Networking is not as easy as most people think. It actually requires a lot of bravery and courage. Still, there are different ways in which people network, and it’s important to play to your strengths.

First of all, when you are at a global (health) event and you aim to network, do not spend too much time with the people that you already know at the event. Say, for example, you attend an event with some people from your organization; in this case  you should try not to spend too much time with them. I understand that some people feel better when they are surrounded by people they know, but you need to get a bit out of your comfort zone in order to get those (new) contacts on your list. We often hear that ‘’we grow when we are out of our comfort zones’’, and there is some truth to that, including when it comes to networking and socializing at High-Level and other formal global health events.

On a good day, I consider myself to be a “professional networker”. Perhaps I’m not the CR7 or Leo Messi of networking, but I do have a fairly “decent game”, even if I say so myself.   A year ago I did an internship at the WHO with the Coordinated Resource Mobilization unit, on the same floor as the office of the – then brand new – DG, Dr Tedros. When I saw him for the first time, I was very excited. I introduced myself and made clear my ‘’intentions’’  which are  to invest the skills I gained during my internship at WHO around the globe and, hopefully one day work for WHO as I have always been passionate about global health.  Whether these top dogs eventually get back to me (or other youngsters) is another matter, that takes a bit of luck, I guess. At least I didn’t shy away from introducing myself to Dr Tedros. My motto in life is “to never give up” (a bit like Rick Astley), and trust me, that is also good advice when it comes to networking (although of course you shouldn’t start stalking people, like some sort of networking paparazzi : )).

Some people – the “naturals” – introduce themselves in a very social way. They may for instance go to a person and say things like ‘’I like your hair, the color of your suit/dress, or even lipstick’’ and just like that, they start a conversation! BUT is this always the right approach to networking and getting good contacts at more formal events? Well, I have my doubts and I  honestly don’t  know to what extent this strategy works out for people.  It is probably the right approach for Kim Kardashian, but I for one did not go up to Dr Tedros and say “Boy, do YOU have a nice moustache!”

After this more general advice, I would like to outline some techniques and tactics for networking at global health events. I was privileged to attend some events last year, as well as a few in 2018, and I have observed a lot of ways in which people get contacts.  As I mentioned before, it is not easy, in fact it takes some skill & some guts, and not necessarily in that order.

First things first, you should have a target group or person in mind. You must know what you want and how to go about getting it.  (A bit like in love, dare I say : ) ) I know this requires a lot of courage, but to paraphrase Nike’s motto, “Nothing is impossible”. Keep in mind that even Cristiano and Leo had to start somewhere.  A recent example perhaps, the first time I met with the Minister of Health from my country, Dr Aaron Motsoaledi, was during a session on BRICS at the 70^th WHA in 2017. I had targeted this event because I knew that he was going to be one of the main speakers. I wanted to introduce myself, so, after the session I went straight to him to do so. This was not easy – as you know Ministers and other officials are always in a hurry, and particularly so at these kinds of events. I told him who I am, where I come from, what I was doing then and what I would like to do in the future. Perhaps more than in the game of love, you should know how to “sell” yourself when you’re networking. If you don’t know how to do that, just watch Cristiano before he shoots a freekick.

Over the past few weeks I attended the WHA71 in Geneva, and just one week later, headed for Brussels to attend the European Development Days Conference. Personally I felt there was a bit of difference In terms of networking at the EDD conference and the WHA71.

Perhaps I should have done more research before the WHA (or specific sessions), as the event felt a bit overwhelming and intense. I felt a bit like the Germans in their first game at the World Cup – rusty, and not entirely up to the challenge (even if I wore my most fancy dress). It was not easy to approach people at the WHA71, and I tried to learn from more experienced networkers such as the Tony Kroos of the global health scene. At the EDD, on the other hand, there were a lot of young people with similar interests as me, still “trying to get there”. It was relatively easy for me to relate and ‘’hustle’’, and I definitely felt like a fish in water there.

Some more advice, don’t fake it, and don’t show any desperation while you are networking. It is good to make your intentions clear, but you should also take it slow and get to understand more about the work that you would like to do. Also, it does not hurt to ask the person you’re approaching to be your mentor, at least if you are genuinely interested in moving into the same field. In short, do some good research, know what you want and most importantly, do not bite more than you can chew.

One no-nonsense piece of advice to end with, it is important to understand that when you ask for a business card, you must have a safe place to put it. I mean sometimes people consider it rude if you take a business card and then put it in a (filthy) pocket. So make sure you have a safe place to store the card and of course always end with ‘thank you, I will be in touch  soon’ or words to that effect. In addition, if you are lucky to get the business card, don’t keep it for too long without communicating, it is recommended that you email the person after a day or two. In that case, you can also send your CV, depending on your motives. Give them a week or so, and if they don’t respond, perhaps send another email  as a follow up and reminder. Persistence pays with these people who are usually high-fliers, very busy and may not always have the time to respond to every email. After all, Cristiano & Leo are also not always available for an autograph! : )

As many in the TB community have already said, 2018 is a “Now or Never” moment for the fight against TB. If global leaders fail to do something substantial about this tragic disease after the UN HL meeting on TB, chances are that it will keep getting worse.

It breaks my heart to see so many people all over the world suffering from TB. Personally, I did not think that the disease was such a huge problem until 2009, when someone close to me told me that she had been diagnosed with TB. It was a difficult moment, and I have since gained an interest in the fight against the disease, because like many other diseases, it can lead to poverty as well as place a host of economic and social burdens on patients and their families.

The BRICS countries (Brazil, Russia, India, China, and South Africa) face a huge TB burden themselves: together they account for 46% of all incident cases of TB and 40% of all TB-related mortality. India alone has about 27 percent of the estimated global cases of TB, as well as a quarter of drug-resistant TB patients. Many of these TB patients or victims are young adults in their most productive years.  With all that in mind, and as a South African citizen myself, I am really counting on the BRICS countries to take decisive action that stops the disease in its stride.

On the 23^rd of May 2018, I attended a BRICS health ministers panel discussion at the WHA in Geneva. At the event, BRICS countries came together to reflect on the upcoming UN high level meeting on TB. The health minister of South Africa, Dr Aaron Motsoaledi, chaired the meeting, with other key participants being Mao Qunan, DG of Disease Prevention and Control Bureau, China; Gilberto Occhi, Minister of Health Brazil; Veronika Skvortsova, Minister of Health, the Russian Federation; J.P Nadda, Minister of Health, India; and of course Dr Tedros, a rather well-known gentleman by now I presume.

Dr Motsoaledi presided over the meeting, as the current president of BRICS. He stressed that the problem of TB is now beyond the ministers of health as there are many political, economic and social determinants of the disease. Hence, it is important for heads of state to attend the UN high level meeting on TB in person, he emphasized. He believes that with issues requiring a higher authority, involving heads of state could be a more efficient way of finding solutions and reflecting on the decisions that the UN high level meeting needs to make. This, I believe, is the kind of action that the BRICS countries could advocate as a global community to high level policy-makers, however, it remains unclear how they are going to mobilize heads of state to attend this meeting. The fact that the TB and NCD High-Level meetings follow each other closely in September, in New York, could be both an asset and a disadvantage. I can only hope they succeed, because as we all know, poor health in one part of the world has the risk of affecting us all, especially in this age of globalization.

Dr Motsoaledi also highlighted the need for countries to commit to spending 0.1% of their gross domestic product on TB research and development (i.e. one the five asks for heads of state, see below), and argued that current methods of approaching things must change if one is to hope for better outcomes.

Finally, he presented “the five asks” (see Project Syndicate for similar “TB asks” by Ditiu (Stop TB) & Sidibé (UNAIDS)) agreed upon by the BRICS, which heads of state should work towards:

• Reach all people by closing the gaps on TB diagnosis, treatment and prevention
• Transform the TB response to be equitable, rights-based and people-centered
• Accelerate development of essential new tools to end TB
• Invest the funds necessary to end TB
• Commit to decisive and accountable global leadership, including regular UN reporting and review

Dr Tedros, adding to this, emphasised the need for everyone to work together. Indeed, he stated that joint productive effort could lead to significant change, particularly in developing countries. Dr Tedros also insisted that the BRICS countries should be role models in the fight against TB, and highlighted the importance of working with the private sector to advance R&D.

China has committed to providing medical assistance and emergency medical aid to Belt and Road partners, in addition to providing support with regards to the management of major infectious diseases, including HIV, tuberculosis, and malaria. So there might be many TB related synergies too with the Belt & Road Initiative in the years to come.

India is certainly a key actor now in the global TB battle. The country is advocating for TB treatment to be seen as right. In March, during the 2018 Delhi End TB Summit, PM Modi set the bar high, as he called for all partners, public and private and the civil society, to work together towards ending TB in the world. The belief is that if India can be successful in ending TB, then globally the chances of eradicating the disease will also improve. As you probably recall, Modi committed to ending TB in India by 2025, 5 years ahead of (SDG) schedule. Let’s hope India can pull it off. Modi’s pledge certainly has injected new momentum in the global fight against TB.

I could tell from this side event that the BRICS countries are doing their best to assist each other, and also help other countries, and this makes me believe the world at large should not lose hope or give up the fight against TB. It is expected that at the UN high level meeting, the new and innovative strategies for combatting TB will be produced, and with the BRICS countries receiving technical input from other countries with better TB prevention & treatment results, they can really become inspirations for other countries within their continents which also have high burdens of the disease. One of the main challenges remains the identification of people who have been infected with the disease, particularly among populations who do not use conventional health services, for a variety of reasons.

With the 10^th BRICS meeting scheduled for July, in Johannesburg (SA), maybe we could even see a breakthrough in agreeing on a BRICS action plan, before the UN high level meeting kicks off in September. In a previous (2017) BRICS meeting, the BRICS Leaders Xiamen Declaration  specifically mentioned the need to improve the surveillance of TB and also agreed to set up a TB research network. If these action plans are indeed implemented, plus some others, BRICS countries could indeed take the lead on TB in the years to come.

As already mentioned above, it’s certainly now or never. But even if the UN HL meeting outcome were a bit disappointing,  or not the breakthrough hoped for by the TB community, not all hope is lost.

You never know; if per chance some nasty multi-resistant form of TB were to hit Mr Trump, that might also be a “game changer” in the global battle against TB ! : )

When I was in primary school, toilet paper was a luxury. Some people used newspapers as a substitute for toilet paper. But we couldn’t always afford to buy a newspaper, so some of us used stones, and sometimes soil. Although things have improved in many villages of my country, toilet paper is still a luxury in quite a few rural areas.

Teenage pregnancies in SA are  a threat to achieving the so called “unfinished business of the” MDGs. Teenage pregnancies are mostly reported in the rural areas. When young people start dating back home, their parents are usually not aware of it. In fact, teenagers are not allowed to discuss these things with their parents. Due to this lack of education about safe sex, plenty of teenagers put their health at risk with unsafe sex. If they actually have heard about contraceptives (in school, by coincidence or sheer luck), it’s also not easy for them to go to a clinic to request contraceptives in rural areas because the community is small, and most people fear that some nurses do not know how to be confidential. Also for some people, going to fetch the condoms from the clinics is anything but straightforward as they fear that they might be seen by others who know them and therefore make it public knowledge around the village. In short, most young people engage in unprotected sex.

If they fall pregnant, the health care they receive in this condition not really up to standard, particularly because some people try to hide their pregnancy before it shows due to fear for the community. This means that they take (too much) time before going for their check-ups in the clinics. As most of them are not educated enough about safe sex and safe abortions, they end up having many children that they cannot maintain.

Similarly, some people fear testing for HIV/AIDS because they worry that should they be found positive, the nurses may not be discreet about the outcome of the results and could go around telling other people about it. This also applies to those who are already on treatment and are meant to go to the clinics for ARVs etc. Some people end up not going for ARVs due to fear of being judged. Some of these people worry that their families will see the pills in the homes which could create a lot of discomfort and “not so cool“ moments.

It has also been reported that high school learners are a key population at high risk of HIV acquisition. Even more painful in this situation is that most of these learners are reported to be having sex in the bushes after school hours. There is no entertainment in most rural areas, so when you are dating, you and your partner just meet on the road since parents don’t really allow their children to date.  But kids still do it anyway, and when they meet, they can’t really go for movies or anything. And so they end up going to the bushes to sleep under a tree, or to the mountains. In fact, I remember my grandmother telling me that most of the teenage pregnancies were formed in the mountains and bushes, confirming that the learners had found a home in the bushes ..:. This I find very painful because the bushes are not safe and these kids put their health at risk. In addition, many girls have sexual partners who are older than them, sometimes much older, as most of them see it as a way of survival.  So called “blessers” and sugar daddies exist everywhere, including in the country side.

Against this rather dire backdrop, it is somewhat encouraging that adolescent health is increasingly a global priority. Better late than never, you might say. WHO and partners launched guidance to help countries improve adolescent health. Other global health stakeholders also focus more and more on adolescent health.

From the above picture, you get a sense why adolescent health in rural areas in LMICs should be a key focus. Adolescents are often neglected in health and social policies, and experience many troubles in accessing health services and information. In addition, many serious diseases in adulthood have their roots in adolescence. For example, drug use, sexually transmitted infections including HIV, poor eating and exercise habits, all lead to illness causing death later in life.

Adolescents in the countryside should not be overlooked, based on a wrong assumption that rural adolescents are more traditional & conservative than their peers in slums & cities. Teenagers are teenagers, anywhere in the world, and are bound to experiment. Governments and donors should really prioritise improving the health of adolescents by creating more platforms for education and after school activities. And yes, like anywhere else in the world, parents also need to be (more) involved.

Given SA ’s political and economic weight in the SADC and African Union (AU), the country plays an important leadership role on various global fora, ensuring in this way also that African countries have an active role in setting the global health agenda. In the past, SA has been invited to participate in G7 meetings, though rarely. This was made up by the country’s inclusion in the G20 and the BRICS club. Both are increasingly important in the global health governance architecture, and for South Africa’s global health influence, it’s thus a good thing to be part of them. Even more so now that Xi Jinping’s “Health Silk Road”  (in the slipstream of One Road, One Belt) seems to be taking off. Will be interesting to see whether South Africa can play a role as a broker in the coming years in Africa (together with Ethiopia and Rwanda perhaps), SA certainly seems well-positioned in “South-South” Co-operation. And with PEPFAR money less sure than before, to some extent Chinese funding might also come in handy. As for South-Africa’s role in WHO, by way of example, it is rumoured that SA (via former Pres. Zuma) was very influential in the strong AU support for Dr Tedros, and thus part of the reason for the victory of Tedros (the first African DG of WHO).

What about SA’s role then with respect to some of the major diseases in the region?

HIV/AIDS remains one of the greatest obstacles to achieving the SDG health goals in Sub-Saharan Africa. In the past, we have witnessed SA‘s strong leadership in HIV access as the largest single country contributing to the number of people on antiretroviral treatment globally (via its civil society groups, in partnership with the global advocacy movement). As you know, the current strong South-African (government) leadership on universal access to ARV treatment, and health care as a human right,  wasn’t always there, sadly, but it is a role model now for Africa, much like its civil society.

South Africa has also been a strong promoter for affordable medicines and has lead with resolutions and other activities to create and  improve  affordable medicines, especially for HIV/AIDS.  In addition, SA has contributed to lowering the cost of ARVs by about 50% for its domestic purchases. This helped other countries in Africa to also purchase at lower costs. SA has also been a strong advocate and taken leadership in the area of TB, advocating for activities and funding for TB and the  ‘STOP TB’ work internationally. It has also purchased large numbers of TBXpert kits (for TB diagnostics); these large purchases have helped reduce costs.

This country has also played a role in a number of key global responses , eg. more recently in initiating the Ebola resolution at WHO in 2015 and coordinating with other member states to push this process forward. Along with others, during the Ebola crisis in West Africa, the South African Cabinet committed close to $3 million to set up the first mobile P4 laboratories and also contributed safe suits to affected countries. The country also sent some health professionals to deal with the epidemic, and the  Ebola Response Fund, a joint initiative of the South African government and the private sector,  raised 1 million USD in cash and resources. This work eventually helped trigger the global programme on Health Emergencies at WHO which plays a vital role now in outbreaks.

In terms of assessed contributions, South Africa is also the biggest  African contributor, in line with the size of its economy. However, now that some of the former key donors from the West seem increasingly reluctant to continue to take the lead, perhaps South Africa (and other BRICS countries) could and should step up?

Some examples of SA’s (more regional) health diplomacy then, zooming in more on the SADC and SSA. End of April 2015 the South African Health Minister, Minister Aaron Motsoaledi, welcomed  delegates from across Sub-Saharan Africa to a three-day regional consultation on Global Health Sector Strategies for HIV, sexually transmitted infections (STIs) and viral hepatitis. Motsoaledi emphasized the importance of ensuring that the global strategies build on experiences and ideas from Sub-Saharan Africa – the region in the world most affected by HIV, STIs and viral hepatitis.

Malaria and HIV are major problems in the SADC and South Africa is playing an important role in joint efforts to tackle them. In  November 2017, Dr Aaron Motsoaledi  hosted  five other Ministers of Health from Angola, Botswana, Namibia, Swaziland and Tanzania at a commemoration held  under the theme “Strong cross border collaboration is key to malaria elimination”. This event involved several  activities including giving mosquito pesticide sprays to households and awareness activities on  preventing malaria. The Republic of South Africa is working with Mozambique and Swaziland through the MOSASWA (Mozambique, South Africa and Swaziland) Cross Border Malaria Initiative whose target  is to accelerate the transition from pre-elimination to elimination of malaria in Swaziland and South Africa and to accelerate from control to pre-elimination in southern Mozambique in order to achieve zero local transmission in Swaziland, South Africa and Maputo province by 2020.  Just a few days ago, the Financial Times reported on the “Elimination8 plan” , of which the aim is “to end malaria by 2020 in four so-called frontline states where transmission levels are already low — below 10 per 1,000. These are Botswana, Namibia, South Africa and Swaziland. Four higher-transmission, “second line” countries — Angola, Mozambique, Zambia and Zimbabwe, where transmission rates can climb as high as 400 per thousand — have until 2030 to get the job done.”

When it comes to UHC, a key target of health SDG goal 3, SA has released some major policies on National Health Insurance, although they are currently (still) being contested by private interests.  South Africa’s Minister of Health Aaron Motsoaledi is also  among the global advocates of UHC, at various international fora and flagship events.  If UHC were to work (well) in SA, no doubt that would propel the current UHC movement in Africa even more.    SA can also create a platform to work with other African Countries on policy implementation.

In many other ways, the health related challenges that South Africa faces (social determinants (cfr. the water crisis in Cape Town, situation in the slums, …); NCDs & tackling the commercial determinants of health (for example, Big Alcohol in Cape Town); not to mention planetary health, are challenges that most other countries in the world face, and certainly in SSA.  In many ways, you can say that South Africa is a key SDG battleground (for example when it comes to tackling its massive inequality). Hopefully, SA can also take the lead in Africa with respect to many of these new global health challenges. The recently introduced soda tax, a first in Africa, was certainly a nice start!

I can say without any fear of contradiction that the Global Health Watch launch was quite interesting and beneficial to me. Global targets are frequently set but rarely met, which motivates the need to look at both global concerns and local particularities. The economic consequences of poor health in many countries have been the centre of attention for many years, and the same is certainly true for me. I learnt a lot during the launch, and I found that I still have much to learn, even though most of the issues were not new to me. Below I will try to give some key message delivered by David McCoy, well known in global health circles and certainly among readers of this newsletter, in a keynote speech at the event. I will also give some of my own reflections in this regard.

First of all, it is important to understand why David McCoy said what he said at the launch. We are involved in a struggle for health (everyone ‘s health worldwide), he emphasized, and if we want to win this struggle we need to understand the issues and engage with them, in order to liberate ourselves.

McCoy started the discussion by providing a general history of the GHW-5 Report. The Report – the fifth edition already of the Global Health Watch report – is divided into five sections:  Political Economy; Health Sector; Beyond the Health Sector; Watching; Alternatives, Actions and Change. It focuses on what is happening in the field, on the ground, and at the global level.

McCoy made a very powerful statement about global inequality and emphasised the need to mobilize people’s health “movements” as problems of inequality within countries cannot be addressed without observing and taking into account global issues.

According to McCoy, a political economy of health highlights two fundamental matters, which he thus considers as the key challenges for global health in the 21^st century: 1) the state of global inequality and 2) ecological collapse. Inequality is a central issue that we need to address as a global health community because it lies at the heart of all the issues we face. It is often a question of inequality in terms of power and political influence, where power is concentrated in the hands of the few and so it causes moral, cultural, social and economic crises. Regarding ecological collapse, McCoy’s argument was that environmental degradation is already causing a number of vicious cycles. He also discussed food problems that we face over weather conditions and greenhouse emissions that we have failed to avoid, even after decades of scientific warnings.

McCoy devoted a great deal of attention to neoliberalism, which is one of the root causes of global health issues and challenges.  If we are to understand the struggle we’re in, we need to understand also what we’re up against, and thus have a firm grasp of neoliberalism, he emphasized.  Neoliberalism is not a science nor the natural human condition, rather it’s the belief that free markets are best for allocation of resources. McCoy also pointed out the ideas in neoliberalism that there is no limit, and that “greed is good” for the economy, presumably because wanting ever more stimulates economic growth. He made reference to two books, one of which was “A short history of neoliberalism by Susan George”  (1999). In this book, George describes neoliberalism as a doctrine that sees competition as the best way to improve society.

McCoy also mentioned  the importance of getting involved in democratic politics because according to him  for  global health to be improved, we need to redistribute wealth and power, and we need to constrain the destructive power of multinational corporations (MNCs) and private capital. The only way to do this is through politics, he emphasized. There is now so much power concentrated in few hands and we can see  evidence everywhere of democracy having been undermined. As an alternative, he said people  can change things through protest, boycotts, blockades, strikes, etc. This is how the suffragettes and civil rights movement kickstarted real change. And it is not inappropriate to draw parallels between apartheid South Africa and the current global political economy.

McCoy also argued for “Public-Public-Partnerships” which he defined as cooperative working arrangements between separate organisations that work in the public sphere or in the public interest. They can include government departments, publicly funded universities, public-interest NGOs and charities, a publicly funded press like the BBC, ombudsman bodies, etc. As you might have guessed, the term is designed to provide a counter-posing view to that of public-private partnerships (‘PPPs’). In his opinion, it’s vital to set up broad(er) alliances with organisations outside the health sector also, and try to change things on various global platforms and political venues (WTO, WHO, WB, IMF, G20, …). That’s where (part of) the real battle happens, rather than in ministries of health.

We shouldn’t be too romantic about government, he acknowledged, as most of the global inequalities that we see are in fact caused by governments. Also, public–public partnership does not mean that there shouldn’t be any partnerships with the private sector. But he stressed the focus should be more about shaping the way in which we think about politics. Human beings are susceptible to propaganda. This is how millions of dollars are being used. Therefore, education is very important; we have to be careful about media and the information we receive. It is important to engage citizens in political discussions. I concur with him; we need good people in politics and in parliament, and citizens really have to become ‘citizens’ again, not just consumers.

We must also think of the global community, he argued. He gave the example of Facebook, which has created a lot of global dis-community, and is creating divisions and groups. I don’t know whether Facebook’s creation of dis-community is deliberate or not, but McCoy did emphasize that we must form a positive global community for effective global governance.  As for how exactly to do that, he was a bit less clear.

David McCoy ended his keynote by stating that we need “public humanitarianism”, beyond medical humanitarianism. We have humanity and our common humanity must thus be used to strengthen our humanitarian public health. For this endeavour to be successful, we need to engage with political powers and also use education as a political action.

In conclusion, a few criticisms perhaps. It is very important to mention that we keep having similar conferences and seminars analysing the same issues as addressed by McCoy and other panellists at this event, but no substantial action ever seems to be taken afterwards. I admit that these movements, like the People’s Health Movement, are very critical and sharp in their analysis. However, they’re a bit weaker when it comes to solutions and ways forward.  A lot of what they say is very true, for example when it comes to the need to go back to our roots and rethink politics. Too often we consider politics as a ‘dirty game’. Yes, it is, I think,  a ‘dirty ‘ game because  bad people are in politics, and so we need (more) good people in politics to make a beneficial contribution to the struggles we face. In such a light, it is somewhat doubtful whether the People’s Health Movement is indeed a movement and not merely trying to be a movement.

I hope that real change is possible. I am hoping for change and I am hoping that we can create that global community for effective global governance. And let me end on this note: I strongly admire David McCoy’s continued fight for change, even if he admitted being a pessimist himself. Somehow this pessimism didn’t lead to cynicism, and that’s a lesson for all of us.