This week, the world had/has its eyes on the Eurovision song contest (my wife, who is Chinese, asked me “why on earth do they always have to shout on the stage?”), but more importantly, on the mess in the Ukraine and on Nigeria’s missing girls, among others. The latter is no doubt a good thing, better late than never, even if there might be hidden agendas. The ‘war on Terror’, although now labelled otherwise, is never far away when Western leaders start using words like ‘evil’, yet, in this case it appears the Obama administration actually offered support to the Nigerian government right after the abduction. So I’d say the American government at least paid attention in due time, which cannot be said about the world media which have gone into overdrive only recently. Anyway, I don’t feel qualified to say much about this horrific story, it’s up to the Nigerians to do so (and as far as I can tell, they do).
The key global health news this week was probably the statement issued by WHO a few days after the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus. Chan declared the spread of polio a global public health emergency. She got – predictably – worldwide attention.
Meanwhile, the global health community pays somewhat less attention to Pfizer’s ‘tax optimization’ strategy (or attempt) in the UK. As much as your hear Jim Kim and other Dybuls about the homophobia laws in SSA, as deafening feels their silence on tax optimization by Big Pharma. To me, this sounds like a ‘no brainer’, and very much part of a 21st century global health agenda. The broader development community seems to be well aware of this, but global health stays somewhat behind. Maybe because it could harm the ‘let’s all be friends and live happily ever after’ PPP paradigm?
In this week’s editorial, our brand new ITM colleague (and from now on also member of the IHP editorial team, Remco van de Pas) writes about the importance of the mantra ‘First, do no harm’, in global health. Unlike me, Remco still remembers some Latin from his days in high school, as you’ll notice. (If I didn’t know better, I would have guessed he’s a politician from Antwerp (but no, he’s Dutch).) For a more extensive introduction of Remco and his career so far, see here. Welcome on board, Remco!
You might see some more changes in the future in this newsletter, including in the intro.
Enjoy your reading.
The editorial team
First, do no harm (Primum non nocere)
Remco van de Pas (ITM)
“The world in which we live – with its contradictions and conflicts, its growing gap between the poor and the rich, its seemingly inexplicable eruptions of violence- is much less formed by what we glorify and mythologize than by the painful events that we try to forget” (Adam Hochschild, in ‘King Leopold’s Ghost’)
“First, do no harm”, that’s what I promised when I took the Hippocratic Oath about a decade ago. This principle came to my mind, when I cleaned up my office last week at the Wemos foundation and moved to ITM. While doing so, I recovered many papers on global health governance that have been written over the last years, for instance a recent Globalization and Health paper by Lee & Kamradt-Scott that clarifies its meaning. A considerable part of these papers analyze the shortcomings of the global health system (fragmentation, lack of coordination, legitimacy of old and new actors, etc.) and offer mechanisms to overcome these. This includes the model recently proposed by The Lancet—University of Oslo Commission on Global Governance for Health: A UN Multistakeholder Platform on Global Governance for Health, together with an independent monitoring mechanism (See this excellent analysis by David McCoy of the strengths and (mainly) weaknesses of the proposed solutions to improve global governance for health.)
An element that is relatively lacking in these models is that global health institutions themselves sometimes induce externalities that have a negative effect on health. A classic example is the Population, Health and Nutrition department of the World Bank that in the 80’s and 90’s via direct lending to the health sector in low-income countries, under macro-economic structural adjustments programs unduly restricted financial investment in social sectors, including health care. Senior management of the World Bank now acknowledges, albeit reluctantly, the errors of these policies, but their lasting effects on financial access to health services are considerable. Another example is the debate on global disease control programs and funding that ‘pulled’ health workers away from the general health system. This has also, partially, been redressed. We should learn from these historical failures, before designing new systems and governance mechanisms.
The ‘first do no harm’ principle can also be found in the last chapter of Globalization and Health: Pathways, Evidence and Policy (2009), by Ronald Labonté and Ted Schrecker: “A starting point must be the recognition that many neoliberal policies of the past thirty years have failed to produce the results claimed by their proponents. Hence the generic policy recommendation: First, do no harm. Specifically, abandon policy measures that demonstrably increase health inequity, such as those limiting the scope for public provision for basic health-related needs, or resulting in their commodiﬁcation”.
At a time when the distribution of wealth and capital is again strikingly similar to the 19th century’s distribution, a relevant litmus test for new global health initiatives could be whether they help to maintain or rather redress some of these huge wealth (and related health) inequalities. This is a question of power asymmetries and politics, I realize. However, for global health programs to move forward in a sustainable way, we have to ask these uncomfortable questions, and research, analyze, and propose concrete mechanisms such as ‘Not to do harm in the first place’.
Highlights of the week
We start the newsletter selection this week with a new section. In ‘Highlights of the week’, we will offer you the global health (and occasionally broader development) stories of the week. We realize this will always be a somewhat (or very?) arbitrary exercise, especially as sometimes on Friday afternoon something ‘big’ happens or is published. But let’s give it a try. And of course, if a news item pops up later in this newsletter, it doesn’t mean (at all) that it’s not relevant. So we do encourage you to read on after this section.
1. WHO – WHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus
From a BMJ news article: “The World Health Organization has declared the spread of polio a global public health emergency, which, if left unchecked, could derail efforts to eradicate the disease. The 14 members of WHO’s international health regulations emergency committee met at the end of April alongside representatives from the nine states where wild poliovirus has been found in the past 12 months: … … The committee presented its findings to Margaret Chan, WHO’s director general, informing her that the cross border spread of wild poliovirus in 2014 was an “extraordinary event.” On 5 May Chan declared the situation a global public health emergency under international health regulations. The last such declaration was made in 2009 over the H1N1 influenza pandemic.” A nice analysis, you find, among others, in this NYT article.
Related to this news, we also want to recommend the LancetComment, ‘Mandatory polio vaccination for travellers: protecting global public health’ (by two people from the GPEI). As for their conclusion, ‘When a disease control imperative risks bruising national pride, the former must win out’, we are not sure every politician will agree.
2. The Broker – Africa: an increasingly powerful post-2015 player?
The African continent’s increased economic self-assurance resonates in the post-2015 process, where African countries form a strong alliance with other developing countries in the G77. Africa’s successful effort to draft a common post-2015 strategy once more underscores its footprint in the post-2015 process. The question however remains whether, in the coming period, internal differences and diversity will throw a spanner in the works. (very nice read, and will be interesting to know what the World Economic Forum meeting in Abuja will add to this analysis).
3. Lancet (Early Online) – Leaving no one behind: an agenda for equity
In line with the recent debate on global wealth inequalities and capital in the 21st century, Kevin Watkins (ODI) provides strong arguments why including health equity is of importance in the upcoming 2015 development framework. And also why the politicians of developed and developing countries aren’t that keen on it…
4. CGD – Health Aid Eligibility and Country Income Status: A Mismatch Mishap?
“The income level of a country alone should not make a country ineligible or less eligible for donor funding – especially when estimates of such income levels can change overnight. Due to new purchasing power estimates released this week by the International Comparison Project, GDP per capita numbers have indeed changed overnight. And that means that country income classifications –and aid eligibility designations – will be on the move too. As a result, less health aid will go to the countries that need it most.” Amanda Glassman lists some of the implications for the Global Fund and Gavi policies in this respect, and the need to revisit them again.
5. Lancet – Offline: The third revolution in Global health
In his weekly contribution, Horton says that after (1) metrics & data, and (2) accountability, it’s now time for a third global health revolution, focusing on quality of care. “During recent weeks, WHO has brought together some of the best international minds to reflect on how to trigger a third revolution in global health—a revolution in the quality of care.”
6. WHO (news) – United Nations agencies report steady progress in saving mothers’ lives
“New United Nations data show a 45% reduction in maternal deaths since 1990. An estimated 289 000 women died in 2013 due to complications in pregnancy and childbirth, down from 523 000 in 1990.”
“Another WHO study, also published today in The Lancet Global Health, adds new knowledge about why these women are dying. “Global causes of maternal death: a WHO systematic analysis”, finds that more than 1 in 4 maternal deaths are caused by pre-existing medical conditions such as diabetes, HIV, malaria and obesity, whose health impacts can all be aggravated by pregnancy. This is similar to the proportion of deaths during pregnancy and childbirth from severe bleeding. “Together, the two reports highlight the need to invest in proven solutions, such as quality care for all women during pregnancy and childbirth, and particular care for pregnant women with existing medical conditions,” says Dr Flavia Bustreo, Assistant Director-General, Family, Women’s and Children’s Health, WHO. They also underscore the importance of having accurate data.”
UHC & post-2015
7. Harvard Gazette – Leaders share universal care experiences
For some reason, having ‘leaders’ and ‘Harvard’ in one sentence just seems about right, pretty much like ‘Bill Clinton’ and ‘cigar’. Anyway, a panel of experts convened by Harvard School of Public Health (HSPH) discussed the challenges nations may face when trying to implement health care for all. The First Annual Global Health Symposium, Transforming Health Systems for Universal Health Care, took place on April 15. A nice quote by the one and only Julio: “When universal health care aligns with national priorities, it is more likely to work. In my opinion, the number one reason for success for reform is when it connects to the broader agenda in a country.” Julio F also pointed out that the increased cost of health care in nations that adopt universal systems means that the shift has to be accompanied with an emphasis on preventive and primary care.
8. CSIS report – UHC going global: a Conference report of the CSIS Global Health Policy Center
The Global health policy center at the Centre for Strategic and International Studies convened a conference January 14, 2014, to explore advances in UHC with a Washington DC audience. Must-read, if you want to know what Jim Kim (for the WB), Ariel-Pablos-Méndez, Jonathan Quick, Tim Evans, Nils Daulaire, Margaret Kruk and others said at the event. (must-read)
9. Devex – How Tim Evans will lead World Bank efforts toward UHC
Tim Evans also talked to Devex this week (in an exclusive interview) on how he intends to lead the World Bank efforts towards the global health nirvana, UHC.
10.UHC Forward – Sustainable Healthcare Among Focus Of WEF on Africa
Meanwhile, UHC is on the agenda at the WEF meeting in Abuja, Nigeria. At the event, UHC falls under the theme with the catchy title: ‘Health Systems Leapfrogging in Emerging Economies’. See also this WEF blog post, “Global health means economic health” for some rather standard propaganda on the (undeniable) merits of GAVI.
11.HFG – Universal Coverage of Essential Health Services in Sub-Saharan Africa: Projections of Domestic Resources
Given the African region’s healthy economic outlook, will resource mobilization for health still be an imperative in 2020? USAID’s Health Finance and Governance (HFG) Project looks ahead at the region’s health financing priorities by projecting domestic health spending per capita to 2020 relative to an internationally accepted target for universal coverage of essential health services.
12.Global Health Governance – “How healthy are election manifestos in India? a health policy perspective”
Raghavendra Madhu and Lalit Yadav; http://blogs.shu.edu/ghg/2014/05/07/how-healthy-are-election-manifestos-in-india-a-health-policy-perspective/
As you know, BMJ pays a lot of attention to the ongoing Indian elections and the importance (?) paid to health by parties, but other blogs do too. In this blog post on Global Health Governance, authors also explore the BJP & Congress party manifestos in terms of health care. They conclude: ”both the political party manifestos have fallen short of addressing all of the serious health issues that are facing Indian families.”
13.NYT- At the U.N., a Free-for-All on Setting Global Goals
Very nice analysis of what’s going on behind the scenes in the SDG negotiations. Check it out.
The next (67th) World Health Assembly is coming soon to a theatre in Switzerland (19-24 May)… and this time, we’ll have an IHP correspondent over there. On the WHA agenda are, among other issues, a proposed policy for a global coordination mechanism om NCDs, the ongoing WHO Reform, Antimicrobial Drug Resistance and a proposed resolution on health promotion & health in all policies.
14.GFO new issue – issue 243
This new GFO issue features, among others, an analysis (by Kate MacIntyre) of the way the Fund manages its finances, and also the announcement of $310 million in renewal and interim funding by the Fund.
As we already reported in a previous IHP newsletter, Aidspan published a guide to the new funding model (see here ).
15.Science Speaks – Access to treatments for MDR TB, hepatitis C, other health threats set to expand with UNITAID grants targeting market barriers
“The first new tuberculosis drug in more than 40 years, a treatment for hepatitis C currently priced in the United States at $84,000, and an early infant diagnostic test for HIV are among the breakthrough medicines and technologies the global health financing organization UNITAID is aiming to make available to people in low- and middle-income countries through $160 million in grants announced Tuesday.” See also the UNITAID press release. Grants approved by UNITAID’s executive board this week include grants to MSF, Partners in Health, the Malaria Consortium, and others.
16.Plos – Mass Vaccination Campaigns Reduce the Substantial Burden of Yellow Fever in Africa
Neil Ferguson and colleagues estimate the disease burden of yellow fever in Africa as well as the impact of mass vaccination campaigns.
17.Plos – Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision
In this Collection Review, Sema Sgaier and colleagues highlight the key points from the PLOS Volunteer Medical Male Circumcision Collection and give some recommendations on the way forward. (must-read, even if you’re not circumcised yourself yet ! ) Check out also another article from the collection – “Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up” in which E Njeuhmeli and colleagues present original research that assesses interim results from a voluntary medical male circumcision intervention to prevent HIV in Sub-Saharan Africa.
18.NEJM (Perspective) – Ebola: a growing threat?
From the conclusion: “The latest outbreak of Zaire ebolavirus in West Africa again has shown the limited ability of our public health systems to respond to rare, highly virulent communicable diseases. The medical and public health sectors urgently need to improve education and vigilance. And rapid, reliable diagnostic procedures must be implemented in key regions within or closer to the areas where these viruses are endemic so that local public health systems do not have to rely on distant reference laboratories, which should play a more confirmatory role in the future. Moreover, to optimize diagnostic-response capabilities, it is essential that information be shared in real time, as it was during the pandemic of the severe acute respiratory syndrome and during recurrent outbreaks of influenza.”
Meanwhile, AFP reported on the Mano River summit in West Africa. ““The countries of west Africa’s Mano River Union — Guinea, Liberia, and Sierra Leone — kicked off a summit meeting on Sunday with the region’s Ebola outbreak high on the agenda.” It appears the worst is behind us.
19.Medical Anthropology – special issue: The politics and anti-politics of infectious diseases control
For all who are interested in the politics and anthropology of health, the current issue of Medical Anthropology is a good read (even for those of you that are apolitical, it seems). It’s a special issue entitled “The Politics and Anti-Politics of Infectious Diseases Control.” Edited by Ian Harper and Melissa Parker, the special issue contains three articles. The issue also contains, in addition, a nice essay, entitled ‘ Slow research – Slow Research: Thoughts for a Movement in Global Health’. Slow Research, like slow food, is good for health. Will this lead to a slow health movement? (most of my colleagues don’t “do” slow, though)
20.Science Speaks – International Microbicide Partnership, pharmaceutical company agreement sets path for woman-controlled HIV prevention
“The announcement … that Janssen R&D Ireland pharmaceutical company will give the nonprofit International Microbicide Partnership exclusive worldwide rights to develop, make and market sexual and reproductive health products with the antiretroviral dapivirine was heralded by both organizations as a stride for global public health in general, and HIV prevention for women in particular.” Science Speaks reports on this agreement.
21.Lancet (Comment) – Decisive action to end apathy and achieve 25×25 NCD targets
“With political will and leadership, the (NCD) 25×25 targets are well within reach. But despite robust evidence, well-proven cost-effective interventions, and a compelling case for action made by Kontis and colleagues (in this new Lancet article) to address risk factors for NCDs to save millions of lives, political apathy prevails.” (sounds a bit like a rerun of the worldwide “nonresponse” to climate change)
22.Plos ( Policy Forum) – Call to Action: Promoting Domestic and Global Tobacco Control by Ratifying the Framework Convention on Tobacco Control in the United States
Tim K. Mackey and colleagues outline why the United States should ratify the Framework Convention on Tobacco Control (FCTC).
Maternal & child health
23.Lancet Global Health (blog) – Reducing neonatal mortality through skilled birth attendance
Maternal and neonatal survival have been in the headlines again this week as the Institute for Health Metrics and Evaluation (see last week’s IHP newsletter) and WHO released new figures and Save the Children published its annual State of the World’s Mothers report. May 5 was International day of the midwife: what can skilled birth attendance do for maternal and neonatal health and how can it be scaled up, wonders M Aminu in this blog post?
As for the International Day of the midwife, “In 2014 the new subtheme “Midwives changing the world one family at a time” sends a strong signal that midwives provide care that changes families, communities and the world by saving the lives of mothers and babies. This new theme also resonates with the overarching theme that has accompanied IDM for the past years: “The World Needs Midwives Now More Than Ever“.
24.Lancet (World Report) – Accountability in Canada’s Muskoka Initiative questioned
Paul C Webster;
Is the Canadian Prime Minister’s billion dollar initiative for maternal, newborn, and child health failing to meet the standards it has urged on the rest of the world? Paul C Webster investigates. Harper again doesn’t look good, by now a familiar sight in this newsletter.
Health policy & financing
25.CGD – AIDS Donors and Patients Need the World Bank – but Only If It Is Hard to Provoke
CGD fellow Mead Over examines the benefits and challenges of channeling development and health aid through bilateral and multilateral channels, and how foreign policy can influence the continuation or cessation of such funding. He concludes, “Aid that funds entitlements like AIDS treatment should increasingly be channeled through multilateral donors like the Global Fund for AIDS, TB and Malaria and the World Bank on the understanding that multilaterals will only rarely, and with the explicit consent of their boards of directors, curtail entitlement funding to any country for any reason”. Yes, Mead is referring to the gay homophobia story more in particular.
26.WHO – WHO/UNICEF highlight need to further reduce gaps in access to improved drinking water and sanitation
“Since 1990, almost 2 billion people globally have gained access to improved sanitation, and 2.3 billion have gained access to drinking-water from improved sources. Some 1.6 billion of these people have piped water connections in their homes or compounds, according to a new WHO/UNICEF report, entitled Progress on drinking water and sanitation: 2014 update, which also highlights a narrowing disparity in access to cleaner water and better sanitation between rural and urban areas.”
From another much publicized WHO report, on worldwide urban air quality: “7 May 2014 — Air quality in most cities worldwide that monitor outdoor (ambient) air pollution fails to meet WHO guidelines for safe levels, putting people at additional risk of respiratory disease and other health problems. WHO’s urban air quality database covers 1600 cities across 91 countries. Only 12% of the people living in cities reporting on air quality reside in cities where the quality complies with WHO air quality guideline levels.”
27.Guardian – Pfizer v AstraZeneca: big pharma needs a public stake, not a praying mantis
For the left wing warriors among you. Nice piece.
28.Humanosphere – Why is the Gates Foundation still in China?
Why is the Gates Foundation still in China – after all, China is not exactly a low income country anymore, and seems perfectly capable of taking care of itself. In addition to the fact that the Chinese are just very nice people, Tom Paulson explains the main rationale of the Gates foundation. To give you a clue: “The Gates Foundation global health program today is migrating towards becoming a virtual pharma (drug company),” he noted. “China is also growing in its capacity for medical R&D and we think it is in everyone’s interests to help facilitate this.””
29.CDC: Our Global Voices – Helsinki, Finland: the next stop in accelerating Global Health Security
While we and other ordinary EU citizens were watching Conchita Wurst in Denmark, senior leaders from more than 30 countries and four international organizations converged on Helsinki, more particularly on May 5th for two days of intensive discussion, with as over-arching topic ‘improving our ability worldwide to prevent, detect and respond to infectious disease outbreaks at a time when diseases of all types can travel greater distances in less time than ever before and potentially threaten a larger number of people no matter where they live.’ The Helsinki meeting was “the next major step in a historic partnership unveiled Feb. 13 in Washington, D.C., called the Global Health Security (GHS) Agenda.”
30.Health Policy & Planning – new May issue
Check out the new issue of HP&P, with among others articles like, “With the help of a foreign ally: biopharmaceutical innovation in India after TRIPS”, “10 best resources on … mixed methods research in health systems”, “Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence”. And much more.
31.International Journal of Health Services – new issue
Check out also the new issue of this wonderful journal, with among others, the article ‘Big Pharma and the Problem of Disease Inflation’. (however, if you’re a fan of PPPs, please abstain)
32.IDS working paper – Engaging with Health Markets in Low and Middle Income Countries
Gerald Bloom et al.;
Many low and middle-income countries have pluralistic health systems with a variety of providers of health-related goods and services in terms of their level of training, their ownership (public or private) and their relationship with the regulatory system. The development of institutional arrangements to influence their performance has lagged behind the spread of these markets. This paper presents a framework for analysing a pluralistic health system.
33.Social science & medicine – Comment on the recently accepted manuscript: ““Do Sector-Wide Approaches for health aid delivery lead to ‘donor-flight’? A comparison of 46 low-income countries” by Rohan Sweeney, Duncan Mortimer, and David W. Johnston
Elizabeth Paul et al.;
E Paul tears apart a recent research article in SS&M on SWAPS and their impact on health aid.
34.Global Public Health – Improving health services for African migrants in China: A health diplomacy perspective
Megan MM McLaughlin et al.;
In this paper, the authors consider how a health diplomacy approach could be applied to African migrants in China, and the potential advantages and limitations of this strategy.
35.Karen Grepin – Using DHS data just got a lot easier
Karen Grepin picked up blogging again. In her new blog post, she writes about an exciting new tool, ‘The Integrated Demographic and Health Project’, which harmonizes DHS data and documentation for Africa and India to facilitate comparative research across time and countries.
36.Journal of Health Services research & policy – What criteria guide national entrepreneurs’ policy decisions on user fee removal for maternal health care services? Use of a best–worst scaling choice experiment in West Africa
Aleksandra Torbica, Manuela de Allegri et al.; http://hsr.sagepub.com/content/early/2014/05/07/1355819614533519.full
Several countries in sub-Saharan Africa have implemented policies to remove or reduce user fees. The aim of this paper was to identify criteria guiding such decisions among national policy entrepreneurs, those who link up problem definition, solution development and political processes.
37.Swiss TPH symposium: Is ‘Value for Money’ the Best Approach for Weak Health Systems?
This symposium took place on April 9 in Switzerland. Check out the presentations (and the keynote by David Evans) here.
Global health announcements
- Switzerland will be again the venue for a very important public event next week: the Launch of Chatham House Reports on Global Health Governance and Financing: WHO Reform and Sustainable Health Financing (Wednesday 21 May, Geneva). Following a major conference at Chatham House to mark the tenth anniversary of the report of the Commission on Macroeconomics and Health in December 2011, the Chatham House Centre on Global Health Security launched two high-level working groups to examine critical issues in global health governance and financing. The governance group, chaired by Viroj Tangcharoensathien (good that ‘copy-paste exists), examined the role of WHO in global health governance against the background of WHO’s ongoing process of internal reform. The financing group, chaired by John-Arne Røttingen, examined what needed to be done, nationally and internationally, to provide a global framework for sustainable health financing in order to achieve UHC. Stay tuned for this.
- Also upcoming: the 1st International conference on realist approaches to evaluation and synthesis, which will take place from 27-30 Oct. 2014 in Liverpool. This conference aims at providing not only a forum for researchers to present how they used realist inquiry (and their results) but also for all interested researchers, students, policymakers, etc. to come, discuss and learn about the approach. To this end, there will be skills building workshops, themed paper sessions, storytelling sessions, roundtable discussions and thematic poster sessions.
- Must-read by Jonathan Glennie in The Guardian: “Europe’s aid experience shows the value of supporting middle-income countries”. EU aid to its member states has proved highly effective, he argues, so why pull the plug on countries such as India and South Africa?
- Simon Maxwell blogs about a new report by The Independent Vision Group n European Development Cooperation, ‘Reshaping global development: will Europe lead?’ (‘Europe’ and ‘lead’ in one and the same sentence sounds a bit odd, though)