Dear Colleagues,


In the same week that Madrid hosted two Champions League semi-finals (both with a full house), an Amnesty International Report said that the right to protest is increasingly being jeopardized in Spain. Combined with the outrageous amounts of money circulating in international football now, I decided to go for a boycott of the Champions League, the EU’s preferred neoliberal toy. Ilona Kickbusch will be happy to hear this self-imposed boycott only lasted for one day, as it proved far easier to ignore the Champions League when I knew José Mourinho was involved than when Pep Guardiola was expected on the pitch. By the time Ilona’s favourite team – Bayern Munich – had to play Real Madrid, I found myself back in front of the tv-screen (and I didn’t regret it). To sum up: football will always survive, whether we live in communist or neoliberal times. Yes, you can hum Gloria Gayner now.

But let’s go to global health. Today we celebrate World Malaria Day and this week is also the start of   World Immunisation Week (24-30 April), which  aims to promote one of the world’s most powerful tools for health – the use of vaccines – to protect people of all ages against disease. The theme for 2014 is “Are you up-to-date?” That is probably also the annual message at the Global Health Product Development Forum in Seattle, which Bill and Melinda Gates addressed this year (just like all other years, we presume).

Also this week, David McCoy blogged about the Lancet Commission on Global Governance for Health, arguing that the analysis is sound but the recommendations  (very) disappointing. There’s also a new Lancet Global Health issue – recommended reading, even more so for the Canadians among you who still feel proud of their country. Meanwhile, in Stockholm, in a meeting organized by UNFPA and the EPF (European Parliamentary Forum on Population and Development), international parliamentarians gathered to assess progress 20 years after the mythic Cairo International Conference on Population and Development (ICPD) agreement, a milestone. In Cairo itself, there’s not much progress, we guess.

In this week’s editorial, I argue that the global health community should pay much more attention to the emerging global precariat class ( Guy Standing coined the term “precariat” a while ago) and even frame key health battles in these (class) terms (instead of using rather sterile talk of “the bottom quintiles” etc). If the 19th century is back, at least in some ways, we better do it properly. Although the categories don’t overlap completely, other analysts talk about  the strugglers (Nancy Birdsall, CGD) and the fragile middle class (Financial Times). I prefer the term “precariat” though, because it conveys better the rather negative overall assessment I have of the current (neoliberal) form of  globalization, even if the common awareness as a global “class” is not yet there and the term precariat refers more to a reality of increasing insecurity in the North (than in the Global South) – but see for example  Duncan Green on two examples of this class in China, migrant workers and “diaosi”. Although global health should of course remain also focused on the very poor and marginalized – I’m all for a Grand Convergence –  I think the global health community can help in raising the political awareness of this class. Fat chance it will happen though, at least in the short term.



Enjoy your reading.


Kristof Decoster, Werner Soors, Peter Vermeiren, Basile Keugoung & Wim Van Damme




Why the global health community should pay a lot more attention to the global precariat


It’s not often you come across a truly visionary op-ed but in my opinion last week’s viewpoint from Guy Standing in The Guardian, ‘Cheer up – a renewed left is coming’, fits the bill. In the piece, he says the precariat is today’s (emerging) mass class, and like the proletariat in the 19th and part of the 20th century, it will define a new progressive agenda for this age. Not all the examples he gives of “precariat uprisings” in countries around the globe are convincing, and not everybody shares his analysis, obviously, but the man has a point. If the 21st century is to have a progressive agenda, it will need to come through a social and political mass movement with a vital role for this precariat.

Granted, the precariat is not yet a “global” class, and our individualized and fragmented societies don’t exactly facilitate its emergence, but nevertheless, as Standing mentions, “a growing part of the precariat perceives a common predicament, realising that this is a collective experience due to structural features of the economic and political system.” People belonging to this precariat lead very insecure/precarious lives, and “increasingly resemble denizens rather than citizens: people with restricted rights, largely living towards the bottom of a “tiered membership” model of society, in which a plutocratic elite takes the single biggest share, while other classes – the salariat, free-ranging “proficians”, and what remains of the old working class – divide up most of what remains.”

If you share this analysis, and French economist Piketty has provided some more evidence for it lately, the conclusion for the global health community seems obvious.

Especially since 2000, the focus of the main global health stakeholders and donors has been largely on the many poor, marginalized, downtrodden, … in fragile, low and middle income countries. Inspired by a donor-recipient logic, the idea was to do something about the huge health inequities that characterize our world. A great cause, no doubt, and one that isn’t finished yet, far from it. Global health embraced public-private partnerships, with their trademark mix of business spirit, skills and philanthropy, to make progress towards the eradication of extreme poverty and the softening of health inequities, and some (big) successes have indeed been achieved.  For the ‘Grand Convergence in Health’, an even greater effort along these lines is planned, although more domestic revenue will be used too, if all goes well.

Yet, if the global health community really wants to contribute to a more just world in the 21st century, it will also need to embrace the cause of this growing precariat – and frame some of the key global health battles in these (class) terms. As Standing mentions, the size of the precariat is increasing as we speak, in many countries. You have people in LMICs who just escaped extreme poverty and are aspiring for the middle class lifestyle but could fall back any time, people in formerly developed countries who are no longer middle class but living very precarious lives, due to the forces of globalization & technology, austerity policies imposed by financial markets and technocratic institutions, the shrinking of traditional welfare states, … and the global trend towards more insecurity and inequality, within countries, doesn’t seem to stop any time soon.

If global health is about more than just ensuring security for the North, contributing to economic growth and/or  charity,  the global health community should help raise the political awareness of this already emerging class by framing issues as the right of all human beings, regardless of the role people play in the economy. UHC can be a great tool in this fight for more global social justice, although then it would need to be – more than now – framed as a global agenda (and not just a national agenda), as a human right for all, uniting Brazilian rioters with Israeli protesters and desperate Greeks and Portuguese. To some extent, this is happening, if only because UHC has the word ‘universal’ in it, but the political momentum and the framing still seem to be nation-based, mostly. Let’s face it: apart from people like us, in the global health community, who knows the World Bank, WHO and the Rockefeller foundation are leading a global campaign for UHC? Most people talk about UHC for the US, or for Indonesia or for Ghana, not really about UHC as a right for all, around the world (including the marginalized & the very poor, obviously, but also the global precariat). In a way, although it’s a bit of a stretch, what people working in the informal sector are for LMICs, the precariat is for formerly developed countries. So it shouldn’t be too hard to start framing the agenda as such and pointing out similarities.

But UHC is just one example. It’s clear that in other global health struggles too, like  for example in the fight for decent work, the global health community shouldn’t be aligning with the likes of Walmart and co. Equally, in the fight for fair taxation, it’s time to discard the “very respectful language” towards JP Morgan and Goldman Sachs top employees, in fora like Davos, hoping for an innovative ‘partnership’ with them for some global health cause.  And let’s call a spade a spade too when it comes to deteriorating mental health in countries with harsh austerity policies. I personally favour using old fashioned class terminology instead of the rather sanitized language of ‘social determinants of health’.

If global health is indeed (also) about social justice, as it claims to be, it should embrace the precariat’s cause, wholeheartedly. To put it differently: Bill Gates shouldn’t be the (only) face of global health (anymore), in spite of all the good he does. His global health commitment feels too much like benevolent charity by the winners of globalization. His efforts remain very much appreciated, but instead, Guy Standing and others like him should be the faces of a truly progressive agenda for the 21st century. We can think of a number of good global health examples to embody such a “pro-precariat” global health agenda.

Last but not least, there’s one more reason why mainstream global health should pay much more attention to the precariat’s predicament. The ranks of the global precariat are not just swelling due to social and economic trends. From an ecological perspective, increasingly, we are all “the precariat”…




Post-2015 & UHC


1.    Medact – The Lancet-UiO Commission on Global Governance For Health Commissioners should withdraw their recommendations and come up with better ones.

David McCoy;

It’s not often the title of a (lengthy) blog conveys the gist of the piece, but this one does. Must-read!!!  (having said that, the three recommendations David puts forward himself, all seem to go against the “DNA” of mainstream global health)


2.    Lancet Correspondence on manifesto for planetary health

This week’s Lancet issue features three Letters on the Manifesto for planetary health.


Frederick Burkle says Richard Horton and colleagues’ manifesto requires nothing less than a global treaty. Laura Kahn et al argue planetary health needs the “One Health concept” that recognises the links between human, animal, and environmental health. “These factors must be incorporated and integrated before planetary health can be achieved.  We must recognise that planetary health equals human, animal, environmental, and ecosystem health. Achieving planetary health requires implemention of the One Health concept globally.”


And Claudio Schuftan and other members of the People’s Health Movement emphasize that, although they agree with much of the analysis of the manifesto, they regret the manifesto makes no mention of existing social movements, many of which have much the same aims as those being proposed. “The manifesto calls for the creation of a powerful social movement to deliver planetary health and support sustainable human development. But, there is no reference to the work already being done for example by the World Social Forum, Greenpeace, the International Baby Food Action Network, the Food First Information and Action Network, La Via Campesina, ACT UP, the Landless People’s Movement, or the many other movements respected by governments and the UN agencies. There is also no indication of how empowered communities—as partners of the movement—will become empowered.

The need is not for a new social movement; it is for recognition, inclusion, coordination, and strengthening of existing social movements.”


3.    SDGs Working document for May Session of Open Working Group

Check out the Working Document for the 5-9 May Session of the Open Working Group on SDGs, with updated focus areas (see focus area 3 in particular on health and population dynamics).


4.    Foreign Affairs – Failure to launch: how Obama fumbled

Jonathan Alter;

Over to the US. Whatever happens to the Affordable Care Act in the coming months and years, the many mistakes made with the rollout have tarnished Obama’s reputation for competence, Alter argues.

5.    Lancet – Offline: America—a country facing two futures

Richard Horton ;

Horton: The best of the United States of America was on display last week at the launch of the UCLA Center for World Health  (with people like Tom Coates, Victoria Fan and Eric Goosby speaking), while the worst is usually at display in Congress (for example with respect to climate change policies (or the lack of them)). Horton remains hopeful  ((must have been the LA weather; or the LA women?) : “I left Los Angeles believing that UCLA’s extraordinary commitment, if amplified and multiplied across a nation, could ignite a citizen-led movement for political change. My worry is that there is only a very short time before America loses this unique opportunity to choose its future.


As for how international medical students see the future, see this Lancet Global Health blog post. Josko Misse duly call for a healthy future. The International Federation of Medical Students’ Associations (IFMSA) chose post-2015 as the theme of its 63rd General Assembly last month. The meeting led to the Hammamet Declaration on Health post-2015 (see also a previous IHP newsletter).



World Malaria Day


6.    WHO – World Malaria Day 2014: WHO helps countries assess feasibility of eliminating malaria

Today, on World Malaria Day (25 April), WHO launches a manual to help countries to assess the technical, operational and financial feasibility of moving towards malaria elimination. The new guide, “From malaria control to malaria elimination: a manual for elimination scenario planning”, will provide countries with a framework to assess different scenarios and timelines for moving towards elimination, depending on programme coverage and funding availability.


7.    Lancet Global Health (blog) – Managing malaria in times of change

Fatoumata Nafo-Traoré;

The Executive Director of the Roll Back Malaria (RBM) Partnership blogs on funding upheavals, parasite resistance, and political change.


8.    The Independent – Supplement on malaria

This supplement features articles as well as videos. You find the supplement here.


9.    Lancet (Editorial) – Time to contain artemisinin resistance

The theme of this year’s World Malaria Day is elimination: invest in the future and defeat malaria.  However, artimisinin resistance is an increasing concern, and “despite several meetings, plans, and increased funding, including US$100 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria for the Regional Artemisinin Resistance Initiative (in the Mekong area), containment of artemisinin resistance has failed.

As discussed by Nick White in a Comment in this week’s issue, the discovery of a molecular marker for artemisinin resistance in Plasmodium falciparum might offer a window of opportunity for improved surveillance. This year’s World Malaria Day should refocus commitment to address the danger of artemisinin resistance with effective mobilisation of resources in the field, research, and above all leadership.”

10.Lancet Global Health – Basic or enhanced clinician training to improve adherence to malaria treatment guidelines: a cluster-randomised trial in two areas of Cameroon

Wilfred Mbacham et al.;

The prescription of antimalarials for fever, without establishment of its cause, is very common in malaria-endemic countries and thought to be a major cause of drug resistance. WHO therefore recommends use of rapid diagnostic tests for malaria before treatment with artemisinin-based combination therapy. However, uptake of such tests has been slow. Wilfred Mbacham and colleagues, in their Article, describe a cluster-randomised trial of two training packages aimed at improving management of suspected malaria by clinicians in Cameroon. See also the accompanying  Comment (by Neeru Singh et al): “ Overall, Mbacham and colleagues have successfully shown that the introduction of rapid diagnostic tests for malaria diagnosis and control might not succeed unless accompanied by a vigorous programme to change the behaviour of clinicians and health providers to promote adherence to WHO malaria diagnosis and treatment guidelines. Moreover, …, the introduction of rapid diagnostic tests should be accompanied by various (other) strategies:…“

11.World Bank – Fighting Malaria: Results-Based Financing Accelerates Progress in Africa

Marysse Pierre-Louis et al.;

For an update of World Bank programmes and action on malaria, see this article. RBF is the keyword…

12.Euractiv – The EU needs to step up its fight against malaria

Caroline Kent;

This article does the same for the EU’s malaria commitment. “Today is World Malaria Day and an increased EU investment in innovative, accessible and effective responses to the killer disease this year will be crucial to determining whether the world reaches a tipping point in eradicating it, writes Caroline Kent.” Among other issues, she discusses EDTCP2. “ … The EU has just finalised agreement its key contribution to this effort – the second European and Developing Countries Clinical Trials Partnership, or EDCTP2. With a budget of €683 million, EDCTP2 will spearhead collaborative efforts to support the clinical development of new or improved diagnostics, drugs, vaccines and microbicides against malaria (and HIV & AIDS, tuberculosis).”




13.IHP – The World Health Organization and multi-stakeholder governance. To be or not to be?

Remco Van de Pas;

Next week Remco van de Pas joins ITM (and will thus become my colleague). This is his last piece for Wemos Foundation. Remco draws some lessons from two meetings that took place at the WHO premises this month. They will probably shape the direction of the organization for the coming years, he argues. “End of March, a second informal consultation on WHO’s engagement with non-state actors took place, and this week (23-25 April), member states came together to discuss a global coordinating mechanism for NCDs.”  Both meetings discussed cooperation and coordination of WHO with other actors than state governments, defined as “Non-State Actors” (NSAs).  Tricky issue, as you all know.

As a reminder, preparatory documents for the 67th World Health Assembly, you can find here.



Global Fund & GAVI



14.UNICEF and Global Fund coordinate efforts to reach mothers, newborns and children

In a press release, UNICEF and the Global Fund announced a new agreement to better coordinate efforts aimed at reducing the burden of HIV, tuberculosis, and malaria and improving the health of mothers, newborns, and children. … Under the new agreement, the Global Fund and UNICEF will encourage governments and Country Coordinating Mechanisms to integrate packages of care and support for mothers and children, and to apply for Global Fund grants that align HIV, TB, and malaria programming with broader maternal, newborn, and child health efforts.


15.GAVI – GAVI Alliance to present plans to expand impact of vaccines by 2020

As five African countries prepare to celebrate World Immunization Week with the impending introduction of new vaccines, the GAVI Alliance is finalising plans to build on its successes with a major drive to increase access to vaccines and the impact of immunisation programmes by 2020. … The GAVI Alliance is preparing for a key meeting to be held next month in Brussels, where the Alliance will set out the significantly increased impact that can be achieved by supporting immunisation programmes in the world’s poorest countries through to 2020. European Commissioner for Development, Andris Piebalgs, will host the meeting on May 20 where GAVI Alliance will present to its partners the funding requirements needed during the five-year period from the beginning of 2016 to build upon the gains already achieved against the biggest killers of children.”

16.CSIS report – Replenishing GAVI in 2014

Katherine Bliss;

The Center for Strategic & International Studies has published a new report, titled “Replenishing GAVI in 2014: Options for U.S. Engagement.” From the summary: “This report reviews GAVI’s progress and challenges during the current phase of operations and offers recommendations for U.S. policymakers to consider as they develop an approach to the upcoming GAVI replenishment (scheduled for later this year). It suggests that in recognition of GAVI’s strategic importance, accomplishments to date, and potential for future success, the United States should increase its commitment to GAVI for the 2016–2020 period. It also notes that U.S. policymakers may want to condition any future increases (beyond 2020) on GAVI’s success in the next phase in ensuring the sustainability of the current “graduation” schemes and clearly expanding the number of donor countries that are able to commit $50 to $75 million per year or more.”


Other infectious diseases news


17.The World Today – Eradicating polio is in the hands of the Muslim world

Qanta Ahmed;

The debilitating and often deadly virus has almost been eliminated, Ahmed argues. Now athletes, politicians and doctors must unite to finish the job – and there’s a key role for the Muslim community in this: “It needs the leadership of the Muslim world to commit to eradication.”

18.Global Health Governance – Lack of funding hurts Influenza A (H7N9) outbreak response in Africa

Tara Ornstein;

Interesting (and short !) blog post.


19.Guardian – New and better treatments for drug-resistant tuberculosis on the horizon

Sarah Boseley;

A new trial of a novel drug combination that could dramatically shorten treatment for TB, including some of the drug-resistant strains, will start within the year – as long as enough money can be raised. The announcement that the phase III trial, called Stand (Shortening Treatments by Advancing Novel Drugs), is to go ahead in 10 countries was enthusiastically welcomed by campaigners and clinicians. Money comes from the Gates Foundation and others,  but more is needed.

In other news, Saudi Arabia confirmed 20 new cases of Middle East Respiratory Syndrome (MERS) last weekend, adding up to 49 infections in six days, a sudden increase of the disease.




20.World Bank (Investing in Health blog) – Mental Health: Time for a Broader Agenda

Patricio Marquez;

We need to move forward with a broad social agenda to address mental health needs around the world, Marquez argues. “The World Bank, as a multisectoral institution, has a major role to play in supporting national and international agencies to implement the WHO Mental Health Action Plan approved by governments at the 2013 World Health Assembly.”

21.Lancet (Editorial) – Toward better control of colorectal cancer

Worldwide, colorectal cancer is the third most common cancer and fourth leading cause of death from cancer. As discussed in a Seminar by Hermann Brenner and colleagues in today’s Lancet, colorectal cancer offers much better opportunities for secondary prevention by early detection and screening than do most other cancers. However, despite the supporting evidence, recommendations, and availability of screening tests, the uptake of screening of colorectal cancer is disappointingly low in most countries. That needs to change.




22.Humanosphere – Eight facts about health workers and the brain drain

Martin Drewry;

Martin Drewry, Director of Health Poverty Action, discusses the issue of brain drain (and more in particular the connection between migration and health workers). All facts are worth reading but especially fact 7 and 8 – the situation is complex and keeps shifting (with Spain as a key example), and the health worker crisis is about to get a lot worse (for example due to aging populations in developed countries) – are interesting, if not worrying.


Maternal & child health


23.Guardian – Women must be treated as human beings, not commodities, says UN

Before lecturing countries in the developing world and the Vatican on the status of women, we might want to inform our own porn sector. “Women and girls are not commodities and must be treated as human beings with equal rights to men, politicians from across the world who are gathered at a conference in Stockholm heard on Wednesday. Babatunde Osotimehin, the executive director of the UN population fund, UNFPA, told delegates at the international parliamentarians’ conference that they had a duty to raise the status of women in their countries and to remind their heads of state of the commitments they made to improve the lives of women and girls. The politicians are meeting in Sweden this week to discuss progress towards agreements made at the 1994 International Conference on Population and Development (ICPD). (aka the mythic “Cairo conference”)”.

24.US State Department – Gender-Based Violence Emergency Response and Protection Initiative: Bureau of Democracy, Human Rights, and Labor Partnership to Assist Individuals in Crisis

US State department;

The U.S. State Department releaseda fact sheet outlining the objectives of the recently launched Gender-Based Violence (GBV) Emergency Response and Protection Initiative.

25.CSIS (report) – Family Planning and Linkages with U.S. Health and Development Goals

In February 2014, the CSIS Global Health Policy Center led a delegation to Ethiopia to examine the progress made and remaining challenges for expanding access to and demand for family planning services. This report outlines Ethiopia’s health extension program and how health extension workers are providing family planning education and services. The report also gives policy recommendations for future U.S. engagement on issues of family planning in Ethiopia, as well as lessons learned that can be applied in other countries.

In other family planning news, UNFPA & the Gates foundation have signed a memorandum of understanding to help increase access to family planning information, contraceptives, and services in developing countries, particularly for young people.

26.Humanosphere – Challenging the claim that saving kids’ lives reduces population growth

Tom Paulson;

A leading aid and development expert – David Roodman – is challenging a popular claim made by Bill and Melinda Gates, Hans Rosling and others in the humanitarian community often cited to counter the concern that saving kids’ lives in poor countries will exacerbate global population growth.” (must-read)  Roodman challenges the ‘virtuous cycle’ in other words.

You find Roodman’s analysis  here.  He was asked (by GiveWell) to review the scientific evidence on the impact of deaths on births. When a life is saved, especially a child’s life, do families go on to have fewer additional births than they otherwise would? Is the effect more than one-to-one or less?

His preliminary conclusion: “I think the best interpretation of the available evidence is that the impact of life-saving interventions on fertility and population growth varies by context, above all with total fertility, and is rarely greater than 1:1. In places where lifetime births/woman has been converging to 2 or lower, family size is largely a conscious choice, made with an ideal family size in mind, and achieved in part by access to modern contraception. In those contexts, saving one child’s life should lead parents to avert a birth they would otherwise have. The impact of mortality drops on fertility will be nearly 1:1, so population growth will hardly change.”

27.Speaking of Medicine – Acid violence – a most horrific form of denigration of women

Jocalyn Clark;

Jocalyn Clark urges the global health community to press for high level change in legislation regarding acid violence.

28.TMIH – Policy challenges facing integrated community case management in Sub-Saharan Africa

Sara Bennett et al.;

In this article, Sara Bennett and colleagues report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. They analysed how iCCM policies developed and the barriers and facilitators to policy change.

Lancet Global Health May issue


Have an in-depth look at the new (May) Lancet Global Health issue.

It features, among others, a nice Comment, ‘Reassessing the value of vaccines’   (by Till Bärnighausen and a Who’s Who in Global health, with Seth Berkley and others). They argue: “Mortality reduction is already reason enough to have every child on this planet fully immunised, as shown by the MDGs and the post-2015 development agenda. Now this fight is not simply about saving lives, but about maximising the full lifetime potential of these children and the economic health of the families and countries in which they live.”

Another article focuses on the enormous threats for the Sahel Region, a region that risks being left behind in the ‘Grand Convergence’ drive, due to the double population & climate change whammy.  (Having said that, we heard this week from a well-informed global health expert who often gets the chance to listen to climate scientists, that even in London they’re getting afraid that by 2030 we might have a Grand Convergence for health, education etc, but no planet anymore).

Check out also a Letter by our former colleague Tom Decroo (see  here), ‘Lifelong ART for 20 million people in sub-Saharan Africa: communities will be key for success’ and as already mentioned in the intro, the Canadians might want to have a thorough look at Chris Simms’ piece, ‘A rising tide: the case against Canada as a world citizen’. If you think Obama is no good, try Stephen Harper.  In related news, a Lancet World Report discusses  some of the nasty health effects for tar sand region residents in Canada.

There’s also an article on equitable access for global health internships at WHO  (and elsewhere).


Health Policy & Financing


29.JAMA – The Relationship of Health Aid to Population Health Improvements

Eran Bendavid & Jay Bhattacharya; aid to the health sector is related to increasing life expectancy and declining under-5 mortality. The benefits from aid appear to last for several years and have been greatest between 2000 and 2010, possibly because of improving health technologies or effective targeting of aid. (must-read)

30.Lancet (World Report ) – New CEO takes the reins at the Gates Foundation

Susan Desmond-Hellman;

Susan Desmond-Hellmann takes charge of “an organisation hungry for accelerated returns on its game-changing investments in global health”. David Holmes reports.

31.Humanosphere – Gates Foundation seeks to merge science and delivery of global health

Tom Paulson; Humanosphere;

In-depth analysis of some changes at the Gates foundation (and also some coverage of the product development forum in Seattle), by Tom Paulson. (must-read).

Although the Gates Foundation has recently reorganized to devote its global health program, run by former Novartis executive Trevor Mundel, almost entirely to supporting research aimed at finding new drugs or vaccines, and the incoming CEO Susan Desmond-Hellman is a biotech leader and was head of product development at Genentech (and global health people are thus somewhat worried the Gates Foundation is firmly back in “techno-fix” land), the Gates Foundation will also go beyond this, or in the words of Tom Paulson – the foundation will go beyond “the silver bullet or some other kind of magical (Bill likes that word, ‘magical’) targeted intervention”. … A more fundamental transformation is going on, Paulson says, although it’s perhaps a less visible one: the new, intentionally holistic Gates Foundation.  … “Melinda’s push into family planning a few years ago was widely celebrated as a move into some of the more rights-based, highly politicized and socially complex drivers of inequity. … “I can remember when Bill wouldn’t even say the words ‘primary care’ or ‘health systems’ when talking about global health,” said Dana Hovig, a new hire at the Gates Foundation who now has been put in charge of’ a new program there called integrated delivery – the boring name given to this big internal transformation. The foundation recognizes that diseases exist within the broader social, political and economic contexts that determine success as much as a drug or vaccine’s efficacy. “We’re looking at things more holistically.”

Yet, I doubt they look at the global polical economy issues… Gates’ holism still has limits. But hey, it’s a start!

32.Lancet (Correspondence) – Chinese health foreign aid and policy: beyond medical aid

Guanyang Zou et al;

Medical aid has played an important part in China’s foreign aid policy, mainly through sending medical staffs to LMICs. In recent years, China has expanded its initiatives in Africa as part of its health diplomacy, and supports infrastructure development and human resources, and African countries to control infectious diseases, particularly HIV/AIDS and malaria. The 2013 Beijing Declaration further demonstrated its commitment to expand public health initiatives including development of broader health systems in African countries. … The new initiatives are innovative, they differ from the traditional medical aid and promote the implementation of population-based and systems-based health strategies.” This Lancet Letter also discusses in more detail the call from the Global Health Support Programme (GHSP), a China—UK partnership, to improve China’s contribution to global health in health systems development, disease control, and maternal health for LMICs.

33.Open Democracy – Faith and health care in Africa: a complex reality

Jill Olivier; It’s time to move past overly simplistic arguments surrounding Catholics and condoms, and make an effort to understand the real and very complex contributions of faith-based health providers across Africa, Jill Olivier argues.

34.Deloitte – Sufficiency to Efficiency: A Paradigm Shift in Health Financing

“This paper provides a framework (S2E) for successfully transitioning to a more efficient use of available development health  resources and maximizing the value of global health investments.” (Arguably, you would expect Deloitte to say this…)

35.IP Watch – Geneva Health Forum Covers Wide Range Of Policy Issues

Julia Fraser et al.;

Some more coverage of last week’s Geneva Health Forum.

36.IP Watch – One Year On At The Medicines Patent Pool: Interview With Greg Perry

Julia Fraser;

Fraser interviewed Greg Perry who is one year in charge of the Medicines Patent Pool. Intellectual Property Watch sat down with Perry recently to discuss why the MPP is so important as an alternative business model, the context of the MPP, changes in the global approach to the issue of access, and how the MPP fits within the Geneva context.

In another interview(this one for Devex), Amy Lieberman met with B.T. Slingsby, the executive director of the Global Health Innovation and Technology Fund. Focus of the interview is on TB and malaria.

37.Critical Social Policy – Why hasn’t China’s high-profile health reform (2003–2012) delivered? An analysis of its neoliberal roots

Wei Zhang & Vicente Navarro;

From January already, but a must-read.

In March 2013, China’s so-called fourth generation of leadership stepped down. Upon taking office a decade ago, they launched a series of high profile health reform programmes, which have often been touted as a prime example of their commitment to prioritizing social welfare. However, throughout their period in power the reform remained remarkably unsuccessful at delivering as promised. This paper explains the failure. Unlike most of the existing literature which hinges upon issues within the health sector, this paper places the country’s political economy at the centre of the analysis. In particular, it highlights the role of neoliberalism. It argues that rather than improving the population’s health, the primary purposes of the health reform were to, first, accommodate socio-political unrest that was caused by neoliberal policies implemented prior to the early 2000s, and, second, facilitate further neoliberal economic restructuring. Moreover, anti-welfare neoliberal tenets, which run counter to improving health outcomes, were deeply imbedded in the formulation of health reform policies.”

38.Plos (Policy Forum) – Optimal Evidence in Difficult Settings: Improving Health Interventions and Decision Making in Disasters

Martin Gerdin et al.;;jsessionid=C99737C0040E82982B78401B3409D5CE

Martin Gerdin and colleagues argue that disaster health interventions and decision making can benefit from an evidence-based approach.

39.Lancet (Book review) – Are tyrants good for your health?

Helen Epstein;

We don’t often feature book reviews in this newsletter, but we make an exception for this excellent review of Easterly’s new book.

40.JAMA – A Snapshot of US Global Health Funding

Kaiser Family Foundation;

This month’s Visualizing Health Policy shows global health funding’s share of the US federal budget, the recent flattening of US funds for global health, where US dollars for global health are spent, the major areas receiving US global health funding, and how the US public overestimates the percentage of the federal budget that is spent on foreign aid.


Global health videos


To start your weekend on a groovy note, you might want to listen to UNICEF’s “Take The Poo To The Loo”  campaign  – a  public education campaign in India. The techno anthem should bring you in the required mood for the weekend, at least the younger readers among you.




41.TMIH – Stock-outs of essential health products in Mozambique – longitudinal analyses from 2011 to 2013

Bradley H. Wagenaar et al.;

This article assesses the relationship between health system factors and facility-level EHP stock-outs in Mozambique. Stock-outs of essential health products are very common in public-sector clinics in Mozambique and most occur when the stock exists at the district-level but simply isn’t distributed to health facilities in an effective or timely enough manner. The authors also found that clinics with more trained human resources for health experience less stock-outs of these essential drugs and supplies over a three year period.




  • A nice SciDev article explores the recent mergers of Canadian & Australian development aid agencies into foreign affairs and trade ministries.



  • Charles Kenny (CGD) wrote (yet another) marvelous blog post, ‘The Strange and Curious Grip of Country Income Status on Otherwise Smart and Decent People’.



  • And a recent ODI paper explores when redistribution is popular among the general public. If you read the summary, you’ll be as worried as me – there’s only a small window of opportunity, it appears: “Redistributive policies are often perceived as politically costly and fairly difficult to implement. Even among ordinary citizens income inequality may not always be perceived as a negative force but rather as sign of opportunities opening up for them, even if that is not the actual case. This working paper analyses perception data for over 15 thousand ordinary citizens in 40 countries and finds that when individuals perceive the adverse effects of inequality in terms of social tensions and conflict between the rich and the poor, it is more likely that they demand more redistribution from their governments.  However, the effects seem to be stronger at lower levels of actual inequality and in countries with lower levels of social conflict. This research suggests that there is political will from the general public to act upon inequality, but that the challenge is for governments and practitioners toact quickly when inequality is starting to rise in order to capitalise the support towards redistributive policies rather than waiting until  it is high and entrenched in the political and economic system.”

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