Dear colleagues,
We are sending you this week’s harvest of articles on International Health Policies from The Lancet. We also attach an article from BMJ and a selection of the Eldis newsletter from Feb 25th.
Please, let us know what you think of this selection.
If you have experience with such forum or suggestions, positive or negative ones, please, let us know, Regards,
Wim & David
Our selection of the Lancet for this week (not very exciting though).
*Trade and Health- an agenda for action
*Asian countries urged to address HIV-AIDS in MSM
*Denis Mukwege: caring for victims of sexual violence in the DRC

One article from BMJ
*WHO calls on governments to take action on growing health crisis of HIV/AIDS in Asia

Eldis newsletter selection
Health systems reporter: focus on implementing pro-equity health policies

Produced by the IDS Health and Development Information team in collaboration with Eldis and the DFID Health Resource Centre

Feature: Implementing pro-equity health policies

There is widespread evidence of major gaps between health policies as laid down on paper by governments or ministries of health, and their implementation in practice. As a result, newly proposed and effective health interventions may fail to attain high coverage levels and fulfil their potential to reduce mortality and morbidity when implemented.
Various factors enable or constrain the policy implementation. These include the content of the policy itself; the actors involved in implementation, and their interests and incentives; the context within which they are located; and the process of policy implementation.
Introducing and sustaining equity-orientated health policies, such as increasing access to primary care services or targeting vulnerable groups, has been particularly difficult in many countries. This is because such policies often challenge the conventional ways of working within health systems, including existing professional practices that influence who gets access to health services as well as the treatment and nature of care offered to different groups.
Yet, despite the evidence of problems there has been only limited international investigation of the factors explaining the poor achievements of new policies intended to promote equity


Recommended readings

1. Challenging inequity through health systems: final report of the Knowledge Network on Health Systems
Authors: L. Gilson; J. Doherty; R. Loewenson
Publisher: Commission on Social Determinants of Health, WHO, 2007

The final report of the World Health Organisation’s (WHO) Health Systems Knowledge Network looks at how inequity can be addressed through health systems. Key recommendations, primarily aimed at Ministers of Health, government officials and civil society organizations, include the importance of: mobilising intersectoral relationships; facilitating social empowerment; building up universal health coverage, and; strengthening processes of developing and implementing policies. The report also stresses that international actors must support national led health system transformation and action.

The WHO Commission on the Social Determinants of Health concludes that both technical analysis and political commitment are needed to strengthen health systems and address health inequity. Technical analysis can help identify which features of health systems to nurture and protect. Political action and commitment is needed to confront the powerful actors, institutional constraints and socio-cultural norms that act as brakes on health system development for health equity [adapted from author].

Available online at:

3. How can the analysis of power and process in policy-making improve health outcomes?
Authors: K. Buse; C. Dickinson; L. Gilson; S. F. Murray
Publisher: Overseas Development Institute [ES], 2007

An area that contributes to slow progress in achieving the health-related Millennium Development Goals is the analysis of how and why national health policies achieve less than expected, perform differently from expected, or even fail. This briefing paper from the Overseas Development Institute (ODI) argues that national health policies have received less attention than other areas and considers the factors influencing the patterns and effectiveness of health policy change. It then examines how can we move the agenda forward in order to improve health outcomes.

The authors highlight how policy analysis can contribute to meeting health objectives by untangling the complex forces of power and process that underpin change. They argue that health policy analysis has not been adequately developed and applied in low and middle income countries. Building a critical mass of networked researchers and policymakers provides the key to developing the field and improving its contribution to health outcomes. The document then examines what should be on a health policy agenda and provides an outline of commonly used policy frameworks including the Kingdon model of Agenda Setting, which helps make sense of how certain health issues get onto the government policy agenda. The Michael Lipsky’s Street Level Bureaucrats model, which is also explained as a method, examines what happens at the point where policy is translated into practice, in various human service bureaucracies.

Available online at:


Latest additions from the Health systems resource guide

1. A rethink on the use of aid mechanisms in health sector early recovery
Authors: P. Vergeer; A. Canavan; I. Rothmann
Publisher: Royal Tropical Institute, 2009
States emerging from protracted crises struggle to provide basic services. This is no more crucial than in the health sector where vulnerable ‘post-conflict’ populations are frequently in dire need of care. However, development actors are frequently faced with difficult choices – particularly how much emphasis to place on ‘humanitarian’ emergency health relief in the face of a need for health systems building. Yet is it possible to simultaneously provide basic health services whilst also developing local health provision?

This paper considers how aid mechanisms can engender such a ‘twin approach’ and sustain a continuous flow of resources during the progression from humanitarian to development aid. Specifically the research focuses on four ‘post-conflict’ case studies and analyses how particular aid mechanisms have aided early recovery of their health sector. These are:

* general budget support (GBS) in Sierra Leone
* multi-donor trust fund (MDTF) in South Sudan
* extension of humanitarian aid in Liberia as an example of project aid in a nongovernmental context
* technical assistance (TA), as an example of project aid to build the capacity of Timor-Leste’s government.

The authors’ findings/recommendations include:

* the use of GBS in Sierra Leone and the MDTF in South Sudan reveal their limitations in ensuring continued health service delivery and demonstrated in both contexts the need for associated aid mechanisms to boost more immediate health service objectives. Conversely the extension of humanitarian project aid in Liberia revealed it’s constraints in contributing to health system building
* most post-conflict countries witness a major vacuum in human resource capacities at all levels of the state. This has direct consequences for the effectiveness of those aid modalities (e.g. GBS, MDTFs) which are conditioned upon a certain minimum level of government capacity
* in Timor-Leste TA tended to be more ad hoc and fragmented due to reliance on diverse donor provision to vertical programs or duplication of support to specific areas of health systems strengthening
* a paradigm shift is required which allows for an integrated mix of modalities used to balance the multiplicity of objectives (state, non-state, systems building, service delivery) in early recovery settings
* better coordination of donor agencies at country level is needed to determine the choice of aid instruments and their complementarity, in order to ensure that health service coverage for vulnerable populations is maintained while simultaneously (re)building the health system.

Available online at:

5. The financial crisis and global health: report of a high-level consultation
Authors: World Health Organization
Publisher: World Health Organization, 2009

Several countries, notably in Africa, have taken advantage of economic growth to increase levels of domestic spending on health. Aid for health has more than doubled in recent years, coming both from traditional and innovative sources. The economic consequences of the global financial crisis put these achievements at risk and will endanger progress on the challenges that remain.

The purpose of the consultation, for which this information note has been prepared, is:

* to build awareness of the ways in which an economic downturn may affect health spending, health services, health-seeking behaviour and health outcomes
* to make the case for sustaining investments in health
* to identify actions including monitoring of early warning signs that can help to mitigate the negative impact of economic downturns

The consultation suggested five areas where action at global, regional and country levels with support from the World Health Organisation (WHO) will help to ensure that the health sector emerges from the crisis in good condition.

Leaders in health must be prepared to speak out to make the case for health at times of crisis. WHO should ensure a strong voice for health through its work on advocacy.

Country-specific analysis will be essential to guide policy and to assess the potential impact on different populations and institutions. WHO will pay particular attention to monitoring financial flows for health from governments and donors as well as the cost and availability of medicines and other forms of care.

There is widespread agreement that counter-cyclical public spending provides a means of reviving economies. Aid will play a key role in providing a boost that many low-income countries cannot finance alone. The challenge is to ensure that spending is genuinely pro-poor and that, where possible, it has a positive impact on health. Infrastructure investments provide one route, but other opportunities for safeguarding lives and income can also be identified.

Primary health care provides an overarching approach to policy at a time of financial crisis. WHO should provide support, on request, through country offices supported, as necessary, by regional offices and headquarters.

The financial crisis requires that the international health community asks some fundamental questions about the way it operates. Progress will depend on action at country, regional and global level. The WHO is also concerned to increase its own effectiveness, and work is in hand to seek efficiencies, to explore new and better ways of working, and to review priorities.

Available online at:


If you are unable to access any of these materials online and would like to receive a copy of a document as an email attachment, please contact David Hercot at

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