UHC HL meeting: update

HPW - UHC Declaration: Countries Object Over Sexual & Reproductive Health, Migrants & Refugees

https://www.healthpolicy-watch.org/uhc-declaration-countries-object-over-sexual-reproductive-health-migrants-refugees/ “Negotiations over a planned United Nations political declaration on universal health coverage (UHC) reopened last week after about a dozen countries reportedly objected to language in the final draft covering two sensitive issues – sexual and reproductive health and rights (SRHR) and the health needs of migrants, refugees, internally displaced persons and indigenous peoples. The United States was one of the 10-14 countries posing objections, sources told Health Policy Watch, after negotiations over the draft were closed on 24 July. The draft was then put under a “silence procedure” for five days, a period in which countries may file objections to effectively reopen debate. “We regret to inform you that the silence procedure has been broken by several delegations on paragraphs 29, 68, 69, 70 and 71,” the Ambassadors of Georgia and Thailand, co-facilitators of the UN High-Level Meeting on Universal Health Coverage, wrote in a 29 July letter to the president of the UN General Assembly, María Fernanda Espinosa Garcés. As of Monday, 5 August, it remained unclear which other countries besides the US had broken the silence procedure, and over which paragraphs. But time is now running out for negotiators to reach agreement on the declaration, which will be the focal point of the 23 September UN High-Level Meeting on Universal Health Coverage, bringing heads of state and other political and health leaders to the UN in New York….” See also a tweet from Ilona Kickbusch: “This clearly was to be expected - these are the really hot issues for some countries. It is also standard negotiating tactics now - wait until negotiations are nearly finished and then say you can’t accept #healthdiplomacy.”

The Lancet journals announce diversity pledge and no “manel” policy

Lancet (Comment) – The Lancet Group's commitments to gender equity and diversity By the Editors of the Lancet Group. Cfr the Press release: “As part of the Lancet Group’s commitment to increasing gender equity, diversity, and inclusion in research and publishing, all of the publishing group’s 18 medical journals have adopted a new Diversity Pledge and No All-Male Panel Policy. At the same time, the Group reports progress on improving the representation of women scientists and clinicians on their journals’ editorial advisory boards. The initiatives are outlined in [this] commentary (Comment) written by the editors of the Lancet Group, which states that they value diversity in all its dimensions and support the need to improve the inclusion in research and publishing of people across gender, ethnicity, geography, and other social categories. Dr Richard Horton, Editor-in-Chief of The Lancet, says: “We recognise that publication is a chief currency within science, medicine, and public health. It is key to the ability of women and people of colour to contribute, receive recognition, and accrue the experience, visibility, and achievement to compete for advancement. As editors and journals, we are just one part of an ecosystem that includes academic institutions and funders where gender bias is well-documented, and of a broader society that disadvantages certain groups to create an uneven playing field. But we are committed to be the change we want to see, and to playing our part in helping create diversity and inclusion in health research and publishing. We encourage other publishers, journals, and members of the science community to contribute to these pledges.” As part of the Lancet’s own commitment, all 18 Lancet Group journals committed to refreshing their editorial advisory boards to include at least 50% female members. … …  The new diversity pledge commits to further increasing the representation of women and colleagues from low-income and middle-income countries among the journals’ editorial advisers, peer reviewers, and authors. … The new no all-male panel policy states that Lancet editors will not serve as panellists at events with no women on the panel (“manels”). For events the Group sponsors or organises, the aim will be for at least half of any panels to be women (included as panellists, not only as chairs or moderators)…. “

Social Science & Medicine – “I don't see gender”: Conceptualizing a gendered system of academic publishing

Jamie Lundine, D Balabanova et al; https://www.sciencedirect.com/science/article/pii/S0277953619303739 In this article, the authors document research conducted at the London School of Hygiene & Tropical Medicine, with health science editors regarding addressing gendered inequities in health science publishing. Their findings suggest a need for explicit equity policies for journals and publishers. Some of the main messages: “Journal editors equate ‘blinding’ with objectivity in editorial processes. ‘Blinding’ masks social and structural inequities in and outside editorial processes. Our findings suggest a need for explicit equity policies for journals and publishers. Other suggestions include establishing quotas and tracking self-reported equity data.”

Dengue epidemic in the Philippines

Guardian - Philippines declares epidemic after dengue fever kills more than 600

https://www.theguardian.com/world/2019/aug/07/philippines-declares-epidemic-after-dengue-fever-kills-more-than-600 “An outbreak of dengue fever in the Philippines has been declared a national epidemic after causing hundreds of deaths this year in the wake of a government ban on the vaccine. The country has recorded 146,062 cases of dengue from January through to 20 July this year, 98% more than the same period in 2018, the department of health said. The outbreak has already claimed the lives of 622 people. The group worst affected have been children below the age of 10….” “…Health minister Francisco Duque said the government was studying an appeal to allow Dengvaxia back in the Philippine market, but ruled out using the drug to combat the ongoing epidemic which has hit small children the hardest. “This vaccine does not squarely address the most vulnerable group which is the 5-9 years of age,” Duque said. The vaccine, now licensed in 20 countries according to the World Health Organization, is approved for use for those aged nine and older. Duque said the United Nations agency also advised Manila that the vaccine was “not recommended” as a response to an outbreak, adding that it was “not cost-effective” with one dose costing a thousand pesos ($20)….” See also Medicalxpress - Philippines rejects dengue vaccine as outbreak leaves hundreds dead. And see this link from the Telegraph - A ‘perfect storm’: the steady rise of dengue fever worldwide “Dengue outbreaks are spreading across the globe thanks to a “perfect storm” of climate change, rapid urbanisation and intercontinental travel, experts have warned….”

Extreme water stress

Guardian - Extreme water stress affects a quarter of the world's population, say experts

https://www.theguardian.com/global-development/2019/aug/06/extreme-water-stress-affects-a-quarter-of-the-worlds-population-say-experts?CMP=twt_a-global-development_b-gdndevelopment “A quarter of the world’s population across 17 countries are living in regions of extremely high water stress, a measure of the level of competition over water resources, a new report reveals. Experts at the World Resources Institute (WRI) warned that increasing water stress could lead to more “day zeroes” – a term that gained popularity in 2018 as Cape Town in South Africa came dangerously close to running out of water. Qatar, Israel and Lebanon were ranked as the most water stressed countries in the world, with Badghis in Afghanistan and Gaborone and Jwaneng in Botswana the world’s most water-stressed regions. … … Twelve of the 17 high-risk countries were in the Middle East and North Africa….” Still, it’s not only a doom & gloom report:  “…The picture is alarming in many places around the globe, but it’s very important to note that water stress is not destiny. What we can’t afford to do any longer is pretend that the situation will resolve itself,” See also NYT - A quarter of humanity faces looming water crisis (with some neat maps of the world) And a quick link:   'Land of bachelors'? In parched central India, no water means no wife (Thomson Reuters) “Across rural Bundelkhand, parents are dismissing marriage proposals for their daughters, as water shortages leave local men hard-up and their wives facing a harsh life.”

New IPCC report (with focus on food & management of land) & other Planetary Health news

For the new IPCC report, see Climate Change and Land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems.

Guardian - Climate crisis reducing land’s ability to sustain humanity, says IPCC

https://www.theguardian.com/environment/2019/aug/08/climate-crisis-reducing-lands-ability-to-sustain-humanity-says-ipcc Coverage of the report. “The climate crisis is damaging the ability of the land to sustain humanity, with cascading risks becoming increasingly severe as global temperatures rise, according to a landmark UN report compiled by some of the world’s top scientists. Global heating is increasing droughts, soil erosion and wildfires while diminishing crop yields in the tropics and thawing permafrost near the poles, says the report by the Intergovernmental Panel on Climate Change.  Further heating will lead to unprecedented climate conditions at lower latitudes, with potential growth in hunger, migration and conflict and increased damage to the great northern forests. The report, approved by the world’s governments, makes clear that humanity faces a stark choice between a vicious or virtuous circle. Continued destruction of forests and huge emissions from cattle and other intensive farming practices will intensify the climate crisis, making the impacts on land still worse….” See also the NYT - Climate change threatens the world’s food supply, United Nations warns Economist - The IPCC land-use report:  Gloom from the climate-change front line. But not complete doom, if people behave sensibly. BBC News - Plant-based diet can fight climate change - UN Looks like I’ll have at last have to become a vegetarian. Tough. Tough.  In any case, cutting down on meat and dairy products is now official UN advice (also with a view on climate change).

Guardian - We must change food production to save the world, says leaked report

https://www.theguardian.com/environment/2019/aug/03/ipcc-land-use-food-production-key-to-climate-crisis-leaked-report This was a leak from last week on the IPCC report. “…Attempts to solve the climate crisis by cutting carbon emissions from only cars, factories and power plants are doomed to failure, scientists will warn this week. A leaked draft of a report on climate change and land use, which is now being debated in Geneva by the Intergovernmental Panel on Climate Change (IPCC), states that it will be impossible to keep global temperatures at safe levels unless there is also a transformation in the way the world produces food and manages land….”

Guardian –How the world’s dirtiest industries have learned to pollute our politics

G Monbiot; https://www.theguardian.com/commentisfree/2019/aug/07/fossil-fuel-lobby-pollute-politics-climate-crisis?CMP=Share_iOSApp_Other Monbiot is always good for the “bleak read of the week”. “…The tragedy of our times is that the gathering collapse of our life support systems has coincided with the age of public disservice. Just as we need to rise above self-interest and short-termism, governments around the world now represent the meanest and dirtiest of special interests. In the United Kingdom, the US, Brazil, Australia and many other nations, pollutocrats rule….” Worse, “…But in many nations, governments intervene not to protect humanity from the existential threat of fossil fuels, but to protect the fossil fuel industry from the existential threat of public protest. In the US, legislators in 18 states have put forward bills criminalising protests against pipelines, seeking to crush democratic dissent on behalf of the oil industry. …” Links: Guardian - 'Fight for our lives': Fiji calls world leaders 'selfish' as it lays out climate crisis blueprint “Fiji will introduce one of the world’s most ambitious legislative programs to tackle the climate crisis, and has labelled the global community’s decision to set aside the call for global heating to be capped at 1.5C “grossly irresponsible and selfish”. Sayed-Khaiyum [Fiji’s minister for economy & climate change ]was speaking ahead of the Pacific Islands Forum (PIF) in Tuvalu next week, which will be attended by leaders of Pacific countries including Fijian prime minister Frank Bainimarama – a former president of COP23, the UN’s influential climate body, and world leader in the climate fight – and Australian prime minister Scott Morrison….” The Hill - Greenland's ice wasn't supposed to melt like last week until 2070 Climate change is accelerating, and we’re clearly ‘ahead of schedule’….

The Conversation - Green growth is trusted to fix climate change – here’s the problem with that

Christine C Walker; https://theconversation.com/green-growth-is-trusted-to-fix-climate-change-heres-the-problem-with-that-120785 Walker comes back on the recent Decoupling Debunked report. “You may have missed it, but a recent report declared that the main strategy of world leaders for tackling climate change won’t work. It’s called green growth, and it’s favoured by some of the largest and most influential organisations in the world, including the United Nations and the World Bank….” She concludes, accurately: “… Proposals for green growth that rely solely on technology to solve the climate crisis are based on a flawed idea. This is, that the limits to the world’s physical systems are flexible, but the structure of its economies are not. This seems entirely backwards and more a reflection of the importance of politics and power in determining what solutions are deemed viable, than any reflection of reality. So society should ask, are these global institutions promoting green growth because they believe it’s the most promising way of avoiding climate breakdown? Or is it because they believe it’s simply not politically feasible to talk about the alternatives?...”

UN News - Migration and the climate crisis: the UN’s search for solutions

https://news.un.org/en/story/2019/07/1043551 “… The climate crisis is already having an effect: according to the Internal Displacement Monitoring Centre, 17.2 million people had to leave their homes last year, because of disasters that negatively affected their lives. Slow changes in the environment, such as ocean acidification, desertification and coastal erosion, are also directly impacting people’s livelihoods and their capacity to survive in their places of origin. As Ms. Ionesco explains, there is a strong possibility that more people will migrate in search of better opportunities, as living conditions get worse in their places of origin: “There are predictions for the twenty-first century indicating that even more people will have to move as a result of these adverse climate impacts. The Intergovernmental Panel on Climate Change (IPCC), the main UN authority on climate science, has repeatedly said that the changes brought on by the climate crisis will influence migration patterns. The World Bank has put forward projections for internal climate migration amounting to 143 million people by 2050 in three regions of the world, if no climate action is taken.”…”

Lancet Editorial – Bolsonaro threatens survival of Brazil's Indigenous population

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31801-X/fulltext “…Bolsonaro's presidency represents the most serious threat to Brazil's Indigenous population since the 1988 Constitution granted Indigenous people the right to exclusive use of their land. International public pressure on Bolsonaro to halt the rainforest destruction and protect Indigenous territories from illegal intrusion is crucial to secure the integrity and autonomy of the country's Indigenous population, and to protect them from further harm.”

Ebola DRC

As usual, a number of relevant reads again related to the Ebola DRC outbreak. One of the snippets of good news perhaps: so far no new cases in Goma. An overview, in no particular order:

UN News - Security Council gravely concerned by Ebola outbreak in DR Congo, demands immediate end to violence hampering response

https://news.un.org/en/story/2019/08/1043651 On a SC council meeting last week on Friday.

Science - Ebola veteran promises an end to Congo’s epidemic

https://www.sciencemag.org/news/2019/08/ebola-veteran-promises-end-congo-s-epidemic Recommended (insightful) read on Muyembe’s plans, vision on the key challenges and the broader context. He sounds rather bullish. “On 22 July, DRC President Félix Tshisekedi tapped him to head the government’s response to the latest outbreak, in the DRC’s northeast, after Minister of Health Oly Ilunga Kalenga suddenly resigned. Muyembe may be facing the most difficult fight of his life. “In an April report, Muyembe gave a scathing analysis of the response to the outbreak, then led by Ilunga. Now, he has a chance to show he can do better. Speaking to Science on the phone from Goma, Muyembe says the outbreak can be brought under control in 3 to 4 months. “It is ambitious,” he says. “But I think we can achieve it.”…”

BBC News - Half of Ebola cases in DR Congo 'unidentified'

https://www.bbc.com/news/world-africa-49212116 But read also this: “Only about 50% of cases of Ebola in the Democratic Republic of Congo are being identified, the government's response co-ordinator has said.” “…. Jean-Jacques Muyembe warned that the current deadly outbreak could last up to three years.” That’s the same Muyembe, I reckon. So my take home message: anything between 3 months & 3 years, probably…

Cidrap - DRC Ebola impact getting worse for children

http://www.cidrap.umn.edu/news-perspective/2019/08/drc-ebola-impact-getting-worse-children “The Ebola outbreak has killed more than 500 children in the Democratic Republic of the Congo (DRC) since the outbreak began last August, and deaths in kids have accelerated over the past 6 months, Save the Children, a nongovernmental group that is working in DRC, said yesterday….”

Cidrap News – Ebola reports show more health workers infected

http://www.cidrap.umn.edu/news-perspective/2019/08/ebola-reports-show-more-health-workers-infected “[Yesterday] the Democratic of the Congo (DRC) resumed publishing daily reports on the country's ongoing Ebola outbreak, adding more details about the response in Goma and noting that 149 health workers have now been infected with the deadly virus….”

The Conversation - The Uganda vaccine trial: how African researchers are tackling Ebola

Yap Boum et al; https://theconversation.com/the-uganda-vaccine-trial-how-african-researchers-are-tackling-ebola-121517 « … Last week researchers from Epicentre, Uganda Virus Research Institute, Mbarara University of Science and Technology and the London School of Tropical Medicine and Hygiene started a new trial in Uganda. The aim is to provide additional information and to evaluate the safety and immune response generated by a two-dose Ebola vaccine regimen manufactured by Janssen Vaccines and Prevention. The study will take place at the Epicentre Mbarara research centre in Mbarara in the south west of the country. It will last for two years and will include 800 healthcare and frontline workers. The vaccine regimen uses a “prime-boost” approach. This involves two doses 56 days apart. The approach is designed to produce stronger and longer-lasting immune responses. The other reason the vaccine is noteworthy is that it could provide protection against other strains of Ebola viruses. While the DRC is mainly affected by the Ebola Zaire strains, countries like Uganda and Sudan have been exposed to outbreaks by other strains including Ebola Bundibugyo, Ebola Sudan and Marburg virus….”

CGD (blog) - Committing and Allocating Ebola Financing: What’s Next for the DRC?

C Krubiner et al; https://www.cgdev.org/blog/committing-and-allocating-ebola-financing-whats-next-drc#.XURniuySzN4.twitter “As the World Health Organization declares the current Ebola outbreak in the Democratic Republic of Congo to be a Public Health Emergency of International Concern, new funding has been mobilized. Our experts provide four recommendations on how to spend this money well. “

Reuters - Pandemic bonds face scrutiny after Ebola outbreak yet to trigger payout

Reuters See also a previous IHP newsletter. Quote: “The World Bank’s Bennett said the pandemic facility had been very specifically designed to insure against cross-border events rather than single-country outbreaks. But with the instruments due to mature next summer, the bank is examining possible changes to the structure, for instance, seeking out a cost-efficient way of insuring single-country events, he said. It is also looking into instruments that could help tackle outbreaks of different viruses affecting humans, or even livestock such as pigs or poultry….”

Reuters – Three Congolese doctors arrested in connection with WHO official's death

Reuters; “Three Congolese doctors have been arrested for allegedly planning an attack on a hospital that killed a senior World Health Organization (WHO) epidemiologist involved in the Ebola response, a prosecutor said on Wednesday….” “….Lieutenant Colonel Jean-Baptiste Kumbu, a senior military prosecutor, said militiamen involved in attacking treatment centers had, under interrogation, implicated four doctors in planning the raids, including against the Butembo hospital.”

International Health - Emergent threats: lessons learnt from Ebola

Peter Piot et al;  https://academic.oup.com/inthealth/advance-article-abstract/doi/10.1093/inthealth/ihz062/5544162?redirectedFrom=fulltext “…In the midst of the world’s second largest ever recorded Ebola outbreak in the Democratic Republic of the Congo, we reflect on six of the many lessons learnt from the epidemic in West Africa, focusing on progress made and the challenges ahead in preparing for future threats….”

BMJ - Ebola in Sierra Leone and DRC: lessons learnt

https://www.bmj.com/content/366/bmj.l5012 “Sierra Leone experienced an Ebola outbreak from 2013 to 2016. The current outbreak in the Democratic Republic of the Congo just hit the one year mark. Doctors Ian Crozier and Eugene Richardson worked in both places. They told Mara Kardas-Nelson about the differences and similarities in the response in the two countries” Quick links: David Malpass (WB) - Ebola outbreak in east Congo's main city tests flexibility of response Reuters (on the situation in Goma) - Ebola outbreak in east Congo's main city tests flexibility of response

Global Health Security

NYT – Deadly germ research is shut down at army lab over safety concerns

NYT; “Problems with disposal of dangerous materials led the government to suspend research at the military leading’s biodefense center.”   CDC halted the research, among others pointing at flawed wastewater decontamination systems.

Stat News - Sabin Institute acquires rights to develop vaccines for Ebola and Marburg viruses

Stat News; “The nonprofit Sabin Vaccine Institute is taking over development of vaccines to protect against two species of Ebola and a related virus, Marburg, acquiring the rights from GSK, the two entities announced Tuesday. The transfer of the rights for the vaccines will put back into development a vaccine that GSK had shelved after the West African Ebola outbreak of 2014-2016. No money is changing hands; GSK is giving the rights to the institute. The institute will develop the vaccines in collaboration with the National Institute of Health’s Vaccine Research Center….”

German institute for International and Security Affairs - Health and Security: Why the Containment of Infectious Diseases Alone Is Not Enough

https://www.swp-berlin.org/en/publication/health-and-security/ By Daniel Gulati & Maike Voss. “The Ebola epidemic in the Democratic Republic of the Congo (DRC) highlights the urgent need to strengthen cooperation between security, health, and development actors. As the disease spreads, the World Health Organization (WHO) has declared an international health emergency. In crisis situations like these, the interdependencies between health and security are highly complex. Which population groups and which diseases are perceived as suspected health risks, and why, is a normative question for donor countries. It has political consequences above all for affected developing countries. Where health and security are common goals, it is not enough to contain infectious diseases in developing countries. Instead, resilient, well-functioning, and accessible health systems must be established. This fosters the implementation of the human right to health, creates trust in state structures, and takes into account the security interests of other states. In the United Nations (UN) Security Council, the German government could advocate for policies based on the narrative “stability through health.”” Quote: “…Germany aims to strengthening a value-driven multilateralism. In the context of global health, this could be put into prac­tice, for example, at the interface between health, security, and stabilization. The term “global health security” should be scrutinized critically. It is an expression of the dominance and interests of high-income countries and neglects the actual needs of the populations in partner countries. In order to enforce the right to health, global health policy actors must take into account the interests of and trade-offs with other policy fields, act as moderators, and stand up for health priorities and health-related ethical implications. This includes support for healthy living conditions, preventive measures, the detection and treatment of acute and chronic diseases, as well as reha­bilitation….”

WHO - Cross border disease outbreak simulation exercise reinforces preparedness in East Africa

WHO; Article on a “ Field Simulation Exercise (FSX) that occurred in June 2019 at the Namanga One Stop Border Post (above) and the surrounding areas in both Kenya and Tanzania. The exercise was convened by the East Africa Community (EAC) and implemented by the World Health Organization (WHO) to test both countries’ preparedness and response to disease outbreaks….”

AMR

Cfr. a tweet: “Absence of indicators on #AntimicrobialResistance in the #SDG Indicator Framework has been barrier for monitoring progress. Now an indicator is proposed for inclusion in #SDG3 by IAEG-SDG based on  @WHO 's experience. It is posted for consultation by Sept 8 (link: https://bit.ly/2YtFGy9) bit.ly/2YtFGy .” See also here.

Trump & foreign aid: “Rescission 2.0”

Washington Post – Foreign aid funds put on hold for review

https://www.washingtonpost.com/national-security/foreign-aid-funds-put-on-hold-for-review/2019/08/05/8a86e468-b7a4-11e9-bad6-609f75bfd97f_story.html?tid=ss_tw “The Trump administration has temporarily frozen and ordered a review of several key foreign aid funds that Congress has already approved, in a move that critics fear could lead to another attempted rollback of foreign aid. The Office of Management and Budget sent a letter to the State Department and the U.S. Agency for International Development on Saturday, notifying them of the action, which took effect one minute before midnight that day. The OMB asked the agencies for a balance sheet of foreign aid projects that have not yet been funded. Michael P. Duffey, the associate director for national security programs at OMB, wrote that no more money can be obligated from those funds until three days after OMB receives the numbers, a process that could take days if not weeks. … … The letter, viewed by The Washington Post, lists eight areas that cover a variety of assistance: international organizations; peacekeeping operations and activities; international narcotics control and law enforcement; development aid; assistance for Europe, Eurasia and Central Asia; economic support funding; foreign military financing programs; and global health programs….” For more info, see Devex - Trump administration resurrects 'rescission' proposal in latest attack on US aid spending  “The Trump administration appears poised — for the second summer in a row — to attempt to retract billions of dollars in foreign assistance funding already appropriated by the U.S. Congress. In a letter obtained by Devex, the White House Office of Management and Budget directed the U.S. Agency for International Development and the State Department on Monday to freeze more than a dozen accounts and report back on the amount of funding they contain that has not yet been committed to a specific project. The funding in question totals between $2 billion and $4 billion that is set.” ““This review drops a bomb into the end-of-year issuance of new grant/contract awards. Under the guise of reviewing the balance sheet, it actually halts ongoing work at the worst possible moment. Which is precisely the intent,” Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, who led USAID’s disaster response during the Obama administration, wrote on Twitter….” See also Reuters –  “President Donald Trump’s administration has ordered a review of foreign aid that critics fear could lead to sharp cuts in funds for global health, peacekeeping, narcotics control and other programs despite their having been approved by Congress.  …”

Updates on global health actors

AFP - UNAIDS to get new chief after divisive Sidibe era

https://news.yahoo.com/unaids-chief-divisive-sidibe-era-104404653.html “AIDS experts have voiced concern over the future of the United Nations body tasked with fighting the epidemic after top officials [including UN SG Guterres & also current replacement Carlsson] stood behind a former agency chief accused of serious mismanagement. Opinions on the former executive director of UNAIDS, the Malian national Michel Sidibe, remain deeply divided…” “Guterres has received a shortlist of candidates to replace Sidibe. He should make his decision "quite soon," Carlsson told reporters….” As somebody put it on Twitter: what takes him so long?

Global Fund

The Star - Canada must step up in global fight against killer diseases

Jane Philpott (former minister of Health Canada, 2015-17); https://www.thestar.com/opinion/contributors/2019/08/07/canada-must-step-up-in-global-fight-against-killer-diseases.html “In a few weeks, the three-year funding cycle ends for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Canada is at risk of being the only G7 country not to increase its contribution to the fund….”  “…A reduced or flatlined pledge would signal a retreat from global leadership….”

WHO

Via Devex: The World Health Organization is investigating allegations of corruption within its Yemen humanitarian response operations. “On Monday, the Associated Press reported that in October 2018 a team of U.N. investigators in Yemen’s capital city of Sanaa were confronted by armed members of the Houthi militia, who seized the laptops and external hard drives that reportedly contained evidence of fraud, nepotism, and corruption before the U.N. team could depart. According to the AP, the allegations include financial mismanagement by Nevio Zagaria — the head of WHO’s Sanaa office from 2016 to September 2018….”

#HPSRtwitter

Launch of a new hashtag by Olivia Biermann (EV 2018). In addition to all discussions & questions about health policy & systems research, she described the purpose as follows: “Today #HPSRtwitter was born!  Use it to share resources, pose questions, engage in discussions and look for support. Especially useful for young professionals and emerging voices in the field.”

HSG Africa regional network

https://www.healthsystemsglobal.org/regional-network/ Worth checking out, certainly if you’re from SSA. “The Africa Regional Network is a group of Africa-based HPSR networks, connecting for the purposes of learning what each is doing in the field, building synergies, increasing the profile of African Health Policy and Systems Research (HPSR), and seeking ways in which the region can shape and influence the wider Health Systems Global (HSG) society….” With Okikiolu Badejo (EV 2018) & Aïssa Diara as the coordinators.

Lancet Global Health (September issue)

https://www.thelancet.com/journals/langlo/issue/current Most of the articles were already published online before.

• Do start with the Editorial: Passports and privilege: access denied

“Last October, Liverpool, UK, hosted the Fifth Global Symposium on Health Systems Research. At least 10 overseas delegates planning to attend the biennial gathering of researchers, practitioners, and policy makers dedicated to strengthening health systems around the world were unable to do so because they were denied visas for entry to the UK, despite some having been awarded full scholarships to support the cost of the trip. The following month, 16 speakers and delegates from African countries and three from Asian countries could not be present at the second Women Leaders in Global Health conference at the London School of Hygiene & Tropical Medicine due to visa refusals, prompting the Director of the School to write to the UK Home Secretary in protest….” Damning account of the current UK visa situation. Zooming in also on the joint investigation by several All-Party Parliamentary Groups (APPGs) to uncover the scale of the problem for African visitors to the UK.

• Check out also this Comment - Women's global health leadership in LMICs (by E Liu et al)

“A growing urgency to expand women's participation in global health leadership has provided an opportunity to reconsider long-standing institutional policies, facilitating more gender-responsive programmes and policies around the world.  However, most of the new ideas about expanding women's leadership in global health have come from high-income countries. Over three-quarters of the global health organisations assessed in the Global Health 50/50 report  have headquarters in high-income countries. The relative lack of voice from low-income and middle-income countries (LMICs) about women's leadership in global health is problematic because of the unique challenges, social contexts, and political forces that shape women's experiences in these regions. Innovative ideas to encourage women's leadership in health programmes within LMICs are needed.” “To expand global discussions about women leaders in global health, the Special Programme for Research and Training in Tropical Diseases (TDR) co-sponsored by UNICEF, UNDP, the World Bank, and WHO organised a crowdsourcing challenge to identify creative ideas focused on increasing the number of women in a TDR mid-career clinical research fellowship. … … Supported by the Bill and Melinda Gates Foundation, the fellowship is designed to provide individuals from LMICs with a 1-year opportunity to undertake mentored clinical infectious diseases research.” The Comment concludes: “Progress towards gender equality in global health institutions has picked up pace in some high-income countries but needs to expand to LMICs and incorporate voices from these regions. Crowdsourcing challenges present one structured way to engage individuals from LMICs in these discussions, but there are other potential mechanisms. For example, the Women Leaders in Global Health conference will move to Kigali, Rwanda, in 2019, allowing greater regional participation and advocacy.”

• Lancet Correspondence - English: the lingua franca of scientific research

Hardhitting Letter by the founder & managing editor of the Pan African Medical Journal (R Kamadjeu)   “I read with interest the comment by Anne Roca and colleagues in The Lancet Global Health. Does it make sense, however, to cry for the exclusion of French from global health research? What about the exclusion of Portuguese, Arabic, or any of the estimated 7000 languages spoken today? Translating every piece of good research in all possible written languages is not feasible. This is why a lingua franca emerged, so that researchers from various linguistic backgrounds can communicate freely….”  And that’s English now, he implies. Francophone Africa (and Portuguese Africa) should probably draw their conclusions, he says. But for a different take, in the same debate, see also Towards making global health research truly global (by S Saha et al) “ Lancet Global Health and Anne Roca and colleagues put forth a consequential editorial and comment on the importance of language, a word not enough used in global health research. Their core message echoes conversations at our research organisation in Bangladesh. Indeed, as in other non-Anglophone communities, language has shaped our day-to-day research and communication efforts in both obvious and imperceptible ways. We published a paper on barriers that researchers face in low-income and-middle-income countries pertaining to access to resources and literature. One of the authors was interviewed on a Bangla online platform on the impact of such barriers on local early-career scientists. That interview attracted more attention in Bangladesh than the original English article because of its language of delivery. One viewer rightly questioned whether such an important article could reach the Bangladeshi scientists, policy makers, and stakeholders for whom it was most relevant, when written in English. Although we had ended that article with a call to make global health research truly global, evidently, we did not do so even as Bangladeshi authors. Realising our failures, we documented the barriers that language poses in our research context….”

Lancet series: Genomic medicine

https://www.thelancet.com/series/genomic-medicine “The acceleration of documenting genomic variation in disease states and health outcomes has led to an upswell of clinical insights and avenues of exploration. The exciting and maturing area of genomic medicine, encompassing the use of individuals’ genetic information to guide clinical treatment, is featured in this Series. In these five, timely reviews, authors from the National Human Genome Research Institute at the National Institutes of Health (MD, USA) present an overview of efforts to implement genomic medicine, including contemporary tools and resources; the role of pharmacogenomics in drug safety and efficacy; the application of genomics to identifying rare and undiagnosed diseases; enhancing risk assessment through family health history records; and improving the collection of outcomes and evidence to better incorporate genomic techniques in clinical care.” Check out the related Comment - Genomic medicine: time for health-care transformation.

Some papers of the week

HP&P - The impacts of decentralization on health system equity, efficiency and resilience: a realist synthesis of the evidence

Seye Abimbola, M Bigdeli et al; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz055/5543691 “One constant refrain in evaluations and reviews of decentralization is that the results are mixed. But given that decentralization is a complex intervention or phenomenon, what is more important is to generate evidence to inform implementation strategies. We therefore synthesized evidence from the literature to understand why, how and under what circumstances decentralization influences health system equity, efficiency and resilience. In doing this, we adopted the realist approach to evidence synthesis and included quantitative and qualitative studies in high-, low- and middle-income countries that assessed the the impact of decentralization on health systems. … … We identified three mechanisms through which decentralization impacts on health system equity, efficiency and resilience: ‘Voting with feet’ (reflecting how decentralization either exacerbates or assuages the existing patterns of inequities in the distribution of people, resources and outcomes in a jurisdiction); ‘Close to ground’ (reflecting how bringing governance closer to the people allows for use of local initiative, information, feedback, input and control); and ‘Watching the watchers’ (reflecting mutual accountability and support relations between multiple centres of governance which are multiplied by decentralization, involving governments at different levels and also community health committees and health boards). … ”

International Journal of Health Planning & Management -Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Sophie Witter et al; https://onlinelibrary.wiley.com/doi/10.1002/hpm.2882 “Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.”

Journal of Global Health - Current developments in the Global Governance arena: where is alcohol headed?

Sally Casswell; http://www.jogh.org/documents/issue201902/jogh-09-020305.htm Relatively short but nice article on Big Alcohol & Global health governance. Ending like this: “……A global response to prevent marketing, over supply, inappropriate affordability and industry interference in policy is urgently required. Whether the conditions that created the establishment of the FCTC, including a champion within the UN system, are likely to prevail in the current context is unclear. An FCAC is the TNACs’ worst nightmare and strong resistance from them and the member states which represent their interests is to be expected. However, the FCTC was once an unlikely aspiration and provides a valuable precedent for those concerned about the global health risk from the largely unregulated marketing and distribution of alcohol.”

HP&P - Rational trust in resilient health systems

S K Kittelsen et al; https://academic.oup.com/heapol/advance-article-abstract/doi/10.1093/heapol/czz066/5543564?redirectedFrom=fulltext We quite enjoyed this article too (no doubt due to our old research interest in social capital). “The 2014–15 Ebola epidemic in West Africa highlighted the significance of trust between the public and public health authorities in the mitigation of health crises. Since the end of the epidemic, there has been a focus amongst scholars and practitioners on building resilient health systems, which many see as an important precondition for successfully combatting future outbreaks. While trust has been acknowledged as a relevant component of health system resilience, we argue for a more sustained theoretical engagement with underlying models of trust in the literature. This article takes a first step in showing the importance of theoretical engagement by focusing on the appeal to rational models of trust in particular in the health system resilience literature, and how currently unconsidered assumptions in this model cast doubt on the effectiveness of strategies to generate trust, and therein resilience, during acute public health emergencies.”

Human Resources for Health - Health workforce development and retention in Guinea: a policy analysis post-Ebola

Remco van de Pas et al ; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-019-0400-6 By some of my colleagues. “The state of the Guinean health workforce is one of the country’s bottlenecks in advancing health outcomes. The impact of the 2014–2015 Ebola virus disease outbreak and resulting international attention has provided a policy window to invest in the workforce and reform the health system. This research constitutes a baseline study on the health workforce situation, professional education, and retention policies in Guinea. The study was conducted to inform capacity development as part of a scientific collaboration between Belgian and Guinean health institutes aiming to strengthen public health systems and health workforce development. It provides initial recommendations to the Guinean government and key actors….”

Health Systems & Reform - Political Analysis for Health Policy Implementation

P A Campos & M Reich; https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1625251 “Any effort to improve health system performance must address the challenges of policy implementation. This article examines one aspect of implementation—the politics of policy implementation for the health sector, particularly the management of stakeholders in order to help change teams improve the chances of achieving policy objectives. Based on a literature scan of political analyses and descriptions of health policy implementation in low- and middle-income countries, we propose six major categories of stakeholder groups that are likely to influence implementation: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. The categories of stakeholders can be overlapping. We examine the politics of these different stakeholder categories, and then present selected examples of published case studies that show the types of implementation challenges that arise for each category and how implementers can use political strategies to manage specific stakeholder groups and related political processes. ….”

HP&P - Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them

O Onwujekwe et al; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz070/5543565?searchresult=1 HP&P was on a roll this week 😊. “West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. … …  The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. ….”

Global Health Promotion - Understanding the slum–health conundrum in sub-Saharan Africa: a proposal for a rights-based approach to health promotion in slums

D A Alaazi et al; https://journals.sagepub.com/doi/full/10.1177/1757975919856273 “Sub-Saharan Africa is the world’s least urbanized region but is ironically also the region with the largest proportion of urban slum dwellers. However, there exists limited understanding of the impact of slums on health in the region. … …. The majority of studies characterize slums as health-damaging settings, where poverty and unfavorable environmental conditions pose threats to public health and safety. Only a handful of studies suggest a beneficial relationship between slums and health, in such areas as affordable housing provision, employment generation, and community cohesion. We argue that the literature’s overwhelming emphasis on the environmental risks of slums feeds into a neoliberal urban agenda that seeks to clear slums at the expense of their beneficial contributions to health. Accordingly, we advocate a shift in policy discourse, from static characterization of slums as health risks to a health-promotion agenda that emphasizes the housing and service rights of slum populations.”

IJHPM - Opening the Policy Window to Mobilize Action Against Corruption in the Health Sector; Comment on “We Need to Talk About Corruption in Health Systems”

Tim Mackey; http://www.ijhpm.com/article_3655.html Ah, there’s nothing like an application of Kingdon’s MSF on a lazy summer afternoon in August 😊. “Corruption in the health sector has been a “dirty secret” in the health policy and international development community, but recent global activities point to a day when it will no longer be neglected as a key determinant of health. To further explore next steps forward, this commentary applies the Kingdon’s multiple-streams framework (MSF) to assess what opportunities are available to mobilize the global agenda to combat health corruption. Based on this analysis, it appears that Kingdon’s problem, policy, and political streams are coalescing to create a policy window opportunity that can be leveraged based on recent developments in the global health and international development community around corruption. This includes the recent formation of the Global Network on Anti-Corruption, Transparency and Accountability (GNACTA) led by the World Health Organization (WHO), the Global Fund, and the United Nations Development Programme in 2019. It also includes bridging shared goals of addressing corruption in order to make progress towards health-specific goals in the UN SDGs and for achieving UHC.”

Global Policy - Autonomy of Nations and Indigenous Peoples and the Environmental Release of Genetically Engineered Animals with Gene Drives

Z Meghani; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12699 “This article contends that the environmental release of genetically engineered (GE) animals with heritable traits that are patented will present a challenge to the efforts of nations and indigenous peoples to engage in self‐determination. The environmental release of such animals has been proposed on the grounds that they could function as public health tools or as solutions to the problem of agricultural insect pests. This article brings into focus two political‐economic‐legal problems that would arise with the environmental release of such organisms. To address those challenges, it is proposed that nations considering the environmental release of GE animals must take into account the underlying circumstances and policy failures that motivate arguments for the use of the modified animals. Moreover, countries must recognize that the UN International Covenant on Civil and Political Rights and the UN International Covenant on Economic, Social and Cultural Rights place on them an obligation to ensure that GE animals with patented heritable traits are not released without the substantive consent of the nations or indigenous peoples that could be affected.”

Health Promotion International – Applying intersectionality theory in health promotion research and practice

Emma Heard et al; https://academic.oup.com/heapro/advance-article-abstract/doi/10.1093/heapro/daz080/5544760?redirectedFrom=fulltext “…This article provides an overview of the diverse ways public health researchers and practitioners have applied intersectionality theory to better understand and address health inequalities. We map three key applications of intersectionality theory in public health: as an epistemological approach, as a methodological approach, and as a tool for action and intervention….”

Lancet (Letter) – Fiscal policies and global public health

Luke Allen; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31252-8/fulltext PS: Luke Allen is the lead author of the upcoming WHO guide to health-related food taxation. “In his Correspondence on fiscal policies and the gilets jaunes, Franco Sassi  argued that policy makers should consider using hypothecation (earmarking) to increase public acceptance of taxes levied on unhealthy products such as tobacco, alcohol, and sugar-sweetened beverages. …” After giving a few examples (Philippines, UK, …), Allen sees opportunities: “…In an increasingly protectionist fiscal environment, erecting physical and fiscal barriers is suddenly in vogue. Countries like the UK that find themselves deep in behind-the-border trade agreements should capitalise on the trend and adopt a stronger public health stance when negotiating tax and trade policies that influence health. Riding a global wave of populist revolt, President Trump has inadvertently ushered in what could be a golden era for health-related fiscal measures.”

Lancet (Letter) – The harsh effects of sanctions on Iranian health

G Danaei et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31763-5/fulltext The first author is deputy minister in Iran's Ministry of Health and Medical Education.

Some blogs and mainstream articles of the week

IHP - A week of migration & health in Joburg: Where are we? Where do we go?

Thea de Gruchy; https://www.internationalhealthpolicies.org/featured-article/a-week-of-migration-health-in-joburg-where-are-we-where-do-we-go/ Really neat blog. And we’re not saying this because it’s on IHP 😊.

The Hill - Optimists and pessimists on global development

https://thehill.com/opinion/international/455584-optimists-and-pessimists-on-global-development By Homi Kharas. They both have a point, he says.

Madhukar Pai - Archives of Failures in Global Health

https://naturemicrobiologycommunity.nature.com/channels/303-journal-club/posts/51659-archive-of-failures-in-global-health This blog post aims to crowd source and compile a list of failures in global health. With 29 examples by now (and counting…).

IDS - New IDS Bulletin on the political economy of food

https://www.ids.ac.uk/news/new-ids-bulletin-on-the-political-economy-of-food/ “This new issue of the IDS Bulletin, edited by Jody Harris, Molly Anderson, Chantal Clément and Nicholas Nisbett examines a range of perspectives on power in food systems, and the various active players, relationships, activities, and institutions that play a major role in shaping them. It notes the need for mainstream research and policy to grapple with power inequities in the food system, in order, for instance, to challenge the increase in private sector funding that is reshaping food systems. The power of dominant food system actors is often reinforced or overlooked, having negative consequences for those unable to access sufficient healthy food or to participate in decision-making about the food system. The open access articles present the viewpoints that emerged during a workshop on the Political Economy of Food Systems, run jointly by IDS and IPES-Food….”

Nature (Editorial) - Scientists must rise above politics — and restate their value to society

https://www.nature.com/articles/d41586-019-02379-w?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews&sf217131857=1 “Scholars globally are feeling the heat from politicians. They should take inspiration from scientists in the 1950s who raised the alarm over nuclear weapons.”

LSE (blog) - Should academics be expected to change policy? Six reasons why it is unrealistic for research to drive policy change

https://blogs.lse.ac.uk/impactofsocialsciences/2016/05/25/should-academics-be-expected-to-change-policy-six-reasons-why-it-is-unrealistic/ Nice one. Not just relevant for the UK. “UK social scientists feel a growing pressure to achieve policy change. In reality, this process is more complex than it sounds. James Lloyd looks at six reasons that limit the impact research can have on policy change. ….”

Lancet (Letter) - Preparing the next generation of global public health experts

B Vallet; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31631-9/fulltext Focus on SciencesPo's Global Health Masters course (and the assets of it in the field of global health diplomacy).

Tweets of the week

Andrew Harmer:  “Climate twitter is so bleak at the moment that I've started following people who tweet in languages I can't understand.” Madhukar Pai: “Highlight of the Geneva visit: met an African colleague who spoke about how American ‘kids’ with little or no experience come to ‘advise’ her government on what to do. There must be some way to deal with this type of global health consulting malpractice! Please share ideas.”

Devex – Germany, foreign aid, and the elusive 0.7%

https://www.devex.com/news/germany-foreign-aid-and-the-elusive-0-7-95389 “Aid spending has been on an upward trajectory in Germany — but nobody knows how long it will last, with signs that its commitment to development is already beginning to slip….” Quote: “…More broadly, there is a sense that the development sector's current support rests on the patronage of a few actors, including Merkel, but that it does not necessarily have broad backing and could easily disappear….”

Bloomberg - IMF’s Top Job Shouldn't Be Another Stitch-Up

https://www.bloomberg.com/opinion/articles/2019-08-05/imf-top-job-shouldn-t-be-stitch-up-for-eu-kristalina-georgieva “Kristalina Georgieva is a strong candidate to head the fund, but non-Europeans like Singapore’s Tharman Shanmugaratnam shouldn’t be excluded….” Other countries have until Sept. 6 to nominate other candidates.

Some recent Bretton Woods project reads

BWP - Here we go again: Surprise IMF leadership change litmus test for its legitimacy “Lagarde resigns IMF leadership effective 12 September; Will historic gentleman’s agreement finally be challenged? Race comes at crucial time for legitimacy of multilateral system.” BWP -  The Bretton Woods Institutions and the second crisis of multilateralism BWP - Confronted with climate emergency, IMF belatedly attempts to “get real” Key messages of the last article: “Fund's focus on carbon pricing ignores long-standing critiques. Climate damages already contributing to rising debt among climate vulnerable countries. Fund’s policies on climate not yet commensurate to scale of challenge.”

Devex - Calls for DFID to help tackle violence against aid workers

https://www.devex.com/news/calls-for-dfid-to-help-tackle-violence-against-aid-workers-95409 “U.K. lawmakers have called on the Department for International Development to use its diplomatic power and other measures to tackle violence against aid workers after some 270 were killed or injured in the field last year. In a report published Tuesday, members of the International Development Committee — a cross-party group of politicians tasked with scrutinizing U.K. aid spending — called on DFID to step up its efforts in response to data from the most recent “Aid Worker Security Report 2019," which identified 2018 as the second worst year on record….”

Devex - What does the increase in joint ministers mean for DFID? Experts weigh in

https://www.devex.com/news/what-does-the-increase-in-joint-ministers-mean-for-dfid-experts-weigh-in-95382 “For the first time in its history, the U.K. Department for International Development has more shared ministers than those solely working for the department.”

D+C Development Cooperation - A measure of SDG finance

https://www.dandc.eu/en/article/oecd-working-new-way-measure-sdg-finance “One challenge of financing the SDGs is that a growing number of countries are set to lose their eligibility to receive the official development assistance (ODA) on which they have so far based relevant action (see main article). New approaches are required. Additional funds must be mobilised urgently….” “Major progress in this debate was made at the Financing for Development conference in Addis Ababa in 2015. Back then, the OECD assumed the task to develop a new category of international finance and ways to measure it. The result is a concept called Total Official Support for Sustainable Development (TOSSD). … … If TOSSD was established as a second official and equally important finance category alongside ODA, ODA eligibility would become less important. The new finance category would create a major incentive for international cooperation “beyond ODA” and promote the international activities of a whole range of government departments because the allocation of resources could be reported internationally as TOSSD. It is therefore important to adopt TOSSD officially as soon as possible….”

Devex - Report outlines how new DFC and USAID will work together

https://www.devex.com/news/report-outlines-how-new-dfc-and-usaid-will-work-together-95408 “One of the final steps required before the opening of the new U.S. International Development Finance Corporation is now complete. The administration has submitted a coordination report to Congress outlining how the new institution will work with the U.S. Agency for International Development and other government agencies….”

Devex - USAID 'countering Kremlin' framework is not about Russia, officials say

https://www.devex.com/news/usaid-countering-kremlin-framework-is-not-about-russia-officials-say-95380 “USAID has launched a "Countering Malign Kremlin Influence" framework. Agency officials want to make clear that it shouldn't be seen as an attempt to divide countries between the U.S. and Russia.” Nowadays, if you want to work for USAID, it’s a big plus if you enjoy ‘cognitive dissonance’ 😊.

Intrahealth - These Nurses Are Shining a Light on the Gender Barriers They Face at Work

S Rick; https://www.intrahealth.org/vital/these-nurses-are-shining-light-gender-barriers-they-face-work “This month at the 2019 International Council of Nurses Congress in Singapore, a diverse international cohort of nurses gathered to discuss how to dismantle the gender-related barriers nurses face in rising to leadership positions. During one session—called Into the Future: Leadership Skills for 21st Century Nurses—they addressed unpaid care, the glass ceiling and glass escalator phenomena, the lack of decision-making power for nurses, and low self-confidence among female nurses….” Quote: “Why are female nurses kept out of leadership while male nurses shoot to the top?” One factor: “Like many women in any industry, female nurses have reported that they struggle to balance unpaid care responsibilities at home with their duties at work—a struggle that’s often compounded by irregular hours and the international nature of global nurse leadership. But even when that’s not the case, employers have often assumed that the female nurses on their staffs have extensive care responsibilities at home and, as a result, do not consider them for leadership positions….”

IISD - SDG Spending Gap Equivalent to USD 1 Trillion Annually

http://sdg.iisd.org/news/sdg-spending-gap-equivalent-to-usd-1-trillion-annually/ See also a previous IHP newsletter (on a forthcoming Brookings institute paper on financing for SDGs). “Under a business-as-usual scenario, the paper predicts that SDG spending will reach USD 33 trillion or more by 2030. The paper suggests minimum SDG spending needs are approximately USD 300 per capita. The lowest-income countries have the most significant SDG financing gaps.”

• Link:

AP -  Groups: Yemen airport closure ‘death sentence’ for thousands “ The Saudi-led coalition’s closure of the airport in Yemen’s capital, Sanaa, has prevented thousands of sick civilians from traveling abroad for urgent medical treatment, two international aid groups said in a joint statement. According to the Norwegian Refugee Council and CARE, the Sanaa airport’s three-year closure has amounted to a “death sentence” for many sick Yemenis. The two groups appealed late Monday to Yemen’s warring parties to come to an agreement to reopen the airport for commercial flights to “alleviate humanitarian suffering caused by the closure.”…”

• And a tweet from David Clarke:

“We can't reach UHC without private sector engagement,  First meeting of the WHO Expert Advisory committee on the governance of the private sector @who @impactforhealth”.

Curatio Foundation - Health Insurance for Poor: Georgia’s Path to Universal Coverage

http://curatiofoundation.org/health-insurance-for-poor-georgias-path-to-universal-coverage/ From June already. “The study assesses the impact of Medical Health Insurance (MIP) for the Poor on equity in access to essential health care services and financial protection against health care costs for the poor and general population. The document briefly describes identified accomplishments and shortcomings of the public private partnership in realization of MIP and discusses emerging policy options and policy recommendations on the future of MIP. The study was financially and technically supported by the Alliance for Health Policy and Systems Research/World Health Organization and carried out by Curatio International Foundation….”

Health Affairs – August issue:  Military Health Systems

https://www.healthaffairs.org/toc/hlthaff/38/8 The August Health Affairs issue focuses on the military health system in the US. “This month we examine the health systems that serve 1.4 million active duty service members; provide care and coverage for another 8.1 million reservists, retirees, and family members; and provide care for 9.0 million veterans. As the Military Health System (MHS) goes through a major restructuring, it also faces pressures and opportunities similar to those in the civilian sector….”

Former Ministers Denounce Bolsonaro's Dismantling of Public Health

https://www.plenglish.com/index.php?o=rn&id=45244&SEO=former-ministers-denounce-bolsonaros-dismantling-of-public-health “Six former Public Health ministers have denounced in a manifesto that the government of Jair Bolsonaro is currently dismantling healthcare in favor of private interests, with incalculable consequences for the welfare of the majority of Brazilians….”

Plos Med – Expectations of healthcare quality: A cross-sectional study of internet users in 12 low- and middle-income countries

S Roder de Wan et al; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002879 “High satisfaction with healthcare is common in low- and middle-income countries (LMICs), despite widespread quality deficits. This may be due to low expectations because people lack knowledge about what constitutes good quality or are resigned about the quality of available services. We fielded an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal, and South Africa in 2017 (N = 17,996). It included vignettes describing poor-quality services—inadequate technical or interpersonal care—for 2 conditions…” Some of the conclusions: “Majorities of the internet-using public in 12 LMICs have low expectations of healthcare quality as evidenced by high ratings given to poor-quality care. Low expectations of health services likely dampen demand for quality, reduce pressure on systems to deliver quality care, and inflate satisfaction ratings. Policies and interventions to raise people’s expectations of the quality of healthcare they receive should be considered in health system quality reforms.”

Joint Learning Network – Empanelment: A Foundational Component of Primary Health Care

http://www.jointlearningnetwork.org/resources/empanelment-a-foundational-component-of-primary-health-care “In many health systems, empanelment signifies a step toward more effective and better coordinated primary health care by helping to transform reactive care, oriented around visits, into proactive care that can deliver broader improvements to population health. In 2017, the JLN's People-Centered Integrated Care collaborative convened practitioners from 10 countries to further define empanelment and explore its contributions to a country's universal health coverage progress. With the support of facilitators from Ariadne Labs and Comagine Health, the practitioners co-developed this overview of empanelment.”

IISD - Climate Emergency Fund Established to Support Climate Activists

IISD; “A group of individuals have come together to launch The Climate Emergency Fund to avoid a worst-case scenario and restore a safe climate. The Fund will provide grants to climate activists to support their efforts in addressing the “climate emergency.” The Climate Emergency Fund website states that the current climate emergency requires “large-scale disruption and nonviolent civil disobedience.” The Fund argues for a new paradigm that phases out fossil fuel infrastructure and phases in non-fossil energy sources and removes carbon from the atmosphere. To achieve this shift, the Fund argues that the disruption of everyday life and perceived normal reality “is necessary to create a conversation on the climate and ecological crisis” and force needed policy change….”

Reuters -  China coal mine approvals surge despite climate pledges

https://mobile.reuters.com/article/amp/idUSKCN1UW0EM “Approvals for new coal mine construction in China have surged in 2019, government documents showed, with Beijing expecting consumption of the commodity to rise in the coming years even as it steps up its fight against smog and greenhouse gas emissions. Long-term cuts in coal consumption are a key part of China's energy, environment and climate goals, but the fivefold increase in new mine approvals in the first-half of 2019 suggests China's targets still provide ample room for shorter-term growth….”

Foreign Policy - Who Will Invade Brazil to Save the Amazon?

S Walt; https://foreignpolicy.com/2019/08/05/who-will-invade-brazil-to-save-the-amazon/ “It's only a matter of time until major powers try to stop climate change by any means necessary. “ Interestingly, in this piece, Stephen Walt argues that while very unlikely, Brazil is a bit more vulnerable (to pressure) than other big countries with major climate impact like the US, China, India …   (among others, because the country has no nuclear weapons). But of course he also favours other means (than invading) (like sanctions, linked to trade agreements etc).

Amnesty – Amnesty international to divest from fossil fuel companies

Amnesty “Amnesty International will divest from fossil fuel companies in acknowledgement that investment in an industry whose products are the primary source of the climate crisis is at odds with the organization’s mission of protecting and championing human rights. The decision was taken at Amnesty’s highest decision-making forum - the Global Assembly – which is formed of delegates from around the world. The assembly also voted to take further steps to reduce the organization’s climate impact including by aiming to be totally carbon neutral by 2035, to slash air travel by a third and move towards holding more international meetings virtually….”

Devex - In search of common ground on sustainable agriculture

https://www.devex.com/news/in-search-of-common-ground-on-sustainable-agriculture-95012 “Agriculture is responsible for the vast majority of deforestation, but tackling it means engaging with a challenging array of stakeholders — as UNDP's Green Commodities Programme has discovered. “

Guardian - Economics is a failing discipline doing great harm – so let's rethink it

Andrew Simms; https://www.theguardian.com/commentisfree/2019/aug/03/economics-global-economy-climate-crisis “Our global economy should serve rather than dominate people – and that includes factoring in the climate crisis, too.” Andrew Simms is co-author with David Boyle of Economics: A Crash Course, published this week.

Guardian - Burundi malaria outbreak at epidemic levels as half of population infected

https://www.theguardian.com/global-development/2019/aug/08/burundi-malaria-outbreak-at-epidemic-levels-as-half-of-population-infected “World Health Organization records 1,800 malaria deaths since start of year, almost equalling number of lives claimed by Ebola in DRC.”

Global Fund - Time to Act on the 2018 TB Commitments

https://www.theglobalfund.org/en/news/2019-08-06-time-to-act-on-the-2018-tb-commitments/ “Nearly one year after the first United Nations High-Level Meeting on Tuberculosis, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Health Organization call for immediate action to implement the commitments made by heads of state and governments….” “Targets that were agreed in the October 2018 Political Declaration of the High-Level Meeting of the General Assembly on the Fight Against Tuberculosis for 2018-2022 are: (1) to provide appropriate diagnosis and treatment to 40 million people with TB, including 3.5 million children and 1.5 million people with drug-resistant TB; (2) to reach at least 30 million people with preventive treatment, including 4 million children under the age of 5; 6 million people living with HIV and 20 million other household contacts of people affected by TB; (3) to mobilize US$13 billion annually needed by 2022 for implementation; and (4) to mobilize US$2 billion annually for TB research and innovation….” “… The Stop TB Partnership, in collaboration with Avenir Health, has produced a breakdown of what the global 40 million and 30 million treatment targets mean for each country, using the latest estimates of TB disease burden and data on case notifications published by WHO. This country-by-country breakdown (http://www.stoptb.org/resources/countrytargets/) provides indicative targets and benchmarks that could be used to inform country dialogue, further refinement and development of national and sub-national targets, linked to the development and updating of national strategic plans for TB and associated funding requests, including to the Global Fund….”

BMJ Analysis – Unmasking the vulnerabilities of uninfected children exposed to HIV

https://www.bmj.com/content/366/bmj.l4479 “Although programmes to reduce vertical transmission of HIV mean fewer children are acquiring HIV, more needs to be done to understand the longer term outcomes of exposure, say Vundli Ramokolo and colleagues.” Some of the Key messages: “The number of uninfected children born to mothers with HIV has increased, reaching over 14 million in 2017. Exposure to maternal HIV infection, maternal and infant antiretroviral drugs, and a household that includes people with HIV contribute to multiple health disparities. Long term cohort studies are required to quantify which exposures drive outcome disparities and elucidate possible interventions. Simultaneously, routine health services in high burden HIV settings should be equipped to provide early and timely identification and management of health disparities.”

Cidrap News - MERS analysis highlights concerns over healthcare spread

http://www.cidrap.umn.edu/news-perspective/2019/08/mers-analysis-highlights-concerns-over-healthcare-spread “In its latest annual global risk assessment of MERS-CoV, the World Health Organization (WHO) said transmission, symptom profile, and virus characteristics haven't changed since its last report, but officials are still deeply concerned about transmission in hospitals….” “Since its last update in June 2018, 219 cases were reported in four countries: Saudi Arabia (204), Oman (13), South Korea (1), and the United Kingdom (1). However, of the 97 secondary cases reported to the WHO, 52 were linked to transmission in hospitals, including 23 infections in healthcare workers….”

AMR

NEJM (Perspective) - Sustainable Discovery and Development of Antibiotics — Is a Nonprofit Approach the Future?

Travis B Nielsen et al ; https://www.nejm.org/doi/full/10.1056/NEJMp1905589?query=featured_home « Shifting to a nonprofit-driven model for development of antibiotics could encourage discovery and development of truly needed drugs that improve patient outcomes and permit more effective control over the postapproval use of antibiotics to prolong their effectiveness. »

HP&P - Coca-Cola’s political and policy influence in Mexico: understanding the role of institutions, interests and divided society

Eduardo J Gomez; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz063/5543873?searchresult=1 “In response to Mexico’s burgeoning industrial epidemics of obesity and type-2 diabetes, triggered in part by sugar-sweetened carbonated beverages’ ability to readily market their products and influence consumption, the government has responded through a variety of non-communicable disease (NCD) policies. Nevertheless, major industries, such as Coca-Cola, have been able to continuously obstruct the prioritization of those policies targeting the consumption, marketing and sale of their products. To better understand why this has occurred, this article introduces a political science agenda-setting framework and applies it to the case of Coca-Cola in Mexico. Devised from political science theory and subsequently applied to the case of Coca-Cola in Mexico, my framework, titled Institutions, Interests, and Industry Civic Influence (IPIC), emphasizes Coca-Cola’s access to institutions, supportive presidents and industry efforts to hamper civic mobilization and pressures for greater regulation of the soda industry. … … My proposed analytical framework helps to underscore the fact that Coca-Cola’s influence is not solely shaped by the corporation’s increased economic importance, but more importantly, its access to politicians, institutions and strategies to divide civil society. Additionally, my proposed framework provides several real-world policy recommendations for how governments and civil society can restructure their relationship with the soda industry, such as the government’s creation of laws prohibiting the industry’s ability to influence NCD policy and fund scientific research.”

Lancet Oncology (Series) – Cancer control in small island nations

https://www.thelancet.com/series/small-island-nations “In this five-part Series on cancer control in small island nations in The Lancet Oncology, the Series authors highlight the current state of cancer control in the Pacific and Caribbean islands. These island nations all face similar challenges of a growing cancer burden, inadequate cancer surveillance, geographically isolated small populations, vulnerable ecological and economic situations, insufficient resources, poor access to screening and treatment, and overburdened health-care systems. The authors discuss the specific challenges relevant to each of these regions, and provide several examples of promising innovative strategies to improve all aspects of the cancer care continuum that are emerging in some areas. The Series papers emphasise the crucial role of collaborative approaches—including through funding and investment opportunities with more developed countries—to create comprehensive cancer control programmes to improve cancer planning, prevention, and treatment in these under-resourced small island nations.” And a few quick links: WEF - Denmark is experimenting with ‘culture vitamins’ to lift people out of depression “Depression affects 300 million people across the globe and is the leading cause of disability worldwide according to the World Health Organization (WHO). It costs the global economy $1 trillion every year but fewer than half of those affected receive any treatment. So Denmark is trying a different approach: People suffering from depression are encouraged to take part in cultural activities. They call it Kulturvitaminer – “culture vitamins” – and it is being trialled in four cities….” Guardian - Revealed: how Monsanto's 'intelligence center' targeted journalists and activists And in the category ‘rocket science’, the Guardian - Fast-food outlets on commuter routes may fuel obesity crisis “Fast-food outlets along commuter routes could be contributing to the obesity crisis, research suggests. A study by a US academic found that a greater density of fast-food outlets on commuter routes is linked to higher body mass index (BMI) scores among those travelling along them….”

The Telegraph - ‘Extensive discrimination’ means thousands of Indian women miss out on healthcare, experts warn

https://www.telegraph.co.uk/global-health/women-and-girls/extensive-discrimination-means-thousands-indian-women-miss-healthcare/ “Women in India are missing out on healthcare because of “extensive gender discrimination”, with the youngest and oldest most affected, researchers have found.  According to a study of some 2.4 million patient appointment records in one of India’s largest public hospitals, hundreds of thousands of women are not able to access the healthcare they need.  The study, published in the journal BMJ Open, found that two thirds of hospital appointments were filled by men in 2016, meaning that around 400,000 women were “missing” from care.   “Discrimination means we are missing many women in the healthcare system,” said Professor Ambuj Roy, from the department of cardiology at the All India Institute of Medical Sciences in Delhi. …”

NPR - War Is The Enemy Of Breastfeeding

NPR “…Studies on breastfeeding in a conflict zone are scarce, but a few suggest that war and violence are tremendous obstacles to a mother's ability to breastfeed her baby. In war-torn countries, there are lots of reasons why mothers don't breastfeed their infants….” “…Just as conflict and violence can take a toll on health, they can also lead to a reduction in breastfeeding, says Michael Malcolm, professor of economics at West Chester University in Pennsylvania. He, along with co-authors Vidya Diwakar of the Overseas Development Institute in London and George Naufal of the Public Policy Research Institute at Texas A & M University, wrote a paper on the topic: Violent Conflict and Breastfeeding: The Case of Iraq.  The authors compared breastfeeding rates among women who lived in high-conflict areas of Iraq with those who lived in lower-conflict areas, determined by a database counting war casualties, in the years 2006 and 2011. They found that in high-conflict areas, there’s  approximately a 60% rate of breastfeeding compared to 68% in lower conflict areas….”

Forbes - Revving The Innovation Engine

https://www.forbes.com/sites/unicefusa/2019/07/23/revving-the-innovation-engine/#1ce0ba8a2ba9 “A new Sprint Support program backed by The Bill & Melinda Gates Foundation has UNICEF working with startup companies in a whole different way, to help their cutting-edge ideas blossom — and, in time, boost results for children. The focus for this first initiative: improving immunization.”

Project Syndicate - Killing a Silent Killer of Women

M Hossain; https://www.project-syndicate.org/commentary/anemia-study-women-workplace-nutrition-by-muttaquina-hossain-2019-08 “A promising new study indicates that, with the right approach, anemia can be significantly reduced in as little as ten months. Given the prevalence and far-reaching consequences of this deadly nutritional disorder – which disproportionately affects women of child-bearing age in developing countries – implementation cannot come too soon.” The study: Effectiveness of Workplace Nutrition Programs on Anemia Status among Female Readymade Garment Workers in Bangladesh: A Program Evaluation.

NEJM (Perspective) - Immediate Transfusion and Transfusion Volume in African Children with Severe Anemia

https://www.nejm.org/doi/full/10.1056/NEJMe1908869?query=featured_home “Severe anemia is common among children in sub-Saharan Africa and presents a unique challenge, given the high prevalence of malaria, infectious diarrhea, and malnutrition in underresourced regions. The guidelines of the World Health Organization (WHO) suggest transfusing a volume of 20 ml of whole-blood equivalent per kilogram of body weight, but it is unclear whether that volume is appropriate, as is the timing of transfusion in a child with severe anemia, irrespective of the location. In this issue of the Journal, two articles by Maitland and colleagues report the results from the Transfusion and Treatment of Severe Anemia in African countries ….” See Transfusion Volume for Children with Severe Anemia in Africa &  Immediate Transfusion in African Children with Uncomplicated Severe Anemia.

Lancet Global Health – Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30315-8/fulltext Cfr the press release: “The Lancet Global Health: Automatically chlorinating water at public taps cuts child diarrhoea by almost a quarter in urban Bangladesh. Randomised trial finds novel treatment device that automatically dispenses small amounts of chlorine can create safe water without the need for electricity at public taps in densely populated urban area.” “A novel water treatment device that delivers chlorine automatically via public taps without the need for electricity, reduced child diarrhoea by 23% compared with controls (156 cases out of 2,073 child measurements [7.5%] vs 216/2,145 [10%]) over 14 months in two urban neighbourhoods of Bangladesh, according to a randomised trial following more than 1,000 children published in The Lancet Global Health journal. …”

Guardian - ‘We lose so many women’: the tragedy of unsafe abortion in Kibera

https://www.theguardian.com/global-development/2019/aug/05/we-lose-so-many-women-the-tragedy-of-unsafe-abortion-in-kibera?CMP=twt_a-global-development_b-gdndevelopment “With terminations outlawed in Kenya, women and girls in its largest slum have to rely on expensive and unreliable under-the-counter pills, toxic chemicals or other homemade remedies. The consequences can be fatal.”

Plos Med - The gender-based violence and recovery centre at Coast Provincial General Hospital, Mombasa, Kenya: An integrated care model for survivors of sexual violence

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002886 “Marleen Temmerman and colleagues describe a model of care for people who have experienced sexual violence, set in Kenya.”

Plos Med (special issue) – Maternal and Child Health & Nutrition

https://collections.plos.org/mch-special-issue “In many parts of the world maternal and child health outcomes are increasingly impacted by indirect causes, many of which are related to nutrition. Women with diabetes, anemia or who are overweight are at a higher risk of childbirth-related complications. Their newborns, in turn, are also at a higher risk of experiencing adverse health outcomes later in life. With nearly one in three persons suffering from at least one form of malnutrition in the world – from undernutrition to obesity via diet-related non-communicable diseases – and infant nutrition being crucial particularly in the first 1,000 days of life, this Special Issue highlights the importance of nutrition for maternal and child health.” Check out some of the articles.

Devex - How voluntary licensing agreements are transforming HIV care

https://www.devex.com/news/how-voluntary-licensing-agreements-are-transforming-hiv-care-95362 “In 2014, ViiV Healthcare, a pharmaceutical company dedicated to ending the HIV epidemic, and the Medicines Patent Pool, an organization funded primarily by Unitaid to increase access to medicines in lower-income countries, signed two voluntary licensing agreements. The agreements allowed generic manufacturers to produce and sell low-cost versions of the ViiV-developed HIV drug dolutegravir in all low- and lower-middle income countries, and across sub-Saharan Africa. The licenses also cover pediatric HIV treatment in upper-middle income countries….”

WHO Lays Out Five-Year Regulatory Action Plan

https://www.raps.org/news-and-articles/news-articles/2019/7/who-lays-out-five-year-regulatory-action-plan From 10 July. For the new WHO plan, see Delivering quality-assured medical products for all (2019-2023) - WHO's five-year plan to help build effective and efficient regulatory systems. “As part of efforts to increase access to quality medical products around the globe, the World Health Organization (WHO) this month crafted a five-year plan to promote regulatory collaboration and reliance, and to help national regulatory authorities (NRAs) solve capacity issues and other challenges. According to WHO surveys, only 30% of NRAs in 2018 had the capacity to effectively and efficiently regulate medical products, although there was greater capacity to regulate medicines and vaccines than other products. One way to combat this lack of capacity is through collaboration, with which WHO has succeeded in helping to spur initiatives in Africa and the Caribbean. “In the coming years, WHO will play an important role in supporting the transition from donor- to country-based procurement by strengthening regulatory systems for selected LMICs [low- and middle-income countries]. A strong voice from WHO will be needed to reduce the risk that individual countries may promote local production as part of their national development agenda without parallel efforts to strengthen regulatory systems – the only way to ensure that products meet international standards of quality, safety and efficacy,” the report says. The report also outlines possible ways to combat the limited scope of WHO’s prequalification eligibility list, capacity issues in responding to public health emergencies, the flood of substandard and falsified medical products into LMICs and poor postmarket monitoring by national regulators….”

BMJ Analysis - Evaluation of pharmaceutical industry-led access programmes: a standardised framework

Peter Rockers et al; https://gh.bmj.com/content/4/4/e001659 “Pharmaceutical industry-led access programmes are increasing in number and scope worldwide. We present a new standardised framework for evaluation of these programmes that includes three components: a taxonomy of 11 access programme strategies; a series of logic models, one for each strategy and a set of measurement indicators. The logic models describe pathways of potential programme impact…” What’s this all about? “…More than 20 large biopharmaceutical companies, in partnership with the World Bank and the Union for International Cancer Control (UICC), recently committed to expanding their efforts to improve access for non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) as part of the Access Accelerated initiative. Access Accelerated programmes go beyond a narrow focus on medicines, and aim to address the full range of health system barriers to access….”

Stat News – Novartis faces another crisis. And for CEO Vas Narasimhan, this time is different

https://www.statnews.com/2019/08/07/novartis-faces-another-crisis-and-for-ceo-vas-narasimhan-this-time-is-different/ (gated) “Novartis CEO Vas Narasimhan began his tenure with an inherited scandal. Now he’s got one all his own. The revelation on Tuesday that AveXis, Novartis’s gene therapy division, submitted falsified data to the Food and Drug Administration is at the very least a blemish on the brief reign of Narasimhan, a rising figure who took over in early 2018 with a promise to change the culture at the Swiss drug maker. But it also threatens to become a much bigger scandal….” See also NYT.

Healthcare middle managers’ experiences of developing capacity and capability: a systematic review and meta-synthesis

T A Hartviksen et al ; https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4345-1 “Healthcare middle managers play a central role in reducing harm, improving patient safety, and strengthening the quality of healthcare. The aim of this systematic review was to identify the present knowledge and critically discuss how healthcare middle managers experienced to develop the capacity and capability for leadership in a healthcare system characterized by high complexity….”

Lancet Editorial – Improving occupational health in China

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31799-4/fulltext “China has the largest working population in the world—about 776 million in 2018, and most workers spend half their lives working. The Chinese Government prioritised occupational health in the action plan of Healthy China 2030 as one of its 15 major health projects. Last week, the National Health Commission (NHC) announced the latest official data on the country's occupational health status and unveiled China's strategy to address the challenges in occupational health. …” The editorial concludes: “China's determination to improve occupational health is a welcome step towards translating its economic gains into health benefits for all workers in China. Lessons learnt from China might have important implications for other low-income and middle-income countries like India and Brazil, where similar actions are warranted to accelerate progress towards Sustainable Development Goal 8—”full and productive employment and decent work for all”.”

Guardian - Free speech and privacy on the wane across the world

https://www.theguardian.com/global-development/2019/aug/08/free-speech-and-privacy-on-the-wane-across-the-world “Autocratic rule, increased media restrictions and use of mass surveillance affect almost half global population, researchers find. Nearly half the world’s people are living in countries where their freedom of speech and right to privacy are being eroded, researchers have found. “Strongman” regimes seeking to squash voices of dissent and solidify political power are increasingly monitoring citizens through technology, cracking down on protests and jailing journalists, according to a ranking of 198 countries on issues including mass surveillance and data privacy. The report, launched on Thursday by global risk analysis company Verisk Maplecroft, found that about 3.38bn people, or roughly 46% of the global population, live in countries deemed to be at “extreme risk” in relation to right to privacy and freedom of expression….”

Humanitarian Health Digest – 2^nd quarter 2019

http://hopkinshumanitarianhealth.org/assets/documents/HHD_2Q_2019_Finalv2.pdf “The Humanitarian Health Digest is a quarterly bibliography of published peer-reviewed journal articles on humanitarian health. The Digest is compiled by the Johns Hopkins Center for Humanitarian Health and The Lancet. It includes one or two new commentaries on peer-reviewed articles cited in the Digest. The objective of the Digest is to provide links to peer-reviewed articles on humanitarian health from a wide variety of journals in one place for ease of reference….” Do check out also the commentary by O Sekkides – “PHEICs and their unclear purpose”.

Richard Smith (blog) - Populism and the NHS

BMJ Blog; “Britain’s much loved NHS is a prime target for populist politicians, says Richard Smith.”

Vox - Facebook is building tech to read your mind. The ethical implications are staggering.

https://www.vox.com/future-perfect/2019/8/5/20750259/facebook-ai-mind-reading-brain-computer-interface “Our brains are perhaps the final privacy frontier.” Some quick links: Guardian -  First human-monkey chimera raises concern among scientists “Researchers reprogrammed human cells before injecting them in the monkey embryo.” Scidev.net - Nanotechnology: a blessing or a curse for developing nations? “Nanotechnology has the potential to boost nutrition and crop resilience. But questions remain about its safety, with research lacking. Experts say global regulation is needed, especially to protect developing nations.”

10^th anniversary EV4GH will be celebrated in 2019-2020

http://www.ev4gh.net/ev-10th-anniversary-blog-series/ Among others, with a series of short blogs by EV alumni who reflect on their experiences since their participation in the venture, and on the network. Adithya Pradyumna  (EV 2014) just kicked off the series. New contributions will be published in the coming months. So do check from time to time!

Human Resources for Health - Paramedics, poetry, and film: health policy and systems research at the intersection of theory, art, and practice

L Brady (EV 2018) et al; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-019-0373-5 “Violence is a public health issue. It is the consequence of a complex set of interacting political, social, and economic factors firmly rooted in past and current injustice. South Africa remains one of the most unequal countries in the world, and in some areas, the rates of violence are comparable to a country that is at war. Increasingly, paramedics working in high-risk areas of Cape Town are being caught in the crossfire, and in 2018, there was an attack on a paramedic crew nearly every week. These attacks are a symptom of much deeper, complex societal issues. Clearly, we require new approaches to better understand the complexity as we collectively find a way forward. It is in this context that we are collaborating with paramedics, poets, and filmmakers to tell human stories from the frontline thereby bringing the lived experiences of healthcare workers into policy making processes. In this commentary, we share a series of poems and a poetry-film that form part of a larger body of work focused on the safety of paramedics, to catalyze discussion about the possibilities that arts-based methods offer us as we seek to better understand and engage with complex social issues that have a direct impact on the health system.”

Vaccine - Wound-only injection of rabies immunoglobulin (RIG) saves lives and costs less than a dollar per patient by “pooling strategy”

Omesh K Bharti (EV 2010); https://www.sciencedirect.com/science/article/pii/S0264410X19310084?via%3Dihub “Since 2008, we in Himachal Pradesh have used a “pooling strategy” to help patients save money by pooling vials of antirabies vaccine at a centralized hospital and sharing them using the intradermal technique. In 2014, there was an acute shortage of rabies immunoglobulins (RIG) and two patients died after four injections of rabies vaccine were administered without RIG, which was not commercially available. After an extensive literature review and technical and ethical committee clearances, in June 2014 we started to infiltrate equine RIG (eRIG) into wound/s only without the recommended systemic intramuscular (IM) injection. WHO recommended this technique in 2018. … …  Since February 2018, Himachal has started following the new WHO recommendations on PEP (post-exposure prophylaxis) regimens of three intradermal antirabies vaccines instead of four, thereby saving hundreds of vaccine vials that became useful during shortages of rabies vaccine in India. To date, more than 700 vaccine vials have been saved in a single clinic at DDU hospital during the past 6 months alone. Not giving PEP to patients who have consumed raw milk from a suspected rabid cow has also saved 62 vials. Currently, 90 “pooling centers” have been established for sharing of vaccine and eRIG vials in Himachal State, generating huge savings that have enabled the government to provide PEP free of charge to all. The new WHO guidelines are a positive step towards a rabies-free world by 2030.”