Nature (news) – Gloomy 1970s predictions about Earth’s fate still hold true
“Four decades ago, the Club of Rome predicted looming economic collapse in its iconic ‘Limits to Growth’ report. An update of the analysis sees much the same picture.”
Must-read (and act).
“…The latest version of the report — by researchers with the Stockholm Resilience Centre in Sweden and the Norwegian Business School in Oslo — used an Earth-system model that combines socio-economic and biophysical variables, alongside a wealth of historic and new socio-economic data, to draw up their conclusions….”
“To prevent human civilization from more environmental damage than it might be able to endure, the authors call on world leaders to consider more policies they deem unconventional. Only more extreme economic and behavioural changes than are currently being enacted will allow the world to achieve all 17 SDGs together, the authors say. These policies might include immediate transformation of energy systems, greater use of family planning to stabilize populations and actively encouraging more-even distribution of wealth so that the richest 10% take no more than 40% of income….”
Oxfam (blog) – Is flying the new smoking?
Pertinent question, not just for the aid community but also for academics. The article went viral which shows that the time has come to take this issue seriously.
For a poll on some possible ways to approach this issue, see also Duncan Green’s blog – Should aid workers and academics fly? Time to vote on the best approach, please.
Guardian – Leaders move past Trump to protect world from climate change
“Far too little is being done to protect people from the heatwaves, storms and floods being supercharged by climate change, according to a high-level international commission. It aims to rebuild the political will to act that was damaged when US president, Donald Trump, rejected the global Paris agreement. The Global Commission on Adaptation is being led by Ban Ki-Moon, Bill Gates and Kristalina Georgieva, CEO of the World Bank. It involves 17 countries including China, India, South Africa, Indonesia, Canada and the UK….”
The aim is to jump-start adaptation efforts.
“… The commission will produce a major report on adapting to climate change for the UN climate summit in September 2019, followed by a year of action to implement its recommendations.
… “Scientists and economists believe the cost of adaptation could rise to $500bn per year by 2050 and, in the mid-term, $300bn by 2030,” said Ban. This money is available, he said: “I don’t think it is a matter of [getting the] money. The money can be mobilised. If there is political will, I think we can handle this matter.”…”
40 years Alma Ata
All eyes will be on Astana, next week. Via UHC 2030: “The Global Conference on Primary Health Care in Astana, Kazakhstan, October 25-26, 2018 and the 40th Anniversary of the Declaration of Alma-Ata mark the momentum that is building towards ensuring comprehensive, integrated, rights-based and people-centered quality health care within reach of all people and prioritizing those most in need. “
At WHO, last-minute preparations (and adjustments of the draft) seem to be taking place, probably right till the meeting end of next week. Curious for the final result!
UHC 2030 – Call for CSOs to endorse a statement for the Global Conference on Primary Health Care
“…Civil society groups around the world are reflecting on this historic moment and are calling for bold action from governments, development partners, and fellow civil society actors to drive progress for social, physical and mental health for all. They want to make sure that the calls to action coming out of Astana have impact. So the UHC2030 Civil Society Engagement Mechanism (CSEM) facilitated an inclusive, consultative process to develop a civil society statement, and over 50 individuals, organizations and networks have so far contributed….”
As a reminder, others might want to endorse an Alternative Civil Society Astana Declaration on Primary Health Care
(signed by PHM, Viva Salud, Health Poverty Action, and many others already).
Below you find some of the supplements & special issues launched ahead of the Astana event:
The Lancet special issue on primary health care
“Primary health care is in crisis… Leadership after the Astana meeting is essential to rejuvenate and revitalise all aspects of primary health care.” – The Lancet special issue on primary health care marks 40 years since landmark Alma-Ata Declaration. Forty years since the Alma-Ata Declaration of 1978, global leaders will convene in Astana (Kazakhstan) on 25-26 October to renew their commitment to primary health care. In the lead up to the conference, The Lancet publishes a special issue on primary health care….” “…The aim is to renew political commitment from member states and global organisations to developing people-centred primary health care, building on the principles of the Alma-Ata Declaration….”
- Do start with the Editorial – The Astana Declaration: the future of primary health care?
- Then read the excellent Comments (among others from Tedros, Peter Hill – Primary health care and universal health coverage: competing discourses? (not really, according to Hill) – Nigel Crisp & Elizabeth Iro – Putting nursing and midwifery at the heart of the Alma-Ata vision ; …
You know this is an absolute must-read. (by D Watkins, G Yamey, …)
- Check out also the article by colleagues Yibeltal Assefa, Wim van Damme et al focusing on the lessons Ethiopia contains for other resource poor countries – Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in Ethiopia
“Weakness of primary health-care (PHC) systems has represented a challenge to the achievement of the targets of disease control programmes (DCPs) despite the availability of substantial development assistance for health, in resource-poor settings. Since 2005, Ethiopia has embraced a diagonal investment approach to strengthen its PHC systems and concurrently scale up DCPs. This approach has led to a substantial improvement in PHC-system capacity that has contributed to increased coverage of DCPs and improved health status, although gaps in equity and quality in health services remain to be addressed. Since 2013, Ethiopia has had a decline in development assistance for health. Nevertheless, the Ethiopian Government has been able to compensate for this decline by increasing domestic resources. We argue that the diagonal investment approach can effectively strengthen PHC systems, achieve DCP targets, and sustain the gains. These goals can be achieved if a visionary and committed leadership coordinates its development partners and mobilises the local community, to ensure financial support to health services and improve population health. The lessons learnt from Ethiopia’s efforts to improve its health services indicate that global-health initiatives should have a proactive and balanced investment approach to concurrently strengthen PHC systems, achieve programme targets, and sustain the gains, in resource-poor settings.”
- Health Policy article – Building the case for embedding global health security into universal health coverage: a proposal for a unified health system that includes public health (by N Erondu, R Marten, G Ooms, Rob Yates, …) (another must-read!!!)
“In the wake of the recent west African Ebola epidemic, there is global consensus on the need for strong health systems; however, agreement is less apparent on effective mechanisms for establishing and maintaining these systems, particularly in resource-constrained settings and in the presence of multiple and sustained stresses (eg, conflict, famine, climate change, and globalisation). The construction of the International Health Regulations (2005) guidelines and the WHO health systems framework, has resulted in the separation of public health functions and health-care services, which are interdependent in actuality and must be integrated to ensure a continuous, unbroken national health system. By analysing efforts to strengthen health systems towards attaining universal health coverage and investments to improve global health security, we examine areas of overlap and offer recommendations for construction of a unified national health system that includes public health. One way towards achieving universal health coverage is to broaden the definition of a health system.”
BMJ Global Health supplement – The Alma Ata Declaration at 40: reflections on primary health care in a new era
Most articles already appeared online before. With exception of this one:
Time to abandon amateurism and volunteerism: addressing tensions between the Alma-Ata principle of community participation and the effectiveness of community-based health insurance in Africa
By Valéry Ridde et al.
Summary: “Forty years after the 1978 Alma-Ata declaration, the second international conference on primary health care in October 2018 is expected to reaffirm the place of communities in health systems management and governance. In parts of Africa, community-based health insurance (CBHI)—with communities at the centre—is still seen as a strategy for achieving universal health coverage (UHC)—but there are tensions between the Alma-Ata principle of community participation, as currently interpreted, and CBHI. The tension relates particularly to the community’s role in terms of the voluntary nature of CBHI membership and volunteer involvement of the community in governance and management—this tension requires a rethink of the role of communities in CBHI. We use examples of Rwanda, Ghana, Mali and Senegal to demonstrate the challenges associated with the place of communities in CBHI, and the need to reduce the role of community volunteers in CBHI and instead focus on professionalising management. Countries that still wish to rely on CBHIs for UHC must find ways to make populations enrolment compulsory, and strengthen the professionalisation of CBHI management, while also ensuring that communities continue to have a place in CBHI governance.”
Lancet Global Health – November issue
This issue focuses on quality primary care.
- Make sure you start with the Editorial – Adding quality to primary care
“There is a word missing from the 1978 Declaration of Alma Ata: a close examination reveals that “quality”, the adjective, does not appear in it. True, the stated definition of primary health care includes the notions of practicality, scientific soundness, and social acceptability, all elements of quality when referring to the provision of health care. But the omission of the actual term could almost be taken as a foretelling sign of what happened in the four decades following the Alma Ata conference—the attainment of Health for All through community-led and participative primary health care did not come as a natural evolution for most health systems, and most importantly, health-care delivery suffered from such deficiencies that poor-quality care ultimately became a more formidable obstacle to reducing mortality in low-income and middle-income countries than insufficient access to care.
What has endured is the clearest legacy of Alma Ata—the necessity of strong, resilient primary care services. This legacy has become particularly crucial in the context of the current quest for universal health coverage. And attached to it almost systematically now, and even mentioned twice in the wording of Sustainable Development Goal 3.8, is the term “quality.” In this issue, Margaret Kruk and her colleagues of The Lancet Global Health Commission on High-Quality Health Systems in the SDG Era demonstrate that it is high time to let the word truly sink into the collective mind and the concept permeate the discourse around health systems.
… As Keely Jordan shows in a Comment retracing the place given to quality in global policy documents over the last 20 years or so, while equity and access used to take precedence over quality, the need for people-centred care is slowly surfacing, a notion in line with patient empowerment, a requirement for quality of care identified by the Commission. …”
Then go on and read at least:
- Where is quality in health systems policy? An analysis of global policy documents (by K Jordan, R Marten, M Kruk et al)
- Assessment of quality of primary care with facility surveys: a descriptive analysis in ten low-income and middle-income countries ( new research article by Erlyn Macarayan (EV 2014) et al)
Health Affairs (blog) – Three More Billboards On The Long Road To Global Quality Health Care
Thomas Bollyky et al; Health Affairs;
Wonderful blog, and not just if you have watched “Three Billboards outside Ebbing, Missouri”. One of the must-reads of the week.
“In the past several months, the global health community has published three reports on the poor quality of health care in low- and middle-income nations. That issue is a long-unresolved concern with roots that extend back at least 40 years, to the Alma Alta declaration and its call for “essential health care based on practical, scientifically sound and socially acceptable methods. . .made universally accessible to individuals and families. . .at a cost that the community and country can afford.” The three reports this year—by the World Health Organization (WHO), the World Bank, and the Organization for Economic Cooperation and Development (OECD) in July; by the National Academy of Sciences, Engineering, and Medicine (NASEM) in August; and by the Lancet Global Health Commission on High-Quality Systems in the SDG Era (HQSS Commission) in September—revive this demand for quality care in poorer countries. These reports agree on the terrible consequences of poor quality care, which include millions of unnecessary deaths and trillions of dollars in economic costs annually. … “
“…Unlike McDormand’s character in the movie, however, these three latest reports on global quality of care are careful not to place blame or demand accountability from any particular actor for the lack of progress—there are few “How come, Chief Willoughby?” moments….”
The blog authors argue that the three reports have learned the first lesson from Alma Ata, but perhaps not the second lesson: “…the need to examine and confront the likely constraints, challenges, and opposition that have prevented implementation of quality universal health care. “
10th World Health Summit & Grand Challenges Annual meeting (14-16 resp. 15-18 October, Berlin)
This week’s Featured article by Deepika Saluja already gave you some info on some of the main highlights & key messages. Among which, “Together we are strong”.
Below an overview of links, statements, coverage, analysis, …
Statements, Declarations, reports & plans
M8 Alliance statement – “Health is a driving force for the sustainable development goals.”
“The rich discussions at the World Health Summit in 2018 lead us to highlight the need for action in six key areas of global health: 1. Commitment to support the SDG 3 action plan for health and wellbeing; 2. Commitment to support the global move to Universal Health Coverage; 3.Commitment to a global health agenda that builds on the universal right to health; 4. Commitment to ensure Global Health Security; 5. Commitment to investing in science and technology; 6. Commitment to address violence and sexual exploitation as a public health issue. …”
WHO – Global Action Plan for healthy lives and well-being for all: a historic commitment to unite for health
This is the first stage, a commitment by heads of agencies to work together to define a common vision, commit to an initial set of actions and define accelerators and milestones. (for a quick summary doc, see here ).
Phase 2 starts now (October 2018-September 2019), a broad consultation with stakeholders in countries, regions and globally. In Phase 3, September 2019 and beyond, the plan will be launched formally.
Reuters – International aid saves 700 million lives but gains at risk: report
On a new ONE report.
“International aid financing and innovation has helped to save nearly 700 million lives in the past 25 years, but those gains could be lost if momentum and political will wane, global health experts said on Monday. A report by international aid advocacy group the ONE Campaign said the progress against preventable deaths and diseases since 1990 could stall, and even go into reverse, unless donor governments make new commitments to innovation and action….”
For more detail on this report, and its recommendations, see the report: Empowered Citizens, Empowered Systems: A Radical New Plan for Global Health
See also Devex: “… According to the United Nations Development Programme, achieving SDG 3 on good health and well-being for all will require an additional $371 billion per year by 2030. To remedy this, the advocacy organization suggests donors, governments, and philanthropic organizations “mobilize more money for health and deliver more health for the money.” Its key recommendations include low-income countries increasing their health spending to $112 per person; new country donors such as China stepping up to invest; reassessment of the Abuja Declaration, a 2001 commitment on health financing for the African Union countries and donors; and testing of new financing models…..”
Coverage of the WHS & Grand Challenges meeting
Merkel played a ‘home match’ in front of a very multilateral crowd that cheered her on, at the joint keynote of the WHS/Grand Challenges on Tuesday evening: “Angela Merkel has urged countries to work together in the fight against global health threats, warning that disease and epidemics are security risks that do not respect national borders. Addressing international health experts in Berlin, the German chancellor acknowledged that global cooperation was under pressure, but said nations cannot ignore health challenges….”
Recommended – on the opening plenary & setting the scene for the whole week in Berlin: Ten years after establishing the Berlin World Health Summit, the M8 alliance of medical institutes around the globe sees some noticeable progress in political commitment to the health agenda. “Gifts” presented at the opening ceremony yesterday in the German capital include the announcement of German Health Minister Jens Spahn to establish a Hub for Global Health and step up its financial contributions to the World Health Organization (WHO) to 115 million euros over the next four years. The three-day summit also will receive a global action plan to catch up with the United Nations Sustainable Development Goal (SDG) 3 on health and well-being for all….”
“Answering the call by German Chancellor Angela Merkel, Ghana’s President Nana Addo Dankwa Akufo-Addo and Norway’s Prime Minister Erna Solberg for a global action plan for pushing global health, heads of 11 major health organisations today signed “a commitment to find new ways of working together to accelerate progress towards achieving the United Nations’ Sustainable Development Goals” at the close of the World Health Summit in Berlin. The Action Plan was necessary, according to German Health Minister Jens Spahn (HPW, United Nations, 15 October 2018) in order to avoid falling behind on fulfilling the health-related targets of the United Nations 2030 Sustainable Development Agenda. Supported by UN Secretary General Antonio Guterres and presented in Berlin by World Health Organization Director General Tedros Adhanom Ghebreyesus, the Action Plan attempts to avoid fragmentation and duplication of work of the signatory organisations.
… Despite the announcement today and a number of new commitments made by the German government, activist and development organisations are not satisfied with the World Health Summit. The German development organisation “Bread for the World” on the last day of the summit in a blog post criticised the dominance of big pharmaceutical companies at the Summit….”
Sometimes German sounds lovely: World Health Summit, großer Name und nix dahinter?
Could be a strong diagnostic tool, but there are still many concerns on whether it’ll be useful.
Excerpt: “… On Tuesday, at a meeting in Berlin, the Bill and Melinda Gates Foundation announced a new training scheme for clinicians around the world. The foundation will bring successful applicants to the Chan Zuckerberg Initiative’s research center in San Francisco so they can learn how to use IDseq from DeRisi’s team. Each clinician will get a backpack-size sequencer, a year’s worth of chemical reagents, and technical support so they can start doing sequencing in their home countries. DeRisi’s grand plan is to turn IDseq into a common dashboard, shared by disease detectives around the globe. If enough people use it, they could theoretically start spotting the movements of diseases across borders, the emergence of new illnesses, or the spread of drug-resistant strains. …”
Lunch session – WHO sets the global health agenda? The increasing role of venture philanthropies in Global Health: Win-win situations or conflicts of interest with and for the WHO?
For the (4 p.) Discussion paper, see Philanthrocapitalism in global health and nutrition: analysis and implications
“This discussion paper is an executive summary of a forthcoming article by Nicoletta Dentico (Health Innovation in Practice) and Karolin Seitz (Global Policy Forum).”
“Over the last two decades, the philanthropic sector has grown in terms of the number of foundations, the size of their annual giving, and the scope of their activities. Spending concentrates on certain selected areas, especially health, education, and nutrition. Civil society organizations, scientists, and the media have finally started to devote more attention and research to the growing influence of philanthropic foundations in global development, in particular with regard to the influential members of philanthrocapitalism. Through their grant-making, personal networking and active advocacy, large global foundations play an overwhelmingly active role in shaping the global development agenda and in setting the funding priorities for international institutions and national governments alike. A new discussion paper by Nicoletta Dentico and Karolin Seitz presents major areas of concern in particular with regard to the arena of global health and nutrition and formulates recommendations to political decision-makers.”
Op-Ed by Peter Sands, ahead of the WHS.
Sands made quite an impression at the WHS, certainly on me. I understand a bit better his position/paradigm now on the need for global health to engage more with the private sector (including, from my vantage point at least, still the alcohol sector, ahum) : )
See also an interview with Sands in the Telegraph – What global health experts could learn from bankers Focusing on the need for (more) speedy data collection (on infectious diseases), a topic he elaborated on in Berlin.
The wry joke of the WHS, for me at least, was when Sands called for more ‘global solidarity’ (instead of the current global health framing in vogue which focuses more on Global Health Security). Knowing his background (banker), people from all over the world hit by the financial crisis and its aftermath must no doubt have found this stance ‘comforting’.
As for Bill Gates, seeing him on a stage (at the joint keynote event) made it clear to me that this man is, indeed, fascinated by innovation (in all respects). For better, in most cases, (and, in some cases, also for worse).
Some analysis of the Global Action plan, Germany as a new global health powerhouse, …
Blog – Elevating Global Health to the UN Security Council
Excellent blog by K Polin & R Dhatt, related to Germany’s entrance to the UN Security Council & the role it could play there in terms of global health. “Focusing on global health in the Security Council could unite its members and support Germany’s aim to reform its “two-class” structure. To ensure that this goes beyond political maneuvering and has an impact, Germany should increase funding to health systems and broaden the discussion to include other issues such as non-communicable diseases and human rights at the Security Council.”
Medium – How Germany Can Take the Lead in Global Health
Chris Elias & Trevor Mundel (Gates Foundaiton) https://medium.com/@ChrisJElias/how-germany-can-take-the-lead-in-global-health-b51d8b17ab4f
Focus here on the role Germany could play in global health R&D.
“…the Gates Foundation is engaging with CureVac AG and BioNTech, two German biotechnology companies that are pioneering new ways to make vaccines. They use the body’s own administered mRNA, the molecules that turn genetic information into proteins. The implications of mRNA vaccines are enormous: They could be developed quickly, perhaps fast enough to respond to a serious infectious disease outbreak like Ebola. Plus, they would be cheap….”
“German Minister of Education and Research speaking at #Grandchallenges event in Berlin – highlighting new Global AMR R&D hub. “
“Fantastic news: the London School of Hygiene and Tropical Medicine @LSHTM will now have a presence in #Berlin #Germany led by @johanefeld” (PS: the Wellcome Trust, Gates Foundation,… are doing the same)
“Couldn’t agree more with @JeremyFarrar closing comment – we need to shift the center of gravity in #GlobalHealth to Africa, India – places where the research is used. #GrandChallenges”
“Germany will provide half billion Euro’s for coordination of #AMR over the next years #WHS @BMBF_Bund”
“This is NOT a @who action plan – presently it’s a venture of 11 organizations and it will include many more actors in the next phase! @DrTedros said clearly that now it is about dialogue and reaching out. #SDG3 #SDG3ActionPlan”
“This could be big for #globalhealth, but let’s see how much donors drive for focus on impact vs merely commitment/process. @OIEAnimalHealth & @WMO should be part of the commitment, to encompass #OneHealth and #climate dimensions (but we’ll get there)”
“The M8 Alliance has announced Makerere as the winner of the bid to host the African Regional @WorldHealthSmt 2020 -The First in Africa. I congratulate our committed staff and the Mak College of Health Sciences for the job well done.”
Some early analysis of Global Action plan
BMJ Global health blog – Toxic masculinity: a poor excuse for poor global health
S Fisseha & M Hildebrand (from Global Health 50/50) https://blogs.bmj.com/bmjgh/2018/10/16/toxic-masculinity-a-poor-excuse-for-poor-global-health/
“… The proposed text falls in to the same trap that Global Health 50/50 an initiative that has analysed the gender policies of 140 leading global health organizations has identified. It equates gender equality with a women’s empowerment agenda, and paying scant, if any, attention to what gender means to health outcomes across the whole of society. Empowering women to decide freely on all matters related to their health, including their sexual and reproductive health and rights, is critical. Nevertheless, global health urgently also needs to conceptually and programmatically understand gender as one of the most significant social determinants of health for everyone – women, men, boys, girls and people with non-binary identities….”
- There was also some commotion on the lack of attention for NCDs in the (stage 1) Global action plan, but this, I think, is partly due to the fact that the document looks like a hasty job. Anyway, a few tweets on this issue:
Robert Marten – “The #SDG3 Road Map mapped 3.1-3.3 and 3.7-3.8, but did not map 3.4 (#NCDs) and 3.5 (substance use). Why not? Seems difficult to call this a roadmap for SDG3. It seems more of a #MDG+#UHC roadmap. http://www.who.int/sdg/global-action-plan/Global_Action_Plan_Phase_I.pdf …”
Katie Dain – “Unbelievable! Just been alerted by colleagues at #WHS2018 that draft #GlobalActionPlan on SDG3 completely misses #NCDs in framework for action?? Is that a mistake or a strategic decision to leave out no. 1 cause of mortality & morbidity worldwide? @WHO”
Overall analysis of NCD & TB UNGA HL meetings in New York
HPW – An Expert View: After The UN High-Level Meetings On TB, NCDs, What Happens Next?
Must-read. Alternatively, you can also listen to the webinar mentioned again.
“The United Nations late last month sought to hold landmark high-level meetings on ending tuberculosis and fighting noncommunicable diseases like cancer and cardiovascular disease, with mixed results. Now a Swiss-based expert is looking at the outcomes and what comes next, and in a webinar talked about the political trade-offs resulting from the meetings, the need to push for an integrated agenda on Universal Health Coverage, and how the private sector should be engaged.
The webinar, entitled “Two Weeks After: The UNGA and its HLMs – What next?,” was organised by the Global Health Centre of the Graduate Institute of Geneva on 11 October, and featured Ilona Kickbusch, director of the centre, as the respondent. Kickbusch, a former World Health Organization official at various levels, was recently elected co-chair of UHC2030, a multi-stakeholder platform to promote universal health coverage. She was at the UN General Assembly throughout the week. A recording of the webinar is available here.”
Some other links to analysis:
By Robert David Newman (and also recommended)
Mario Ottiglio on LInkedin – Beyond the UN Summit on non communicable diseases: So what?
“… An immediate thought is that the NCD community would seriously benefit from a Gates Foundation-type organization, a (big) global player able to move the needle and operate organically across the NCD value chain. … This is more relevant when it comes to national implementation – since it is there where stories need to emerge. There is a desperate need to continue making national investment case when it comes to NCDs (important for the next WHO NCD Plan). … … Finally, the upcoming global debate on the decade of healthy aging could become a very important springboard for NCDs. … In industrial democracies, there are already more over 60 than under 15; globally we reach that point in 2020, when the WHO will declare 2020–30 The Decade of Healthy Aging and when a new NCD Global Action Plan should be launched. “
UNFPA report – All countries need to strengthen health systems, reproductive rights, UNFPA report says
“Continued progress on decreasing fertility rates and family size is dependent on health systems providing universally accessible reproductive health services, according to the United Nations Population Fund 2018 “State of the World Population: The Power of Choice: Reproductive Rights and the Demographic Transition” report. Family size is closely linked with reproductive rights, which are then tied to many other rights, such as employment and health — and no single country can claim that all of its citizens have full access to reproductive rights at all times, according to the UNFPA report released on Wednesday.”
See also UN News – World population set to grow another 2.2 billion by 2050: UN survey.
Ebola outbreak DRC – not a PHEIC (but this should not be read as an encouraging signal…)
WHO – Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo
You probably already know by now what’s been decided, but in case you want to have the full detail on the reasons why. Among others, WHO thinks there’s no added value (in a PHEIC) as the international response is already quite impressive. Having said that, for example, WHO’s contingency fund for emergencies’ pockets are not full…
See WSJ – “The World Health Organization called for an intensified response to a worsening Ebola outbreak in the Democratic Republic of Congo, including more assistance from United Nations peacekeeping troops…, and more resources …” but stopped short of declaring a global public health emergency. “
Coverage & analysis:
Science – Ebola outbreak in Congo is not yet international emergency
“The deadly outbreak of Ebola that’s been stubbornly defying containment efforts in the northeastern Democratic Republic of the Congo (DRC) for more than 2 months does not rise to what’s known as a Public Health Emergency of International Concern (PHEIC). That’s the conclusion of an emergency committee convened by the World Health Organization (WHO) that has reviewed the outbreak….”
Not everybody agreed, though:
“…Jeremy Farrar, who heads Wellcome Trust in London, issued a statement that a spokesperson said emphasizes the seriousness of the situation without questioning the committee’s conclusion. “Many of the elements are there to make this a public health emergency of international concern,” Farrar said. “Declaring this could have released more resources, including finance, health care workers, enhanced security and infrastructure—as well as more international political support.”…”
And the same goes for Larry Gostin (see Stat News coverage):
“Professor Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown, said he believed the committee made the wrong call. Declaring a PHEIC would have led to the mobilization of more resources, he said. In particular, Gostin said the response teams in this outbreak need additional protection, functioning as the response teams are in a conflict zone. “The WHO has neither the mandate nor the expertise to deal with security threats,” Gostin said. “The United Nations needs to train and deploy peacekeepers in support of a public health mission. Without security protection, conflicts and public distrust will propel this Ebola outbreak, and threaten public health responses in the future.”…”
We bet many of you will want to read Laurie Garrett’s take (Foreign Policy ) – Welcome to the First War Zone Ebola Crisis “The world thought it knew how to deal with Ebola outbreaks—but it’s never dealt with one like this before.”
Latest situation report (via Cidrap news) – More Ebola cases reported from Beni, WHO update covers more ‘red zone’ risks
“The WHO is concerned about recent cases from a ‘red zone’ that is close to internally displaced person camps.”
And a quick link: Ebola experts from CDC were pulled from outbreak zone amid security concern.
Trump embraces foreign aid to counter China’s global influence
NYT – Trump embraces foreign aid to counter China’s global influence
“President Trump, seeking to counter China’s growing geopolitical influence, is embracing a major expansion of foreign aid that will bankroll infrastructure projects in Africa, Asia, and the Americas — throwing his support behind an initiative he once sought to scuttle. With little fanfare, Mr. Trump signed a bill a little over a week ago that created a new foreign aid agency — the United States International Development Finance Corporation — and gave it authority to provide $60 billion in loans, loan guarantees, and insurance to companies willing to do business in developing nations…”
Corporate power needs to be reined in
Independent – Majority of the world’s richest entities are corporations, not governments, figures show
“Corporations account for 157 of the 200 largest entities on the planet, according to a list compiled by Global Justice Now.”
… Campaigners are calling for the treaty to be legally enforceable at a national and global level. The UK, which currently sits on the UN human rights council, has traditionally been hostile to the treaty, which is supported by Ecuador, South Africa and a number of other developing countries….
Nick Dearden, director of Global Justice Now, said the vast wealth and power of corporations is at the heart of global problems including inequality and climate change. “The drive for short-term profits today seems to trump basic human rights for millions of people on the planet,” he said. “
Some other links along more or less the same lines:
(Lovely) blog by Nick Dearden related to a new UNCTAD report – “Power, Platforms and the Free Trade Delusion”.
“A blacklist of 21 countries whose so-called “golden passport” schemes threaten international efforts to combat tax evasion has been published by the west’s leading economic thinktank. Three European countries – Malta, Monaco and Cyprus – are among those nations flagged as operating high-risk schemes that sell either residency or citizenship in a report released on Tuesday by the Organisation for Economic Cooperation and Development (OECD) The Paris-based body has raised the alarm about the fast-expanding $3bn (£2.3bn) citizenship by investment industry, which has turned nationality into a marketable commodity….”
Fourth session of the Open-ended Intergovernmental Working Group to draft a binding treaty to regulate multinationals and other businesses (Geneva, 13-20 October)
“From 13-20 October 2018, the fourth Session of the Open-ended Intergovernmental Working Group to draft a binding treaty to regulate multinationals and other businesses [will be] held in Geneva. As determined in the last session, the President of the Working Group will present the recently published Zero Draft of the UN Binding Treaty for discussion.”
Check out a related Policy brief (South Centre) – https://www.southcentre.int/policy-brief-56-october-2018/
“The release of the Zero Draft of the Legally Binding Instrument to Regulate, in International Human Rights Law, the Activities of Transnational Corporations and other Business Enterprises by the Chairperson of the Open-ended Intergovernmental Working Group on Business and Human Rights (OEIGWG), is likely to revive discussions on the recognition of corporate entities as subjects of international law. The present brief examines corporate entities’ human rights obligations in the context of the Zero Draft, taking into account the views and comments presented during the first three sessions of the OEIGWG and the need to advance the discussion on those entities’ obligations under international law.”
For a related blog (by M S R Subashinghe), see Let’s seize the opportunity to ensure a strong, international binding treaty on business and human rights.
And a tweet:
“Great success today of our Press Conference in @UNGeneva. From the streets and the territories to the institutions and the global conversation. The time for a #BindingTreaty that regulates transnational corporations has arrived. Join us to #StopCorporateImpunity”
Liverpool HSR symposium
With some reflections on the 4 key themes and some cross-cutting reflections.
“The Liverpool Statement calls on leaders, donors and the research community to broaden and expand foreign and domestic investment in the field of health policy and systems research, particularly for building capacity in LMICs and opportunities for embedded research. Funding must align with national priorities, but provide opportunities for broadening how research agendas get set in ways that are open to innovation and inclusive of marginalised voices.”
WHO 2018 symposium on health financing for UHC (Tuesday 9 October, Liverpool)
Short report of the one-day meeting, and also all presentations.
Quick link with some coverage on the opening plenary: #MeToo movement resonates at global health systems research conference
Finally, for the ones who want to know how I look back on the incident related to a previous IHP intro, see Short Liverpool epilogue (on IHP).
Lancet Planetary Health (October issue)
“The Institute for Health Metrics and Evaluation (IHME) held a workshop in Seattle (March 1 and 2, 2018) to plan a new Initiative—the Global Burden of Disease (GBD)-Pollution and Health Initiative—to increase knowledge on the contributions of pollution and climate to the GBD study.
…The concept of the Initiative originated from the 2017 Lancet Commission on pollution and health
…The challenges confronting the GBD-Pollution and Health Initiative are formidable. Nonetheless, we believe that this Initiative is timely and that by leveraging the GBD study’s enormous global influence, the Initiative’s findings will inform low-income and middle-income countries on how to pursue the Sustainable Development Goals while avoiding the health and environmental tragedies that have plagued past development….”
Annual IMF/WB Bali meetings – more (overall) analysis
Devex – 5 takeaways from the World Bank meetings in Bali
Recommended. On climate change; China & debt sustainability; Human Capital; Accountability; Private finance.
(PS: the World Bank is currently undertaking a study of the Belt and Road Initiative to better understand where risks and opportunities lie so that the latter might be maximized while guarding against the former…)
- Eurodad analysis – Annual Meetings round-up: As uncertainty reigns in the global economy, there are strong calls for a rethink of Fund and Bank policies
“With the country still reeling from the devastation of the Sulawesi tsunami, Indonesia played host to the Annual Meetings of the International Monetary Fund (IMF) and World Bank Group (WBG), in Bali last week. The sobriety of the moment was reflected in gloomy forecasts from the IMF, which issued stark warnings of debt and trade risks to global growth. Meanwhile, controversy surrounded the World Bank’s new Human Capital Index; the 2019 World Development Report; and the ‘private finance first’ approach at the core of the Bank’s Maximising Finance for Development. CSOs and academics raised their voices to shine a light on the risks that the policies of the Bretton Woods Institutions (BWIs) posed to human rights and sustainable development across the Global South. Eurodad presented new research on the harmful impacts of Public-Private Partnerships and on IMF loan conditionality, and facilitated dialogue on better creditor coordination to solve debt crises.”
- Check out also Bretton Woods Project – Annual Meetings Wrap-up: ‘Headwinds’ overshadow Bali holiday
“Downside risks materialise as crises loom; As climate change bites, Bank continues incremental progress; MFD, WDR, EPG and GCI: Can you spell instability? The Human Capital Project: What human rights and state obligations? Bali: Imposed silence beyond the gilded halls.”
End Poverty Day (17 October) & analysis of new WB report
WB report: Poverty and Shared Prosperity 2018
“The Poverty and Shared Prosperity series provides a global audience with the latest and most accurate estimates on trends in global poverty and shared prosperity. The 2018 edition — Piecing Together the Poverty Puzzle —broadens the ways we define and measure poverty. It presents a new measure of societal poverty, integrating the absolute concept of extreme poverty and a notion of relative poverty reflecting differences in needs across countries. It introduces a multi-dimensional poverty measure that is anchored on household consumption and the international poverty line of $1.90 per person per day but broadens the measure by including information on access to education and basic infrastructure. Finally, it investigates differences in poverty within households, including by age and gender. ”
For the WB’s press release, see Going Above And Beyond To End Poverty: New Ways Of Measuring Poverty Shed New Light On The Challenges Ahead.
“With nearly half the world living on less than $5.50 a day, a new World Bank report introduces new tools to help countries better identify the poor and implement policies to improve living standards.”
The Conversation – Why the World Bank’s optimism about global poverty misses the point
Brilliant analysis. Excerpts:
“… World Bank poverty estimates have come in for a lot of criticism. For example, Jason Hickel, an anthropologist at the London School of Economics, has pointed out that there’s often a large gap between national poverty lines and the international poverty line stipulated by the bank. If we are to have a serious debate about world poverty on End Poverty Day, we have to start by acknowledging that the global problem of poverty is far more extensive than World Bank rhetoric would have us believe. Two big factors need to be confronted. The first is that the majority of the world’s poor live in countries that have experienced strong economic growth. The second is that the growth strategies these countries have practised create and reproduce poverty. For example, more than 55% of South Africa’s population lives below the country’s upper poverty line, of R1,138 (USD$80) a month. But, according to the World Bank, only 18.85% of the South African population lives in poverty. This suggests that the international poverty lined touted by the World Bank systematically underestimates the extent of global poverty….
This point is partially acknowledged in this year’s report. Accordingly, the World Bank proposes new and higher poverty lines – USD$3.20 and USD$5.50 a day, respectively. According to the report, almost half the world’s population lives below the USD $5.50 a day poverty line. However, we need to go further than this – indeed, the World Bank’s widely touted story of historically low poverty levels must be rejected. … In his recent book Global Poverty, development economist Andy Sumner shows how a new geography of poverty has emerged in the global South.
Whether we use monetary estimates – Sumner uses a poverty line of $2.50 a day – or estimates of multidimensional poverty; that is, poverty measured according to health indicators, education levels, and economic standards of living – as many as 70% of the world’s poor currently live in what the World Bank refers to as middle-income countries. “
“… This pattern of development clearly shows how poverty is a matter of distribution that is related to the kind of employment opportunities that are created when southern countries are embedded in global value chains. The factory jobs that are established when transnational corporations set up shop in countries like Mexico or Vietnam are fundamentally precarious. And it is precarious workers who capture the least of the value that is created in global production networks. This is why precarious workers live in poverty in middle-income countries in the global South….”
For more optimistic analysis of the new WB poverty measurement methodology, see:
M A Lugo (on the WB’s ‘Let’s talk Development’ blog) – Why the World Bank is adding new ways to measure poverty
F Ferreiro (on the same WB blog) – A richer array of international poverty lines
Analysis of World Bank report on future of work: World Development report 2019: the Changing Nature of Work
ILO expresses concern about World Bank report on future of work
“Following the publication of the World Development Report 2019 on ‘The changing nature of work’, the ILO questions the approach to some key issues addressed in the publication.” “….we remain concerned about the WDR’s approach to labour market institutions, regulations, the informal economy and social protection, and its lack of consideration of the gender dynamics of the changing nature of work. In addition, where we may agree with certain observations in the WDR, we find that the analysis and policy solutions fall short of a comprehensive approach to reducing inequality….”
See also the Guardian – Oxfam criticises World Bank for backing deregulated labour markets
“Aid charities and trade unions have denounced a World Bank report that advises some of the poorest countries in the world to accept the demands of multinational corporations to hire and fire workers and remove laws protecting workers’ rights. Oxfam said the report’s main message was that governments should abandon labour market regulation and rely instead on low levels of welfare to prevent workers falling into extreme poverty. With poor countries facing the twin threats from large corporates unwilling to negotiate with trade unions and young start-ups insisting on casual labour arrangements, Oxfam said the World Bank appeared to offer labour market deregulation as the only way to prepare countries for the changing nature of work….”
PS: Joe Kutzin qualified, in one respect, on Twitter: “Appears that @WorldBank #WDR2019 report recommends delinking of social insurance from employment. If this is the case (at least for the health part), then congratulations. Wage-based health insurance is a 19th century artifact that is ultimately inconsistent with #UHC”
Devex – Bill Gates to Europe: ‘Stay generous’ on aid to stop US cuts
“Bill Gates entered the debate over the European Union’s next seven-year budget Wednesday, telling a packed meeting of the European Parliament’s development committee that maintaining high levels of EU aid would prevent budget cuts in Washington. “In terms of U.S. foreign aid, as long as Europe stays generous, I believe there is a bipartisan consensus where the U.S. overall it may cut a few things, but the overall level I believe will be maintained,” Gates told European parliamentarians, researchers and aid advocates in Brussels. “The [U.S.] Congress has a longer timeframe, what I would call a more responsible view of cooperation, than the current executive branch position.”…”
Annual AidWatch report (CONCORD)
Devex – EU aid dips as least-developed still forgotten: AidWatch report
“…The latest edition, published Wednesday, offers a different perspective on the 2017 aid data released by the Organisation for Economic Co-operation and Development. CONCORD argues that spending on refugees and international students within the donor country, tied aid, interest repayments on concessional loans, debt relief, and future interest on cancelled debts should not be counted as official development assistance. The report found the amount of European aid “inflated” in this way was 19 percent in 2017, or about €14 billion ($16.20 billion), down from 22 percent in 2016. CONCORD attributed the decrease largely to a 10 percent drop in aid spent on refugees in donor countries, and an 82 percent drop in debt relief….”
“… For CONCORD, this partly means pushing for more support to least-developed countries. “As the EU, we think we are the champion on the 2030 Agenda [for Sustainable Development], and leaving no one behind is a key principle,” De Fraia said. Yet Europe is still well short of the U.N. target of 0.15 percent of GNI going to LDCs by 2020 and 0.20 percent by 2025. The report found that between 2014-2016, 0.11 percent of ODA from the EU institutions and member states went to LDCs. Only a handful of EU donors, such as Belgium, Ireland, and Sweden, featured seven or more LDCs in their top 10 ODA recipients….”
“De Fraia said the growing emphasis on private sector investment was partly to blame, as companies are reluctant to invest in risky environments. …”
Aid & #MeToo
Guardian – Global register set up to keep criminals out of aid sector
“The UK is to help launch a global register of dangerous criminals with the aim of preventing them finding their way into the aid sector, in the wake of the aid abuse scandal, it has been announced. As the international development secretary Penny Mordaunt prepared to address a conference on Thursday on abuse within the sector, Whitehall officials confirmed the government planned to put £2m into the first year of a five-year the pilot scheme. The project will be run with Interpol and the Association of Chief Police Officers’ criminal records office and will cost a total of £10m, Mordaunt’s department, the (DfID), said on Tuesday evening….”
See also Devex – Could a global register of aid workers prevent sexual abuse? and the Independent – Global list of sex predators in the foreign aid sector to be launched.
Guardian – Penny Mordaunt confronted on stage by protester over failings on aid sex abuse
“Penny Mordaunt was dramatically confronted on stage by a protester who accused her of failing to give women a voice at a conference on sex abuse in the aid sector. Alexia Pepper De Caires, a whistleblower and former Save the Children employee, approached the minister while she was delivering her speech in London on Thursday….”
“… Mordaunt apologised to Pepper De Caires on stage and, alluding to a scathing attack on the summit contained in an open letter sent to her by campaign group Code Blue on Wednesday, offered the platform to the protester and her colleagues. Mordaunt, who also said it would be appropriate if Pepper De Caires and her colleagues were given the closing slot at the summit, said: “I’m sorry, I wasn’t aware of the specific issue with Code Blue until today.”…”
On the International Safeguarding Summit in London, see also Devex – “… The summit kicked off with the controversial announcement that a charity currently under investigation — Save the Children — will play a key role in a new register of aid workers. The register will be piloted in Asia and Africa in an effort to prevent perpetrators of sexual misconduct from moving around the sector. Save the Children is currently under investigation by the U.K. charity regulator for its handling of sexual harassment allegations, and is not bidding on contracts from the U.K. Department for International Development until the investigation is complete. As she announced the register, U.K. aid chief Penny Mordaunt was interrupted on stage by campaigner Alexia Pepper de Caires, a high-profile activist and Save the Children whistleblower. De Caires said she was “disgusted” to learn “that Save the Children would be awarded a headline project to try and tackle sexual misconduct in the sector when they are still under investigation by the Charity Commission themselves….”
For more info on the International Safeguarding Summit (held in London on Thursday), see https://www.gov.uk/government/topical-events/safeguarding-summit-2018
PS: encouragingly, as some of you might already have noticed, the #MeToo Movement Gathers Force In India (NPR Goats & Soda).
United Nations agencies call for ban on virginity testing
“Virginity testing — a gynecological examination conducted under the belief that it determines whether a woman or girl has had vaginal intercourse — must end, says UN Human Rights, UN Women and the World Health Organization (WHO). In a global call to eliminate violence against women and girls everywhere, this medically unnecessary, and often times painful, humiliating and traumatic practice must end….”
Statement made at the World Congress of Gynecology and Obstetrics in Rio de Janeiro.
Fyi – The FIGO World Congress of Gynecology and Obstetrics is the single largest global congress on maternal and infant health, bringing together obstetricians, gynecologists and related health professionals from around the world.
Another tweet related to this conference: “The FIGO Committee on Pregnancy and Non-Communicable Diseases launched the Global Declaration on Hyperglycemia in Pregnancy today at #FIGO2018.”
Access to Medicines
HPW – “The People’s Prescription”: New Report Calls For Value Creation Instead Of Value Extraction In Pharmaceutical R&D
“A new report, “The People’s Prescription: Re-imagining health innovation to deliver public value,” calls for restructuring research and development innovation systems to create, rather than extract, value. It also calls for long-term “mission-oriented” public investment, and a public return on this investment. “Health innovation is about making new treatments and cures available to the people that need them. Profits might be earned but not at the cost of doing what the health system is meant to do: heal,” Mariana Mazzucato, professor in the Economics of Innovation and Public Value at University College London (UCL), and director of UCL’s Institute for Innovation and Public Purpose, said in the introduction of the report. The People’s Prescription: Re-imagining health innovation to deliver public value was released today, 15 October, and is the result of a collective effort between Mazzucato through the UCL Institute for Innovation and Public Purpose, and STOPAIDS, Global Justice Now and Just Treatment, according to the report press release. The report will be officially launched on 17 October in London….”
BMJ (News) – Drug companies are incentivised to profit not to improve health, says report
For more on this new report, see also this BMJ news article: “Government funding for health innovation is subsidising drug industry profits while providing little public health benefit, a report from leading health economists says. Most new drugs are not meeting public needs while economic and regulatory incentives have created a “highly inefficient pharmaceutical sector” which spends more on marketing than research and development, and focuses the research it does do on profits, the report explains….”
“… The report suggests a number of ways health innovation funding could be reformed to ensure the public gets more benefit from the research it pays for. As a first step it proposes “delinking” the cost of research and development from the price of any resulting product. Research would be paid for by governments through a combination of grants, subsidies, and rewards for successful achievement of milestones set according to public health priorities. … … Other suggested reforms include attaching conditions to public funding….”
Lancet Offline – The fetishisation of “global”
Having been to perhaps a few too many global health events, Richard Horton (one of the few planetary health travellers on this planet) begins to have doubts about “the fetishisation of the “global”. Global summits. Global campaigns. Global actions. What is this idea of the “global”?…”
He dwells in this Offline among others on the important work of the The Lancet Commission on Global Mental Health and Sustainable Development, co-chaired by Vikram Patel and Shekhar Saxena, launched at a recent Summit. “… A decade of campaigning has made mental health a core priority for the international health community. The Lancet Commission’s goal is to accelerate action on mental health. But it does so not by repeating old messages. Instead, the Commission aims for a radical reappraisal of mental health. It situates mental health as foundational for sustainable development. It defines mental health as a continuum rather than a binary. As Vikram Patel noted, when we talk about mental health, “we are talking about ourselves”….”
It’s mainly Irene Agyepong’s recent Lancet lecture that gave him some doubts on the fetishisation of global. She concluded: “…The trajectory towards UHC cannot be taken for granted, she warned. If grand global goals are to be realised, country demand, ownership, leadership, institutions, ideas, interests, and resources are essential. The principle global goal should be to catalyse human capacity building in countries. Global commitments mean little unless they take account of the domestic challenges faced by country policy makers. Above all, she urged global health leaders to “resist the gold rush lure of fix-all, global technological magic bullets”. ”
Lancet Series – Terrorism and health
“Terrorist attacks present a major challenge to society, placing governments, citizens, infrastructure, and health systems under acute pressure. This Series of papers commissioned jointly by The Lancet Infectious Diseases and The Lancet Psychiatry reviews the history of terrorism and mental health, and preparedness planning for biological and nuclear incidents. It provides a balanced, practical approach on necessary steps for the prevention of incidents, preparation, management of response, and communication of vital information regarding necessary actions and risk to the general public.”
Forecasting future health
Lancet – Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories
“Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health scenarios, highlighting a need for a more robust modelling platform from which policy options and potential health trajectories can be assessed. This study provides a novel approach to modelling life expectancy, all-cause mortality and cause of death forecasts —and alternative future scenarios—for 250 causes of death from 2016 to 2040 in 195 countries and territories.”
Interpretation of the results: “With the present study, we provide a robust, flexible forecasting platform from which reference forecasts and alternative health scenarios can be explored in relation to a wide range of independent drivers of health. Our reference forecast points to overall improvements through 2040 in most countries, yet the range found across better and worse health scenarios renders a precarious vision of the future—a world with accelerating progress from technical innovation but with the potential for worsening health outcomes in the absence of deliberate policy action. For some causes of YLLs, large differences between the reference forecast and alternative scenarios reflect the opportunity to accelerate gains if countries move their trajectories toward better health scenarios—or alarming challenges if countries fall behind their reference forecasts. Generally, decision makers should plan for the likely continued shift toward NCDs and target resources toward the modifiable risks that drive substantial premature mortality. If such modifiable risks are prioritised today, there is opportunity to reduce avoidable mortality in the future. However, CMNN causes and related risks will remain the predominant health priority among lower-income countries. Based on our 2040 worse health scenario, there is a real risk of HIV mortality rebounding if countries lose momentum against the HIV epidemic, jeopardising decades of progress against the disease. Continued technical innovation and increased health spending, including development assistance for health targeted to the world’s poorest people, are likely to remain vital components to charting a future where all populations can live full, healthy lives.”
Read also the related Lancet Comment – Major strides in forecasting future health
Some key journal (and other) articles of the week
Review of International Studies – President Donald Trump as global health’s displacement activity
Sophie Harman & Sara Davies; https://www.cambridge.org/core/journals/review-of-international-studies/article/president-donald-trump-as-global-healths-displacement-activity/171E5289240708B11F78AB23EEBDD74D#.W8BjYbteAak.twitter
“The United States presidential election of Donald Trump in 2016 was observed by global health commentators as posing dire consequences for the progress made in global health outcomes, governance, and financing. This article shares these concerns, however, we present a more nuanced picture of the global health governance progress narrative pre-Trump. We argue that Trump’s presidency is a displacement activity to which global health’s pre-existing inequalities and problems of global health security, financing, and reproductive health can be attributed. Unfettered access to sexual and reproductive rights, sustained financing of health system strengthening initiatives, affordable medicines and vaccines, and a human security-centred definition of global health security were already problematic shortfalls for global health governance. Trump no doubt exacerbates these concerns, however, to blame his presidency for failings in these areas ignores the issues that have been endemic to global health governance prior to his presidency. Instead of using Trump as a displacement activity, his presidency could be an opportunity to confront dependency on US financing model, the lack of a human-security centred definition of global health security, and the norm of restricting reproductive health. It is such engagement and confrontation with these issues that could see Trump’s presidency as being a catalyst for change rather than displacement as a means of preserving the uncomfortable status quo in global health. We make this argument by focusing on three specific areas of US-led global health governance: reproductive health and the ‘global gag rule’, health financing and the President’s Emergency Plan for AIDS Relief (PEPFAR), and pandemic preparedness and global health security.”
Globalization & Health – Donor financing of human resources for health, 1990–2016: an examination of trends, sources of funds, and recipients
Angela E Micah, Joseph Dieleman et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0416-z
“Skilled health professionals are a critical component of the effective delivery of lifesaving health interventions. … … In response, more international development agencies have provided funds toward broader health system initiatives and health workforce activities in particular. Nonetheless, estimates of the amount of donor funding targeting investments in human resources for health activities are few. We utilize data from the Institute for Health Metrics and Evaluation’s annual database on development assistance for health….”
“…We find that the amount of donor funding directed toward human resources for health has increased from only $34 million in 1990 to $1.5 billion in 2016 (in 2017 US dollars). Overall, $18.5 billion in 2017 US dollars was targeted toward human resources for health between 1990 and 2016. The primary regions receiving these resources were sub-Saharan Africa and Southeast Asia, East Asia, and Oceania. The main donor countries were the United States, Canada, Australia and the United Kingdom. The main agencies through which these resources were disbursed are non-governmental organizations (NGOs), US bilateral agencies, and UN agencies.
“…In 2016, less than 4% of development assistance for health could be tied to funding for human resources. …”
BMJ Global Health – Mind the costs, too: towards better cost-effectiveness analyses of PBF programmes
Y-Ling Chi, Kalipso Chalkidou et al; https://gh.bmj.com/content/3/5/e000994
Short summary: “The evidence surrounding the cost-effectiveness of performance-based financing (PBF) is weak, and it is not clear how PBF compares with alternative interventions in terms of its value for money. It is important to fill this evidence gap as countries transition from aid and face increasing budget constraints and competing priorities for the use of their domestic resources. In conducting cost-effectiveness analyses of PBF, researchers should be mindful of the identification, measurement and valuation of costs and effects, provide justification for the scope of their studies, and specify appropriate comparators and decision rules. We also recommend the use of a reference case to lay out the principles, preferred methodological choices and reporting standards, as well as a checklist.”
Nature (Editorial) – The best research is produced when researchers and communities work together
“Knowledge generated in partnership with the public and policymakers is more likely to be useful to society and should be encouraged.”
Was widely retweeted this week.