Plenty of news this week, with the WHO financing dialogue (2nd event in Geneva); the release of a number of working papers by ‘The UNAIDS and Lancet Commission: Defeating AIDS — Advancing global health’; some brief coverage of events (like the European development days in Brussels and ITM’s annual colloquium in Bangalore); the December issue of the Lancet Global Health; the usual Global Fund update, even more important with the Global Fund Replenishment coming up; World Aids day is also approaching, … so HIV will again feature quite prominently in this newsletter. In Cape Town, the 2013 Emerging Voices face to face programme started, preparing for the ICASA conference. We will join them next week (which also implies that next week’s newsletter will probably be much shorter, hurray!). On 25 November, the International day of ending violence against women was celebrated. WHO was involved in a social media row, on self-inflicted HIV in Greece, this week. Pretty bad timing, with the financing dialogue going on. Meanwhile, pope Francis lashed out against capitalism. Again. To support the pope’s fight for justice, we hope the global health community will boycott Walmart, Ryanair & Amazon. For a start.
Yesterday some of us also attended Be-Cause Health’s annual seminar in Brussels. The topic was complexity this year, and what the use of complexity science for the health sector could be. Is this more than just the latest buzzword? Pretty interesting stuff, no wonder with keynote speakers like Ben Ramalingam, Paul Bossyns, Jean Macq & Bruno Marchal, among others, and not to forget Karel Gyselinck, chairman of Be-Cause Health, who gave a trademark inspiring speech to conclude the event. We hope to offer you some coverage of this workshop in the coming weeks. At some point, it appeared Donald “Mr. known unknowns ” Rumsfeld was one of the first complexity theorists.
In this week’s guest editorial, EV 2012 Francisco Oviedo-Gomez from Costa Rica reflects on so called ‘nanny’ health policies from a human rights perspective.
Enjoy your reading.
Kristof Decoster, An Appelmans, Peter Delobelle, Basile Keugoung & Wim Van Damme
Supporting “nanny” health policies: A human rights perspective
Dr. Francisco Oviedo-Gomez MD MPH, Advisor on Health Systems and Health Services, Ministry of Health of Costa Rica
The approval of tobacco control laws around the world as a consequence of the adoption of the Framework Convention on Tobacco Control ( FCTB) has sparked fierce debate in recent years, more in particular on the role of states in enforcing health policies which aim to create mechanisms for people so that they would refrain from practicing unhealthy habits. The increasing NCD burden around the world is one of the main reasons that have made the enforcement of such policies a key debate in the early 21st century. So this debate is here to stay.
Current examples of such policies are: notification of calorie counts in restaurants, reduction of sugar level in processed beverages, reduction or elimination of salt in processed food, specific guidelines for food services in schools, increased taxes for unhealthy products, so called “nudge policies”, etc.
Many have called these actions an unacceptable intrusion of states and governments in people’s lives limiting their fundamental rights. Some compare those governments to a “nanny” who decides what is better for her (allegedly) defenceless children, who are not capable to take their own decisions and who may never be. In this vision, people become (too) dependent on governments, with authorities taking (too many) decisions for citizens.
Some other critics are even less kind in their comparisons: for them these policies are clear steps on the road towards totalitarianism, limiting people’s fundamental rights in order to keep the control of people’s lives in the hands of the state, not only on health related matters but also in other aspects of their daily life.
With arguments like these pretty common in mainstream and social media, it does not come as a surprise that many people are scared or are having second thoughts about endorsing such kinds of policies. And to be honest, from a historic perspective, these fears are not totally unfounded.
During the 20th century many countries witnessed the failure of policies that aimed to solve social and health problems, ending up creating new and more chaotic problems. One of the best examples of this was the Prohibition in the United States: from 1920 to 1933 a nationwide ban was declared on the sale, production, importation, and transportation of alcoholic beverages.
Unfortunately one of the main outcomes of this policy was that organized crime got a major boost. Mafia groups focused on prostitution, gambling, and theft until 1920, when organized bootlegging emerged in response to Prohibition. Rather than reducing crime, Prohibition transformed some cities into battlegrounds between different bootlegging gangs.
Despite the failure of Prohibition, one can still argue in favour of enforcing restrictive health policies, by pointing out the mistakes of previous policies and taking into consideration the lessons learnt (see also here). The aim should be to improve the new mechanisms by adopting a human rights perspective instead of creating merely restrictions to educate “unwilling children”.
Ensuring the human right to health depends on a series of different conditions that together provide the foundation for people to claim their right. Access to good information is one of them
-people need to be well-informed, based on the best possible scientific evidence, on health- but also providing people with the means to act upon this information, if they want to. The state has to play a role in both.
In Costa Rica (see English translation here) some of the main supporters of the recent adoption of the tobacco control law were waiters and waitresses. They pointed out the constant harm suffered by them, as they were permanently exposed to a hazardous working environment in bars and clubs where (inside) smoking was allowed. Respiratory problems were a major problem among this group.
Non-smoking waiting staff , as well as waiters and waitresses who had decided to stop smoking, could not claim their right to health, since they did not have an effective tool that allowed them to work in a non-harmful environment.
We live nowadays in an information society where people can easily access information on what may harm their health, so in principle they can avoid the danger and live healthy lives, however –as the case of waitressing workers in Costa Rica shows, very often people need more than just access to information to make an effective and actual change in their lives.
Any starving person living on a fixed income will not think twice at lunchtime, when considering whether to spend 8 US$ on a “healthy” salad and a bottle of water or just 3US$ for a “high-calorie” meal of a hamburger, French fries and soda.
If we have learnt something from failed experiences in the past like the prohibition period, it is that the answer does not lie in declaring tobacco products illegal – or French fries for that matter-, but in creating the necessary conditions so that people may not only take informed decisions, but can live and work in an environment in which these decisions can come true.
Social changes are never easy and sometimes they are not welcomed at all at first, especially if they imply some kind of restrictions. However, if their justification is found in the necessity to protect vulnerable or unprotected groups and the mechanisms to enforce the changes are reasonable and well oriented, in time the change may become accepted as something logical and even basic. Slavery is a case in point.
Just to show you another example of what I am referring to: in 1872 the British Parliament adopted the “Licensing Act” which restricted the opening hours for pubs and prohibited children from drinking spirits in a pub. The drink trade regarded this Act as an attack on private property. Liberal thinkers felt they needed to protect the “liberty of a few against the power of the many” and so considered it better that “England should be free rather than… compulsorily sober”. Supporters of the Act replied that “drunken freedom” was not exactly “liberty”.
Nowadays, I think no one would argue with the importance of not letting children drink alcohol, we consider it just ‘common sense’ now. Sadly, for many health policies currently under discussion, that is not always so clear to many people. But maybe it is just a matter of time and in a few decades, these policies will seem to us as reasonable as we consider the 1872 policy now. In the meantime we should try to orient our policies so that they not just prevent people from doing “bad things” but rather encourage them – not force – to take the right choices.
A scholar once said that “freedom is not the right of just doing what we want, but the right of being able to choose and doing what is correct”. If we, as a society, through our governments, do not make sure that we have the tools and mechanisms to assert our fundamental rights we are not effectively protecting our freedom. Whether informed people then make the “correct” health choices is up to them. As they say in English: ‘You can lead a horse to water but you cannot make it drink’. Which is fair enough.
WHO Financing dialogue & reform
1. WHO – 25-26 November financing dialogue meeting
This WHO webpage provides a short summary of the (second) Financing dialogue meeting which took place this week in Geneva. It also features background documents, the opening address of Margaret Chan, presentations, and the new Programme Budget web portal. You can also find the following document: “Investing in the World’s Health Organization – Taking steps towards a fully-funded Programme Budget 2014-2015.”
According to Twitter (Ilona Kickbusch), participants at the financing dialogue acknowledged significant progress towards greater transparency and accountability.
Still according to Twitter, Margaret Chan sang happy birthday to Nils Daulaire at the meeting, adding the phrase “bring me the money”.
2. WHO – WHO reform stage 2: evaluation report
An Independent Evaluation Team from PwC was selected to carry out the evaluation of stage 2 of the WHO reform. This is the final report. It highlights the key findings arising from the evaluation together with the recognition of achievements to date, and recommendations to overcome the challenges PwC identified.
To give you a taste: “In many ways, the above (…) is illustrative of the paradox of such an ambitious reform. The culture that WHO is seeking to implement through reform is one that is results-oriented, takes into account transversal ways of working across organisational silos, and adheres to a risk management mindset. It is this culture, however, which is needed in the first place to drive the implementation of the reform successfully.” But there is a silver lining, according to PwC: “Relying on legacy ways of working to implement new ones inevitably carries material risks. We believe, however, that these risks are for the most part manageable; and that they have to be compared to the risk of not implementing the reform. The latter would have understandably more negative consequences on the future prospects for the Organization and for global health.”
3. The Graduate Institute Geneva – Global Health Programme working paper – Decentralisation and WHO reform: a broader perspective
In light of the ongoing WHO reform process, the Permanent Mission of the Federal Republic of Germany to the United Nations Office and other international organizations in Geneva organized an event to discuss “Decentralisation in WHO:
Advantages and Challenges” on 21 January 2013. This working paper is a slightly revised version of the presentation given by Ilona Kickbusch, one of the three speakers at the event. It offers an alternative approach to decentralisation. The paper argues that the greatest challenges of the WHO reform are governance challenges.
The UNAIDS and Lancet Commission – Defeating AIDS : Advancing global health – 3 working papers up for discussion
The world is seeking to define a new development agenda and accountability framework to succeed the MDGs which expire in 2015. The international community must ensure the achievements of the AIDS response are carried forward in the post-2015 era, including ambitious targets towards ending AIDS, and usher in a new era of social justice, global health and sustainable development. To bring this debate to the global arena, The UNAIDS and Lancet Commission: Defeating AIDS — Advancing global health was launched in May 2013. Through a programme of consultations, the Commission will deliberate on strategies to ensure that the vision of the global AIDS movement, zero new HIV infections, zero discrimination, and zero AIDS-related deaths, can be realised in the coming decades. The Commission also seeks to ensure that the principles and achievements of the AIDS response inform a more equitable, effective, and sustainable global health agenda. The final Commission report will be published in the Lancet (soon).
Three working papers were released here, you can submit your comments on them (and on the work of the Commission) by emailing Responses@lancet.com. They feature plenty of discussion questions, so check them out. Must-reads, obviously.
Other Post-2015 related articles
We already draw your attention to an upcoming Reproductive Health Matters issue, which can be published any day now. See here for a table of contents. The issue will offer new development paradigms for post-2015 for health, SRHR and gender equality.
4. Municipal Services project – Universal health coverage: Beyond rhetoric
This paper raises critical questions around the wide and growing enthusiasm for Universal Health Coverage, which is increasingly seen as a silver-bullet solution to healthcare needs in LMICs. “In short, the UHC model is built on, and lends itself to, standard neoliberal policies, steering policy-makers away from universal health options based on public systems. Building and improving the public healthcare system is not part of this mainstream narrative, with the state generally confined to the role of system manager.” (Must-read).
5. UHC forward – You can’t have one without the other: Why the private sector matters in reaching UHC
Thierry Van Bastelaer;
Van Bastelaer takes issue with a recent Oxfam report, “Universal Health Coverage: Why Health Insurance Schemes are Leaving the Poor Behind.” “Arguing, as Oxfam does, that the public sector can finally bring about universal health coverage on its own ignores the complex political and economic realities in most developing countries.” He argues for a close collaboration between the public and private sectors.
6. Devex – Make Recife count: Adapt HRH to the UHC agenda
“It’s an ideal moment for the HRH movement to latch onto the movement toward UHC. UHC holds a privileged position in the post-2015 development agenda as a favorite of WHO and the World Bank, and — more importantly — as a strategy for low- and middle-income countries to improve health equity, reduce health system fragmentation and reinforce economic development. Since human resources are an essential UHC input, the HRH community can both ride the UHC momentum and help drive the agenda.”
7. Development Progress – Changing the mindset on aid
Gail Hurley, Policy Specialist on Development Finance and Inclusive Globalisation at UNDP in New York, argues that there will always be a need for international public finance, even in an increasingly uncertain aid landscape, and that this need will shift and evolve. With this in mind, she proposes a universal system for compulsory assessed contributions to international public finance.
Lancet Global Health (December issue)
The December issue from Lancet Global Health is out. Most of the articles were already covered in previous newsletters. So check out the issue, freely available as you know.
Do read the Editorial by Zoë Mullan, ‘Some things change, some stay the same” (see The Pretenders), which introduces the issue. “… The Lancet Global Health this month contains many such examples of stubborn global (health) problems, but also some instances of change: for the good, mostly, but which nevertheless necessitate careful consideration amid the political and social currents flowing around them.”
Other nice Comments are the one on ‘Poverty, risk behaviour & cash transfers’ (by Bertozzi et al) commenting on the paper by Lucie Cluver and colleagues in the same issue of The Lancet Global Health, a rigorous evaluation of the impact of interventions that seek to modify the underlying structural determinants of HIV transmission (by alleviating poverty with cash transfers). Bertozzi et al suggest that ”poverty-alleviation programmes could increase risk behaviour (eg, cash transfers to poor young men) while others could decrease risk behaviour (eg, cash transfers to female heads-of-household or to poor adolescent girls).”
Other Comments pertain to “Strengthening of primary-care delivery in the developing world: IMAI and the need for integrated models of care” (with IMAI as the acronym for Integrated Management of Adult and Adolescent Illness) – see here; and to Neglected diseases research & development, which is still not what it should be (see here ). ( otherwise, they’d be called ‘Fad diseases R&D’, which we hope someday will come true)
There’s also a somewhat pessimistic Lancet Letter on the ‘Inverse primary care law’ in Africa.
Global Fund update
8. Global Fund Observer (issue 232)
The new GFO issue reports on a NFM regional meeting in Lusaka; on the conference in the Ethiopian capital Addis Ababa on 11-12 November which brought together ministers of health and finance, civil society groups and donors to discuss how to accelerate domestic spending on health in Africa; it also features a viewpoint by Alan Whiteside with overall message “What should follow the Millennium Development Goals is the era of Domestic Resource Mobilization.” And much more.
9. Global Fund news flash 32
With some news on the upcoming replenishment meeting in the US – “This year’s Replenishment adopted a new and distinctive approach, identifying and relying on four pillars of support: Traditional donors, implementing partners, emerging economies, and the private sector.” Dybul’s mood is bullish. But apparently, the fight against HIV is still a bipartisan issue in the US, even if, according to the Economist, Congressmen find it hard to agree that the sky is blue, these days.
The newsletter also features key dates related to the implementation of the New Funding Model.
Meanwhile, the GF proudly announced new results, which show strong momentum – good timing, obviously, with the replenishment coming up.
10. World Bank – World AIDS Day: Bank, Global Fund Focus on Saving Lives, Stronger Health Systems
According to Wilson, World AIDS Day marks a new and closer phase of partnership between the World Bank and the Global Fund. Read why.
11. Scidev.net – End of line for hard-to-detect malaria?
A low-cost, portable device that can detect malaria in people who show no symptoms is soon to be tested in Africa.
12. AllAfrica – Africa: New Push On Malaria
AllAfrica discusses the Gates Foundation’s plan to synchronize the efforts of the malaria community worldwide towards the goal of global eradication, building on the foundation’s original eradication call of six years ago. The Gates foundation made the announcement on the sidelines of the American Society of Tropical Medicine and Hygiene (ASTMH) conference held in Washington, DC, recently.
13. WHO – Adolescents falling through gaps in HIV services
For World AIDS Day 2013, WHO launched new HIV recommendations to increase testing, counselling, treatment and care for the neglected group of adolescents. More than 2 million adolescents between the ages of 10 and 19 years are living with HIV, and many do not receive the care and support that they need to stay in good health and prevent transmission. In addition, millions more adolescents are at risk of infection.
The failure to support effective and acceptable HIV services for adolescents has resulted in a 50% increase in reported AIDS-related deaths in this group compared with the 30% decline seen in the general population from 2005 to 2012.
See also The Guardian coverage.
14. UNAIDS – World AIDS Day message 2013
Sidibé was quite early with his (short) World Aids Day message, perhaps due to Thanksgiving. He is hopeful. Other World AIDS day related UNAIDS material you find here. Latest estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS) show that the world continues to close in on the goal of ending the AIDS epidemic by stopping HIV transmission and halting AIDS-related deaths. Remarkable progress has been made over the last decade—yet significant challenges remain. (the standard sentence in HIV circles to make clear to policy makers around the world the fight ain’t over yet) (let’s hope UNAIDS editors will be a bit more creative in the coming years, as chances are decision makers like Boris Johnson, aka ‘Borisconi’, who seem unfortunately more and more common in our countries, aren’t be impressed by dry jargon like this; also, they probably couldn’t care less. The guy in Australia now in charge is another case in point.)
15. CSIS –Stepping Up the Pace: IAC 20 heads to Melbourne
Katherine E. Bliss;
“When researchers, activists, health care providers, and policymakers convene in Melbourne, Australia, July 20–25, 2014, for the 20th International AIDS Conference (IAC), they will be asking themselves—and each other—what recent progress the world has made in understanding how to control, and potentially, cure, HIV/AIDS, and what it will take to accelerate efforts to reach the world’s most underserved populations with proven prevention and treatment strategies. The conference theme, “Stepping Up the Pace,” serves as a call to action to hasten progress in scaling up life-saving HIV/AIDS services.” Bliss discusses some of the possible topics for next year.
16. Plos (Policy Forum) – Harnessing Poverty Alleviation to Reduce the Stigma of HIV in Sub-Saharan Africa
Alexander Tsai et al.;
Alexander Tsai and colleagues highlight the complex relationship between poverty and HIV stigma in sub-Saharan Africa and discuss possible ways to break the cycle.
17. One – 2013 AIDS Report: It’s time to stop saying ‘AIDS in Africa’
Progress in the battle against AIDS is widely divergent in different African countries, so much so that to talk about ‘AIDS in Africa’ as one epidemic needing a single approach has become an anachronism. While some African countries have reached a ‘tipping point’ against the disease, others lag far behind.
18. CGD – Ambassador Goosby’s Legacy: Research, Implementation Science, and Impact Evaluation
Over looks back favourably on Goosby’s research legacy.
19. CGD – Sneak Preview: CDC’s Effort to Measure the Determinants of AIDS Treatment Quality
Mead Over & Yuna Sakuma;
This blog is the second in a series of three on the quality of PEPFAR’s HIV treatment programs. Over & Sakuma examine why some facilities do better than others in reducing patient attrition over the course of the treatment cascade and what factors contribute to treatment success. The CDC has been collecting data at the facility level on three categories of the determinants of quality.
Apparently, Over was extremely busy just before Thanksgiving, as he also wrote a blog post on PEPFAR workshops on impact evaluations, workshops that are intended to support the in-country teams who want to include an impact evaluation proposal in their March 2014 Country Operation Plan submission. (the turkey will have been well deserved for Mead Over, this year; not sure he still needs it, though)
20. Lancet Correspondence on WHO’s new guidelines for antiretroviral treatment
Bassett et al. reflect on a Lancet Comment (by Kenneth Mayer and Chris Beyrer) from July, on WHO’s new guidelines for antiretroviral therapy, which framed as all but inevitable “treatment as prevention”, now embraced by WHO. “Absent from the gathering momentum for massive expansion of antiretroviral drug use is discussion of at least three important issues”, they say. After listing these, they conclude: “The WHO advice is aimed largely at Africa, where most people with AIDS live and most Ministries of Health rely on WHO guidelines. WHO has a critical role as a non-partisan purveyor of treatment standards. Long a champion of primary health care and health systems strengthening, it seems WHO has been dazzled by a medical model of unproven benefit.”
Obviously, the authors replied.
21. Lancet online (World Report) – 2013 Prince Mahidol Award winners announced
This year the prestigious awards pay tribute to four people who have dedicated their careers to turning the tide against HIV/AIDS. David Holmes reports. “After narrowing down a field of 64 nominees, the board of trustees announced in late November that the award in the field of public health would be shared by World Bank Group President Jim Yong Kim (…) and Peter Piot (…). The award in the field of medicine was conferred jointly on (…) Anthony Fauci and David Ho (…).”
Some other HIV related news:
- On the International Day for the Elimination of Violence against Women, the UN said gender-based violence (GBV) is a serious violation of human rights and increases the risk of HIV infection. “In some countries where there’s a high prevalence, it’s been shown that women who are subjected to intimate partner violence, sexual violence, are 50 percent more likely to be HIV-positive than other women.
- AFP reported that “Rwanda launched Tuesday a national drive to ‘non-surgically’ circumcise 700,000 men in a bid to cut rates of HIV infection, claiming to be the first country in the world to do so.” (with PrePex, that is)
- IPS reports on the roll-out of Option B+ in Uganda, with pros and cons.
- Reuters reported European drug regulators gave their backing on Friday to two new medicines for multidrug-resistant tuberculosis.
- The Wall Street Journal examined controversy surrounding the Kochon Prize, a prestigious honor for major contributions to the fight against TB. The selection committee chose a Tibetan TB program, however, the prize recipient has to be approved by the WHO director-general, and the WHO administration, which advises the director-general, didn’t approve the choice because the hospital has ties to the Tibetan government-in-exile, which is not recognized by the UN. (a bit a neglected story, here in Belgium).
We also want to draw your attention to the Lancet Comment (by Alimuddin Zumla et al) on WHO’s 2013 global TB report, which already appeared online a month ago.
22. Wired – The surge
Matthieu Aikins; http://www.wired.com/wiredscience/polio-vaccine/
As you might remember, ‘The Surge’ was a term linked to George Bush in the not too distant past. However, in Wired magazine, journalist Matthieu Aikins now examines efforts to eradicate polio, with a focus on Afghanistan and Pakistan. The feature includes photography and video.
23. GAVI – GAVI Alliance to support introduction of inactivated polio vaccine in world’s 73 poorest
The GAVI Alliance is to begin providing support for the introduction of inactivated poliovirus vaccine (IPV) as part of routine immunisation programmes in the world’s 73 poorest countries, GAVI’s Board decided a week ago.
The GAVI Alliance Board also took decisions on additional vaccines for the Alliance’s future portfolio, and it also took the decision to begin providing country support for a vaccine against Japanese encephalitis (after a vaccine produced in Chengdu, China, received WHO prequalification).
24. WHO – Informal note on the outcomes of the meetings of Member States on NCD-related assignments (Geneva, 11-15 November 2013)
Last week, Member States agreed on recommendations to the Executive Board for advancing the follow up to the Political Declaration of the High-level Meeting of the
United Nations General Assembly on the Prevention and Control of NCDs. Pursuant to resolution WHA66.10, Member States met in 3 meetings to develop: (1) the draft terms of reference for a global coordination mechanism on the prevention and control of NCDs; (2) the draft terms of reference for the United Nations Interagency Taskforce on the Prevention and Control of NCDs; and (3) a limited set of action plan indicators for the WHO global action plan for the prevention and control of NCDs 2013-2020.
25. Lancet – Offline: DOHaD—coming out, with questions
Horton reflects on some of the things he heard at the World Congress on Developmental Origins of Health and Disease (DOHaD) and why the ‘developmental approach’ is still not really acceptable to the mainstream NCD community. He concludes: “The DOHaD community should be proud of the growing scientific strength of its field. But it needs to think more strategically and self-critically about how it brings existing knowledge together for policy, how it will add new knowledge from intervention studies, and how it works with, not against, the efforts of others. It might also consider a stronger alliance with colleagues in maternal and child health.”
European Development Days
This is a short report from our colleague and human rights lawyer Rachel Hammonds who attended the eighth edition of the European Development Days in Brussels. You find a wealth of information on the website. Many sessions were livestreamed.
The 8th annual edition of European Development Days (EDD) (http://eudevdays.eu/) was the place to be in Brussels for those interested in better understanding how key development stakeholders are positioning themselves during the post-2015 agenda debates. With 5000 participants from 125 countries EDD was billed as “Europe’s foremost platform for dialogue and exchange on international development issues” by EU Commissioner for Development Piebalgs. Debates, workshops and high level panels were organised around 12 themes including health, food, climate, rights, trade, education and inclusiveness. It is impossible to summarise such a diverse event so I will stick to three observations.
Inspiring women leaders from the South figured prominently – including the Liberian President Ellen Johnson Sirleaf, Senegalese MP Magatte Mbodj and Jamaican Prime Minister Portia Simpson-Miller. Second, human rights figured prominently – the 20th anniversary of the UN Office of the High Commissioner for Human Rights and of EU operations in the field of human rights were showcased in the opening reception. In addition, rights figured in several health sessions including a Belgian, Spanish, Dutch workshop exploring the link between the right to health and equity and a UNAIDS, International HIV/AIDS Alliance session on ‘Defeating AIDS- advancing global health’ highlighting the importance of using the lessons of the AIDs response to inform global health. In addition to an engaged diverse panel that session benefited from energetic passionate moderating by MEP Michael Cashman – whose shoes will be very hard to fill (he retires at the end of the this term in office.) Finally, despite my best efforts I am no closer to visualising what an EU road map towards a “decent life for all’ would look like. Business as usual was not the message but how daring and ambitious will leaders be? The jury is still out. We citizens have to get more engaged and push for change.
ITM/IPH colloquium 2013 in Bangalore
This Colloquium was the third in a series of regional colloquia on research for the control of neglected infectious diseases, including zoonoses. The first of these thematic colloquia was organised in Peru in 2009 and focused on Latin America, the second one was held at South Africa (focusing on Africa), and the Colloquium 2013 focused on Asia. You can check the colloquium blog for reports of some of the sessions. Below you find an overall assessment by Upendra Bhojani (IPH) & Werners Soors (ITM).
Doing justice to the most neglected: the ITM Colloquium 2013
From 21-23 November, ITM and IPH co-organised the Colloquium 2013 ‘Health systems and control of neglected diseases in Asia’ in Bangalore, Karnataka. The event brought together an unusual mix of scientists and practitioners – academics, activists and programme officials. While this in itself can already be considered exceptional, it was not the only feature to be remembered. The Colloquium – over and above a wealth of case studies – also gave room to singular reflective moments. There was prof Jacob John kindling up the audience with his concept of ‘public health negligence’ to explain the persistence of neglected diseases, and Freddie Ssengooba setting forth that health systems are to programmes what physiology is to anatomy (no, muscles and bones can’t make a movement on their own). And of course there was the ever reflective prof Guy Kegels, who warned against health systems strengthening for the sake of health systems strengthening: we don’t necessarily prefer the strongest systems, but those that most adequately serve their public goals. He was backed by Bruno Marchal who described ideal stewardship as steering in the public interest. For those interested, more is to be found on www.colloq2013.in and (for those subscribed) on the dedicated Facebook page..
Equally interesting was how the concept of ‘neglected diseases’ was interpreted, beyond the prevalent list of 17. Already months before the Colloquium, prof Marleen Boelaert in the preparatory meetings of the Scientific Committee had made a case for expansion to other diseases of poverty, infectious or not. This allowed screening of the submissions for the Colloquium in a most comprehensive way. Then – in the pre-Colloquium press meeting – the question came back, this time from the journalist: “Is it really only about these rare diseases?” No, it was not: right from prof Marleen Boelaert’s inaugural speech and throughout many a presentation, a broader and more political meaning was given. It made the Colloquium all the more relevant. As prof Jacob John ironically put it: “Neglected diseases are those we don’t want to control”. Or do we?
Upendra Bhojani & Werner Soors
Health Policy & Financing
26. Report ELRHA – An evidence review of research on health interventions in humanitarian crises
This report confirms the need for further research to strengthen the evidence base on public health interventions in humanitarian crises. The evidence review, commissioned by ELRHA and funded by DFID and the Wellcome Trust, was led by the London School of Hygiene and Tropical Medicine in partnership with The Harvard School of Public Health and the Overseas Development Institute. The report analyses the strengths and weaknesses of the evidence, and the key gaps, across a range of health sectors.
27. Impatient optimists – The power of crazy ideas
Prosser spent last week at the Global Health Supply Chain Summit in Ethiopia, “mingling and mixing with logisticians, academics, private sector distribution experts, and ministry of health representatives, all talking about the important and complicated process of getting health products to the people who need them.” She says it’s time to take innovative ideas from other sectors and apply them to global health supply chains, and gives some examples.
28. BMJ (Viewpoint)– Doctors must confront homophobia because it causes harm
All doctors have a duty to speak out against homophobia because such discrimination can lead to psychological and physical trauma, writes Vivienne Nathanson, after the World Medical Association recently stated that homosexuality is not a disease.
29. WHO – WHO issues new guidance for treating children with severe acute malnutrition
On 27 November, WHO released new treatment guidelines for the almost 20 million children under-five worldwide who have severe acute malnutrition.
30. Lancet (Editorial ) – The two-child policy in China: what to expect?
This Editorial comes back on the new child policy in China. “The core issue for China’s population policy is not the number of children a family should have, but the lack of recognition or respect for fertility freedom, which unfortunately remains in the new policy. Birth control policy should first and foremost be built on respect for each individual’s right to reproduce free of coercion, decide the number and spacing of their children, and attain the highest standard of sexual and reproductive health.”
Will be interesting to see how a notion like a country’s ‘carbon budget’, if it ever materializes, will influence countries’ child policies in the future…
31. Xconomy – Gates Foundation Health Chief on Coaxing Pharma to Do Good
Xconomy features a two-part interview with Trevor Mundel, president of the Gates Foundation’s global health operations, on the challenges of implementing global health programs and working with the private sector.
32. Plos Editorial – Integrating Health Care to Meet the Needs of the Mother–Infant Pair: A Call for Papers for Year 3 of the Maternal Health Task Force–PLOS Collection
The Plos Year 1 and Year 2 Maternal Health Task Force Collections have helped build the evidence base for various approaches to improving the quality of maternal health care, and have placed maternal health in the context of women’s health. This year, under the theme Integrating Health Care to Meet the Needs of the Mother–Infant Pair, the editors aim to strengthen the evidence for approaches to providing integrated care from pre-conception, throughout pregnancy, childbirth, and the postnatal period, to the child’s early days and years of life. “Through this Collection, we will contribute to a better understanding of how and when to integrate maternal and infant health care comprehensively, to include conditions such as HIV, malaria, exposure to environmental risks, and other situations that have a significant impact on both maternal and infant health.”
33. Scidev.net – Weak research capacity holds back progress on diseases
Threats to strengthening the capacity of health research in LMICs, such as a lack of research infrastructure and overdependence on donor funding, need more action, as research holds a key to tackling neglected disease there, the World Health Summit in Berlin heard last month. “Many people do feel strongly that weakened research capacity in those countries in which diseases are most endemic may be one of the major factors in their inability to curb, prevent, and treat diseases,” Jo Ivey Boufford, president of the New York Academy of Medicine, told delegates at a symposium of the World Health Summit in Berlin.
34. FT – Indian health activists move to prevent Gilead’s drug patent
Indian health activists are seeking to prevent Gilead from patenting its new treatment for Hepatitis C in the country in a fresh battle over affordable access to medicine.
“The Initiative for Medicines, Access & Knowledge in India said it had filed a ‘pre-grant’ application in Calcutta to block” Gilead’s patent application, a legal action that follows previous spats in India over intellectual property on medicines including those for HIV and cancer and could open the way for local generic drug manufacturers to sell low-cost versions of the product domestically and export it to other low-income countries without strong patent protection laws.”
35. News Medical – Global health organizations join forces to raise awareness on dangers of fake medicines
1.Fake medicines increasingly put patients and the general public at risk across the world. In response to this challenge, ten partners who represent healthcare professionals, disease-specific organizations, product-development partnerships, foundations, international financing institutions, as well as the research-based pharmaceutical industry have joined forces to raise awareness about the dangers of fake medicines.
2.The Fight the Fakes (http://www.fightthefakes.org) campaign will create a global movement of organizations and individuals that will speak up and help spread the word about this under-reported, yet growing threat to public health.
“Fake medicines increasingly put patients and the general public at risk across the world. In response to this challenge, ten partners who represent healthcare professionals, disease-specific organizations, product-development partnerships, foundations, international financing institutions, as well as the research-based pharmaceutical industry have joined forces to raise awareness about the dangers of fake medicines. The ‘Fight the Fakes’ campaign will create a global movement of organizations and individuals that will speak up and help spread the word about this under-reported, yet growing threat to public health.”
36. Health 4 Africa – Public good through private drug shops: Improving access to medicines in Uganda
In this blog post, Phyllis Awor reports on her research project in Uganda where quality of care for children was greatly improved at drug shops after implementation of a modified integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhoea program. She talked about this topic at the recent “Harare 25” meeting in Dakar.
Global health podcasts & videos
- The PHM & the Municipal Services Project released this short video. “ The universal health coverage agenda opens the door for privatization of public health systems in the global South. In India, insurance-based coverage has skewed public health priorities and starved primary care. This animation video calls on people everywhere to mobilize around public alternatives to achieve health for all.” (a “must-watch” for pope Francis)
37. IHP – Changing perceptions in Pakistan: from ‘Our Malala’ to ‘Their Malala’
EV 2010 & 2012 Asmat Malik from Pakistan reflects on Malala, the courageous girl who is applauded around the world for her education activism, but increasingly less so in her own country, as her image there is now linked (tarnished?) with geopolitics.
38. Health Policy & Planning – Global Fund investments in human resources for health: innovation and missed opportunities for health systems strengthening
Diana Bowser et al.;
This article aims to determine the scope and impact of investments in HRH by the Global Fund, the largest investor in HRH outside national governments. The authors conclude: “The narrow disease focus and lack of co-ordination with national governments call into question the efficiency of funding and sustainability of Global Fund investments in HRH and their effectiveness in strengthening recipient countries’ health systems.”
39. Social Science & Medicine – Health sector demand-side financial incentives in low- and middle-income countries: A systematic review on demand- and supply-side effects
Saji. S. Gopalan et al.;
This review investigated the existing evidence on Demand Side Financial Incentives’ demand- and supply-side effects in LMICs.
40. BMJ – Implementation research: what it is and how to do it
David Peters et al.;
Implementation research is a growing but not well understood field of health research that can contribute to more effective public health and clinical policies and programmes. This article provides a broad definition of implementation research and outlines key principles for how to do it.
41. Health Financing in Africa – Universal Health Coverage: a 12-country study to better understand the challenges of fragmentation among health financing schemes along the road to UHC
In this blog post, Allison Kelley presents a descriptive research project being carried out by experts from two Communities of practice – Financial access to health services and PBF – in 12 Francophone African countries. One of the project’s innovations is its collaborative approach. Funding comes from France’s Muskoka Fund & Cordaid.
42. HP&P – Social capital to strengthen health policy and health systems
Jessica Ogden et al.;
This article recounts the development of a model for social capital building developed over the course of interventions focused on HIV-related stigma and discrimination, safe motherhood and reproductive health.
43. Policy & Politics – Market size, market share and market strategy: Three myths of medical tourism
Neil Lunt et al.;
The aim of this article is to contribute towards greater theoretical and empirical understanding about medical tourism developments globally. This evidence leads the authors to examine some widely-held assumptions regarding the size and shape of global medical travel. Their paper examines three central issues: First, do published figures and projections ‘add-up’; are figures from multiple sources consistent, and what decisions and interests are involved for those compiling these statistics? Second, how should any emerging global industry be understood and explained? Finally, given this analysis and market understanding how, if at all, can national governments stimulate activity?
44. Global Public Health – Limitations of the Millennium Development Goals: a literature review
Maya Fehling et al.;
With the MDGs showing uneven progress, this review identifies possible limitations arising from the MDG framework itself rather than extrinsic issues. A multidisciplinary literature review was conducted with a focus on limitations in the formulation of the MDGs, their structure, content and implementation. Articles describe MDGs as being created by only a few stakeholders without adequate involvement by developing countries and overlooking development objectives previously agreed upon. Others claim MDGs are unachievable and simplistic, not adapted to national needs, do not specify accountable parties and reinforce vertical interventions.
45. Alliance – Inclusion of Quasi-Experimental Studies in Systematic Reviews of Health Systems Research
The Alliance HPSR and the Harvard School of Public Health organized a workshop on 14 and 15 November to discuss the inclusion of quasi-experimental studies in systematic reviews of health systems research. The workshop was an initiative of the Alliance’ Advisory Group on Health Systems Research Synthesis. One of the main outcomes of the workshop is a series of papers which are being developed and will be published in the Journal of Clinical Epidemiology in 2014. Additionally, breakout sessions on the topics of the workshop are being planned at the upcoming Third Global Symposium on Health Systems Research in Cape Town.
- Alex Evans wrote a paper on ‘Delivering the Post-2015 Development Agenda