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IHP news 433 : A few reads you might have missed in August

( 25 August 2017)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.

Dear Colleagues,

Holidays - the Mother of all bourgeois dreams - are almost over for most people, including for the writer of this intro. After immersing myself in a week of mass tourism in a few central European countries and contemplating how the remainder of mankind will party in 2099 (probably with elegant gas masks around their hipster beards, while frantically dodging (virtual and real) killer drones on a numbing machine beat), IHP resumes its normal activities.

However, as the (shorter) summer editions of the newsletter of the past few weeks were less comprehensive, as announced, in this week’s issue we will also emphasize journal articles and reports of the past few weeks you might have missed. We reckon many of you have be on holidays as well. So if you want to know what the main global health policy news & peer reviewed articles were in the latter half of August, do read on. For once, we don’t distinguish between ‘Highlights’ and the other sections. It’s all important, you know us . Comments will be minimal, though.

Enjoy your reading.

The editorial team

Global governance of health

Foreign Affairs – Global Health Gets a Checkup: A Conversation With Tedros Adhanom Ghebreyesus

Foreign Affairs;

(must-read) If you haven’t done so yet, do read this insightful and frank interview with dr Tedros. (We were rather struck by his answer on the questions related to the Ethiopian government, human

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rights, and journalists in his country who ‘break the law’. But credit where it’s due, Tedros didn’t shy away from these questions.)

Global health research and policy - Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

Lara Gautier & Valéry Ridde; Global Health Research and Policy;

“The rise on the international scene of advocacy for UHC was accompanied by the promotion of a variety of health financing policies. Major donors presented health insurance, user fee exemption, and results-based financing policies as relevant instruments for achieving UHC in Sub-Saharan Africa. The “donor-driven” push for policies aiming at UHC raises concerns about governments’ effective buy-in of such policies. Because the latter has implications on the success of such policies, we searched for evidence of government ownership of the policymaking process. We conducted a scoping review of the English and French literature from January 2001 to December 2015 on government ownership of decision-making on policies aiming at UHC in Sub-Saharan Africa. … …We extracted, synthesized and analyzed data in order to provide insights on ownership at five stages of the policymaking process: emergence, formulation, funding, implementation, and evaluation. The majority of articles (24/35) showed mixed results (i.e. ownership was identified at one or more levels of policymaking process but not all) in terms of government ownership. Authors of only five papers provided evidence of ownership at all reviewed policymaking stages. When results demonstrated some lack of government ownership at any of the five stages, we noticed that donors did not necessarily play a role: other actors’ involvement was contributing to undermining government-owned decision-making, such as the private sector. We also found evidence that both government ownership and donors’ influence can successfully coexist. Future research should look beyond indicators of government ownership, by analyzing historical factors behind the imbalance of power between the different actors during policy negotiations. There is a need to investigate how some national actors become policy champions and thereby influence policy formulation. In order to effectively achieve government ownership of financing policies aiming at UHC, we recommend strengthening the State’s coordination and domestic funding mobilization roles, together with securing a higher involvement of governmental (both political and technical) actors by donors.”

For some quick key messages, you might also want to read Lara Gautier’s (related) blog Are African

governments in the driver’s seat when it comes to health financing policymaking?

“A review published in Global Health Research and Policy explores whether governments have ownership of the policy making process in health financing in Sub-Saharan Africa and what exactly this ownership means. …”

Lancet Global Health – September issue

http://www.thelancet.com/journals/langlo/issue/current

A rather important issue, as usual. Among the articles that didn’t appear online earlier, we would like to flag, among others:

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The editorial on World Suicide Prevention Day: “Every year on Sept 10, World Suicide Prevention Day is an opportunity to raise awareness and increase literacy on a highly complex and wide-reaching global health problem. “ “…Increased global awareness and better data have improved countries' commitment to suicide prevention. This momentum must be maintained to overcome the remaining hurdles. For the sake of those who are at risk and for the bereaved who are too often forced to manage a mixture of shame, guilt, and stigma on their own, stopping suicide must be a global priority.”

Tuberculosis in children: under-counted and under-treated “Tuberculosis is the number one infectious cause of death worldwide but remains underappreciated as a cause of morbidity and mortality in children….“ Comment linked to a new study in the Lancet Global Health - The global burden of tuberculosis mortality in children: a mathematical modelling study.

Improving the quality of WHO guidelines over the last decade: progress and challenges (by WHO staff, among others Susan Norris who is a member of the GRADE Working Group, whose framework and methods for guideline development are used by WHO staff who develop guidelines)

Joint external evaluation process: bringing multiple sectors together for global health security “…There is a tendency for each government sector to work in silos. Feedback from countries that have undergone the voluntary JEE process is that it has helped to establish and strengthen cooperation, coordination, and collaboration between different sectors and agencies. A key requirement of the JEE is the inclusion of multiple sectors during both the self-evaluation and the external evaluation…”

Community health systems: allowing community health workers to emerge from the shadows (by Jérome Pfaffmann et al) Important Lancet letter related to the conference organized by USAID and UNICEF (in collaboration with WHO and the Gates Foundation) in Johannesburg, South Africa, March 27–30, 2017, to support countries' ambitions to “institutionalise” community health. The authors list three key required shifts, as well as ten principles to institutionalise community health.

Bringing all together for research capacity building in LMICs- author’s reply

Obligations under global health partnerships in LMICs should be contractual

Gender myths in global health (by Sarah Hawkes & Kent Buse) “We commend The Lancet Global Health and in particular Zohray Talib and colleagues (June, 2017) for drawing attention to the paucity of women leaders in global health and the agenda they advance to achieve gender equality. Nonetheless, the authors lead with a persistent “gender myth” when they claim that “women carry a disproportionate burden of disease”….”

Global Health Research and policy - China’s engagement with development assistance for health in Africa

M Shajalal et al (love that ); https://ghrp.biomedcentral.com/articles/10.1186/s41256-017-0045-8

“As an emerging donor in health related development across the world, particularly towards Africa, the People’s Republic of China (PRC) has been increasing its influence within the field of global public health over the past few decades. Yet between the period of 2000 and 2013, little is known about the scope, scale and priority of China’s grant-making programs. Based on data sourced from the China Aid Database (version-1.2), descriptive analyses were applied to analyze the features of 531

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health related projects that were undertaken between 2000 and 2013. … …. The total value of China’s grant-making programs in the health related sector between 2000 and 2013 was 5.67 billion USD, with 531 projects undertaken. During the five year period between 2004 and 2008, China had a contribution of 1.54 billion USD, which increased to 3.8 billion USD during the five year period between 2009 and 2013 – an 146.26% increase. In terms of specific diseases, China is most concerned with building an African public health system through donations targeted towards general health (313 projects), combating Malaria (115 projects) and maternal, neonatal and child health (MNCH), (12 projects). When it comes to recipient countries, if counted in total value, Zimbabwe received the most financial assistance from China, totaling 1.08 billion USD and 19 projects, while Angola and Tanzania received more projects - 30 and 29 projects respectively. In terms of the channeling of aid funding, most projects were targeted towards infrastructure, equipment and medicine (304 projects in total), followed by medical teams (189 projects). Moreover, there is a statistically significant relationship between aid to Africa and Chinese exports to Africa.” In conclusion: “During the past decade, Chinese aid projects played an important role in the African public health system through providing funding for infrastructure, equipment and medicine, training health professionals, as well as disease treatment. However, very limited attention was paid towards disease prevention, health promotion and awareness initiatives, and health education. Furthermore, serious questions were raised regarding the long-term financial sustainability and actual impact these projects have on health development.”

Belt and Road Forum for Health Cooperation: Towards a Health Silk Road (Beijing, 18-19 August)

Over to nowadays then. For some important reads related to this forum in the Chinese capital, from last weekend (with among others, people like Tedros & Sidibé present), see below.

Do check out also the picture (Xinhua) (with only 2 women, in a sea of ‘men in black’ - the “healthy Silk road” looks predominantly male, for the time being.)

UNAIDS – China’s belt and road initiative to play a key role in overcoming global

health challenges

http://www.unaids.org/en/resources/presscentre/featurestories/2017/august/20170821_belt-and-

road

“Michel Sidibé, the Executive Director of UNAIDS, has urged international health leaders to prioritize health development. While giving his keynote address at the opening ceremony of the Belt and Road High Level Meeting for Health Cooperation: Towards a Health Silk Road, Mr Sidibé also expressed to the Vice-Premier of China, Liu Yandong, his appreciation for China’s efforts through the Belt and Road initiative to create greater cooperation for better health and highlighted the ongoing work to strengthen China–Africa health connections. More than 20 ministers and deputy ministers of health and the Director-General of the WHO, Tedros Adhanom Ghebreyesus, attended the meeting, which was held in Beijing, China, on 18 and 19 August. The meeting looked at ways to collaborate across shared health goals, including innovation and technology, vaccine safety, nutrition, maternal and child health and human resources for health. A communiqué issued at the end of the meeting commits China to support UNAIDS in its work in related fields and includes concrete actions and deliverables, including the creation of a public health cooperation network and an alliance for sustainable health development. …”

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For more info on this communiqué, see Xinhua - Belt and Road countries to enhance health cooperation: communique “…A communique was adopted by countries involved in the Belt and Road Initiative to synergize efforts in medical emergency response and epidemic prevention. The communique, approved at a symposium attended by officials from more than 30 countries, the World Health Organization and the Joint United Nations Programme on HIV/AIDS, is also aimed at protecting public health and strengthening people-to-people exchanges among countries under the initiative.”

Or read the communiqué in full here.

As one Twitterandi noted, nothing on NCDs in there (no surprise, he added).

WHO - New vision and strengthened partnership for WHO and China

http://www.who.int/mediacentre/news/releases/2017/vision-partnership-china/en/

“WHO Director-General Tedros Adhanom Ghebreyesus concluded a 3-day official visit to the People’s Republic of China paving the way for stronger and more strategic WHO-China collaborations. Outcomes of Dr Tedros’ meetings with high-level leadership in the Government of China included a new financial contribution to WHO from China (i.e. China increases its voluntary contribution to WHO by 50 %) and strengthened commitments to improve the health of billions of people represented in the 60 countries engaged in the Belt and Road Initiative….”

For Tedros’s speech at the event, see here. Read also an op-ed by Tedros in the China Daily - China can help WHO improve global health. And he addressed young Chinese researchers in a separate address at Peking university – see Universal Health Coverage: The Key to a 21st-Century Health System.

(personal comment: it seems rather likely that Tedros will be even more friendly to the Chinese (including their state capitalist /authoritarian model) than his predecessor)

A few more tweets related to recent actions/activities of Tedros:

“Thanks to DG @DrTedros for committing to new Chief Nurse position at WHO. Support #nurses & midwives!”

“The first time a DG of WHO asks to meet with interns to listen and engage with some of the smartest future leaders! @DrTedros”

(and a tweet from Jim Kim himself) : “Excellent brainstorming session with @DrTedros and @WHO – looking forward to taking the WBG-WHO partnership to a new level.”

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BMJ Opinion – A good start for WHO: but the new DG election process needs an independent monitoring body

Ilona Kickbusch et al; BMJ blog;

Recommended. Kickbusch et al assess the WHO election process that led to the election of dr Tedros (in two rounds).

WHO Consultation - Rules of procedure of the governing bodies

http://apps.who.int/gb/CONSULT-Rules/index.html

“At the meeting between the Director-General and the Officers of the Executive Board on 31 July – 1 August 2017, the Officers of the Board recommended that Member States be requested to contribute their views on the roles and methods of work of the Executive Board and its Officers, with a view to improving efficiency and equity in decision-making. …” The Secretariat now organizes this consultation.

Lancet – China, Africa, and US academia join hands to advance global health

Lei Peilong et al (China Harvard Africa Network team)

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31931-1/fulltext

Now that the US government doesn’t feel like ‘home’ anymore, when it comes to global health (and many other issues), the China Harvard Africa Network can only take off more. Love the acronym, by the way – CHAN.

“…Since 1979, the Harvard T H Chan School of Public Health (HSPH) has held partnerships with the Chinese government and important Chinese academic institutions, and has had similar ties with African governments and academic institutions. In April, 2016, under the leadership of the National Health and Family Planning Commission, ten Chinese universities joined leading African universities from the Africa Research Implementation Science and Education (ARISE) Network, and HSPH, to establish the China Harvard Africa Network (CHAN). This tripartite network examines the current knowledge on health-care systems for information that could be used to strengthen the health-care systems in Africa and China; CHAN also seeks to build capacity and produce pragmatic solutions for the advancement of health in both regions and beyond….”

They conclude: “…The sustainable development agenda calls for inclusive “North–South, South–South and triangular regional and international” partnerships that promote and enhance the capacity building of countries with low incomes and middle incomes. CHAN is an example of the multifaceted cooperation required to push global health development forward in the 21st century.”

(Now let’s hope that won’t come at the expense of criticism of some of the more unsavory aspects of governance in some of the network’s countries.)

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DFAT (Australian government: department of Foreign Affairs and Trade)– Evaluating a decade of Australia’s efforts to combat pandemics and emerging infectious diseases in Asia and the Pacific 2006-2015: are health systems stronger?

http://dfat.gov.au/aid/how-we-measure-performance/ode/strategic-evaluations/Documents/ode-peid-evaluation-final-report.pdf

See a tweet from Gorik Ooms: “Future health security investments need to be better integrated with the health systems of partner countries.”

“..Applying a health systems lens, ODE’s evaluation examines the implementation characteristics and effectiveness of Australia’s work to strengthen the human and animal health systems involved in the response to emerging disease threats. In doing so, it addresses an important gap. Whilst the aid program’s response to emerging infectious diseases over the last decade has generated a large amount of information, there has been limited analysis of the effectiveness of interventions in different contexts and lessons for future investments. Given the growing profile of health security as a global development issue and its increasing importance within the Australian aid program, this evaluation is timely. Policy makers and implementers would do well to consider its lessons closely.”

Lancet (Letter) - Aggregate health spending

D Bishai et al; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31932-3/fulltext

Excerpt : « …Many, if not most, studies about health systems research published in The Lancet evaluate the efficiency of donor-funded interventions and strategies concerning the $46 billion of development assistance used for health in LMICs. Occasionally, there are studies of the efficiency of the $317 billion spent by governments in LMICs on health, but few studies have examined the value of the $477 billion out-of-pocket spending by residents of LMICs. In the long term, universal health coverage will reduce out-of-pocket spending. In the short term, health systems researchers and donors interested in improving health for the poor should address the value of the large expenditures on health care paid by ordinary people and their governments. Indeed, a new paradigm for development assistance sees it catalysing accountability of governments, as opposed to directly saving lives. Research strategies need to measure the connection between development spending and improved accountability. To that end, it is important to highlight that only a small amount of the global $8982 billion health-care budget is devoted to improving the responsiveness and capability of health systems to promote health. The future goal of investments in development assistance should be to catalyse reforms in health systems to help people achieve better health with the money that they are spending.”

Lancet (Letter) - False and real, but avoidable, dichotomies

Gorik Ooms et al; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31445-

9/fulltext

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You know you have to read this. “Although we join Julio Frenk and Octavio Gómez-Dantés (Feb 11, p 667) in calling for integrative thinking in global health, we believe it is important to distinguish between avoidable and false dichotomies. Some of the dichotomies mentioned as false are indeed artificial and avoidable, but nonetheless real; they require conscious effort to be resolved….”

Read also Julio Frenk et al’s (important) reply - False and real, but avoidable, dichotomies – Authors' reply. “We agree with Gorik Ooms and colleagues that the dichotomies we discussed in our Viewpoint are artificial and avoidable. We call these dichotomies false not because they do not exist, but because they are not genuine or true, which is another meaning of this adjective. They are real and have had very negative consequences…. ”

Before we lose you altogether, they continue: “…In our Viewpoint, we discuss the re-emergence of dichotomous thinking with the recurrence of the old dilemma between investing in the social determinants of health or in health care. This dichotomous thinking process could also happen with other topics. A danger exists that these false divides could influence the global health security agenda because many people are adopting a reductionist approach to health security by limiting it to the control of outbreaks….”

Globalization & Health - ICTs and the challenge of health system transition in low and middle-income countries

Gerry Bloom et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-

0276-y

“The aim of this paper is to contribute to debates about how governments and other stakeholders can influence the application of ICTs to increase access to safe, effective and affordable treatment of common illnesses, especially by the poor. First, it argues that the health sector is best conceptualized as a ‘knowledge economy’. This supports a broadened view of health service provision that includes formal and informal arrangements for the provision of medical advice and drugs. This is particularly important in countries with a pluralistic health system, with relatively underdeveloped institutional arrangements. It then argues that reframing the health sector as a knowledge economy allows us to circumvent the blind spots associated with donor-driven ICT-interventions and consider more broadly the forces that are driving e-health innovations. It draws on small case studies in Bangladesh and China to illustrate new types of organization and new kinds of relationship between organizations that are emerging. It argues that several factors have impeded the rapid diffusion of ICT innovations at scale including: the limited capacity of innovations to meet health service needs, the time it takes to build new kinds of partnership between public and private actors and participants in the health and communications sectors and the lack of a supportive regulatory environment. It emphasises the need to understand the political economy of the digital health knowledge economy and the new regulatory challenges likely to emerge. It concludes that governments will need to play a more active role to facilitate the diffusion of beneficial ICT innovations at scale and ensure that the overall pattern of health system development meets the needs of the population, including the poor.”

Historic health plan led by Africans for Africans

Sunday Independent;

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Related to a recent meeting in Accra, Ghana: “…In a landmark first, world-renowned African health experts, professionals and academics converged under a single, newly-formed health organisation, African Forum for Research and Education in Health (AFREhealth), to map out solutions to tackle the continent’s health challenges - led by Africans, for Africans. It was a defining moment as African health solutions have almost always been guided by Western experts. The continent’s leading health figures debated and discussed a continent-wide campaign to tackle key bottlenecks to health solutions in Africa. At the heart of this was the clarion call to African governments to prioritise health care in their countries, to do more to retain local health professionals and curb the exodus of their skills to foreign markets, and for more investment in supporting African health research to ensure locally-relevant- and- led health solutions. “An African-led think tank in health is the game-changer for the continent,” Ghanaian-born AFREhealth chairperson, Professor Peter Donkor, told delegates….”

Among others: “…Despite the differences in cultures, languages and governments, there was a common thread in the representing countries health direction: a growing shift to a primary health care (PHC) approach, a concept at the heart of South Africa’s National Health Insurance (NHI) system expected to replace the curative health care approach in the next nine years.”

For more on AFREhealth, see also Health 24 “…Something needs to be done, as Africa has 24% of the world’s burden of diseases but only 3% of the global health workforce. African health experts are set to tackle health challenges on the continent by providing innovative solutions led by African health specialists under Africa’s first health umbrella body, African Forum for Research and Education in Health (AFREhealth). “Africa needs African solutions led by Africans. Through AFREHealth, the continent’s leading health figures from more than 60 medical and nursing schools have come together to improve health outcomes, build capacity and improve the education and training of health professionals across Africa.”

Lancet - Building virtual communities of practice for health

B Struminger et al; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31666-

5/fulltext

Communities of practice have “arrived’, that much is clear. Yet another example: “…The non-profit Project ECHO (Extension for Community Healthcare Outcomes) is an example of an initiative that is building such communities of practice in more than 23 countries on six continents. ECHO's collaborative model of medical education and care management …”

WHO – Open WHO

Open WHO;

WHO launched a new e-learning platform with video courses on epidemics, pandemics, … With free courses!

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Devex – IKEA and MSF tackle 'underreported' crises with new partnership model

https://www.devex.com/news/ikea-and-msf-tackle-underreported-crises-with-new-partnership-

model-90896

“… As mounting crises in Yemen, Syria, Northern Nigeria and elsewhere squeeze the budgets of humanitarian agencies, the 142 million euro, 30-staff philanthropic arm of the Swedish furniture company IKEA last year noticed that its nonprofit partner, Médecins Sans Frontière, was less and less able to afford the kind of advocacy and communications operations needed to raise the profile of its work. This was particularly true in the most fragile contexts where media attention was lacking….” Hence the new partnership model. (gated)

Devex – Opinion: Reducing inequality, not just poverty, should be the central aim of aid

Jonathan Glennie ; https://www.devex.com/news/opinion-reducing-inequality-not-just-poverty-should-be-the-central-aim-of-aid-90922#.WZ_h6XJdEIc.twitter

Must-read by Jonathan Glennie.” Reducing inequality, not just poverty, should be the central aim of aid. This is the profound paradigm shift now required to respond to the world as we find today.”

“…while the epic battle, played out in the grey corridors of U.N. conference rooms, has been won, the traditional world of aid appears not to have got the memo.”

Glennie then explores: “…what does that mean for aid in the SDG era? Let’s follow the logic.”

“When the aim of aid was to end extreme poverty, it made sense to argue aid would end when that goal was achieved. But the new aim of aid is to fight inequality, and we know we will never end inequality and that constant work is required to combat it. Aid, therefore, will always be needed. The challenge for aid in the 21st century is to respond in theory and practice to this changing reality, one in which all countries now expect not just to deal with extreme poverty but to converge on decent living standards for all.”

Global Policy Watch – Eradicating poverty and promoting prosperity in a changing world – A false start?

https://www.globalpolicywatch.org/blog/2017/08/04/eradicating-poverty-and-promoting-

prosperity-in-a-changing-world-a-false-start/

(Must-read) Reflections on the 2017 United Nations High-Level Political Forum on Sustainable

Development.

Read also:

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Global Dashboard - The Global Goals – 43 countries, lots of info and some

promising progress

http://www.globaldashboard.org/2017/08/07/global-goals-43-countries-lots-info-making-progress/

5 messages from Alice MacDonald having returned from the High-Level Political Forum in New York (10 July): We should be optimistic about progress; there’s some cool stuff happening at national level (well, at least in some countries); ‘Leave no one Behind’ is getting a bit well “left behind’…; we need better data; the goals really are for everyone.

Devex – There is a major obstacle to tracking disability inclusion in the SDGs

https://www.devex.com/news/there-is-a-major-obstacle-to-tracking-disability-inclusion-in-the-sdgs-

90762

“As countries work through the early stages of implementing the Sustainable Development Goals, a development agenda designed to represent everyone, some disability experts are questioning how effectively national plans can incorporate people with disabilities. One major challenge could impede this process: there is no accepted definition of what it means to be a person with a disability, and no single, international system for collecting demographic information on people with disabilities….”

IJHPM - Challenges Facing Global Health Networks: The NCD Alliance Experience; Comment on “Four Challenges that Global Health Networks Face”

Katie Dain (NCD Alliance);

http://www.ijhpm.com/article_3400_0.html?utm_source=dlvr.it&utm_medium=twitter

Must-read!!! “Successful prevention and control of the epidemic of noncommunicable diseases (NCDs) cannot be achieved by the health sector alone: a wide range of organisations from multiple sectors and across government must also be involved. This requires a new, inclusive approach to advocacy and to coordinating, convening and catalysing action across civil society, best achieved by a broad-based network. This comment maps the experience of the NCD Alliance (NCDA) on to Shiffman’s challenges for global health networks – framing (problem definition and positioning), coalition-building and governance – and highlights some further areas overlooked in his analysis.”

Draft outcome document for the WHO Global Conference on NCDs (to be held 18-20 October in Montevideo, Uruguay, is now available online

https://ncdalliance.org/news-events/news/web-based-consultation-on-outcome-document-for-

who-global-conference-on-ncds-open-now

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“The outcome document, called the Montevideo Roadmap 2018-2030 on NCDs as a Sustainable Development Priority, will be negotiated by Member States starting 29 August to be finalised before the end of September….” Today (25 August) is the last day for web-based public consultation.

Global Public Health –From a global crisis to the ‘end of AIDS’: New epidemics of signification

N Kenworthy et al; http://www.tandfonline.com/doi/full/10.1080/17441692.2017.1365373

“In the past decade, discourses about AIDS have taken a remarkable, and largely unquestioned, turn. Whereas mobilisations for treatment scale-up during the 2000s were premised on perceptions of an ‘epidemic out of control’, we have repeatedly been informed in more recent years that an end to AIDS is immanent. This new discourse and its resulting policies are motivated by post-recession financial pressures, a changing field of global institutions, and shifting health and development priorities. These shifts also reflect a biomedical triumphalism in HIV prevention and treatment, whereby shorter term, privatised, technological, and ‘cost-effective’ interventions are promoted over long-term support for antiretroviral treatment. To explore these changes, we utilise Treichler’s [(1987). How to have theory in an epidemic: Cultural chronicles of AIDS. Durham, NC: Duke University Press] view of AIDS as an ‘epidemic of signification’ to develop a review of ‘End of AIDS’ discourses in recent years. We use this review to investigate the political and philanthropic interests served by efforts to rebrand and re-signify the epidemic. We also hold up these discourses against the realities of treatment access in resource-poor countries, where ‘Ending AIDS’ has not heralded the end of an epidemic per se, but rather the end of external support for treatment programmes, highlighting new difficulties for sustaining treatment in this new era of the epidemic.”

CGD (blog ) - Taking Stock of Aid Agency Evaluations in Global Health: Here’s What We Know about Evaluation Quality and What Funders Can Do Better

J M Keller et al; https://www.cgdev.org/blog/taking-stock-aid-agency-evaluations-global-health

“… The evaluation community has made tremendous progress on quality over the past decade. Several funders have implemented new evaluation policies and most are conducting more evaluations than ever before. But less is known about how well aid agencies are evaluating programs. To fill in the gap, we—together with our colleagues Julia Raifman Goldberg, Felix Lam, and Alex Radunsky—set out to assess the quality of global health evaluations (both performance and impact evaluations). We looked specifically at publicly available evaluations of large-scale health programs from five major funders: USAID, the Global Fund, PEPFAR, DFID, and IDA at the World Bank. We describe our findings in a new CGD Working Paper and accompanying brief. Check out the brief recap of our findings below….”

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CGD (blog) - Is UK Aid Being Spent Properly? We Just Don’t Know

Kalipsou Chalkidou; https://www.cgdev.org/blog/uk-aid-being-spent-properly-we-just-dont-know

Brandnew CGD fellow, Kalipsou Chalkidou (wish I had a name like that) ponders the idea of a NICE for aid. “…some colleagues and I recently proposed the creation of an independent public body that would assess the value for money of overseas development assistance (a “NICE” for development).”

International Journal of Environmental Research and Public Health - Building Responsive Health Systems to Help Communities Affected by Migration: An International Delphi Consensus

K Pottie et al; http://www.mdpi.com/1660-4601/14/2/144/htm

“Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration. An international Delphi consensus process was used to identify policy approaches to improve health systems for populations affected by migration. Participants were leading migrant health experts from Americas, Europe, Middle East, Asia, and Australasia. … …Participants identified the following key areas as priorities for policy development: health inequities, system discrimination, migrant related health data, disadvantaged migrant sub-groups, and considerations for disadvantaged non-migrant populations. Highly ranked items to improve health systems were: Health Equity Impact Assessment, evidence based guidelines, and the International Organization for Migration annual reports. Policy makers need tools, data and resources to address health systems challenges. Policies need to avoid preventable deaths of migrants and barriers to basic health services.”

Scientific American - A CDC for Africa: But the body modeled after the U.S. agency needs funding

https://www.scientificamerican.com/article/a-cdc-for-africa/

Ask Jeff Bezos. Or Micheal O’Leary. Etc … Better even: tax them properly that you won’t have to “ask” them.

BMJ Global Health – Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

C Lu et al; http://gh.bmj.com/content/2/3/e000364

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“Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda….” Conclusion: “…findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities.”

Bloomberg – Bill Gates Says U.S. Likely to Maintain Aid Levels for Africa

Bloomberg;

From mid-August. “The U.S. will probably maintain its current levels of aid to Africa despite President Donald Trump’s proposals to slash funding, according to Bill Gates, the world’s richest man. Trump said in May his government would no longer allocate funding for family planning, a move that has the potential to undermine aid programs in the poorest countries in the world. However, with Congress in control of the budget, it’s unlikely that all cuts proposed by the Trump administration will go ahead next year, Gates said in an interview in Dar es Salaam, Tanzania’s commercial capital….”

An optimistic Gates, in other words, apparently after he had some chats with senators & Mattis & McMaster, a few of the more sensible people in the administration (we’ve been told). But he also predicted no big new aid programs (like PEPFAR) would see the light, under a Trump administration.

USAID update

Start Mark Green at the helm of USAID

Devex - USAID chief Mark Green's first day at the office (he addressed his staff on the first day)

Devex - Former USAID chief Rajiv Shah lays out his advice for Mark Green

https://www.devex.com/news/former-usaid-chief-rajiv-shah-lays-out-his-advice-for-mark-green-

90917

Well worth a read. “Now is not the time to lay low. That is the advice for the new head of the U.S. Agency for International Development Mark Green from his predecessor Rajiv Shah. Faced with looming budget cuts, three potential famines in East Africa and more than 65 million people displaced, Green must also navigate an administration determined to “get out of the business of development and aid,” Shah said, as U.S. Congress weighs President Donald Trump’s proposed 30 percent cut to the aid budget….”

Devex – Exclusive: Documents reveal largest USAID health project in trouble

https://www.devex.com/news/exclusive-documents-reveal-largest-usaid-health-project-in-trouble-

90933

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Meanwhile, “The largest contract ever awarded by the U.S. Agency for International Development — a project described as a “cornerstone” of U.S. efforts to end AIDS, malaria, and maternal and child death — is reporting results that could put access to lifesaving health commodities at risk. The Global Health Supply Chain – Procurement and Supply Management project is a $9.5 billion effort, implemented by Chemonics International, that supports the U.S. government’s most important health initiatives, including the President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, and population and reproductive health programs. The project coordinates a complex international supply chain of global health commodities to ensure that items ranging from condoms, to HIV tests and treatments, to high-tech lab equipment are delivered to warehouses and health clinics at the right time and in the right quantities, effectively impacting health outcomes for tens of millions of people in dozens of countries. According to the most recent quarterly reports, obtained and reviewed by Devex, that simply isn’t happening. Between Jan. 1 and March 31, 2017, only 7 percent of the health commodity shipments delivered through the GHSC-PSM project arrived at their destination “on time and in full” — a common metric for measuring the performance of a supply chain….”

FT – Threat of infectious disease outbreaks haunts Africa

https://www.ft.com/content/0fb7817a-8754-11e7-bf50-e1c239b45787

Strong childhood immunisation programmes are needed as urbanisation gathers pace, argues Jakaya Kikwete, the former President of Tanzania.

Laurie Garrett moves on from CFR

http://links.cfr.mkt5175.com/servlet/MailView?ms=NTQ3NjE1MDMS1&r=NTIzMzIzOTIxMzcS1&j=M

TIyMzkwMTQ3OAS2&mt=1&rt=0

Do read her latest newsletter (with especially the first part a must-read on current Trump & global health ramifications); interestingly, she’s also not that convinced by the optimistic climate change “can do” messages from Bloomberg, Gore and others. Especially after she read two new (grim) papers. The latter part of her newsletter provides a best-of of Garrett’s work of her years at CFR. Garrett now leaves the Council on Foreign Relations to commence a new chapter, with new policy dimensions.

Lancet - Global Health – Generation men

Nina Schwalbe; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31939-

6/fulltext?utm_source=Global+Health+NOW+Main+List&utm_campaign=f43ccfcc24-

EMAIL_CAMPAIGN_2017_08_17&utm_medium=email&utm_term=0_8d0d062dbd-f43ccfcc24-

858767

Must-read!!! Not exactly a ‘Schwalbe’, this very articulate & hard-hitting Lancet Letter on “Generation Men in Global Health”.

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Excerpt: “…Not only has there still never been a female UN Secretary-General, but the major global multinational institutions related to health lack sufficient female leadership. WHO has just replaced a woman with a man as it its next Director-General, which means that, of the so-called H6 UN Agencies (UNAIDS, UNFPA, UNICEF, UN Women, WHO, and the World Bank Group) related to improving the health of women and children, at least four of the six leaders are now male. Gavi, the Vaccine Alliance and the Global Fund to Fight Aids, TB, and Malaria are also run by men, and their senior leadership is male dominated. At WHO, less than 25% of senior management are women. Even the UN Special Advisor for Sustainable Development, who oversees the Every Woman Every Child movement, is male….”

She also explores why this might be the case.

(PS: personal confession: I sort of miss Margaret Chan already)

Section 27 - Search for new Executive Director of SECTION27

http://section27.org.za/2017/08/search-for-new-executive-director-of-section27/

“Mark Heywood, Executive Director of SECTION27, intends to step down from this leadership position in early 2018. He wishes to pass on the baton to new leadership. “

Lancet Global Health (blog) – The World Bank in Kagame’s Rwanda

Chris Simms; http://globalhealth.thelancet.com/2017/08/14/world-bank-kagames-rwanda

We’re fans of Simms’ blogs, and even more so when he writes about ‘Jim Kim in Rwanda’.

Bloomberg - Michael R. Bloomberg to Convene Heads of State and CEOs at Inaugural Global Business Forum

https://gbf.bloomberg.org/news/michael-r-bloomberg-convene-30-heads-state-100-ceos-inaugural-

global-business-forum/?utm_source=Twitter&utm_medium=social&utm_campaign=GBF17

Can’t wait. “Bloomberg today announced a selection of featured speakers for the first-ever Global Business Forum, which will bring heads of state together with global CEOs to discuss opportunities for advancing trade and economic growth, and the related societal challenges – from climate change to workplace automation to terrorism – facing both groups. The daylong Forum will be an unprecedented convening of major business and government leaders from all regions of the world. It will take place on Wednesday, September 20th, 2017 in New York City, during the week of the United Nations General Assembly.”

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Global Fund update

Devex – The Global Fund to name new director in November

Devex ;

“The Board of Directors of the Global Fund to Fight AIDS, Tuberculosis and Malaria plans to select the organization’s next executive director at its meeting in November 2017, according to an update published this week. The search process represents a second attempt at identifying qualified, well-vetted candidates to lead the Global Fund, after the board canceled its previous effort to select a new leader for the multibillion dollar health organization, citing problems with the recruitment process. The fund received 92 applications for the position before its July 21 deadline, and board members “and others with networks in the global health sector” will continue additional outreach to potential candidates until the first week of September, according to Monday’s post. At that time, the Executive Director Nomination Committee will meet to finalize a long list of candidates for interviews. …”

New GFO issue

http://www.aidspan.org/node/4311?pk_campaign=email-attrib-Word-PDF-download&pk_kwd=gfo-

issue-318

Among others, we want to flag in this issue:

Activists stunned by Global Fund decision to end funding for regional HIV programming in Africa

Changes to the role and structure of CCMs likely as the Global Fund develops a CCM evolution plan

GFO (Analysis)- Unitaid: key innovation partner of the Global Fund

http://www.aidspan.org/node/4290

From the previous GFO issue. “A closer look at an organization that helps build the evidence for scale-up of the most impactful interventions for HIV, TB and malaria.”

BMJ Global Health – Square peg in a round hole: re-thinking our approach to evaluating health system strengthening in low-income and middle-income countries

J Borghi et al; http://gh.bmj.com/content/2/3/e000406?cpetoc

“Health system strengthening is an essential step towards achieving universal coverage goals in low-income and middle-income countries (LMICs). However, health systems are complex and health system strengthening initiatives are often introduced with limited understanding of how they will work in practice and the risk of potential adverse events. Aid flows to health systems in LMICs have increased substantially in the last 15 years. Donors want to know whether their investments in health system strengthening represent value for money relative to disease control programmes and how to optimise the design of such programmes. Conventional evaluation methods ignore the complex dynamic nature of health systems and are insufficient to serve donor needs. System dynamics and

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agent-based modelling methods can reflect the complexity of health systems and be used to estimate value for money for health systems investments in LMICs and predict health system response to any stimulus prior to its introduction, including the detection of potential adverse events. There has been very limited application of system dynamics and agent-based modelling within the evaluation of health system strengthening initiatives in LMICs, and their future use by researchers is highly recommended.”

BMJ Global Health – Global health security: where is the data to inform health system strengthening?

Seye Abimbola, Steph Topp et al; http://gh.bmj.com/content/2/3/e000481

“…For this editorial, we examined the extent to which there is publicly available data on health system input and performance that could inform the judgement as to whether countries are adequately prepared for infectious disease outbreaks or have sufficient response capacity….”

“…To assist global and national stakeholders take action on areas for which health systems require strengthening and investment, reputable data should be publicly available. What we found was not encouraging, especially in terms of data to reflect the current conditions of preparedness and response capability for emerging infectious diseases….”

The authors also offer a few potential ways forward.

Global Policy – Follow the Money: How Trends in Financing Are Changing Governance at International Organizations

E Graham; http://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12450/full

“This article considers how trends in financing are changing governance at intergovernmental organizations (IGOs). Over the course of the twentieth century IGO funding rules changed in two important ways. First, they were altered to allow states greater control over the financial contributions they provide, allowing states to ‘earmark’ contributions. Second, funding rules made private actors eligible contributors, providing an important entry point for private actor influence. I focus on three primary effects of these changes on IGO governance: (1) how the increased reliance on earmarked contributions undermines traditional conceptions of multilateral governance; (2) how private actors are empowered by their ability to earmark resources as they emerge as major funders; and (3) on the surge in ‘minilateral’ governance associated with the rise of pooled funding mechanisms. I draw on delegation theory to illustrate these changes conceptually and provide examples from a wide variety of institutions within and outside the UN system. I conclude by outlining fruitful avenues for research on financing IGOs.”

Part of a new special issue in Global Policy - Resourcing International Organizations.

Make sure you also read: Vertical Funds: New Forms of Multilateralism (by Stephen Brown)

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“The United Nations and other multilateral organizations have always been prominent in the health field. UN agencies like the World Health Organization (WHO), however, have come increasingly under the influence of major individual donors which provide earmarked funding. Since 2000, two major vertical funds in the health field – the Global Fund and the GAVI Alliance – provide new models of multilateralism and their funding patterns, together with those of WHO, are examined in some detail. We review the extent to which the two new funds and WHO conform to traditional definitions of multilateralism by reference to several test areas: degrees of concentration of funding sources; the influence of individual funders; sustainability; and transparency. We also draw lessons from the analysis for the UN development organizations.”

Global health events & announcements

UHC symposium in Kampala (16-18 August)

Some links:

Kampala Symposium statement.

Day One Bulletin & Day 2 Bulletin.

Global Health Events coming up in the months ahead

It’s clear that the coming months will be rather hectic, in terms of global health events, with among others:

The World Health Summit in Berlin (October), the NCD conference in Montevideo (October), the 10th ECTMIH conference in Antwerp (October), the 4th global HRH forum in Dublin (November) (for an update, see the latest WHO HRH newsletter), and many other global health events you might want to attend (if you find proper funding, among others). And let’s not forget the annual UNGA meeting (September). But there’s a lot more, starting with the Medact conference (early September) Health through Peace 2017 (in York, UK), and the Global Evidence Summit in Cape Town (September).

Some other announcements & global health news/upcoming webinars/calls…

From the NCD Alliance newsletter:

“Applications open for young people to attend Global NCD Alliance Forum:

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A pre-Forum youth workshop will be organised on 7-8 December ahead of the 2nd Global NCD Alliance Forum from 9-11 December 2017, in Sharjah, United Arab Emirates on the theme of Stepping up the pace on NCDs: making 2018 count. The youth workshop aims to support the meaningful engagement of youth advocates in the Forum proceedings and the global NCD movement in the long term. Youth delegates from across the world will work together to enrich and energise civil society advocacy activities leading up to the UN High-level Meeting on NCDs in 2018. The Youth Planning Committee of the Forum is calling for applications from youth advocates to attend the youth workshop and Forum. Limited travel grants available. Deadline: 1 September.”

https://www.surveymonkey.com/r/YouthSharjah17

As already mentioned before, the working group on Effective Health Cooperation of the Medicus Mundi International Network launched an essay contest among Network members, their partners and other organizations engaged in international health cooperation.

You find all info here: MMI essay contest: Health cooperation beyond aid: Pathways for change Deadline is Sunday 3 September !!! “…The author of the most convincing/inspiring contribution selected by our jury will be invited to present his/her essay at a session on “health cooperation beyond aid” hosted by MMI EHC at the 10th European Congress on Tropical Medicine and International Health (ECTMIH 2017) taking place in Antwerp, Belgium, in October 2017.”

Coming up : Webinar 5 September: health Labor Market Analysis –An approach for

informing strategic investments in the health workforce (by EV4GH, USAID, HSG, …)

http://mailchi.mp/de7d69a53eaa/webcast-health-labor-market-

analysis?e=49d0a46978&utm_content=bufferf53cc&utm_medium=social&utm_source=twit

ter.com&utm_campaign=buffer

First in a series of two webinars.

Coming up: GBD 20th Anniversary Event (September 25, in Seattle) The event is co-hosted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and The Lancet.

Coming up - Public financing for UHC: towards implementation: WHO Symposium on Health Financing for UHC (30 October-2 November, Montreux)

http://www.who.int/health_financing/events/uhc-towards-implementation/en/

“WHO’s Department of Health Systems Governance and Financing will be holding a meeting to share and exchange knowledge on experiences and best practices in the field of public finance and health financing. This event will build from the foundation set during the December 2014 and April 2016 meetings of this Collaborative Agenda on Fiscal Space, Public Financial Management, and Health Financing, which mapped the key issues and questions related to this technical area, and also developed the conceptual foundations for particular sub-topics. As the third in this series of global meetings, discussions and presentations will centre on the practical issues countries face in implementing policies and reforms that intend to institutionalize and sustain progress towards Universal Health Coverage (UHC). Representatives of national health and finance ministries and other relevant government bodies, partner agencies, foundations, initiatives, and civil society organizations will be brought together to delve into specific technical issues, build consensus, motivate collaboration, and push the knowledge agenda forward with respect to how to mobilize

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and use public funds to finance better health in countries. The objectives of this meeting are: To engage and build on the evidence base for how countries can implementing strategies to mobilize and use public funds to finance progress towards UHC; To continue to push the knowledge forward through discussions that identify priority areas for the ongoing collaborative agenda….”

HSG updates

Check out the HSG August newsletter

Among others, we want to flag this (important) blog post - What makes a great organized session?

It certainly helps if you have “Tim Evans For All” in your session, but absent that, here you find some great tips & tricks.

HSG Media fellowship

http://healthsystemsresearch.org/hsr2018/hsg-media-fellowship/

A first! And a great development, no doubt.

Alliance - Launch of Rapid Reviews to Strengthen Health Policy and Systems: A Practical Guide

http://www.who.int/alliance-hpsr/events/global-evidence-summit/en/

“The Alliance for Health Policy and Systems Research is pleased to announce that a new publication titled, Rapid Reviews to Strengthen Health Policy and Systems: A Practical Guide will be released at the Global Evidence Summit in Cape Town on 14 September 2017….”

UHC

Lancet (Editorial) – Charlottesville: symptomatic of a broader pain

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32285-7/fulltext

Lancet editorials tend to be wise (certainly when benchmarked against this newsletter’s intros), but this one is exceptionally wise. It concludes: “…Hate, racism, and anti-Semitism are always unacceptable. But as uncomfortable as it can feel, we must work to illuminate the causes of the causes of the feelings of disenfranchisement among disadvantaged white Americans. Universal access to high-quality health care can be one important means to strengthen these frayed social bonds.”

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BMJ Global Health - Progressive realisation of universal health coverage: what are the required processes and evidence?

R Baltussen et al; http://gh.bmj.com/content/2/3/e000342

“Progressive realisation is invoked as the guiding principle for countries on their own path to universal health coverage (UHC). It refers to the governmental obligations to immediately and progressively move towards the full realisation of UHC. This paper provides procedural guidance for countries, that is, how they can best organise their processes and evidence collection to make decisions on what services to provide first under progressive realisation. We thereby use ‘evidence-informed deliberative processes’, a generic value assessment framework to guide decision making on the choice of health services. We apply this to the concept of progressive realisation of UHC….”

Economist (Leader) – Why developing countries must improve primary care: The changing burden of disease requires a better approach to keeping people healthy

https://www.economist.com/news/leaders/21727068-changing-burden-disease-requires-better-

approach-keeping-people-healthy-why

Even the Economist is on board now.

Report from 25-27 April 2017 global meeting on ‘Strategic Purchasing for UHC: Unlocking the potential’

http://www.who.int/health_financing/events/strategic-purchasing-meeting-2017/en/

You find key messages & a summary of discussions on the way forward on this page.

Meanwhile, on the platform Collectivity (now with 1000+ members !) a group has also been set up

on Strategic Purchasing.

Joint Learning Network – Eight Countries Outline a Framework for Strategic Communications for UHC

http://www.jointlearningnetwork.org/news/eight-countries-outline-a-framework-for-strategic-

communications-for-uhc

“Since February 2017, the JLN, in partnership with the USAID’s Health Finance and Governance Project (HFG), has been working with eight countries to share expertise and best practices for effective strategic communications and stakeholder engagement to support universal health coverage (UHC) policy reform efforts. Countries participating in the Stakeholder Communications

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joint learning exchange aim to co-author a practical guide to strategic communications for UHC, while taking back the new knowledge to their countries to draft their own plans. As part of the joint learning process, 25 country delegates came together for an in-person workshop on July 20-21, 2017, in Accra, Ghana. Policymakers, health reform implementers, and public affairs professionals joined the workshop from Bangladesh, Cambodia, Ghana, Malaysia, Nigeria, Peru, Senegal and Sudan….”

Health Systems & Reform (Commentary) - Health Systems for Ageing Societies in Asia and the Pacific

http://www.tandfonline.com/doi/full/10.1080/23288604.2017.1356429

By A Mahal & Barbara McPake. From a (forthcoming) special issue.

American Health care reform

KFF – Kaiser Health Tracking Poll – August 2017: The Politics of ACA Repeal and

Replace Efforts

KFF;

“The August Kaiser Health Tracking Poll finds that the majority of the public (60 percent) say it is a “good thing” that the Senate did not pass the bill that would have repealed and replaced the ACA. Since then, President Trump has suggested Congress not take on other issues, like tax reform, until it passes a replacement plan for the ACA, but six in ten Americans (62 percent) disagree with this approach, while one-third (34 percent) agree with it. A majority of the public (57 percent) want to see Republicans in Congress work with Democrats to make improvements to the 2010 health care law…”

Most people (about 80%) actually want to make Obamacare work.

So far Trump et al aren’t listening much. See for example:

Stat News - Former HHS chiefs urge Trump to stop undermining Obamacare

https://www.statnews.com/2017/08/20/hhs-chiefs-obamacare/

“Don’t make things worse. That’s the advice of former U.S. health secretaries of both parties to President Trump and the GOP-led Congress, now that “Obamacare” seems here for the foreseeable future. The 2018 sign-up season for subsidized private health plans starts Nov. 1, with about 10 million people currently served through HealthCare.gov and its state counterparts. Stability should be the immediate goal, said former Health and Human Services secretaries Kathleen Sebelius, Mike Leavitt and Tommy Thompson. At minimum: Dispel the political and legal uncertainty — fueled by presidential tweets — around billions in subsidies for consumers’ insurance co-pays and deductibles. The three former officials shared their views with The Associated Press.”

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But then again, Trump’s core business is ‘undermining’ stuff.

JAMA Internal medicine – Progress Toward Universal Health Coverage: a Comparative analysis in 5 South-Asian countries

http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2646775

Afghanistan, Bangladesh, India, Nepal, and Pakistan, that is.

Reuters –India aims to revamp health scheme, lower costs after criticism

http://in.reuters.com/article/india-health-idINKCN1AV0MK

(from earlier this month) “India’s health ministry has trimmed its cost estimates for extending its main public health programme (i.e. the National Health Mission) by 25 percent after criticism from a federal think-tank over inefficiency and slow progress, according to government documents seen by Reuters. The new estimate of $25 billion for a three-year extension of the flagship health programme, down from an initial figure of about $33 billion, comes as Prime Minister Narendra Modi pushes a multi-pronged agenda to revamp health services. Planned reforms include streamlining spending and bureaucracy, slashing prices of life-saving drugs and medical devices, and nudging companies such as PepsiCo to make more healthy products….”

BMJ (Analysis) –Keeping up with the Johanssons: How does UK health spending compare internationally?

http://www.bmj.com/content/358/bmj.j3568

“Decisions about the appropriate amount to spend on health require more than a simple comparison with what other countries spend, argue John Appleby and Ben Gershlick.”

R4D - Getting Health’s Slice of the Pie: Tips and tools for increasing public funds for health

K Krusell et al; http://www.r4d.org/blog/getting-healths-slice-pie-tips-tools-increasing-public-funds-

health/?utm_content=bufferbf57f&utm_medium=social&utm_source=twitter.com&utm_campaign

=buffer

Blog on a recent workshop dedicated to the rather complicated MoF & MoH relationship, all with a view on ‘boosting domestic resource mobilization’.

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Planetary health

Lancet (Editorial) – Minamata Convention on mercury: a contemporary reminder

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32287-0/fulltext

“…On Aug 16, UNEP announced that the Minamata Convention came into force. This Convention aims to protect human health and the environment from exposure to anthropogenic emissions of mercury and its compounds. By holding governments worldwide accountable for the mercury lifecycle, reparations to those affected will be made. Key agendas include banning new mines and phasing out existing ones by 2020, as well as implementing control measures to reduce emissions….” Let’s find out whether it’s achievable.

(New) Planetary health newsletter

https://planetaryhealthalliance.org/subscribe

From the Planetary Health Alliance.

Lancet Planetary health – August issue

http://www.thelancet.com/journals/lanplh/issue/current

Do start with the Editorial, A sixth mass extinction? Why planetary health matters

“…Previous mass extinctions might have been inevitable but it is not too late to stop this latest (and self-imposed) assault on our ecology”, this Editorial argues. And explores how the principles of planetary health can help address the sixth mass extinction. Let’s hope the Lancet is right…

Check out also: Rethinking food waste for a healthier planet; The impact of megacities on health: preparing for a resilient future; and much more…

(BMJ news) - Global climate is warming rapidly, US draft report warns

http://www.bmj.com/content/358/bmj.j3824

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You probably got this via the media, from earlier this month. “The global climate is warming rapidly and will continue to do so even if “greenhouse” gas emissions are reduced substantially, US climate experts conclude in a draft report leaked to the New York Times.” As you know, the thug-in-chief doesn’t want to hear much about it.

Nature (Commentary) – Catalyzing a political shift from low to negative carbon

Glenn Peters et al; Nature;

“Policymakers are beginning to understand the scale of carbon dioxide removal that is required to keep global warming “well below 2 degrees C”. This understanding must now be translated into policies that give business the incentive to research, develop and deploy the required technologies.”

See also Vox - It’s time to start talking about “negative” carbon dioxide emissions Apart from the enormous technological challenges to make it happen, that looks like a very wicked global governance problem (with ‘Common but Differentiated Responsibilities’ & all that fancy stuff) in the making as well.

Guardian - Russian tanker sails through Arctic without icebreaker for first time

https://www.theguardian.com/environment/2017/aug/24/russian-tanker-sails-arctic-without-

icebreaker-first-time

Hurray!

Post-Carbon - Why Climate Change Isn’t Our Biggest Environmental Problem, and Why Technology Won’t Save Us

R Heinberg; http://www.postcarbon.org/why-climate-change-isnt-our-biggest-environmental-

problem-and-why-technology-wont-save-us/

(recommended, especially for Michael Bloomberg & his many fans) “Our core ecological problem is not climate change. It is overshoot, of which global warming is a symptom. Overshoot is a systemic issue. Over the past century-and-a-half, enormous amounts of cheap energy from fossil fuels enabled the rapid growth of resource extraction, manufacturing, and consumption; and these in turn led to population increase, pollution, and loss of natural habitat and hence biodiversity. The human system expanded dramatically, overshooting Earth’s long-term carrying capacity for humans while upsetting the ecological systems we depend on for our survival. Until we understand and address this systemic imbalance, symptomatic treatment (doing what we can to reverse pollution dilemmas like climate change, trying to save threatened species, and hoping to feed a burgeoning population with genetically modified crops) will constitute an endlessly frustrating round of stopgap measures that are ultimately destined to fail. …”

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Lancet - Highly hazardous pesticides: policies should focus on bans, rather than secure storage, studies suggest

“Global policies on access to highly hazardous pesticides – commonly ingested in acts of self-poisoning and suicide in rural Asia – should focus on national bans, rather than safe storage, according to two studies in The Lancet and The Lancet Global Health journals. “

“… How to prevent pesticide self-poisoning? Two Articles assess the effectiveness of restriction of access to highly harmful pesticides by using lockable storage containers in rural Asia, and laws regulating their sale and import in 16 countries to prevent deaths from pesticide self-poisoning….”

See here and here.

Infectious diseases & NTDs

Outbreaks

Sierra Leone

WHO Afro (news release) - Preventing spread of disease in wake of mudslides is vital, says WHO

http://www.afro.who.int/news/preventing-spread-disease-wake-mudslides-vital-says-who-0

“The World Health Organization (WHO) is working closely with the Government of Sierra Leone to prevent the spread of infectious diseases such as malaria and cholera in the wake of last week’s mudslides and flooding in Freetown. The Organization is also working with partners to ensure ongoing health care for the injured and displaced, and to provide psychological aid to those coping with trauma….”

See also UN News - UN health agency rushes to prevent malaria, cholera outbreaks in flood-hit Sierra Leone.

Buzzfeed – How Ebola Prepared Sierra Leone For A Massive Natural Disaster

Buzzfeed

“The Ebola epidemic, which killed almost 4,000 people three years ago and became the West African country’s worst ever public health crisis, is now guiding the country’s latest disaster response.” Encouraging lessons have been learnt, it appears.

BMJ (news) Flooding in south Asia raises fear of disease outbreaks

http://www.bmj.com/content/358/bmj.j3962

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“Flooding has killed more than 800 people and displaced over a million in India, Nepal, and Bangladesh, raising fears of widespread outbreaks of waterborne and vectorborne disease.”

And a quick link: “India appears to be in the grip of a swine flu outbreak with 1,094 recorded deaths over the past eight months, said an official report on Wednesday. “ (BBC News)

HIV/AIDS

Lancet (World Report) – President of Zambia declares HIV testing mandatory

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32295-X/fulltext

“The President of Zambia has announced HIV testing will now be mandatory in all government health facilities, causing concern among health activists. Andrew Green reports.” “Zambia is moving forward with mandatory HIV testing for all patients who visit government health facilities, Health Minister Chitalu Chilufya told The Lancet, confirming President Edgar Lungu's surprise announcement of the new policy in mid-August. The move appears to contradict WHO recommendations against mandatory or coerced testing. And it has sparked an outcry among international and local HIV activists, who are pushing the government to reverse its decision….”

Lancet (Editorial) - Losing the fight against HIV in the Philippines

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32211-0/fulltext

Editorial from a few weeks ago. “… The Philippines is facing an unprecedented HIV crisis. New infections have doubled in the past 6 years to more than 10 000 new cases last year alone. Undoubtedly, stigma remains one of the major reasons for the spread of HIV in the Philippines, as Risa Hontiveros, Filipina Senator and Vice-Chairperson of the Senate Committee on Health, said on Aug 2, urging the Government to declare the HIV epidemic a national emergency.”

“Duterte” Harry’s harsh punitive policies on drug use don’t help either.

CSIS (report) – Advancing Country Partnerships on HIV/AIDS

R Downie; https://www.csis.org/analysis/advancing-country-partnerships-hivaids

From the executive summary: “…President Trump’s proposed FY 2018 budget calls for steep declines in global HIV/AIDS funding and other health programs in many countries that benefit from PEPFAR’s presence. Precipitous withdrawals of funding and technical assistance risk undermining, even reversing, hard-won gains. The proposed budget cuts call into question the ability of the United States to sustain progress on HIV/AIDS and could disrupt efforts to encourage country partners to assume more leadership of their own responses to the epidemic. This outcome would not be in the national interest of the United States; it would undermine years of U.S. global health investments and risk a resurgence of the HIV epidemic in countries where intensified efforts could bring epidemic control within reach by 2020. The United States should help countries put the foundations in place for a sustainable HIV response, including ambitious but realistic plans to grow their economies and increase the share of domestic revenues allocated to health. Only then will it be possible to negotiate transitions away from front-line support without putting lives at risk.”

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Malaria

Scidev.net – Next-generation mosquito nets on the way

http://www.scidev.net/global/malaria/news/next-generation-mosquito-nets.html

“The World Health Organization (WHO) has provisionally recommended the use of a new generation of insecticide-treated mosquito nets —a step forward for the prevention of malaria. Interceptor G2, developed by the German chemical company BASF, is treated with a blend of two classes of insecticide.” It kills up to 75 per cent of mosquitoes and remains effective after 20 washes; WHO gives interim approval, awaits further tests to give final go-ahead.

Bloomberg – Novartis Speeds New Anti-Malarial as Older Drug Loses Potency

Bloomberg;

“Novartis AG began testing a new anti-malaria pill in Africa, advancing development of an alternative to its most effective treatment that billionaire philanthropist Bill Gates said risked losing potency. Patients in Mali infected with the mosquito-borne parasite began receiving the experimental drug, known as KAF156, in combination with another medicine, the drugmaker said Monday. More than 500 children and adults across nine countries in Africa and Asia will be enrolled in the mid-stage study over the next few months. The research, being conducted with the Medicines for Malaria Venture, aims to determine the most effective and tolerable dose, and ultimately fill an unmet need for a novel treatment to stave off the development of drug-resistance….”

See also FT Health - New malaria drug could be ‘game changer’

“…The first new malaria drug to emerge for 20 years is beginning clinical trials in nine countries across Africa and Asia. KAF156 could be “a game changer”, its developers say, at a time when the malaria parasite is evolving resistance to existing treatments. Novartis, the Swiss drug company, has developed KAF156 in collaboration with Medicines for Malaria Venture (MMV), a public-private partnership, and charities including the Wellcome Trust and Gates Foundation.”

BMJ Global Health – Ethical implications of fighting malaria with CRISPR/Cas9

M P Neves et al; http://gh.bmj.com/content/2/3/e000396

“Genome editing is a new, cheap and versatile technique which has great promise to combat vector-borne diseases. The current ethical debate worldwide is mainly concentrating on the dangers of germline intervention and less so on the potential for fighting vector-borne diseases. Gene drive technology has been significantly boosted by the CRISPR/Cas9 gene editing tool which may be able to combat malaria by targeting specific stretches of vector DNA and editing genomes at precise locations, working like a molecular scissors. However, CRISPR/Cas9 is currently not a ‘silver bullet’ and needs further research and consideration of the ethical aspects and consequences of its use. In September 2016, the UNESCO Chair of Bioethics at the Medical University of Vienna convened a meeting entitled ‘Fighting Malaria with CRISPR/Cas9: Ethical Implications’, which gathered together infectious disease experts with a focus on malaria, entomologists and ethicists to discuss the advantages and disadvantages of genome editing applied to mosquitoes to fight malaria. Although there was no formal consensus, some general conclusions were reached, in particular that

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any ethical debate needs to involve African stakeholders living in malaria areas and to consider future generations and the environment. The precautionary principle should be taken into account in any discussion, as should be the human cost of doing nothing.”

TB

Lancet Global Health – The global burden of tuberculosis mortality in children: a

mathematical modelling study

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30289-9/fulltext?dgcid=etoc-

edschoice_email_Sept

See also above. New mathematical modelling study. “…We estimated that 239 000 (95% uncertainty interval [UI] 194 000–298 000) children younger than 15 years died from tuberculosis worldwide in 2015; 80% (191 000, 95% UI 132 000–257 000) of these deaths were in children younger than 5 years. More than 70% (182 000, 140 000–239 000) of deaths occurred in the WHO southeast Asia and Africa regions. We estimated that 39 000 (17%, 23 000–73 000) paediatric tuberculosis deaths worldwide were in children with HIV infections, with 31 000 (36%, 19 000–59 000) in the WHO Africa region. More than 96% (230 000, 185 000–289 000) of all tuberculosis deaths occurred in children not receiving tuberculosis treatment. … Tuberculosis is a top ten cause of death in children worldwide and a key omission from previous analyses of under-5 mortality. Almost all these deaths occur in children not on tuberculosis treatment, implying substantial scope to reduce this burden.”

Global Public Health – ‘Exotic no more’: Tuberculosis, public debt and global

health in Berlin

J Kehr; http://www.tandfonline.com/doi/full/10.1080/17441692.2017.1362568

“Geographical divisions between North and South are coming increasingly undone in the field of global health. Settings in the global North, such as Berlin, are becoming linked up to those in the global South in manifold ways. In this article, I show through discourse analysis and ethnographic research how tuberculosis and its meanings have been transfigured in Western Europe through the worldwide circulation of the disease and its definition as a global health epidemic returning to the North from the South through global migration routes. I then draw attention to the ways in which public health professionals in Berlin make sense of locally implemented economic processes of debt and austerity that have been in effect since the early 2000s. Such processes of indebtedness and privatisation render the strong public health infrastructures that characterise the global North increasingly fragile, and are comparable to the structural adjustment policies that have been imposed upon countries in the global South. I argue that economic processes of austerity in Berlin complement the meaning of TB as an immigrants’ disease, while older meanings of TB as a disease of poverty resurface.”

Just in case you get too carried away by Mrs Merkel as a global health “role model”.

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Cholera

Lancet Global Health – The political determinants of the cholera outbreak in

Yemen

J Kennedy, A Harmer & D McCoy; http://www.thelancet.com/journals/langlo/article/PIIS2214-

109X%2817%2930332-7/fulltext?dgcid=twitter_social_world-humanitarian-day17

But of course, no one can beat the Brits at this well-known game of ‘policy incoherence’ bordering downright hypocrisy. With the Saudis as a key partner in crime in the case of Yemen.

See also a tweet: “#Yemen on brink of "catastrophic disaster" says DFID, as it signs off UK arms to Saudi to cause it. https://www.gov.uk/government/news/uk-renews-push-to-tackle-worlds-worst-cholera-outbreak-in-yemen “

Kennedy et al: “At the end of June, 2017, UNICEF and WHO released a statement declaring that Yemen is “facing the worst cholera outbreak in the world”. The statement points out that the outbreak is caused by the civil war that began in 2015, but it does not suggest that one party is more responsible than another, simply noting that “two years of heavy conflict” have resulted in “collapsing health, water and sanitation systems”. Nor does it point to one side being more affected by the outbreak, stating that “cholera has spread to almost every governorate”….”

“…As the Saudi-led coalition has played a key role in the collapse of health, water, and sanitation systems in rebel-controlled areas, it is bizarre that UNICEF recently published a press release welcoming Saudi Arabian “generosity” after the Kingdom donated US$67 million to the cholera response in Yemen.”

Stat News - EXPLORE: How Yemen’s cholera outbreak spread to a half-million

people

Stat News;

Excellent visualizations & infographs. See also WHO - Cholera count reaches 500 000 in Yemen (14 August)

Lancet (Editorial)- Yemen and cholera: a modern humanity test

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32210-9/fulltext

Editorial from last week. “…On the eve of World Humanitarian Day, Aug 19, Yemen must be foremost among priorities of every institution and government acting for global health. “

‘Humanity’ is not exactly in vogue these days, including when it comes to the global response to the Yemen predicament.

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Lancet Infectious diseases - The challenges of cholera at the 2017 Hajj pilgrimage

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2817%2930454-

1/fulltext#.WY1tG8erSoA.twitter

Maybe that’ll wake up the Saudis (and some “allies”).

Johns Hopkins – Review: Cholera Vaccines Effective for Adults, Much Less So

for Children

JH;

“A new review of the research literature led by researchers at the Johns Hopkins Bloomberg School of Public Health shows that cholera vaccines provide substantial protection for adults but provide significantly less protection for children under age 5, a population particularly at risk for dying from this diarrheal disease. The review, which considered seven clinical trials and six observational studies, found that the standard two-dose vaccine regimen reduced the risk of getting cholera on average by 58 percent for adults but only by 30 percent for children under age 5. The findings could help inform policymakers on how and when to use the vaccine, particularly in outbreak settings such as the ongoing epidemic in Yemen, which has seen an estimated 400,000 suspected cases and as many as 1,900 associated deaths since the outbreak began in April 2017. ….” For the study, see the Lancet Infectious Diseases.

Zika

BMJ Global Health – Zika pandemic online trends, incidence and health risk

communication: a time trend study

G Adebayo et al; BMJ Global Health;

The authors aimed to describe the online search trends of Zika and examine their association with Zika incidence, assess the content of Zika-related press releases issued by leading health authorities and examine the association between online trends and press release timing.

This time trend study reports strong correlations between online trends and Zika incidence. This suggests that online trends can aid in surveillance during Zika and other pandemics. Shortcomings in the content and timing of Zika press releases were identified, however. Gaps identified in Zika pandemic press-releases and their reactive pattern with online trends can direct better communication efforts globally in order to better tackle Zika and future public health emergencies. ( for example, WHO materials written at graduate level!) This study also suggests that the monitoring of online trends can be used to complement traditional surveillance efforts.

Science - Zika has all but disappeared in the Americas. Why?

Science ;

Good question. Science tries to find the answer in this article. With the view of Anthony Fauci, among others.

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Yellow Fever

Science –When will yellow fever strike Brazil again? Monkeys and mosquitoes

hold clues

Science;

“… Although the onset of winter slowed the outbreak [in Brazil], scientists fear a resurgence next year. When and where it might reappear depends on the erratic and often maddening behavior of three animals: mosquitoes, monkeys, and humans….”

And an excerpt on the vaccine situation: “…Another problem is more perverse: The vaccine is almost too good at preventing yellow fever. Because it costs so little and protects people for life, making it isn't profitable. Worldwide, just four institutes bother, including Fiocruz. Manufacturers also dislike the uneven market for it: low demand most years, followed by outbreaks that leave them scrambling. Production at Fiocruz, for instance, jumped from 25 million doses in 2016 to a planned 70 million this year—which forced the institute to cut back severely on its vaccine for measles, mumps, and rubella. The market could soon change, however. The World Health Organization (WHO) recently brokered deals in several African and South American countries to vaccinate 584 million people for yellow fever over the next decade, with a goal of eliminating all outbreaks worldwide by 2026. That campaign should steady the market by ensuring stable demand. To boost supply, Fiocruz is also building a new $1 billion plant west of Rio that, in a few years, could produce up to 100 million doses of yellow fever vaccine annually. Still, WHO notes that production of vaccine almost always lags behind projections….”

Lancet Infectious Diseases – Global yellow fever vaccination coverage from 1970

to 2016: an adjusted retrospective analysis

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2817%2930419-X/fulltext#.WZVbmI2KFP4.twitter

“Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention…. … Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO…”

Polio

UN News – More than 350,000 children vaccinated against polio in hard to reach

areas of Syria – UN

http://www.un.org/apps/news/story.asp?NewsID=57382#.WZ73Zj5JbIU

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“A United Nations polio vaccination campaign in Syria has provided protection to more than 355,000 children under age five in two governorates, where violence has made access especially difficult. In response to a recent outbreak of vaccine-derived polio in the country, the UN Children's Fund (UNICEF), the World Health Organization (WHO) and partners have completed the first round of a vaccination campaign in the Deir ez-Zor and Raqqa governorates….”

Devex - What lessons does polio eradication offer for global health?

https://www.devex.com/news/what-lessons-does-polio-eradication-offer-for-global-health-90818

“… Two decades of research and collaboration in public health campaigns across South Asia have taught [him] the importance of languages. Now, Bhattacharya is among those working to ensure that the documentation of the Global Polio Eradication Initiative, or GPEI, is multilingual. He is applying for funding from the Bill & Melinda Gates Foundation to build an international coalition that will advocate across multiple languages for future vaccination-based disease elimination and eradication programs. The latest request for proposals from the Gates Foundation — Applying the Lessons Learned from Polio Eradication to Global Health — is seeking submissions that will help train future generations of leaders to apply best practices gleaned from polio eradication to other public health challenges…”

Some more excerpts: “…Last month, the Journal of Infectious Diseases launched the supplement Polio Endgame and Legacy: Implementation, Best Practices, and Lessons Learned. The 51 articles are intended to serve as a resource on what GPEI can teach us about how to implement public health activities. But these assessments of planning and implementation, vaccine supply and routine immunization strengthening tend to follow a trend of information that is valuable but inaccessible beyond the peer-reviewed journal readership. "There is a certain audience that has access to those peer-reviewed journals and has time to read them, and there is a limit to how much you can put that knowledge into practice,” said Lea Hegg, program officer for polio eradication at the Gates Foundation. “…. “… The polio program has been shaped by Nigerians and Indians and Pakistanis and Congolese and all these people who may not have connections with top-tier global institutions but have the expertise a Harvard [Master of Public Health] should know.”

AMR

Plos Med (Policy Forum) –Antimicrobial resistance: The complex challenge of measurement to inform policy and the public

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002378

(recommended) “Didier Wernli and colleagues discuss the role of monitoring in countering antimicrobial resistance.”

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Graduate institute (Working paper) – Governing antimicrobial resistance: wickedness, competing interpretations and the quest for global norms

E Hutchinson; http://graduateinstitute.ch/files/live/sites/iheid/files/sites/globalhealth/ghp-

new/publications/2017/wp_0014_v4.pdf

“… This paper argues that governing AMR at global level must entail action that insures that effective antimicrobials are available to all, that they be targeted effectively, and that wherever possible alternative ways of improving health and managing communicable diseases must be found and put in place. This means that governments and global health actors need to recognise that antimicrobial efficacy is a global public good that must be accessible and protected; and that norms need to reflect the importance of acting on structural and infrastructural constraints that shape unnecessary antibiotic use so that it is no longer necessary to use antibiotics to secure human health in the face of missing infrastructure, (when diarrheal infection resulting from poor sanitation is treated with antibiotics) missing commodities (antibiotics are often used because diagnostics have not been made available to ensure that medicine is targeted or if vaccine development has not been funded or scaled up) or missing expertise (when health care workers are not trained adequately to make safe decisions about medicine us…”

Devex - Training health care workers to fight antimicrobial resistance

https://www.devex.com/news/training-health-care-workers-to-fight-antimicrobial-resistance-90877

“… The international health nonprofit Management Sciences for Health has also been tapping into what it believes is a key factor in the spread of AMR across low-, middle- and high-income countries: Capacity building. Often, pharmacists, doctors and other health care providers tasked with administering medication are not giving proper instructions to patients, according to Niranjan Konduri, a principal technical adviser at the Systems for Improved Access to Pharmaceuticals and Services, or SIAPS, program, an MSH-led initiative backed by the United States Agency for International Development….”

CIDRAP – New data-sharing platform aims to boost antibiotic discovery

http://www.cidrap.umn.edu/news-perspective/2017/08/new-data-sharing-platform-aims-boost-

antibiotic-discovery

“The Pew Charitable Trusts has announced plans to launch a new cloud-based computing platform that it hopes will "spark" the discovery of new antibiotics to defeat drug-resistant gram-negative bacteria. The publicly available database and interactive data-sharing tool, called the Shared Platform for Antibiotic Research and Knowledge (SPARK), will include curated antibiotic discovery data from accessible sources, along with unpublished data, related content, and expert analysis. The

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hope is that SPARK will allow scientists from around the world who are working on antibiotic discovery to share data, gain new insights, collaborate, and ultimately advance research on molecules that can penetrate and stay inside gram-negative bacteria—the toughest and most pressingly important bacterial pathogens….”

IP Watch (Brief) – Access To Medicines Foundation Details Methodology For 2018 AMR Benchmark

https://www.ip-watch.org/2017/08/24/access-medicines-foundation-methodology-2018-amr-

benchmark/

“The Amsterdam-based Access to Medicines Foundation today published the methodology it will use for its 2018 framework for evaluating how pharmaceutical companies are taking action to limit antimicrobial resistance, addressing the rising the global problem of overuse of antibiotics leading to resistance with few new ones in the pipeline. The methodology will analyse company research and development, manufacturing and production, and appropriate access and stewardship….”

Guardian - Factory farming in Asia creating global health risks, report warns

https://www.theguardian.com/environment/2017/aug/14/asia-factory-farming-creating-global-

health-risks-report-warns

“The use of antibiotics in factory farms in Asia is set to more than double in just over a decade, with potentially damaging effects on antibiotic resistance around the world. Factory farming of poultry in Asia is also increasing the threat of bird flu spreading beyond the region, with more deadly strains taking hold, according to a new report from a network of financial investors….”

CIDRAP – McDonald's expands antibiotic-cutting steps globally

http://www.cidrap.umn.edu/news-perspective/2017/08/mcdonalds-expands-antibiotic-cutting-steps-globally

Hurray! “McDonald's Corporation yesterday announced it will phase out the use of the highest-value human antibiotics in its global chicken supply and signaled that it will take similar actions to limit antibiotics in its supplies of beef, dairy cows, pork, and laying hens.”

And a quick link: first fungal disease awareness week (14-18 August) (sponsored by CDC).

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NCDs

The conversation – The seven tactics unhealthy industries use to undermine public health policies

Rob Moodle; https://theconversation.com/the-seven-tactics-unhealthy-industries-use-to-

undermine-public-health-policies-81137?utm_source=twitter&utm_medium=twitterbutton

Recommended. This is an edited version of an article that appeared in a publication of the American Journal of Public Health.

NPR Goats & Soda - Imagine: Facing Surgery Without An Anesthesiologist On Hand

NPR Goats & Soda;

“… In a 2008 paper in the World Journal of Surgery, Dr. Paul Farmer wrote: "In Africa, surgery may be thought of as the neglected stepchild of global health." Farmer is a physician-anthropologist known for his humanitarian work with AIDS patients in Haiti. Now the World Federation of Societies of Anaesthesiologists takes Farmer's insight a logical step further. "We describe anesthesiology as the invisible sister of the neglected stepchild of global health," says Julian Gore-Booth, chief executive officer of the WFSA. The lack of adequately trained anesthesia providers, plain and simple, means more people die in poor countries…”

Do check out the WFSA’s world map of the problem - World Anaesthesiology Workforce. The hope is that this map will draw (more) attention to the issue.

Guardian – Surgery must be a core part of health care – even in the poorest countries

D Barash; https://www.theguardian.com/global-development-professionals-network/2017/aug/11/surgery-must-be-a-core-part-of-health-care-even-in-the-poorest-countries?CMP=share_btn_tw

“Surgery-treatable conditions kill more people than TB, Malaria and AIDS combined - how can access to surgery be improved in developing countries?” “…Surgically-treatable conditions kill 17 million people each year. That’s more than tuberculosis, malaria, and HIV/AIDS combined. Ensuring everyone has access to life transforming surgery means we need the capacity to perform more than 143m additional surgical procedures each year. The bulk of this work will need to happen in low and middle-income countries like Ethiopia or Tanzania, where millions of people must travel over two hours to find a facility able to provide essential and safe surgical care. Surgery must be seen as an essential element of primary care and a necessary component of sustainable health systems….”

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Do read also (NPR Goats & Soda) Why U.S.-Trained Surgeons Often Aren't Ready For Humanitarian Work Abroad (their skills don’t match, in short)

Vox – No, poor people don't eat more junk food than everyone else

https://www.vox.com/science-and-health/2017/8/7/16011002/junk-food-rich-poor-people

We bet you didn’t you know this. I also didn’t know, frankly, although the fact that I gained a few kilos while playing a couple of days for “Homo Turisticus” in Vienna & Budapest should perhaps have given me a clue.

Based on a new study in Economics and Biology.

Lancet (Comment) - Born to run: our future depends on it

A Santos Lozano et al; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32103-

7/fulltext

Springsteen already had it right, decades ago. “…Physical activity needs to become, once again, a main component of our lives. “ (no, he didn’t frame it like that )

As a nice start, WHO is working on a Global Action plan to boost physical activity, as you know. See a blog on Plos (by Karen Milton) on The Global Action Plan for Physical Activity.

Lancet (Comment) - Eliminating asthma deaths: have we stalled?

C Jenkins; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31587-8/fulltext

This article explores this question. (7 August)

NEJM – Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015

http://www.nejm.org/doi/full/10.1056/NEJMoa1603693?query=featured_home

Do read also the related Editorial.

“Rheumatic heart disease ranks as one of the most serious cardiovascular scourges of the past century. As a result of improvements in living conditions and the introduction of penicillin, the disease was almost eradicated in the developed world by the 1980s. However, it remains a force to be reckoned with in the developing world, as demonstrated by an assessment from the 2015 Global

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Burden of Disease study (GBD 2015), painstakingly performed by Watkins and colleagues and reported in this issue of the Journal…”

Global Tobacco @work

Global Health Now - Powering Up to Fight Tobacco

Global Health Now;

Stance by Tom Frieden. It’s the best way to save billions of lives. He dwells on Bloomberg

Philantropies’ work in this respect, MPOWER policies, …

Tobacco Companies Fail the Corporate Social Responsibility Test of a Free-Market

Advocate

W Savedoff; CGD;

“Philip Morris International and other cigarette manufacturers are among the most profitable firms in the world, selling the world’s most lethal legal product. They prominently advertise their commitment to corporate social responsibility on everything from child labor to renewable energy. They’ve even conceded that smoking is dangerous and say they are committed to a smoke-free world. But none of these initiatives make up for breaching their most fundamental corporate social responsibility—one defined quite cogently by free-market-advocate Milton Friedman—to pursue their profits “without deception and fraud.” …“

Reuters - India threatens Philip Morris with 'punitive action' over alleged

violations

Reuters;

“The Indian government has threatened Philip Morris International Inc with “punitive action” over the tobacco giant’s alleged violation of the country’s anti-smoking laws, according to a letter sent to the company by the federal health ministry.”

Reuters – Philip Morris International CEO cheers U.S. FDA tobacco proposal

Reuters;

Clearly there’s more reason to cheer for Philip Morris in the US. “The chief executive of Philip Morris International said he was “extremely encouraged” by the U.S. Food and Drug Administration’s recent proposal to lower nicotine levels in cigarettes and nudge smokers toward less harmful alternatives such as e-cigarettes. The FDA’s announcement was “one of the best articulated positions in many years,” Andre Calantzopoulos, PMI’s chief executive, said in an interview on Monday….”

Guardian - Revealed: how British American Tobacco exploited war zones to sell cigarettes

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Whenever you think Big Tobacco can’t sink any lower, they surprise you again. “Documents show how the world’s largest publicly traded tobacco company pursued growth and profit amid instability in African and Middle East countries”

Nature - Chronic diseases spike in Middle East as conflicts rage

A Maxmen; Nature;

“Rising rates of chronic disease and deaths from violence can be curbed only if fighting is brought to an end, say researchers.” Article based on a series of reports published on 3 August in the International Journal of Public Health.

“… Across the Middle East, deaths resulting from violence grew by 850% between 1990 and 2015, according to a series of reports published on 3 August in the International Journal of Public Health. The increase accelerated after 2010, corresponding with the beginning of the Arab Spring movement and wars in Syria and Iraq. At the same time, the authors found, the incidence of many chronic diseases has also risen dramatically; the death rate from diabetes, for instance, grew 216% over the study period. Taken together, the analyses describe a disturbing deterioration in health across a broadly defined Middle Eastern region, which includes 22 countries — including Afghanistan, Iraq, Syria, Somalia and the United Arab Emirates — that are home to more than 580 million people….”

Journal of Equity in Health - An exploratory study assessing psychological distress of indigents in Burkina Faso: a step forward in understanding mental health needs in West Africa

E Pigeon-Gagné, Valéry Ridde et al;

https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-017-0633-8

“Poverty is known as an important determinant of health, but empirical data are still missing on the relationships between poverty, other adverse living conditions, and psychological distress, particularly in low-income countries. This study aimed to assess mental health needs and psychological distress among the poorest in rural settings in Burkina Faso where food security and access to water, electricity, schooling, and healthcare are limited….”

Finally, some quick links:

FT - Coca-Cola, PepsiCo and Nestlé to limit sugar in Singapore drinks A first in Asia.

Or “The power of a state in global health” (cfr a tweet from Robert Marten).

Independent - France becomes first country to ban all plastic cups and plates to save environment

Stat News - Thank you, Justin Bieber. Your honesty about mental health benefits all of us

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Sexual & Reproductive / maternal, neonatal & child health

BMJ Global Health – Decriminalisation of gender-based violence is a global health problem

J Mannell & Sarah Hawkes; http://gh.bmj.com/content/2/3/e000438

“In some countries we are seeing a recent roll-back of legislation protecting survivors of gender-based violence. This is a global health problem because of the implications for the health of women, children and those with marginalised gender or sexual identities. A growing body of evidence points to the serious consequences of gender-based violence for both physical and mental health outcomes, which is not being considered in these legislative changes. The United Nation’s SDGs provide a key moment for ensuring that states uphold global commitments to gender equality and non-discrimination on the basis of gender or sexual identities.”

Inaugural issue of The Lancet Child & Adolescent Health

http://www.thelancet.com/journals/lanchi/issue/current

“The inaugural issue of The Lancet Child & Adolescent Health is now online, featuring new research on cyberbullying, HIV treatment, hand transplantation, and congenital Zika virus syndrome.”

Make sure you start by reading the Editorial - Child and adolescent health: greater than the sum of its parts.

“… Paediatrics and child and adolescent health, as a united body, are far greater than the sum of their parts. The Lancet Child & Adolescent Health is committed to giving a platform to these diverse but allied disciplines.” (i.e. paediatricians, adolescent medicine specialists, psychologists, social workers, educators, and crucially, the adolescents themselves….)

BMJ Global Health – Implementing the WHO Safe Childbirth Checklist: lessons from a global collaboration

WRG Perry et al; http://gh.bmj.com/content/2/3/e000241?cpetoc

“The WHO Safe Childbirth Checklist (SCC) was developed to ensure the delivery of essential maternal and perinatal care practices around the time of childbirth. A research collaboration was subsequently established to explore factors that influence use of the Checklist in a range of settings around the world. This analysis article presents an overview of the WHO SCC Collaboration and the lessons garnered from implementing the Checklist across a diverse range of settings….”

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Bloomberg - Why We Can’t Have the Male Pill

https://www.bloomberg.com/news/features/2017-08-03/why-we-can-t-have-the-male-pill

“A condom alternative could be worth billions. What’s taking so long?” Bet you also want to know, even if you’re not a man.

In-depth analysis & recommended.

Health Policy & Planning –Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review

G Chan et al;

https://academic.oup.com/heapol/article/doi/10.1093/heapol/czx098/4093363/Barriers-and-

enablers-of-kangaroo-mother-care

“Kangaroo Mother Care (KMC) is an evidence-based intervention that reduces neonatal morbidity and mortality. However, adoption among health systems has varied. Understanding the interaction between health system functions—leadership, financing, healthcare workers (HCWs), technologies, information and research, and service delivery—and KMC is essential to understanding KMC adoption. We present a systematic review of the barriers and enablers of KMC implementation from the perspective of health systems, with a focus on HCWs and health facilities….”

UNAIDS – New campaign launched to raise awareness about maternal health

http://www.unaids.org/en/resources/presscentre/featurestories/2017/august/20170807_maternal-

health

From early August. “Mediaplanet has [today] launched a new campaign to raise awareness about maternal health around the world. Created in partnership with UNAIDS and other international organisations, the campaign looks at a range of case studies on issues affecting pregnant women and mothers, and draws on insights from community health-care providers, as well as public health advocates.”

Access to medicines

FT health – Generic drugmakers feel pinch as prices crumble

https://www.ft.com/content/b27cee6e-8221-11e7-a4ce-15b2513cb3ff

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“Intensified competition hurts copycat pharma groups while buyers drive harder bargain”.

“If a company makes money by copying the inventions of others, is it entitled to skim a thick layer of cream off the top? That is the question on the lips of investors in generic drugmakers, after a torrid second quarter that resulted in billions of dollars being wiped from the market value of the biggest players — Israel’s Teva Pharmaceutical and Netherlands-based Mylan. …”

See also the last week’s FT Health Newsletter ’s intro - Tough times for generic drugs industry.

Globalization & Health –Merger mania: mergers and acquisitions in the generic drug sector from 1995 to 2016

M-A Gagnon et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-

0285-x

« Drug shortages and increasing generic drug prices are associated with low levels of competition. Mergers and acquisitions impact the level of competition. Record merger and acquisition activity was reported for the pharmaceutical sector in 2014/15, yet information on mergers and acquisitions in the generic drug sector are absent from the literature. This information is necessary to understand if and how such mergers and acquisitions can be a factor in drug shortages and increasing prices. » “…Data on completed merger and acquisition deals that had a generic drug company being taken over (i.e. ‘target’) were extracted from Bloomberg Finance L.P….”

Conclusion : « The recent blitz in mergers and acquisitions signals that the generic drug industry is undergoing a transformation, especially in the United States. This restructuring can negatively affect the level of competition that might impact prices and shortages for some products, emphasizing the importance of updating regulations and procurement policies. »

FT – GSK chief vows to stop ‘drifting off in hobbyland’ with R&D

https://www.ft.com/content/93055876-76cf-11e7-90c0-90a9d1bc9691

“Emma Walmsley (GSK’s new CEO) says UK drugmaker will introduce more commercial rigour.” Bodes ill for GSK’s global health activities, if you ask me. Greater emphasis will go to producing blockbuster drugs.

WHO Bulletin –Strategic procurement and international collaboration to improve access to medicines

A Ferrario et al; http://www.who.int/bulletin/online_first/BLT.16.187344.pdf?ua=1

“Efficient procurement of medicines should not be confined to a search for the lowest prices, as it needs to support the creation of a healthy market where products of good quality are available at

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affordable prices on a sustainable basis and at the right time. In this context, a strategic approach to procurement is vital. Such an approach should encompass all activities that might improve the efficiency of procurement – e.g. activities to minimize low-value repetitive purchases, increase the benefit of economies of scale and reduce transaction and transport costs. Here, we will provide examples of the experiences of countries in the World Health Organization’s European Region in improving the efficiency of procurement of medicines. We will also explain how international collaboration could help improve individual country’s efforts….”

IP-Watch - Malaysia Inclusion In Gilead Voluntary Licence – A Product Of Compulsory Licence Pressure

https://www.ip-watch.org/2017/08/24/malaysia-inclusion-gilead-voluntary-licence-product-

compulsory-licence-pressure/

“Gilead’s announcement today that they would include four middle-income countries (Malaysia, Thailand, Belarus, Ukraine) in their sofosbuvir voluntary licence was a welcome surprise, and will enable millions access to their highly effective, but exorbitantly priced, drug. The decision to include these countries, however, no doubt is a response to increasing pressure from within these countries to either issue a compulsory licence (CL) or a government use licence (GUL), invalidate the sofosbuvir patents, or block data exclusivity for the drug….”

See also Stat Plus – Under pressure, Gilead expands Sovaldi licensing deal to four middle-income countries “Under pressure to widen access to a pricey hepatitis C medicine, Gilead Sciences (GILD) has expanded a licensing deal that will allow generic companies to now sell lower-cost versions in four middle-income countries – Ukraine, Belarus, Thailand and Malaysia.”

Lancet Infectious Diseases (Newsdesk)– Essential medicines for hepatitis C: at what price?

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30465-6/fulltext

“Effective new hepatitis C drugs have been added to WHO's Essential Medicines List, but governments are struggling to afford them. Vijay Shankar Balakrishnan reports.”

And a quick link: (Reuters) India grants Pfizer patent on pneumonia vaccine in blow to aid group

“India has granted Pfizer Inc a patent for its powerful pneumonia vaccine Prevenar 13, in a blow to some health groups that said this would put the treatment out of reach of thousands in poorer nations. The decision by India’s patent office bars other companies from making cheaper copies of the vaccine and allows Pfizer to exclusively sell it in India until 2026. It’s a big victory for the U.S. drugmaker in a market that has the world’s largest number of pneumonia cases, a lung disease that kills nearly a million children a year globally. The decision also has international implications, as several poorer nations rely on India’s robust drugs industry to supply cheaper copies of medicines and vaccines….”

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Social determinants of health

For a nice social determinants of health visualization tool, see IHME.

And a quick link (Nature Microbiology) - Tapping Bollywood to improve sanitation in India

“A new movie called "Toilet - A Love Story" is making waves in India. It is a splendid example of how mainstream Bollywood movies can tackle pressing social and developmental challenges in the country.”

Human resources for health

WHO – Understanding National Health Workforce Accounts

http://www.who.int/hrh/documents/brochure_health_workforce_web_3.pdf?ua=1

16-pager.

Plos Med – Harmonization of community health worker programs for HIV: A four-country qualitative study in Southern Africa

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002374#abstract2

In a qualitative study, Jan-Walter De Neve and colleagues investigate how community health worker programs can be better integrated with the wider health systems in four countries in Southern Africa.

Miscellaneous

IISD – ILO Launches Global Commission on the Future of Work

http://sdg.iisd.org/news/ilo-launches-global-commission-on-the-future-of-work/

“The International Labour Organization has launched a high-level commission to address the future of decent and sustainable work opportunities and the challenges of delivering social justice in the rapidly transforming world of work in the 21st century. The Commission will consider issues relating to work and society, decent jobs for all, the organization of work and production, and the governance of work.”

The Commission will have its work cut out, to say the least. See for example:

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* “We need a (Marshall Plan) that places youth employment in Africa at the centre of development” (Thomson Reuters - Promise or peril? Africa’s 830 million young people by 2050)

* Tim Jackson in the Guardian - The future of jobs: is decent work for all a pipe dream?

“… Recognising the dangers, the International Labour Organisation (ILO) has launched a two-year Future of Work initiative running up to its own centenary in 2019, with a huge, wide-reaching agenda. It’s a timely endeavour. Enormous human consequences hang on it. But the statistics are salutary…. … “Decent work for all” is perhaps the most fundamental of the Sustainable Development Goals (SDG 8). But its delivery is looking increasingly like a pipe dream….”

Devex – Beijing's new partners: How China works with traditional donors

https://www.devex.com/news/beijing-s-new-partners-how-china-works-with-traditional-donors-

90667

Another trend: “In 2015, China and Australia quietly announced a landmark program to help tackle malaria in Papua New Guinea. Over three years, Australia would invest $4 million Australian dollars ($3.2 million), while China would provide technical assistance and an unspecified in-kind contribution. Working closely with Port Moresby, the program utilizes Australian and Chinese expertise to assist with the implementation of PNG's National Malaria Strategic Plan. As China continues to grow as a global power, so too does its footprint on the development sector. Its rise comes at a moment when the status quo is shifting in the aid industry. Traditional standard bearers such as the U.S. and EU may still drive the majority of funds and set the agenda, but protectionist policies and changing domestic priorities are setting in motion significant changes. Tentatively, but with increasing success, China has been partnering with countries such as Australia, New Zealand and the United Kingdom on third-country development projects. In doing so, they are shifting from donor-recipient relationships to partners in development….”

Devex – Pakistan's $100B deal with China: What does it amount to?

https://www.devex.com/news/pakistan-s-100b-deal-with-china-what-does-it-amount-to-90872

Important in-depth story, on Pakistan’s deal with China – and further evidence of the rise of China’s “aid”.

You might also want to read (Devex) - At Mekong Forum, a focus on US disengagement and China's rise (from early August)

Xinhua – Commentary: BRICS ready to play its role in global governance

http://news.xinhuanet.com/english/2017-08/06/c_136503530.htm

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Comment from earlier this month, more evidence that China wants to move from “BRICs to BRICS plus”. “… China does not want to limit future cooperation to the five nations. In March, Foreign Affairs Minister Wang Yi said that China would explore expansion modalities for "BRICS Plus" and build a wider partnership through dialogue with developing countries and international organizations. "BRICS plus" will provide opportunities for other economies and inject impetus into economic globalization, said the chief economist of the Eurasian Development Bank Yaroslav Lissovolik.”…”

Science – A bold open-access push in Germany could change the future of academic publishing

http://www.sciencemag.org/news/2017/08/bold-open-access-push-germany-could-change-future-

academic-publishing

“Over the past 2 years, more than 150 German libraries, universities, and research institutes have formed a united front trying to force academic publishers into a new way of doing business. Instead of buying subscriptions to specific journals, consortium members want to pay publishers an annual lump sum that covers publication costs of all papers whose first authors are at German institutions. Those papers would be freely available around the world; meanwhile, German institutions would receive access to all the publishers' online content. Consortia of libraries and universities in the Netherlands, Finland, Austria, and the United Kingdom have all pushed for similar agreements, but have had to settle for less than they wanted. In the Netherlands, for example, Elsevier—the world's biggest academic publisher—has agreed to make only 30% of Dutch-authored papers freely available by 2018, and only after a significant increase in the annual sum libraries pay. In Germany, too, an agreement with Elsevier seems elusive. But Germany's consortium, named Projekt DEAL, plans to hold firm, and it thinks a successful outcome could help trigger what some call a "big flip," a global transition toward open access. "If it works, it would be a model for the rest of the world," says one negotiator, mathematician Günter Ziegler of the Free University of Berlin….”

Washington Post - Trump says opioid crisis is a national emergency, pledges more money and attention

Washington Post;

News from earlier this month. Wonder when he’s gonna call his own presidency a national emergency actually.

For an update on this, see NYT : “Two weeks ago, in response to a reporter’s question, President Trump proclaimed that he considered the opioid crisis to be “a national emergency,” leading many news organizations to report that a national emergency had been declared. But the Trump administration, perhaps caught off guard by the president’s statement, has not yet taken the legal steps to give those words force.”

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IS Global - Cooperation and Knowledge: Where the Right Thing Is the Smart Thing

G Fanjuli; http://www.isglobal.org/en/healthisglobal/-/custom-blog-portlet/cooperacion-y-

conocimiento-donde-lo-correcto-se-encuentra-con-lo-inteligente/289262/0

“This is the first in a series of five posts written by Gonzalo Fanjul (ISGlobal) and Carlos Mataix (ITDUPM) and published in Spanish in Planeta Futuro-El País that will analyse the concept of Virtuous Circles in Cooperation and its importance for the future of Spanish development aid….”

CNBC: Secret team at Amazon is working on health care projects

https://www.engadget.com/2017/07/26/cnbc-1492-health-care-amazon/

The '1492' squad is reportedly looking at hardware and software. If you, like me, hate Amazon’s decent work “agenda” & winner-takes-all attitude ( “benefiting” mainly the very top of the company) as much as I hate Ryanair’s and Uber’s, there’s no doubt reason to be worried.

Guardian - Clinical trials revolution could change the future of medical research

https://amp.theguardian.com/science/head-quarters/2017/aug/24/clinical-trials-revolution-could-

change-the-future-of-medical-research

“With the stakes in clinical research so high, today sees the launch of a new and much-needed way of reporting clinical trials.” “…today one of these reforms takes hold for the first time in clinical medicine, … a new type of journal article called a Registered Report in which the journal commits to publishing clinical trials regardless of their outcome….”

WB (Investing in Health blog) - Finger Splints, Coding, Drones and R2D2: The Evolving Face of Technology and Development

http://blogs.worldbank.org/health/finger-splints-coding-drones-and-r2d2-evolving-face-technology-

and-development

For the “techies” among you.

And from the London School: Drones and phones: how mobile tech is fighting global diseases

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NPR Goats & Soda – Global Problems Aid Groups Should Prepare For, If They Want To Survive

NPR Goats & Soda;

Key messages from a July report on the Future of Aid: INGOs in 2030. The team of researchers came up with 23 areas of concern. And their message to INGOs is: adapt or die.

BMJ analysis –Mapping the drivers of overdiagnosis to potential solutions

http://www.bmj.com/content/358/bmj.j3879

“Thanya Pathirana and colleagues explore strategies to tackle the problem of too much medicine”.

Emerging Voices

Social Science & Medicine – Community Action for Health in India’s National Rural Health Mission: One policy, many paths

Rakhal Gaitonde (EV 2012) et al;

http://www.sciencedirect.com/science/article/pii/S0277953617304197

“Community participation as a strategy for health system strengthening and accountability is an almost ubiquitous policy prescription. In 2005, with the election of a new Government in India, the National Rural Health Mission was launched. This was aimed at ‘architectural correction’ of the health care system, and enshrined ‘communitization’ as one of its pillars. The mission also provided unique policy spaces and opportunity structures that enabled civil society groups to attempt to bring on to the policy agenda as well as implement a more collective action and social justice based approach to community based accountability. Despite receiving a lot of support and funding from the central ministry in the pilot phase, the subsequent roll out of the process, led in the post-pilot phase by the individual state governments, showed very varied outcomes. This paper using both documentary and interview based data is the first study to document the roll out of this ambitious process. Looking critically at what varied and why, the paper attempts to derive lessons for future implementation of such contested concepts.”

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Research

Book – Unprepared: Global Health in a Time of Emergency

Andrew Lakoff;

http://www.ucpress.edu/book.php?isbn=9780520295766

Probably a must-read. At least if you find the time… “Recent years have witnessed an upsurge in global health emergencies—from SARS to pandemic influenza to Ebola to Zika. Each of these occurrences has sparked calls for improved health preparedness. In Unprepared, Andrew Lakoff follows the history of health preparedness from its beginnings in 1950s Cold War civil defense to the early twenty-first century, when international health authorities carved out a global space for governing potential outbreaks….”

Global Health Health Affairs – A Voucher System To Speed Review Could Promote A New Generation Of Insecticides To Fight Vector-Borne Diseases

D Ridley et al; http://content.healthaffairs.org/content/36/8/1461.abstract

“Many in the scientific community are concerned about the potential increase in prevalence of insect-borne diseases such as Chagas disease, Chikungunya, dengue fever, malaria, and Zika in the United States and around the world. Beyond vaccines and drugs to prevent and treat these diseases, a comprehensive approach to fighting these diseases should include control of disease-carrying vectors, such as mosquitoes. Vector-control methods, such as using insecticides to treat bed nets and spray the walls of homes, have prevented millions of deaths from malaria. However, mosquitoes are becoming resistant to insecticides, and no new class of insecticides for vector control has been introduced in decades. We recommend the creation of a new type of incentive for the development and commercialization of safe new insecticides: a Vector Expedited Review Voucher, to be awarded to a sponsor that introduces a novel insecticide for public health use. The voucher could be redeemed to expedite registration of a second, more profitable, product by the US Environmental Protection Agency.”

Global Health Action – Are health and demographic surveillance system estimates sufficiently generalisable?

P Bocquier, P Byass et al; http://www.tandfonline.com/doi/full/10.1080/16549716.2017.1356621

“Sampling rules do not apply in a Health and Demographic Surveillance System (HDSS) that covers exhaustively a district-level population and is not meant to be representative of a national population. We highlight the advantages of HDSS data for causal analysis and identify in the literature the principles of conditional generalisation that best apply to HDSS. A probabilistic view on HDSS data is still justified by the need to model complex causal inference. Accounting for contextual

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knowledge, reducing omitted-variable bias, detailing order of events, and high statistical power brings credence to HDSS data. Generalisation of causal mechanisms identified in HDSS data is consolidated through systematic comparison and triangulation with national or international data.”

Global Health Action –Rebuilding research capacity in fragile states: the case of a Somali–Swedish global health initiative

A Ahmed Dalmar et al; http://www.tandfonline.com/doi/full/10.1080/16549716.2017.1348693

“This paper presents an initiative to revive the previous Somali–Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.”