It’s Friday, so my coffee consumption is going through the roof. The Christians among you probably have other things to do this weekend, so we’ll keep this intro short. The atheists, agnostics, Muslims, Buddhists, Hindus and new agers among you will surely not mind. As for the “Socialist” who has his very own religion, global health, maybe this weekend is a good time to chant his planetary manifesto together with his beloved ones.
In this week’s guest editorial, Agnes Nanyonjo ( from the Malaria Consortium Uganda, and also an EV 2012) provides some of her impressions of the 2014 Geneva Health Forum, focusing mostly on day 1 of the three-day conference. For overviews of the consecutive days at the Geneva Health Forum, see also the GHF website (with short concluding videos ).
Enjoy your reading.
Kristof Decoster, Werner Soors, Peter Vermeiren, Basile Keugoung & Wim Van Damme
From health systems to systems for health
Agnes Nanyonjo (Malaria Consortium Uganda & EV 2012)
The 2014 Geneva Health Forum attracted a multitude of participants from different sectors to the world health capital. They gathered for three days of debate on integration and interconnectedness of health care, as this year’s theme was ‘Global Health: Interconnected Challenges, Integrated Solutions’. The sessions by and large were designed to encourage interaction among participants and had session formats ranging from freewheeling fish bowls, a world café, … to more traditional ones like Q&A, debate etc.
Integration can mean different things to different people working in different sectors, as has been previously highlighted by Rifat Atun, one of the plenary session speakers at the Forum. He stated in a 2010 Health Policy and Planning paper for example that “systematic analysis of the relative merits of integration in various contexts and for different interventions is complicated as there is no commonly accepted definition of ‘integration’—a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings.“
As panel discussants burst out into debate, this became all too clear: from integrated disease care over integrated provision of health service packages to multisectoral approaches to health, different views of integration abounded according to people’s perspectives and experience. There was however a general consensus that integrated care happens at different levels: the global, national, local and patient level.
From a patient perspective, integrated care was generally regarded as patient centred care. Participants agreed that integrated care should be hinged around a patient-provider partnership. This patient-provider partnership is so valuable as patients experience illness in varying contexts. Given the multiple causes of ill health that cannot be explained by the traditional biomedical model alone, the identity of hospitals will have to move away from fancy buildings built around doctors to networks built around patients with good and continuing relationships between patients, their carers and health service providers. It was evident that patient centred care will require bottom up approaches with patients as drivers of intervention.
At the local level, the need to recognize the interdependence between the biomedical approach to disease and systems thinking and the implications of this interdependence for policy and practice were echoed throughout the debate. At the national level it was agreed that states particularly need to offer mechanisms for access to financial protection, high performance health delivery and equity.
As we are all citizens of the world, from the global perspective integration is also a desired key feature of future health systems as it encompasses a systems perspective with elements of governance, economic, social, political and commercial determinants of health. Given the rapid gains we have seen in health in the last decade in terms of life expectancy and child mortality, health systems need to equip themselves to address gaps in equity even faster in the coming decades through integrated care. They shall then no longer be seen as health systems but increasingly as systems for health. Since we know all too well that what shapes national health policy shapes global health policy and vice versa, implementation of integrated health systems raises a key governance question: “Who will lead the global health integration agenda while respecting national approaches to health?”
Although no health system can boast of being truly integrated, as it is not possible (and also not necessary) to integrate everything, integration of health systems and services remains a key priority on the global health agenda.
Geneva Health Forum
As already mentioned in the intro, the 2014 Geneva Health Forum website features very nice short videos and documents with the conclusions of day 1, 2 and 3 (see
You can also check the hashtag #GvaHF14 on Twitter.
World Bank (& IMF) spring meetings
1. Devex – New high-level support for universal health coverage
As mentioned in last week’s IHP newsletter, World Bank President Jim Kim convened an impressive panel on the sidelines of the bank’s spring meetings on Friday to lend their (very emerged) voices to the growing chorus of support for a global goal for UHC by 2030. If you just can’t get enough of Kim, Chan, Bloomberg, Summers, et al, you can watch the ‘Universal Health Coverage by 2030’ event again here.
This short article summarizes a few key messages, among others Larry Summers’ message for finance ministers around the world that the argument for UHC is firmly rooted in economics, and that it is more affordable and more effective than they may think.
2. UHC Forward – World Bank seeks to bridge differences over best way to improve healthcare
This article goes a bit more in-depth, and sees emerging “convergence” between two global health post-2015 camps.
3. Humanosphere – Gates Foundation won’t take a stand on universal health coverage |
Not sure Tom Paulson agrees with this assessment. He noted about the event: “What was funny (or, well, funny-strange maybe) was watching the Gates Foundation (in casu, Chris Elias, chief of the development program for Gates) work so hard to avoid taking a position on this goal of ensuring all people have access to affordable, basic health care.” Nice analysis.
4. Health Policy Project – The Most Important Meeting in Town
This is the most detailed article we’ve seen on the event, by senior health economist Sarah Alkenbrack. Well worth reading. Reporting on the event, she mentions why UHC is important and what countries can do to achieve UHC (6 take home messages).
Another event, organized by the Permanent Missions to the UN of France and Japan, in collaboration with the Permanent Missions to the UN of Thailand, Benin and Chile, focused on UHC implementation – for the video, see here.
This event focused on successful implementation of UHC in several countries. Panelists demonstrated the importance and feasibility of ensuring that everyone has access to primary health services without financial risk. Country representatives discussed how their countries expanded quality primary healthcare and developed sustainable financing models. WHO and the World Bank Group discussed implementation and monitoring of UHC. An interactive discussion then allowed the audience to ask questions about implementing and monitoring UHC, and discuss the links between health and the sustainable development agenda.
For some encouraging news on Obamacare, see The Guardian.
Global Partnership for effective development cooperation meeting in Mexico
Whereas the SDG (& post-MDG) discussions focus on ‘what’ needs to be in the post-2015 development agenda, some commentators consider the Global Partnership for effective development cooperation as dealing with the ‘how’. The first meeting since Busan took place in Mexico this week. Not sure you noticed.
5. Global Partnership for effective development cooperation – Global Leaders pledge new action to boost development co-operation
“38 new initiatives were launched by governments, business, private foundations and civil society to push forward effective development co-operation at the first High-Level Meeting of the Global Partnership for Effective Development Co-operation.
Launched in Busan, South Korea in December 2011 and led by Ministers from Indonesia, Nigeria and the United Kingdom, the Global Partnership helps nations, business and organisations work better together to end poverty. Over 1500 participants from over 130 countries including developing countries like the Central African Republic, emerging providers like Brazil and Turkey, Northern donors, parliamentarians, leaders from big business like Unilever and H&M and came together to discuss progress in development co-operation and to anchor the Global Partnership in a post-2015 development framework.” For the communiqué, including an annex with Voluntary Initiatives, see here. For some of the focal themes of the meeting in Mexico, see here. For the Progress Report of the Global Partnership, released early April, see here. Results so far are mixed, as you can imagine, but it’s early days.
At the event, Ban Ki Moon lauded GAVI as an example of a truly global partnership, no surprises there.
6. Guardian – Global alliance warns of no end to poverty unless countries pull together
This Guardian article reviews the outcomes of the meeting in Mexico.
Some more in-depth analysis, before the event, of the Global Partnership’s (lack of ?) momentum, you find in the Guardian (including an analysis by the wonderful Jonathan Glennie), Devex (see also here), Nicola McIvor (Oxfam) on Duncan Green’s blog, …
7. Lancet Correspondence on Commission on Global Governance for Health
The debate on the Lancet Commission on Global Governance for Health report continues. Check out in this week’s Lancet issue the People’s Health Movement position (by our colleague and well known “Socialist” Pol de Vos et al). They aren’t very happy about the Commission’s recommendations, which fail to address the root causes of persistent health inequities in their opinion. They also emphasize a key role for WHO, including in the governance structures of multilateral organisations whose decisions influence the global social and economic determinants of health. (must-read)
Another Lancet Letter (by P M Carrera) emphasizes the Health in All Policies (HiAP) approach which can complement the mechanisms foreseen in the Commission.
Obviously, the authors of the Commission reply, and they do so rather well. See here.
8. Lancet (Editorial) – Water and sanitation: addressing inequalities
On April 11, a high-level meeting on sanitation and water for all took place in Washington, DC. “The high-level meeting gathered ministers and representatives of finance, health, and water and sanitation from 46 countries, donors, international organisations, and civil society to discuss how to reach water and sanitation targets. Margaret Chan and Jim Kim were both in attendance. The UN-Water Global Analysis and Assessment of Sanitation and Drinking—Water (GLAAS) project, led by WHO, simultaneously released a preliminary report ‘Investing in Water and Sanitation: Increasing Access, Reducing Inequalities. Special Report for the Sanitation and Water for All (SWA) High-Level Meeting (HLM)’.”
Beyond direct health outcomes, investing in water and sanitation is essential to achievement of post—2015 sustainable development goals. The Lancet highlights four areas going forward.
9. Forbes – The Lancet Tries To Get Socialism Via The Public Health Route
A bit of entertainment for the Easter holidays, from an Adam Smith Institute fellow. He kicks off like this: “The Lancet, something that used to be a very good magazine for doctors about medicine seems to be transforming itself into the vanguard of the new revolution. That’s certainly what their “from public to planetary heath: a manifesto” reads as, a method of imposing socialism once again but this time using the arguments of public health.”
10.Global Health Promotion (Preface) – Governance for health, wellbeing and sustainability – what is at stake
If Richard Horton is a “Socialist”, I don’t know which innovative term we should use for Ilona Kickbusch, the Godmother of global health. In this short article, she says what’s at stake in the 21st century. Pointing out that “The new 21st century dynamics of health find their paradigmatic expression in the global obesity epidemic”, she ends her piece like this: “No longer is it sufficient to focus on a lack of technical capacity (i.e., do it better) to address noncommunicable diseases – rather it will require facing the political matrix of power, interests, institutions which reinforce unsustainable production and consumption patterns, unsustainable lifestyles and inequalities. Public health action at this point will require a mind shift towards a new political and social movement for health which addresses the social, commercial and political determinants of health.” It’s time for an interview with Fox News, we reckon.
11.Global Health Promotion – The post-millennium development goals agenda: include ‘end to all wars’ as a public health goal!
“The peace agenda should not be the monopoly of the UN Security Council, and the current consensus-building process setting the post-MDG agenda is a rallying point for the global community. The human rights approach will not suffice to eliminate wars, because few are fought to protect human rights. The development agenda should therefore commit to eliminating all wars by 2030.”
12.CSO petition – Sign On: The actions we need for the future we want – a civil society red flag
Civil society organizations are concerned about how the post-2015 discussions are evolving. “Little seems to be underway to reverse the trend of doing business as usual and that the UN is about to lose the opportunity to transform the current vicious cycle of development focused on economic growth alone that fuels inequalities, inequities, environmental degradation and marginalization into a virtuous cycle where human rights and justice prevail. Despite the statement of the UN Secretary General that “no one will be left behind,” the Sustainable Development Goals are not on track to be built on the essential priorities for a sound and effective post 2015 global agenda, namely human rights and dignity for all.” …”The most important lesson from the MDGs has yet to be learned: that sustainable development is impossible unless human rights are at its center as a foundational pillar of vibrant, equal and prosperous societies.”
13.Global Health Workforce Alliance – Concept Note: A global strategy on Human Resources for Health for Post-2015
No comment needed here, the title says it all.
Global Fund, PEPFAR & GAVI
14.Aidspan – China after the Global Fund
Yanzhong Huang and Jia Ping;
Yanzhong Huang & Jia Ping come back on their recent CFR paper on the Global Fund’s China legacy, and say that the – mixed – legacy of the Fund in China has important implications for global health governance, the Fund’s future financing model, and China’s handling of its own public health challenges.
15.PEPFAR – Statement from Ambassador Deborah Birx, U.S. Global AIDS Coordinator, on the Principles of PEPFAR’s Public Health Approach
Deborah Birx, who was confirmed as the new U.S. global AIDS coordinator last week, released a statement on the principles of PEPFAR’s public health approach.
In related news, in a Global Post Commentary by L M Frett, the Planned Parenthood Vice President calls for bold leadership from Birx as she becomes the first woman to take on the role of U.S. Global AIDS Coordinator. Not sure whether it’s because she’s a woman, but that includes integrating family planning and HIV services, according to Frett. The commentary also calls on Birx to reverse the decision prohibiting PEPFAR funding for contraception.
As for GAVI, they got kudos in Mexico (see above), so the odds look good for the upcoming replenishment process which will officially launch in May, 2014. This should lead to a pledging conference to be held towards the end of the year. (see here ).
16.Lancet (early online) – Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention
Alexandra Jones, …, Peter Piot & Mark Dybul ;http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62230-8/fulltext“Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.”
17.BMJ (Feature) – Some progress and some missed targets in the TB epidemic
Janice Hopkins Tanne; http://www.bmj.com/content/348/bmj.g2626
There is promise of new treatments for TB, although some goals set by WHO for 2015 are likely to be missed, said Jennifer Philips of New York University Langone Medical Center in remarks made at a TB day symposium on 24 March at the New York Academy of Sciences.
18.Ebola & polio update
- Guinea’s Foreign Minister Francois Fall said on Monday the west African country had brought the spread of the deadly Ebola virus under control after more than 100 people have died. Meanwhile, news outlets (see AP ) reference a report published in the New England Journal of Medicine suggesting the Ebola virus in West Africa is a new strain.
- “While global health agencies confront the recent Ebola outbreak in western Africa, researchers funded by US federal agencies are gaining ground in efforts to develop medicines to combat the deadly virus” (see CQ Health Beat).
- Pakistani officials said on Monday they would begin administering polio vaccines to children at security checkpoints in the country’s tribal belt to protect against Taliban attacks.
- Meanwhile, in yet another worrying polio development, polio spread to Equitorial Guinea (see here).
19.Guardian – Two shots of HPV vaccine against cervical cancer enough, says WHO
“Reaching a greater number of girls in developing countries with the HPV vaccine that can prevent most cases of cervical cancer has … become more feasible. The World Health Organisation’s expert advisory group said that two shots of vaccine against human papillomavirus (HPV), rather than the three doses currently recommended, will offer sufficient protection to girls so long as they have it before they reach the age of 15.”
20.CDC Foundation – CDC Foundation and George W. Bush institute to partner in $3.6 million grant to address global cervical cancer;
http://www.cdcfoundation.org/pr/2014/cdc-foundation-bush-institute-partnership-to-address-global-cervical-cancer The CDC Foundation and the George W. Bush Institute Wednesday announced a new partnership to help stem the tide of cervical cancer in low- and middle-income countries based on a $3.6 million grant from the Gates Foundation.
21.NEJM (Editorial) – Therapy for Hepatitis C — The Costs of Success
Jay H Hoofnagle et al.; http://www.nejm.org/doi/full/10.1056/NEJMe1401508?query=featured_home“Welcomed and exciting results from three large, controlled trials of different regimens of oral antiviral agents for chronic hepatitis C, genotype 1”, have been published in the NEJM (for the MDs among you).
Very encouraging indeed, but the cost remains very high –see below.
22.Nature (news) – Hepatitis C drugs not reaching poor
“The publication last week of the first treatment guidelines for hepatitis C virus (HCV), and the advent of drugs that can cure most infections of the virus, have left public-health researchers with a touch of déjà vu.” This article gives a nice overview of recent debate & developments.
See also a Financial Times article on the same topic: ‘Drug groups step up race for hepatitis C treatments’.
23.Lancet Global Health – Readiness of the primary care system for non-communicable diseases in sub-Saharan Africa
André Pascal Kengne et al.;http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70212-8/fulltext
You probably know the answer.
Kengne et al comment on a new study in the Lancet Global Health by Robert Peck and colleagues who report the results of a cross-sectional evaluation of the preparedness of 24 public and not-for-profit Tanzanian health facilities to provide routine care for selected NCDs.
24.BMJ news – South Korea’s national health insurer sues tobacco industry for $51.9m in damages
South Korea’s state health insurer has joined the ranks of countries suing the tobacco industry for the health related costs of disease caused by smoking. The country’s National Health Insurance Service (NHIS) announced on 14 April that it had filed a suit for damages of 53.7 billion won from the local market leader KT&G Corporation and the local units of Philip Morris International and British American Tobacco.
25.Lancet Editorial – Cigarette packaging in China—not going far enough
In other news from the Far East, the Lancet focuses on a new WHO report, Tobacco Health Warnings in China: Evidence of Effectiveness and Implications for Action, published on April 8, which summarises evidence on the effectiveness of China’s written health warnings on tobacco packaging.
26.Lancet Viewpoint – Classification of mental disorders: a global mental health perspective
KS Jacob & Vikram Patel ;
80% of people affected by mental disorders live in low-income and middle-income countries, which benefit from scarcely 10% of global mental health resources. So the needs are enormous in LMICs. But are the current (psychiatric & western) classifications satisfying, if only because many of these patients are seen by primary care staff (rather than psychiatrists)?
In his weekly Offline article, “The dis-eases of exile”, Richard Horton zooms in on the plight of many migrants in Europe, both in terms of physical health (& access) and mental health. His story rings more than a couple of bells with me, unfortunately.
Maternal and child health
27.Humanosphere – Private health care for diarrhea in Africa kills 20,000 kids annually
Tom Murphy ;
“Children in sub-Saharan Africa who suffer from diarrhea are receiving lifesaving treatment at a lower rate when visiting private hospitals as compared to public ones. Closing that gap would save an estimated 20,000 lives each year.” Murphy reports on a new research article in the American Journal of Tropical Medicine & Hygiene.
28.Pew – Africans among the most morally opposed to contraception
“Several African nations stand out among the most conservative on the issue of contraceptive use, according to a recent Pew Research Center survey of people in 40 countries. Nigeria, Ghana, Uganda, Kenya and Senegal ranked among the nine countries with the most moral opposition to contraception.”
29.Euractiv – UK warns MEPs against evangelical attack on EU development aid
‘One of Us’ used to be just a nice Abba song for me, reminding me of the time I was secretly in love with the blonde from the Swedish band (pretty much like every other young boy, I’m afraid), but now it’s also a bunch of Conservative Christians who have already gathered 1.8 million signatures for a “European Citizens Initiative”. They try to ban EU funding for activities linked to abortion or the destruction of human embryos. This could also obstruct life-saving operations in the developing world, most notably in the area of maternal health. Now the Commission has to look into this.
Looks like we’re hell-bent on organizing our own ‘culture wars’ here in Europe, perhaps to mitigate for the fact we don’t really have an impact anymore on the socio-economic fundamentals through our national politicians?
Health Policy & Financing
30.Lancet (World Report) – Tackling violence against health-care workers
Globally, health-care workers experience high rates of violence and abuse in the workplace. More focus should be put on preventing such attacks, say experts. Roxanne Nelson reports.
31.Journal of health Diplomacy – Power: The nexus of global health diplomacy?
Robert Marten et al.;
The Journal of Health Diplomacy has a number of interesting articles online since mid-March or so. “To understand global health diplomacy, studying the dynamic relationships, policies and processes between actors and institutions is necessary; to understand these interactions, power is the critical unit to study to help assess and understand how countries influence global health policy,” argues Robert Marten, one of my global health heroes.
Another articlein the same journal (by Catherine M (!) Jones) zooms in on what research on national policies on global health can reveal about global health governance. “Using the example of Health is Global: a UK Government strategy 2008-2013, this commentary aims to show that various theoretical perspectives on the development of NPGH (=national policies on global health) illuminate different aspects of the policy process, some of which may intersect with Global Health Governance processes.”
32.Journal of Health Diplomacy – African perspectives in global health diplomacy
René Loewenson et al.;
This paper explores, through a review and analysis of published literature in English, the perspectives that have informed African health diplomacy; particularly in Anglophone Sub-Saharan Africa. A thematic analysis of literature on health diplomacy in Africa pointed to common themes in African diplomacy on health, including: a liberation ethic; African unity and interdependence; and developmental foreign policy. Examples are provided that demonstrate how these perspectives have specifically informed negotiations on global health.
33.Lancet Correspondence – North Korea: a challenge for global solidarity
Espen Bjertness et al.; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60677-2/fulltext
On the basis of the Commission of Inquiry on human rights in the Democratic People’s Republic of Korea, a recent Lancet Editorial presented evidence of gross violations of human rights in North Korea. To ensure the right to health for all people of North Korea, increased academic collaboration could be a small step on the way to success, this author argues. I don’t know how he defines ‘success’.
34.TMIH (Editorial) – HINARI grows: one step closer to health information for all
Caleb van Essen et al.; http://onlinelibrary.wiley.com/doi/10.1111/tmi.12310/full Hinari is growing, which is good news for researchers in developing countries. Yet, it’s still not that well known.
35.Humanosphere – Visualizing health funding gaps in West and Central Africa
Leach-Kemon comes back on the IHME report from last week and points out West- and Central Africa need more help as they have been relatively neglected by donors compared to other areas in SSA. Very nice blog post. The Conclusion: “At the conclusion of the launch event for the Financing Global Health report, Morrison asked the panelists at the event to name the main takeaways from the report for US legislators. Murray responded, “Evidence is starting to accumulate that funding is making a difference.” These analyses indicate that if donors invest more global health dollars in Western and Central Africa as they have elsewhere on the continent, it may translate to accelerated health progress in these regions.”
36.UHC Forward – West Africa: Underscoring the WAHO/Health Ministers’ Meeting
Speaking of West Africa, a six-day meeting of the 15th Ordinary Meeting of the Assembly of ECOWAS (=Economic Community of West African states), Health Ministers, under the auspices of the West African Health Organization (WAHO), is underway in Monrovia. The theme: UHC: issues, Challenges and Opportunities
37.WHO Afro – Africa´s health challenges require concerted action from all stakeholders
http://www.afro.who.int/en/media-centre/pressreleases/item/6468-africa%C2%B4s-health-challenges-require-concerted-action-from-all-stakeholders.html Health experts held a two day meeting in Luanda, Angola to discuss a range of issues aimed at improving the health of people living in the African Continent. The two-day meeting preceded the African Health Ministers meeting (16-17 April) in Luanda. It was jointly organized by the African Union Commission (AUC), WHO and the Government of Angola. (including an address by Sambo)
38. IPCC report 3
The third report of the IPCC which was released last weekend, stressed: “If countries hope to achieve their economic aspirations without pushing the global climate system deep into uncharted territory for humans, they have a rapidly closing window for taking extensive action at the lowest cost”.
The Economist wasn’t very fond of this third IPCC report, apparently (unlike the first and the second), but we’d rather recommend this nice blog post by Owen Barder on how to avoid dangerous climate change: “Setting a Price on Carbon Immediately Is Necessary to Avoid Dangerous Climate Change”.
39.African Development Bank (blog) – Using the high-end health market for regional integration in Africa
Seye is by now an Emerged Voice, we reckon. Read his latest proposal, linking regional integration, medical tourism and financing primary health care for the poor.
40.HPSR – People-centred science: strengthening the science of health policy & systems research
Kabir Sheikh et al.;
Excellent preparation for the Cape Town symposium later this year. Must-read.
41.Plos Medicine – Indoor Residual Spraying in Combination with Insecticide-Treated Nets Compared to Insecticide-Treated Nets Alone for Protection against Malaria
Philippa West et al.;
In a cluster randomized trial in Tanzania, Philippa West and colleagues examine whether indoor residual spraying in combination with insecticide-treated nets is effective for reducing Plasmodium falciparum infection prevalence in children, anemia in young children, and entomological inoculation rate.
42.BMC Health Services – Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey
M Chenge et al.
Concerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, DRC, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure.
43.BMC Public Health – Adapting a community-based ART delivery model to the patients’ needs: a mixed methods research in Tete, Mozambique
Freya Rasschaert et al.;
To improve retention in antiretroviral therapy, lessons learned from chronic disease care were applied to HIV care, providing more responsibilities to patients in the care of their chronic disease. In Tete – Mozambique, patients stable on ART participate in the ART provision and peer support through Community ART Groups (CAG). This article analyses the evolution of the CAG-model during its implementation process.
44.Health Research Policy & Systems – Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers
Andrew J Milat et al;
Decisions to scale up population health interventions from small projects to wider state or national implementation is fundamental to maximising population-wide health improvements. The objectives of this study were to examine: i) how decisions to scale up interventions are currently made in practice; ii) the role that evidence plays in informing decisions to scale up interventions; and iii) the role policy makers, practitioners, and researchers play in this process.
45.International Journal for Equity in Health – A community-based approach to indigent selection is difficult to organize in a formal neighbourhood in Ouagadougou, Burkina Faso: a mixed methods exploratory study
Valéry Ridde et al.;
In most African countries, indigents treated at public health centres are supposed to be exempted from user fees. In Africa, most of the available knowledge has to do with targeting processes in rural areas, and little is known about how to select the worst-off in an urban area. In rural communities of Burkina Faso, trials of participatory community-based selection of indigents have been effective. However, the process for selecting indigents in urban areas is not yet clear. This study evaluates a community-funded participatory indigent selection process in both a formal (loti) and an informal (non-loti) neighbourhood in the urban setting of Burkina Faso’s capital. This was an exploratory study to evaluate the processes and effectiveness of participatory targeting.
46.BMC Public Health – Building on the EGIPPS performance assessment: the multipolar framework as a heuristic to tackle the complexity of performance of public service oriented health care organisations
Bruno Marchal et al;
In health, one of the most comprehensive performance of health systems frameworks was developed by the team of Leggat and Sicotte. Their framework integrates 4 key organisational functions (goal attainment, production, adaptation to the environment, and values and culture) and the tensions between these functions. Marchal et al modified this framework to better fit the assessment of the performance of health organisations in the public service domain and propose an analytical strategy that takes it into the social complexity of health organisations. The resulting multipolar performance framework (MPF) is a meta-framework that facilitates the analysis of the relations and interactions between the multiple actors that influence the performance of health organisations. (when you have ‘multipolar’ & ‘meta-frameworks’ in one sentence, you know my colleague Bruno Marchal is involved)
47.Globalizations – special issue: free trade and transnational labour
For the Socialists among you.