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Dear Colleagues,
After all the commotion around the NCD summit last week, it’s perhaps tempting to forget about infectious diseases (if your name is not Rick Perry). So this week we would like to draw the attention of our readers to the increasing number of ARV stockouts in SSA and elsewhere. Mit Philips and colleagues from MSF wrote an editorial on the issue. They argue that ARV stockouts are perhaps the indicator “par excellence” of health systems performance. Which would imply that we’re not doing very well in terms of Health Systems Strengthening, in spite of all the rhetoric. 

ARV stock outs: no longer an exception?

Recently there have been a series of worrying reports in the press on stock outs or near stock-outs of Antiretroviral drugs (ARVs) in the following countries: Swaziland, CAR, Malawi, Mozambique, DRC, Nepal, India, … and the list only seems to grow.

The consequences for patients and health workers are dire.

Read the rest of this editorial

Enjoy your reading.

David Hercot, Kristof Decoster, Josefien Van Olmen, Basile Keugoung & Wim Van Damme

Global Health Policy & Financing

1. Science Speaks – Global Fund Board responds to Independent Review Panel reform recommendations

David Bryden;

Bryden gives an interesting perspective on the GF independent review panel reform recommendations we highlighted last week and on the GF Board reaction to it.


Meanwhile, the USA House appropriations bill includes a 300 million cut in funding for the Global fund. No surprises there. Science Speaks reports.

2. Lancet – Five reasons to fund the Global Fund

The Lancet ;

The editors from The Lancet also express their view after the release of the recommendations of the independent review panel of the GF.

As a consequence of the shortfall in funding and the evaluation report, the GF board decided to extend the submission period for round 11. Global Fund Observer reports. They also call on readers to comment on the report. We believe a significant response from Global South experts is vital at this very moment. So don’t hesitate to chip in.

3. BMJ (news) – GAVI rolls out vaccines against child killers to more countries

Peter Moszynski;

GAVI announced that it will provide funding for 16 developing countries to introduce rotavirus vaccines and for 18 to introduce pneumococcal vaccines.

Orin Levine already commented  on this great news: “Progress demands performance. “

4. BMJ (editorial ) – Why don’t we know how much vaccines cost?

Fiona Godlee;

Fiona Godlee sketches some of the challenges for GAVI and its executive officer, Seth Berkley. At issue is GAVI’s strategy.

5. Support local governance to get research into policy

Justin Parkhurst;

To see the research they fund in action, donors should work with good local governance, not informal networks, writes Justin Parkhurst.

6. Guardian ‘Poverty matters’ – Africa’s leaders are committed to winning the fight against malaria

Jakaya M. Kikwete;

In a post on the Guardian ‘Poverty Matters’ blog,  Tanzania President Kikwete wrote:  “The African Leaders Malaria Alliance (ALMA) is spearheading the fight against malaria in Africa, bringing together 40 heads of state and offering a compelling example of what is possible through co-operation, leadership, commitment, and sound management of national and international funds.”  The Alliance launched an ALMA scorecard for accountability and action last week. Leaders are now able “to measure our own performance against a set of key malaria metrics including national policies, financial controls, delivery of prevention and treatment commodities, and, most importantly, lives saved.

7. KFF – GlobalPost Examines Country Ownership In GHI Rwanda Program

As part of its special report “Healing the World,” GlobalPost examines country ownership within the Global Health Initiative. A GHI focus on gender-based violence was considered a curious decision by the Rwandan health minister.

8. WHO – Closing the gap: Policy into practice on social determinants of health – Policy into Practice on Social Determinants of Health

sdhconference – Discussion-paper-EN.pdf (PDF 2MB)

This WHO discussion paper aims to inform proceedings at the World conference on social Determinants of Health  in Rio, later this month, about how countries can implement action on social determinants of health, including the recommendations of the commission on social Determinants of Health.

9. CGD – Outing Global Development “Committers”: The Case of the UN Global Strategy on Women’s & Children’s Health

Nandini Oomman;

Nandini Ooman has read in detail the lengthy one year progress report of the UN Global Strategy for Women’s and Children’s Health. She couldn’t find many hard figures on who actually committed what, or on whether these commitments had been fulfilled. In other words: there is still much room for improvement.

More on child health: with pneumonia being the leading single cause of mortality in children aged less than 5 years with approximately 1.6 million children dying each year, Rudan and colleagues propose a research agenda to speed up progress in the fight against this disease (Get the PDF in Plos).

10.   Lancet – Women and Health Initiative: integrating needs and response

Ana Langer, Julio Frenk & Richard Horton;

New strategic approaches are needed to move the unfinished agenda on women forward. In one such response, the Harvard School of Public Health has launched a worldwide effort called the ‘Women and Health Initiative’.

11.   BMJ (editorial)  – Seeking a better world for women and girls

Janice Du Mont & Deborah White;

Du Mont & White argue that a moral and political movement is needed to end gendered oppression. With such a movement, it is more likely that  the MDG focus on promoting gender equality, empowering women, educating girls, and improving maternal and child health is achieved.  And although a multisectoral strategy is essential, the health sector has the potential to take the lead in this regard.

NCD summit follow up

12.   Smart Global Health – Reflections on the UN High-Level Meeting on Noncommunicable Diseases

J. Stephen Morrison;

Lots of people made an effort to assess the outcomes of the NCD summit. Opinions differ. For example, Laurie Garrett was fairly negative on her blog. CFR’s Thomas Bollyky sketched the way forward for NCDs.  The Global Health Council emphasized five key time-bound (and thus tangible) commitments. Last week’s editorial by members of the SWIHPS network  who attended the summit also emphasized the positive rather than the negative.

Senior vice-president of CSIS, J. Morrison, also reflected on the NCD summit. “The September 19-20 High-Level Meeting at the UN General Assembly was a high-profile, somewhat risky and ultimately sobering test of the proposition that NCDs could become a new global health priority.” We weren’t there, but this assessment is probably not far from the truth.

Emerging Voices

13.   BMC Health Services Research – The use of reproductive healthcare at commune health stations in a changing health system in Vietnam

Ngo D. Anh & Peter S. Hill; Abstract; PDF

This study describes the pattern of Reproductive Health and family planning service utilization among women at Vietnamese Commune Health Stations and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level.


14.   HP&P – A path to an optimal future for the Affordable Medicines Facility – malaria

O Sabot, M Gordon, B Moonen, A Talisuna and G Amofah, abstract on health policy

Sabot and colleagues argue that the AMFm debate should no longer focus on whether AMFm should continue, but rather on ‘how, when and where’ it should be used. In other words, AMFm should be considered part of the toolkit of interventions that can be used to control malaria.

15.   HAI – AMFm price survey

Health Action International (HAI) Africa ; (PDF 18p, 795 Kb)

HAI released a first report on the impact of AMFm on retail prices of antimalarial drugs in target countries.


16.   Lancet infectious diseases – Time to get serious about HIV antiretroviral resistance

Evan Wood & Julio SG Montaner;

Increasing rates of antiretroviral resistance in low-income settings represent a potential threat to the emerging ‘treatment-as-prevention’ strategy. Urgent action is needed, argue Wood & Montaner in the Lancet Infectious Diseases.

In a CGD blog post, Mead Over explores some of the issues at stake in a debate organized by the Rush Foundation and the Copenhagen Consensus centre:  how to spend a (hypothetic) 10 billion on AIDS in Africa over the 5 coming years? He says the approach might not be the best one but it could definitely trigger interesting debate.

So how about you? What is your suggestion to spend 10 billion on AIDS in Africa? More voices from the South are needed too, in this debate, it seems.

Development & Aid

17.   CGD – What Happens When Donors Fail to Meet Their Commitments?

Owen Barder & Rita Perakis;

Barder & Perakis comment on a survey published last week by the OECD DAC. The donors failed to meet 12 out of 13 targets (!) on improving the efficiency of aid. In this blog post the authors reflect on why this matters, and what it means for the forthcoming summit in Busan.

18.   Action aid (report) – Real aid – ending aid dependency

Developing countries are getting less depending on aid, according to this Action Aid report.

19.   Bill Gates – leaked note to G20

As we mentioned last week, Bill Gates is now also in favour of a Financial Transactions Tax. But he said a lot more in this document, so check it out.

Obviously you got the news on the EC and Barroso’s impassionate defense of the FTT this week. We liked the message, obviously (coupled with a Commissioner’s comment that part of it should be used for development), but still it was kind of weird to see an EC technocrat like Barroso “perform” like this, as if he were Obama.  “We should be more proud to be Europeans!” Yeah, right.

Finally, a few blogs we recommend:

–          By now, the Guardian Poverty matters blog should be part of your daily morning ritual;

–          Global Dashboard, with this week for example interesting posts on resilience (by Andy Sumner) and on Martha Nussbaum & eudaimonia (by Jules Evans);

–          Broker’s Busan blog

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