Dear Colleagues,

While the assembled world press went into a frenzy over the newest royal baby and Pope Francis’s visit to Brazil drew a million youngsters to Copacabana beach for an event worthy of a rock star, global health this week centered around a new UNICEF Report about female genital mutilation, the upcoming World Hepatitis Day and the Steering Committee meeting of the Global Partnership for Effective Development Cooperation in Addis Ababa, Ethiopia.

This weeks’ guest editorial is from EV2010 Amal Shafik, who examines the uprisings in her nation Egypt as part of our series on global social unrest using an interesting lens. Instead of focusing on the role of middle class protests as a corollary of poverty alleviation or the result of a fatal cocktail of structural failures rooted in an outdated global model of industrial civilization, she entertains an almost holistic view on the events unfolding in her country using a vocabulary informed by theosophy and critical history.

Further down below, you will find that shifts in global governance have implications for the NCD response, domestic and donor funding for HIV/TB have increased but budget support has declined in spite of Busan principles related to country ownership. Finally, polio is still around and the oil container used for cooking free school meals that poisoned Indian school children last week contained a pesticide banned in most countries except India.

Enjoy your reading (and the holidays ;-))

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


The memory of a Nation

By Amal Shafik, PhD – health economist from Egypt

The Akashic Records are an energetic imprint of every thought, action, emotion, and experience that has ever occurred in time and space. In Theosophy and New Age discourse, the Akashic Records are records of all knowledge, including all human experience held in the world. The Records are metaphorically described as a library (1). They are in fact the archival memory of the universe. Yet, we neglect to attempt to connect to those archives and start our lives and our karmic journey from scratch, disregarding the fact that we are the products of all the experiences of our past actions.

On January 25th 2011, when the youth of Egypt took to the streets in a peaceful protest it was against the state of despair that the corruption of the administration had led them to. They had no jobs, they had no hope of an income to satisfy their basic needs to settle down and raise a family. They could not see a glimmer at the end of a tunnel that seemed to have no end. Most of them had family members who had chronic illnesses, young needy children or parents entering the senior age group, all in need of health care that was practically non-existent.

The youth movement was not born on the spur of the moment. True, the eruption was sudden and powerful but it was not dissociated from the past, present, nor was the imagined future independent of the actual events. Those young people were only reacting as an outcome of all the recorded disappointments, all the misgivings and wrongdoings of the administrative systems of the past without conscious realization. The negative energies emanating from corruption, nepotism and insensitivity to the needs of the underprivileged, recorded themselves in the energy field surrounding the players of this movement. This energy was the driving force behind the seemingly spontaneous outbreak.

On the 30 th of June 2013, these youngsters had succeeded in connecting with their Akashic Records of past and present, their emotions and experiences, albeit inadvertently, and their actions were the result of this connection. Egypt witnessed the second wave of revolution, but in reality it was witnessing the second level of evolution in the path of citizen’s rights achievement.

When clouds start to turn darker and darker, when they gather and increase in size, when the wind is blowing them your way, then the natural and intuitive action would be to reach for your umbrella. You do this without really processing the external factors involved or analyzing the reasons for your action. In practice, the umbrella was there but it did not provide sufficient protection. It was moth-eaten and the fabric was flimsy. The Egyptian social protection system was fragile and out of date. Egypt suffered from pluralistic systems emanating from different ideologies and having different objectives.

It must be noted that although Egypt belongs to the African Union by geography, is part of the Arab world by ethnicity, member of the Muslim world by belief, none of these entities have a common system of finance, or economy nor education, and least of all health care. Overall the national health insurance system is financially strained, and many reform bills have attempted to expand coverage politically, without sufficient consideration to the allocation of resources.

At the moment, around 57% of the population is enrolled in some form of health insurance or another, which primarily covers public sector employees and students. The informal sector representing the majority of Egyptians is not covered by the current health insurance system or any alternative system.

However, the overall national health insurance system itself is financially strained, and many reform bills attempt to expand coverage politically, without sufficient consideration to the allocation of resources.

Each reform bill was a result of the political environment surrounding it at the time, starting from the inauguration of the medical schools in 1805 at the time of Mohamed Aly to mark the building of a new modern country, through the installation of the free medical care bill of Nasser and the inauguration of the health insurance organization in 1964 as a response to the strong labor movement, to the series of reforms carried out during the 30 years of Mubarak’s rule to the promise of universal health coverage planned to launch Gamal Mubarak’s presidential campaign. Each and every change in the health system was initiated, accelerated, or blocked due to the political context of its time. The main goal of the 25th of January revolution was to provide social justice and ensure human rights. The right to health was at the heart of the demands and shall remain so.

The present state of the health system of Egypt is an accumulation of all past attempts and achievements, the effect of all previous records, something that is never given due attention. We can certainly achieve more by building on the existing groundwork and adapting the reforms to those areas that need strengthening. We cannot, and should not, disregard the importance of the cumulative effect of layers upon layers of past attempts with their ensuing successes or failures. Addressing our efforts to tackle the new areas of concern that have appeared in recent years, should be the focus of any reform efforts.

When clouds start to turn darker and darker, when they gather and increase in size, when the wind is blowing them your way then the natural and inevitable outcome is an outpour of heavy rain. When your population is ever on the increase, when your political administration is ever more distant from the needs of the people, when the basic needs and services are denied to the people, then a popular uprising is inevitable.

Any present state of affairs is the collective memory of all the events past and present and its persistent reality, and only by recognizing this fact can we proceed to build upon it and spare ourselves the time and energy wasted in attempting to obliterate the cumulative memory of a nation.

As with our lives so should it be with our health reform endeavours. The political environment might change over time but the memory of a Nation will stay forever.


Global Health News

1.        UNICEF – Female Genital Mutilation / Cutting: A statistical overview and exploration of the dynamics of change

Both the NY Times and KFF report about the latest FGM assessment from UNICEF, which has found a gradual but steady decline in more than half of the 29 countries in Africa that still practice the tradition. Although the tradition is strongly embedded in countries such as Egypt, Somalia and Guinea, the extensive data which informed this report indicate that young women are less likely to support the practice, which may be indicative of a generational change. The report also shows that the steepest decline in FGM prevalence has occurred in Kenya, one of Africa’s most developed nations, and in the Central African Republic, although reasons for the latter remain unclear.

Jinna Moore also blogged about the report, pointing out some of the more interesting findings, such as the divergence between attitudes and behaviour of surveyed women – which in social psychology is labelled cognitive dissonance and points to the impact of social and peer pressure in this case, the fact that education rates nearly universally influence support for abandoning the practice and that FGM acts not only as a human rights but also a public health issue.

Sarah Boseley in her blog also highlights the fact that, although 125 million women and girls are living with the consequences of FGM, the report suggests that FGM only continues because of social convention, while most women and men wish it would end.

2.        Lancet GH – World Hepatitis Day 2013: Know it, Confront it

In this Lancet comment Lazarus and colleagues draw attention to the global picture of hepatitis ahead of World Hepatitis Day on July 28, indicating that only slightly more than a third of countries report the existence of a national hepatitis strategy or plan. They call for strong national leadership and sound awareness-raising activities under the slogan: ‘This is hepatitis… Know it. Confront it.’

The new Global policy report on the prevention and control of viral hepatitis has also been put online in an interactive format in order to improve awareness and advocacy. You can consult the website here in order to find out exactly what your government is doing for viral hepatitis in your country.

Meantime, Isobel Hoskins in a CABI global health blog post refers to a list of celebs with hepatitis C in an effort to break the silence and get more people to talk about the disease.

3.        TM&H – Unnecessary injecting of medicines is still a major public health challenge globally

In this editorial Gore and colleagues from the World Hepatitis Alliance draw attention to the lack of awareness with regard to unnecessary injections administered in health care settings. Based on still to be released data from the 2012 WHO / World Hepatitis Alliance Global Hepatitis Survey they raise the question of whether progress is being made on reducing unnecessary injections, which is a key WHO strategy for reducing injection-associated disease transmission.

4.        Huffington Post – The Global Plan: Working to improve women’s health

In this ‘Global Motherhood’ opinion piece, US Global AIDS coordinator Eric Goosby  and UNAIDS Executive Director Michel Sidibé discuss progress made on the ‘Global Plan towards elimination of new HIV infections among children by 2015 and keeping their mothers alive’. In spite of some important achievements, there is more work to be done to help women improve their overall reproductive wellbeing. ‘The PEPFAR Blueprint reflects a strong focus on women, girls and gender equality, while UNAIDS continues to champion efforts to address the persistent gender inequalities and human rights violations that put women and girls at a greater risk of HIV,’ the authors write.

Still in regard to maternal health, Jocalyn Clark announces in the PLOS Medicine Community Blog that new content has been added to the Maternal Health Task Force PLOS Collection on Maternal Health, based on the lifecycle approach for considering maternal health centered around the theme ‘maternal health is women’s health.’ The collection is freely available and includes outstanding pieces of research and commentaries related to maternal health.

5.        PLOS Medicine – Recent shifts in global governance: Implications for the response to non-communicable diseases

Devi Sridhar and colleagues from the Go4Health Consortium, in this PLOS Medicine policy forum examine three major trends in global governance and their implications for post-2015 progress related to NCDs. The rise of emerging economies, the increase in multi-bi financing, and institutional proliferation all influence how NCDs will be included in the post-2015 agenda, while it remains unclear how the interests of poorer countries will be advanced. While NCDs may be included under the umbrella of UHC or healthy life expectancy, it is unlikely that alternative or more adequate options will be conceived.

Anand Bhopal in the Global Health Governance journal’s “Young Voices” blog also examines the need for governance in the global health arena and explains why WHO should lead this effort. Bhopal discusses how the WHO is funded, addresses its budget deficit, and examines the future of the global health agency.

6.        PLOS Medicine – Access to Drugs for Treatment of NCDs

In this essay, Thomas Bollyky from the Council on Foreign Relations examines new controversy over patented medicines for NCDs and their affordability in developing countries, noting that India, China and other MICs have taken measures to circumvent patents on medicines for NCDs, and that ‘addressing this latest treatment-access crisis will require another transformation in global health (similar to that what happened in the last decade with HIV/AIDS), but focusing on NCDs, low-cost interventions, and patient-centered strategies,’ he writes.

7.        CGD – You say you want a (data) revolution?

In this blog, Amanda Glassman argues that the call for a “data revolution” in the HLP report on post-2015 development goals would require a series of interventions such as building data quality checks and balances, enhancing functional and financial stability of national statistics offices and supporting the Open Data movement, in accordance with recommendations from the Data for African Development Working Group which is grappling with these issues in the context of sub-Saharan Africa.

The African Development Bank (AfDB), on the other hand, has announced that it has finished deploying its Open Data for Africa platform across the continent as part of the ‘Africa Information Highway’ initiative,  which saw the establishment of live data links between the AfDB, National Statistical Offices, Central Banks and ministries in all 54 countries where the platform has been rolled out.

Health policy & financing

8.        HLSP – Health Care financing in the Asia Pacific region

This paper provides an overview of the challenges of financing health care in the Asia Pacific region, where many countries are trying to achieve universal health coverage, by examining the contributions of the public and private sectors and considering the future of external development aid. The authors conclude with a number of reflections and recommendations for tackling policy issues and developing aid modalities from a donor perspective. The findings were also presented at the 9th World Congress of the International Health Economics Association (iHEA) in Sidney, 7-10 July.

HLSP also published some other reports with lessons from the region, including the relevance of aid effectiveness agendas and the effectiveness of health sector reviews.

9.        Lancet (Global Health) – Domestic and donor financing for TB care and control in LMICs: trend analysis and 2015 goal needs

In this trend analysis of domestic and donor funding for TB – since annual monitoring was started in 2002 – Floyd and colleagues of the WHO Global TB Programme show that the funding for TB control has substantially increased, resulting in impressive and cost-effective gains. Increasing self-sufficiency of countries, including BRICS, form a successful story of TB control, but donor funding remains crucial and more is needed to achieve the 2015 targets.

In a related comment, Vassall and Remme of the LSHTM stress that domestic funding for TB (as for HIV) has increased by more than 160% in nine years’ time, especially in the BRICS countries, supporting the reorientation of Development Assistance for Health (DAH) towards the poorest countries. The substantial resource gap remaining in mainly LIC should however be taken into account, and lessons can be learned from HIV work to improve efficiency, for complementing the demand for more resources.

In this regard, UNITAID has released a new report outlining existing TB diagnostics and the pipeline of expected tools, as well as current and future market needs that may be addressed by the existing technology. The report is part of the effort of UNITAID to identify opportunities and catalyze markets for underutilized products, and address market inefficiencies towards increased access to medicines.

10.   BMC Public Health – Determinants of government HIV/AIDS financing – A ten-year trend analysis from 125 LMIC

This study demonstrates that domestic resources in LMIC showed a threefold increase between 2000 and 2010 and currently support half of all global HIV spending with the main part from SSA countries. Domestic HIV spending is also significantly associated with increased economic growth and with an increased burden of HIV.

11.   FT – Drug groups set for TPP trade clash

Drug companies and development groups have clashed over intellectual property (IP) provisions in the Trans-Pacific Partnership (TPP) negotiations, as the US pushes to expand patent protections but is facing resistance from emerging economies worried about losing access to cheap medicine.

Aid & development

12.   The Guardian – Donors balk at allowing global South countries to lead on development

In this ‘Poverty Matters Blog’ Mark Tran argues that nearly two years after the Busan High Level Forum on Aid Effectiveness, it seems that donors have done little in terms of country ownership (which was established as the default approach at the time), as evidenced by falling levels of global budget support. According to a brief prepared by UK based development NGOs for this week’s meeting of the Global Partnership for Effective Development Cooperation in Addis, ‘the international community may even have gone backwards, despite the (strong) rhetoric from donors.’

The Partnership, which brings together donors, developing countries, civil and private sectors, grew out of Busan to make sure the conference principles would be acted on, and Justine Greening, UK international development secretary, co-chairs the steering committee. A salient feature is the fact that Mexico already confirmed that it will host the first Ministerial-level meeting of the Global Partnership in 2014, which provides a great opportunity to keep the momentum and enhance the key role the Partnership can play in the post-2015 development framework.

13.   SciDev.Net – Africa: Aid can make lives better, project concludes

According to the results of Research and Communication on Foreign Aid (ReCom), a three-year research program of the UN University’s World Institute for Development Economics Research, foreign aid can significantly contribute to economic, social and human development, but practitioners must disclose its failures to make it successful. Evidence of the positive impact of aid has been found in four thematic areas – growth and employment, social sectors, gender equality, and environment and climate change and links have been found to progress in a variety of areas, including health care.

14.   CGD – The case for direct transfers of resource revenues in Africa

This paper shows that by transferring a part of resource-related government revenues uniformly and universally as direct payments to the population, some countries could increase both private consumption and the provision of public goods, in turn reducing poverty and enhancing social welfare. The authors make the case based on theoretical considerations and explore how these direct dividend payments would look in practice in a group of selected African countries

15.   The Guardian – Prioritizing citizen feedback in development

In this The Guardian ‘New development models hub’ blog, Stephen Davenport from Development Gateway examines whether prioritizing citizen engagement through the use of ‘feedback loops’ can render NGOs, donors and governments more responsive. Together with a like-minded group of people he has identified a few steps to take this agenda forward, including advocating and conceptualizing the field in order to make citizen feedback a new norm in decision-making and service delivery.

Global Fund

16.   GFO – Global Fund deserves credit for implementing major reforms, but challenges remain

In this article, the authors confirm that donor confidence in the GF has been restored by the implemented changes, which is clearly critically important in a replenishment year. However, many reforms are still being implemented and a number of unresolved issues remain, in particular with regard to funding for MICs and the application of the concept of ‘country ownership’.

The new GFO issue also features an article with some reflections about the challenges facing the GF, with contributions of Owen Ryan (amfAR), Victoria Fan and Amanda Glassman (CGD) and others. Click here to download the entire GFO Newsletter.

17.   ICASO – Civil society global fund application preparedness guide: Navigating the new funding model series

In early 2013, the Global Fund launched a new funding model, which departed from its predecessor, the rounds-based system, to allow for greater flexibility, predictability and simplicity in the application process, and to promote enhanced engagement of a diversity of stakeholders in all Global Fund activities, as well as improved impact and management of grants. This document provides civil society with concise guidance on key elements of the new funding model application process.


18.   The Lancet Global Health blog – HIV prevention R&D funding in 2012: is the end of the epidemic at risk?

In this blog, Mitchell Warren of AVAC warns for pending budget cuts to investing in HIV prevention R&D and calls for a more diverse global cadre of partners to sustain and build on progress already made in the fight against HIV. He lauds the volunteers who took part in HIV prevention trials and calls for continued collaborations between governments, researchers, policymakers, programme implementers, and civil society.

19.   The Guardian – Advancing antimalarial drug research through open source initiatives

Based on successes of the Malaria Box, Jeremy Burrows of the Medicines for Malaria Venture argues in this blog for more open research within the scientific community in order to tackle not only malaria, but also other neglected diseases. But ‘to really take open source drug discovery to the next level we need more scientists to commit to the vision of contributing to something bigger,’ he writes, ‘as well as scientists willing to roll their sleeves up and actually synthesise and test compounds.’

Alimuddin Zumla from UCL in a Lancet Global Health blog also argues for equitable partnerships for tackling killer infectious diseases, based on lessons learnt during the recent MERS-CoV virus outbreak in Saudi Arabia showing urgent need for scientists and politicians to establish unity of purpose, overriding self-interests, and focusing on research needs for maintaining global health security.

20.   PLOS Medicine – Factors affecting the delivery, access and use of interventions to prevent malaria in pregnancy in SSA

In this systematic review and meta-analysis of factors influencing the uptake of WHO guidelines for the prevention of malaria among pregnant women in SSA, Jenny Hill et al. found that the delivery of insecticide-treated nets through antenatal clinics presents fewer problems than delivery of intermittent preventive treatment (IPT) and tha.t many obstacles to IPT delivery are relatively simple barriers which could be resolved in the short term.



21.   NY Times – Pakistan battles polio, and its people’s mistrust

The NY Times reported on the polio vaccination in Pakistan, where repeated incidents have temporarily halted the campaign and led to a serious setback for the global effort against the crippling disease. The fact that India, Pakistan’s rival in almost everything, eliminated polio two years ago, however, has led to emergency measures in Pakistan which could well be the biggest asset in the local war on polio.

Meantime, NPR’s health blog reports on a setback in polio eradication in Somalia, as this East African country is suffering from the worst polio outbreak in the last years in the world. Part of the problem in Somalia is the fact that the majority of children have never been immunized, and that the outbreak hence occurs in a vulnerable population.

22.   Reuters – WHO had urged India to ban the toxin that killed schoolchildren

The pesticide that killed 23 Indian schoolchildren last week is a nerve poison banned by many countries because of what WHO describes as its ‘high acute toxicity’. WHO had already urged India to consider a ban on the pesticide and warned against the use of pesticide containers for storing water, food and other consumables.

Meantime, in a post in the White House Blog, Jill Biden (wife of Joe) learns first-hand about the joint efforts undertaken by government, civil society and the private sector to improve nutrition across the country, while India Real Time talked to experts on the program and lists 6 ways to fix India’s School Lunch Program, which guarantees one cooked meal a day to 120 million children, and which is considered one of the largest food aid initiatives in the world.

As Harman Boparai in the GlobalPost’s Pulse blog notes, however, location matters for child health in India. As the author reports in his ‘A Doctor’s Notes,’: ‘Now the problem at least in urban centers is fast becoming that of childhood obesity,’ whereas ‘for nearly 1.7 million children in India, the story is still that of missed opportunities and eventually a tragic loss.’

23.   USAID – New assessment guide and tool for HR capacity development in public health supply chain management

In an effort to assist public health supply chain managers in developing countries with assessment of and improving human resources management, the USAID DELIVER PROJECT and People that Deliver have developed a toolkit that provides a structured, rating-based methodology designed to collect data needed for a rapid, comprehensive assessment of HR support capacity for supply chain management. In order to find out more about this toolkit, please click here.

24.   Interpol – Operation Storm: Final report of the international medical products anti-counterfeiting task force initiative

Operation Storm is a multi-country operation, which brought together Customs, Drug Regulatory Agencies and police of participating countries to combat counterfeit drugs. In the run up to the operation, which was overtly conducted in 2008, INTERPOL with WHO and the World Customs Organization organized planning meetings and training sessions. This report discusses the operational outcomes and findings, and provides some recommendations for the way forward.

25.   UN – International Toilet Day

The UN General Assembly officially designated 19 November as World Toilet Day to focus on the plight of 2.5 billion people without access to a toilet or latrine worldwide.

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