domestic and external financing approaches: current experiences and policy actions including risk pooling, revenues from taxes, and revenues from investments in natural resources


To formulate and adopt practical mechanisms for the World Bank, in collaboration with the African Development Bank and  partners in HHA, to support the improvement and expansion of the capacity of country institutions to use development assistance more efficiently. Proposed themes for dialogue:

b1.       Emerging operational and policy modalities for support: Public Private Partnership, Results Based Financing and Program for Results.

b2.       Growing knowledge and evidence base on what works, how it works and how well it works (including the use of measurement tools such as Service Delivery Indicators; systematic interventions to improve quality of services; and impact evaluation).



  • In the run-up to the meeting in Washington, Ray Chambers wrote an op-ed for the Huffington Post to frame the event for lay people: “ … Over the past few years, a debate has emerged around where developing countries should invest their resources, including the funding they receive from entities like the World Bank, as well as loans from other countries. Should they invest in “infrastructure” — clearly needed — or in more “human development” — such as health, nutrition, and education? … That discussion will continue to play out this week as Africa’s Finance and Health Ministers come together to talk about investing in health, and understanding what the issues have been that have prevented further progress.  … The economists who put the forum together looked at the tremendous economic and health improvements in Asia  (where in many cases, improvements in health actually took place before economic growth), and tried to see if there might be some applicability to Africa …  … The humanitarian reason for keeping the world from preventable and treatable diseases should be enough, but the economic reasons should help guide our investment decisions as well. Finance ministers must recognize the symbiotic relationship between health and economic development: investment in health is investment in wealth.”


  • It’s probably a good idea to watch some of the discussions – including Jim Kim’s speech at the end of the first day. A few ‘Kim’ quotes already, thanks to Twitter: “Jim Kim saying there should be no tolerance for ‘my disease more important than your disease’.”  “Jim Kim focusing on donor lack of coordination and fragmentation. Major agencies meeting later to promise to do better.”


Global newborn health conference in Jo’burg


Representatives of UNICEF, USAID and the Gates Foundation attended the world’s first  global newborn health conference in Johannesburg.  Representatives from 50 countries participated  in a four-day conference which focused on scaling up low-cost, high-impact interventions that address the three major causes of newborn mortality: prematurity, birth asphyxia and infection. The conference aimed to highlight the use of low-cost medicines, equipment and health strategies such as exclusive breastfeeding at birth. It also focused on helping countries develop action plans designed to reduce the mortality rates of babies during the first month of their lives. Representatives are expected to prepare a global action plan later this year to address the challenge of reducing newborn deaths and stillbirths.


2.    Global newborn health conference – closing presentation

Catherine Howell;

This prezi presentation gives a (dizzying) summary of the four-day 2013 Global Newborn Health Conference.




3.    Lancet (Comment) – What do people want for health in the post-2015 agenda?

Task Team for the Global Thematic Consultation on Health in the Post-2015 Development Agenda;

The Task team reflects on the global consultation – “what is the world we want for health in the post-2015 era” –  they coordinated. The team also proposes a framework, on the basis of this consultation, for health goals in the post-2015 agenda. Looks neat, I have to say.


Other views on the thematic consultation and on the post-MDG goals for health were published this week by Mark Suzman (Gates Foundation), who argued again for pragmatic goals (just like in Botswana), and by Tim Roosen (Action for Global health).


4.    Guardian (Global Development professionals) – Universal healthcare: 14 steps in the right direction

An expert panel offers some important lessons in developing affordable and sustainable UHC.


UHC & ethical dilemmas conference in Boston


5.    UHC forward (blog) – Beyond the cube

Kyle Beaulieu;

A major theme emerging on day one of the conference “Universal Coverage in Developing- Country Health Systems: Ethical Dilemmas” is that the (three-dimensional UHC ) cube does not go quite far enough, Beaulieu argues in this blog post. He reflects on the first day of the Harvard conference on UHC in developing-country health systems.  The conference goes beyond the technical debate and gives room for contrasting values and worldviews.


To get an idea of the lively debates on the first day, let’s quote our “man in Boston”, Werner Soors – (early next week, he will also come up with a blog post for IHP, if all goes well):


On a lighter note, 82-year old Richard Levins nicely baffled the audience.

Levins – marxist, philosopher of science and John Rock Professor of Population Sciences at Harvard’s School of Public Health – had just delivered a firm defense of Cuba’s succesful path to universal coverage. Then Gita Sen (Indian Institute of Management, Bangalore)  asked Levins how Cuba ensured its drug procurement. Levins’ swift response: “Drugs are produced in South America and dropped from speed boats just off the Cuban coast”. Silence in the audience. Gita murmered “but I meant pharmaceuticals”. “I know”, grinned Richard, “just checking“. “


The second day of the meeting didn’t start well, apparently. But more on that next week.


Global summit on civil registration and vital statistics in Bangkok


6.    Lancet – Modernising vital registration systems: why now?

Nandini Oomman et al.;

Oomman is tweeting like hell on the CRVS event in Bangkok  (#everylife), and so is Richard ‘my religion is global health’ Horton. In this Comment in the Lancet, she calls for a modernization of vital registration systems. The moment seems right.


A few tweets from Horton on the (ongoing) event: (an upbeat one) “ There is already an emerging idea in Bangkok: to create a new Global Alliance for CRVS. Can we deliver this in the next 24 h? …  ( and a gloomy one) “Today, we bury the Health Metrics Network, a great idea, which achieved much, but was killed by institutional politics”.


Global Fund


7.    Lancet (Editorial) – The Global Fund: “a historic opportunity”

This Lancet editorial reflects on the pre-replenishment conference in Brussels last week, where Mark Dybul gave a clear message: “Increased funding now can dramatically alter the course of these diseases, and eventually bring them under control thanks to recent advances in science, falling treatment costs, and implementation know-how.”



8.    IHP – Selling the new Global Fund to fight AIDS, Tuberculosis and Malaria

Rachel Hammonds;

Our colleague Rachel attended an European Parliament hosted panel discussion in Brussels last week, just before the pre-replenishment conference. She reports on the meeting, which featured also Mark Dybul. Check out her three ‘take home’ messages from the panel discussion. The panelists didn’t mince words.


CGD’s Amanda Glassman and Jenny Ottenhoff  reflect on the US picture with respect to the Global Fund, after Obama’s FY 2014 budget request. They are upbeat, but the Global Fund’s new leadership is only halfway, they argue.


9.    Aidspan – The Global Fund Should Take Transparency to Another Level

Robert Bourgoing;

Bourgoing gives some suggestions to the GF to take transparency to another level – from technical transparency to local oversight and accountability  (including supporting and encouraging local watchdogs, …).   “Opening up databases is not enough for change to occur in the way local accountability happens. Rather, change requires a real commitment to accompany those for whom this data is made available as they make their first steps in the maze of aid transparency.”


This week, Bernard Rivers also published a nice viewpoint on the relation between the GF and Principal Recipients, ‘The elephant and the mouse’. He argues things have been improving lately, to some extent (“the Fund may be moving towards less elephant-like behaviour”), and the new funding model offers opportunities.


10. Lancet (Correspondence) – The Global Fund and pharmacovigilance systems in resourcelimited settings


S Xueref et al.;

The Global Fund’s strategy for 2012-2016 provides an unprecedented opportunity to develop and strengthen pharmacovigilance systems, Xueref et al. argue


Bird flu


As mentioned before, bird flu and (potential) pandemics are not a key focus of this newsletter but we nevertheless want to draw your attention to some coverage:


  • This week, the Lancet dedicated an editorial to the story, “From SARS to H7N9: will history repeat itself?”, and a World Report (by Ted Alcorn, on the situation in China). (by the way, the dead pigs in a Shanghai river seem to have nothing to do with it, for some hypotheses on them see this Lancet Correspondence).


  • The Economist pays also some attention to the (pandemic) commotion, both in China (H7N9) and in the Middle East (new corona virus), in a Leader article and an in-depth analysis.


The KFF global health digest also pays attention to the developing story, and Laurie G. (on Twitter).

Syrian health crisis

11. KFF – U.N. Aid Agency Heads Appeal To World Leaders To End Syrian Violence

World leaders must act urgently to break the diplomatic deadlock around Syria if they want to prevent the crisis from reaching a dangerous tipping point”, the heads of the United Nations aid agencies said on Monday. In the statement, an opinion piece in the NYT, Margaret Chan, Anthony Lake and other UN high-level officials wrote: “We, leaders of U.N. agencies charged with dealing with the human costs of this tragedy, appeal to political leaders involved to meet their responsibility to the people of Syria and to the future of the region.”


12. Lancet – Assessing the Syrian health crisis: the case of Lebanon

Adam Coutts et al.;

The failure of the international community to address the crisis in Syria threatens health systems in neighbouring nations too, warn public health doctors Adam Coutts, Fouad M Fouad, and Rajaie Batniji.



World Malaria Day is coming up (25 April ). Some malaria related news this week includes:


13. Guardian – Synthetic anti-malarial compound is bad news for artemisia farmers

Jim Thomas;

Thomas argues that the artemisinin breakthrough by synthetic biologists (see last week’s newsletter) threatens the livelihoods of countless farmers.


An article in Nature from a while ago – February 2013 – might also be worthwhile reading again (for example on the market issues involved, and Jay Keasling’s and Sanofi’s view).


14. Lancet (Comment) – The changing epidemiology of malaria elimination: new strategies for new challenges

Chris Cotter et al.;

Malaria-eliminating countries achieved remarkable success in reducing their malaria burdens between 2000 and 2010. As a result, the epidemiology of malaria in these settings has become more complex. Malaria is increasingly imported, caused by Plasmodium vivax in settings outside sub-Saharan Africa, and clustered in small geographical areas or clustered demographically into subpopulations, which are often predominantly adult men, with shared social, behavioural, and geographical risk characteristics. The shift in the populations most at risk of malaria raises important questions for malaria-eliminating countries, since traditional control interventions are likely to be less effective. Approaches to elimination need to be aligned with these changes  through the development and adoption of novel strategies and methods.




15. GAVI – Indian manufacturer cuts price of childhood vaccine by 30 percent

The cost of immunising millions of the world’s most vulnerable children against five deadly and debilitating diseases is set to fall, thanks to a major price reduction of one third for pentavalent vaccine. The new, more cost-effective price provides the opportunity for the GAVI Alliance to pay up to US$ 150 million less over the next four years compared with using lowest cost alternative suppliers. A supply agreement with Biological E Ltd of India makes the five-in-one shot available to GAVI for just $1.19 per dose, compared to the 2012 weighted average price of $2.17.”  (Timing is everything in this world, and GAVI does seem to have some really good PR people)


See also Reuters on this news.


16. WHO/UNICEF/GAVI/Gates Foundation (Press release) – Better supply systems key to reach all children with life-saving vaccines

In advance of World Immunization Week, global experts are highlighting strategies to further advance progress on the Global Vaccine Action Plan that was endorsed by the World Health Assembly, 2012. Better supply and logistics systems are essential to reach the estimated 22 million children in developing countries who are still not protected from dangerous diseases with basic vaccines, according to a special immunization ‘Decade of Vaccines supplement’ issue published this week by the journal  Vaccine. Articles in the special supplement also underline the need to improve understanding about the health benefits of immunization.


17. Lancet (Correspondence) – Polio eradication: getting the basics right

Asmat Ullah Malik et al.;

Commenting on the polio security crisis in the AfPak region, Emerging Voice Asmat Malik from Pakistan emphasizes the importance of routine immunisation.


Meanwhile, the “Pakistani Taliban on Friday denied any involvement in attacks on polio workers, which have killed 21 people since December, but confirmed it opposed the vaccination as “un-Islamic.”


Still on polio, an article in Nature argued that finding and vaccinating Nigerian nomads may be one of the last obstacles to the eradication of polio.


Health Policy & Financing


18. Lancet (Offline) – Offline: “Viruses don’t need passports”

Richard Horton;

Horton dwells on the mood at the recent (and first) World Health Summit’s regional meeting in Singapore. Bird flu is on everybody’s minds, UHC too (‘Asia is the global lab for UHC’), Myanmar is again part of the global health community,…



19. Globalization & Health – ‘BRICS without straw’? A systematic literature review of newly emerging economies’ influence in global health

Andrew Harmer et al.;

Excellent review article by Harmer and colleagues on BRICS influencing global health (and a nice metaphor too!). The authors examine “what influence, if any, the BRICS wield in global health, and, if they do wield influence, how has that influence been conceptualized and recorded in the literature?”


20. Biomed Central blog – Reverse Innovation in Global Health Systems: Building the Global Knowledge Pool

Alexa Chamay-Berrier;

The Globalization and Health series on “reverse innovation in global health systems” seeks to catalyze worldwide synergies in developing a robust knowledge-base on the bi-directional flow of knowledge and innovations between low, middle, and high-income countries. The series is in line with a broader global movement aimed at recognizing the real potential of LMICs in contributing to health system challenges everywhere. For example, in London, Lord Nigel Crisp recently launched the website Turning the World Upside Down, which focuses on ‘turning our mindsets on global health upside down’.


21. UN nutrition report

A UNICEF nutrition report (‘Improving Child Nutrition: The achievable imperative for global progress’), released earlier this week shows that progress has been made in recent years in addressing stunting in children, and calls for increased efforts to accelerate a response to a condition that affects some 165 million children across the world.


22. UNAIDS (Feature story) – The Nordics: Keeping focused, getting results

The long-standing commitment of Denmark, Finland, Norway and Sweden to international development has rooted them firmly as leaders in international development assistance. They are strong advocates on human rights issues––addressing inequalities between and within countries––and have forward thinking policies for social development and health. This week the Nordic countries came together with UNAIDS in Helsinki to determine how, individually and as a group, they could bolster the response to HIV. Their aim: to build on the unprecedented progress already achieved and attain UNAIDS’ vision of zero new HIV infections, zero discrimination and zero AIDS related deaths.”


23. WHO Bulletin (early online) – Using TRIPS flexibilities to facilitate access to medicines

Dianne Nicol et al.;

The problem of how to mitigate the impact of pharmaceutical patents on the delivery

of essential medicines to the world’s poor is as far from being resolved as it has ever

been (see the recent Novartis case in India for example). Extensive academic commentary and policy debate have achieved little in terms of practical outcomes. Although international instruments are now in place mandating that countries enact legislation that permits the generic manufacture of patented pharmaceuticals, many countries have not yet enacted appropriate legislation and most of those that have yet to make use of it. This paper calls for fresh attempts to enact workable legislation that fits within the prescribed requirements of international law without going beyond them. It argues that high-income nations should refocus on their moral obligation to enact appropriate legislative mechanisms and provide appropriate incentives for their use.


In other WHO related news, check out the April issue of the newsletter on the WHO reform. There’s for example a nice story on what the WHO reform involves in India (strengthening India’s vaccine regulatory authority, for example).



24. Financing health in Africa (blog) – A history of the Bamako Initiative (1/2): Under the leadership of Mr. Grant (and Dr. Mahler)

Jean-Benoît Falisse;

JB Falisse continues his series on community participation and the Bamako Initiative. He interviewed Dr. Agostino Paganini, who was the manager of the Bamako Initiative Support Unit at the UNICEF HQ.


It’s clear – also from the comments below the post – that the assessment of the Bamako initiative is not without controversy, although Jean-Benoît explained well what the focus is of the series: community participation, rather than (the far more controversial) user fees.


A more critical view on the Bamako Initiative, ‘Unpacking the Bamako Initiative’, (suggested by an angry Rob Yates), was published here, this week.



Global health bits & pieces


  • Some news on Gavi & the corruption in Sierra Leone: (see Tom Paulson, on Humanosphere): “What’s perhaps most interesting here is that there’s been so little media hysteria regarding this happening to GAVI (again) as compared to when it happened to the Global Fund to Fight AIDS, TB and Malaria. In both cases, the funding agencies helped identify the fraud. The Global Fund was skewered in many media reports as itself fraudulent and the fund’s executive director was eventually ousted. So far, GAVI seems to have escaped such vitriole.”  (I already said above: GAVI’s PR is flawless)


  • Ghana seized faulty condoms imported from China. (we invite guest editorials/blog posts on this tricky issue J)


  • The amount of HIV in an infected mother’s breast milk spikes when weaning begins, according to a recent study,  Nature reports. “The findings are likely to add urgency to efforts to ensure that infected mothers without access to formula take antiretroviral drugs throughout and beyond the time that they wean their infants.”  (see also a Global Post  article)





25. Speaking of Medicine – Year 2 MHTF-PLOS Collection on Maternal Health – 12 new articles added

Jocalyn Clark;

In November PLOS  called for papers for Year 2 of the Maternal Health Task Force (MHTF)-PLOS Collection on Maternal Health. This week, they launched the new Year 2 Collection page and added 12 research articles recently published in PLOS Medicine and PLOS ONE. The theme of the current Year 2 Collection is “Maternal Health is Women’s Health,” recognizing that it is crucial to consider maternal health in the context of women’s health throughout their lifespans.


26. HP&P – Trade liberalization and tuberculosis incidence: a longitudinal multi-level analysis in 22 high burden countries between 1990 and 2010

Kayvan Bozorgmehr et al.;

The authors of this paper aimed to analyse the association between trade liberalization and TB incidence in 22 high-burden TB countries between 1990 and 2010.

27. Social science & medicine – Becoming and remaining community health workers: Perspectives from Ethiopia and Mozambique

Kenneth Maes et al.;

Many global health practitioners are currently reaffirming the importance of recruiting and retaining effective community health workers in order to achieve major public health goals. This raises policy-relevant questions about why people become and remain CHWs. This paper addresses these questions, drawing on ethnographic work in Addis Ababa, the capital of Ethiopia, between 2006 and 2009, and in Chimoio, a provincial town in central Mozambique, between 2003 and 2010.

28. WHO Bulletin (early online) – Breastfeeding policy: a globally comparative analysis

Jody Heymann et al.;

Based on extensive comparative analysis, the authors find that a greater percentage of women practise exclusive breastfeeding in countries where laws guarantee breastfeeding breaks at work. If these findings are confirmed in longitudinal studies, health outcomes could be improved by passing breastfeeding breaks legislation in countries that do not yet ensure the right to breastfeed, the authors argue.



  • You probably noticed Margaret T. passed away this week. On her legacy for the Global South, see for example this Guardian article.
  • In a blog post, CGD’s Alex Cobham commented on the rise of ‘tackling tax havens’ on the international agenda, and examined whether developing countries will benefit.  As for the European aspect in this ‘war on tax havens’, see for example the news after a recent ECOFIN meeting in Ireland, whereby ministers called for automatic exchange programme to counter tax evasion. The topic is even on Van Rompuy’s watch now.
  • WB economists say urbanisation can be a force for the better, if we manage the urbanisation waves properly in the coming decades.
  • A Devex analysis explores some of the ‘great expectations’ at the WB/IMF Spring meetings.
  • Philantrocapitalists propose a social progress index. (if I may suggest an indicator: a low proportion of philantrocapitalists in a country, as this could imply the rich are properly taxed)

[1]  PT Askes provides health Insurance coverage for civil servants

PT Jamsostek is the social insurance fund for private sector employees; it includes benefits for health, employment injury, retirement & pension and death.

PT Asabri : social insurance for the armed forces and the police, a similar scheme as PT Jamsostek minus health insurance.

PT Taspen: Social insurance for retirement benefits and pensions for civil servants. It previously included the army and police staff until 1989 when ASABRI was established.

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