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IHP news : Turbulent times

(18 March 2016)

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

Dear Colleagues,

We presume many of you are finalizing & submitting your abstracts for the Vancouver symposium, so we won’t annoy you with a long intro this week. For Emerging Voices applicants who still need some final advice for the EV competition (and required documents), we refer to the Storify of the Twitter chat from earlier this week, #BeanEV. Good luck and hope to see you in Vancouver!

As usual, you find the main news in the ‘Highlights of the Week’ section, but do read on for the rest (especially if you’re a researcher). Our selection of highlights doesn’t always correspond with yours, we reckon.

In this week’s (slightly out of the box) Featured Article, Solomon Salve (EV 2014) wonders about the “spirit” of a health system. Consider it an early Easter contribution!

Enjoy your reading.

The editorial team

Featured Article

“The spirit of a health system”: Personal reflections as a Lay leader, Public Health Researcher, and an Anthropologist

Solomon Salve (EV 2014, Health Governance Hub - Public Health Foundation of India)

I am a trained anthropologist from University of Pune-India, and hold a PhD in public health and policy from the London School of Hygiene and Tropical Medicine (LSHTM). In the year 2000, I was also ordained as a Lay Leader to serve the local Church. Although not a trained theologian, my interest in theology does sustain till date. In search of an answer for Health System Strengthening (HSS), the Holy Grail for a health systems researcher, and during the course of a Bible study, I encountered Saint Paul the Apostle in a new way. He appeared to me more as a systems researcher this time. Drawing upon Paul’s analogy of the human body, in this blog I consider the health system

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as a body with different parts and functions. The views expressed here are solely based on my Christian background, and I acknowledge that not everyone shares this point of view, and thus might have a (very) different interpretation of what follows below.

But some background first for readers who don’t have a Christian background. Just before Jesus Christ ascended to heaven he promised his disciples that the Holy Spirit would come on them, and would thereafter be with them as an advocate, a counsellor, a comforter and an encourager. On the day of Pentecost, as promised, all disciples were filled with the Spirit (Acts 2:2). Being filled with the Spirit is not merely a warm feeling in our hearts, but a power to go out and make a difference in the world. In his Epistle to the congregation in Corinthians (1 Cor 12:12), Paul used the metaphor of the human body to describe the relationship of human beings with each other, and how those relationships are unified by the Holy Spirit. The same Holy Spirit lives in every Christian irrespective of his/her nationality, denomination and background, and provides everybody with varying ‘spiritual gifts’ (1 Cor 12:8-10). The Holy Spirit constantly helps believers to exercise their gifts to edify Christ’s body (i.e. the Church) to maintain unity, and to produce the fruits of spirit in their lives: love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control (Gal 5:22-23).

Similarly, the health system is not something that is exterior to human existence, rather it is a “body” formed out of individuals (who, as we have seen above, comprise not just body (& soul), but also spirit). In recent years, scholars have recognised that in addition to the ‘hardware’ of health systems, the ‘software’ (or ‘mortar’ as some have called it recently) also underpins the relationships amongst and between system actors.

If we translate ‘software’ and ‘hardware’ according to Paul’s analogy of the body, then the ‘hardware’ would mean the physical structure of our body; the ‘software’ would be the soul – comprising of emotions, thoughts, and a determination to make decisions; the soul also involves transcendental elements (but that would lead us too far here). In addition to body & soul, there’s still the ‘spirit’ of Jesus Christ, connecting individuals (or at least Christians). There’s something very ‘resilient’ about Christians, if you watch them – and many of them would argue the Holy Spirit gives them strength.

Is there an equivalent of ‘spirit’ for health systems? And if there is, can it be capitalized upon in order to make the health system perform better and more effective, providing good quality care for all people? In addition, is the need for some sort of health system “spirit” actually felt by those working in the field of public health?

To give an example of what I mean (at least according to my world view), I am going to reflect on a small piece of information from my PhD data. This quote is extracted from an interview of a Chief Executive Officer (CEO) of an NGO. When I probed him about challenges of partnerships with Government he said:

“Government is willing to listen...but what happens is that, Government has a limitation in the sense that, top politicians, top bureaucracy, can understand what we are trying to communicate, but down the line right from the level of Directors, secretaries, and also the peripheral functionaries, that ‘spirit of partnership’, that ‘spirit of appreciation’ for the collaborative effort is not forthcoming, whatever they agree at the top level that should percolate down, in words and ‘spirit’, to the ground level, because ultimately service delivery makes all the difference”.‖

[Interview, Chief Executive Officer, NGO]

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From a public health researcher’s point of view, the above quote brings the first level of understanding. The CEO highlights gaps in policy communication, policy implementation and so on. He lays in front of us the divide between the two worlds – the world of top level bureaucrats versus the world of frontline implementers. However, the discipline of public health doesn’t do (full) justice to the term ’spirit’, I feel. I find it difficult to accommodate the word ‘spirit’ within the disciplinary realm. The dominant (biomedical) public health approach often lacks the capacity to perceive the ‘subjectivity’ of individual people and to understand the context of their social relationships. There thus seems to be a need to rely on another disciplinary perspective (or at least one somewhat less dominant in public health). So now I take up the lens of an anthropologist.

Clifford Geertz (1973) states that anthropology is ‘not an experimental science in search of laws but an interpretive one in search of meaning’. The very nature of anthropology being the study of human beings in the broadest sense provides a ‘subjective’ interpretation of the quote. In the above quote, the CEO used the word ‘spirit’ thrice (thus clearly stressing its significance). From an emic perspective (insider’s point of view), he was not merely reflecting on the (content) communication of policy from top to bottom, but he also added the very core element of human existence to it – the ‘Spirit’ (at least, that is my Christian reading of this quote). The CEO acknowledged the fact that there is ‘something’ more essential to relationships beyond structures and ideas. Being an NGO executive, he had the opportunity to sit in various national level meetings, where he connected with the higher authorities and understood their intention of partnerships. However, when he went back to the field he encountered different individuals from the public sector who – clearly - did not have the same ‘spirit’ of partnership and collaboration as witnessed among and promoted by people at the top. The respondent, however, desperately wanted such a ‘spirit’ in the whole system, as it would bring coordination across levels of the public system, unite partners to make it a sustainable partnership, and induce compassion - which would in turn lead towards healthy systems.

Nowadays, secular public health researchers would perhaps use the term ‘emergent property’ (in a complex health system) for such a spirit (and discern ‘virtuous feedback loops’, while they’re at it). And perhaps people inspired by this Spirit (and the overall system) would just be called more ‘resilient’ by these researchers. That is not my view, as you understand by now.

In our daily lives we easily use the idiom, “That's the spirit!” confirming there is ‘something’ beyond our feelings. There is a (growing?) recognition worldwide of the ‘spiritual' aspect of our human existence, broadly or more narrowly defined. For example, in 2014, New York City hosted a conference, ‘caring for the human spirit: driving the research agenda for spiritual care in healthcare'. Similarly, there are attempts to bring back compassion and other spiritual core values into public health. A recent article, “Spiritual Themes and Challenges in Global Health” even expresses interest in bringing spirituality to the center of the global health discourse. As we move towards Universal Health Coverage (UHC) for achieving the Sustainable Development Goals (SDGs) in the post-2015 era, the strengthening of health systems remains extremely important. In my view, in addition to the ‘hardware’ and ‘software’ needed to build resilient health systems, there is a need to also have a universal ‘Spirit’ in the health system.

So perhaps it’s time to take a pause, and ask a simple question: where is the “spirit” of a health system?

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Solomon Salve is a Senior Research Associate at the Health Governance Hub - Public Health Foundation of India (PHFI). His key interest is in health systems and policy research (HPSR), particularly using an anthropological lens to study complex organisational relations, and contribute to health systems strengthening.

Highlights of the week

Nature (news) – The elephant in the room we can’t ignore

http://www.nature.com/news/the-elephant-in-the-room-we-can-t-ignore-

1.19561?WT.mc_id=TWT_NatureNews

“If Donald Trump were to trigger a crisis in Western democracy, scientists would need to look at their part in its downfall, says Colin Macilwain.”

Another great read related to the political crisis in the North is Stiglitz’ The New Generation Gap (Project Syndicate)

European & global refugee & humanitarian crisis

On Thursday & Friday another refugee crisis related summit takes place in Brussels. Stay tuned for more info on this ‘swap deal’ summit.

Meanwhile, some reads & viewpoints ahead of the meeting you might want to look into:

Jeff Sachs: A three-point solution to the migrant crisis. (Jeff is one of the few people, together with Bernard Henri-Lévy perhaps) who have a solution for every major global crisis)

M Marmot: Treating people with dignity not as instruments

Simon Maxwell - Humanitarian issues in the spotlight (for the coming months) (A note based on a reading of the key preparatory documents for the World Humanitarian Summit in Turkey, especially the Report of the High-Level Panel on Humanitarian Financing, and also the Secretary General’s Report, ‘One Humanity: Shared Responsibility’. )

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Planetary health (incl climate change )

Guardian - Surge in renewable energy stalls world greenhouse gas emissions

http://www.theguardian.com/environment/2016/mar/16/surge-in-renewable-energy-stalls-world-

greenhouse-gas-emissions?CMP=share_btn_tw

Somewhat good news: the world’s carbon dioxide emissions seem to have stabilised- to a large extent due to a surge in renewable energy. Yet, they need to fall to have a real impact on climate change. See also The Economist.

Guardian - February breaks global temperature records by 'shocking' amount

https://www.theguardian.com/science/2016/mar/14/february-breaks-global-temperature-records-

by-shocking-amount?CMP=share_btn_tw

As this was the extremely worrying news from earlier this week. It seems feedback mechanisms are already kicking in. So time is running out to avoid catastrophic scenarios.

WHO (press release) - An estimated 12.6 million deaths each year are attributable

to unhealthy environments

http://www.who.int/mediacentre/news/releases/2016/deaths-attributable-to-unhealthy-

environments/en/

A quite important WHO report from early this week then: “An estimated 12.6 million people died as a result of living or working in an unhealthy environment in 2012 – nearly 1 in 4 of total global deaths, according to new estimates from WHO. Environmental risk factors, such as air, water and soil pollution, chemical exposures, climate change, and ultraviolet radiation, contribute to more than 100 diseases and injuries. Noncommunicable diseases contribute to largest share of environment-related deaths. The second edition of the report, “Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks”, reveals that since the report was first published a decade ago, deaths due to noncommunicable diseases (NCDs), mostly attributable to air pollution (including exposure to second-hand tobacco smoke), amount to as much as 8.2 million of these deaths. NCDs, such as stroke, heart disease, cancers and chronic respiratory disease, now amount to nearly two-thirds of the total deaths caused by unhealthy environments. At the same time, deaths from infectious diseases, such as diarrhoea and malaria, often related to poor water, sanitation and waste management, have declined. …”

You find the report here. Coverage for example in the Guardian, Environmental risks killing 12.6 million people, WHO study says.

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Access to medicines

The UN Secretary General’s High-Level Panel on Access to Medicines held its second of two “Global Dialogues” this week in Johannesburg. “The High-Level Panel has been tasked by the UN Secretary-General to review and assess proposals and recommend solutions to address the “policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.””

Some important reads:

IP-Watch - High-Level UN Initiative On Global Public Health Gap Holds Landmark

Hearing

http://www.ip-watch.org/2016/03/11/high-level-un-initiative-on-global-public-health-gap-holds-landmark-hearing/

(must-read). A very good overview of some of the key debates at the London public hearing from last week.

For more on the meeting in Jo’burg, see also IP-Watch. “…High-Level Panel co-chair Ruth Dreifuss closed the day’s session by stating that the issue being addressed is a global problem, not only a developing country problem. She pointed to a lack of innovation and to high prices for medical products, and said a global view should respect the different needs of different countries. The panel is not only focused on medicines, but also diagnostics, for example, which are “key in so many fields of public health.” Dreifuss also said policymakers have to build on good practices and good experiences. They should see what had effect and take into account the limitations of those models and how they should be corrected or upgraded. They should also explore new solutions. And on IP rights, she clarified that they are not authorised to consider IP rights as fundamental rights at the same level as HR and right to health. IP rights are tools, which have proved good tools in certain situation, for certain goods, and certain problems.”

Scidev.net – Plea for treaty on drug research

http://www.scidev.net/global/r-d/news/plea-treaty-drug-research-UN.html

“Health activists are demanding an international treaty on medical research and development (R&D) to speed up the creation of cheap medicines. Outdated intellectual property (IP) regimes and market distortions hold back research on new medicines, activists said at a meeting of the UN Secretary-General’s High-Level Panel on Access to Medicines, held on 10 March in London, United Kingdom. “We do our R&D in an IP system that has created a hugely wasteful process,” said Els Torreele, the director of the Access to Essential Medicines Initiative of grant-making network the Open Society Foundations. “We could do so much better if we weren’t limiting ourselves to only innovating what we can also patent.” “ Basically, they’re calling for a global agreement to delink pharma R&D costs from medicine prices.

TDR – New approach proposed for funding and managing health product R&D

http://www.who.int/tdr/news/2016/funding_managing_health_product_R_D/en/

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“TDR has published Health Product Research and Development Fund: a Proposal for Financing and Operation, describing how a potential pooled fund could operate under the governance of the World Health Organization (WHO) Member States. It also provides new financial modelling tools and mechanisms to guide the fund’s operation.” …” Key report recommendations, to be considered by WHO Member States at a special meeting in May prior to decision-making at the 69th World Health Assembly, include: (1) A fund of sufficient scale (e.g. incremental increase starting at US$ 10–15 million annually, gradually going up to US$ 100 million annually over a 10-year period) should be set up to support health product R&D; (2) The fund’s portfolio of projects (e.g. gradual increase in number of funded projects starting from 5–7 projects per year to an average of 35–40 projects) should be balanced between short-term repurposing and longer-term discovery efforts; (3) The fund should have transparent, objective and non-political evidence-based decision-making processes; (4) The fund should be able to accept “new” funders and maximize leverage by encouraging new partnerships and collaborations.” You find the report here.

IP-Watch - MSF Challenges Pfizer Patent Application For Pneumonia Vaccine In

India

http://www.ip-watch.org/2016/03/11/msf-challenges-pfizer-patent-application-for-pneumonia-

vaccine-in-india/

News from late last week. “Today, Médecins Sans Frontières (MSF, Doctors Without Borders) filed a patent opposition against Pfizer’s vaccine for pneumonia in India. According to an MSF press release, the humanitarian association hopes to prevent United States company Pfizer from getting a patent on the pneumococcal conjugate vaccine (PVC13) so competition can bring cheaper versions to the market. “This is the first time a vaccine (biosimilar) patent has been challenged in India by a medical organisation, with the goal of millions more children being protected against deadly pneumonia,” the release said. The pneumonia vaccine accounts for almost half the price of vaccinating a child in the poorest countries, it said. Pneumonia kills almost one million children each year, according to MSF. Pfizer and GlaxoSmithKline (GSK) are the only two companies manufacturing the vaccine. According to the release, “it is now 68 times more expensive to vaccinate a child than in 2001.”

(PS: Yesterday, GSK CEO Witty announced a 10% drop in price of GSK pneumococcal vaccines for GAVI countries. See the GAVI statement on this news: Gavi welcomes new record low price for pneumococcal vaccine )

Lancet Correspondence – Global platform to inform investments for health R&D

M-P Kieney et al ; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00705-4/fulltext

On the Global Observatory on Health R&D at WHO. “ WHO's Observatory is the ideal platform to use to inform better investment decisions for future R&D. We believe that this platform will become an inclusive global point of access for relevant data on health R&D. “

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Social Science & Medicine –Global health diplomacy: A critical review of the literature

A Ruckert et al; http://www.sciencedirect.com/science/article/pii/S0277953616301046

Recommended. “Global health diplomacy (GHD) describes the practices by which governments and non-state actors attempt to coordinate and orchestrate global policy solutions to improve global health. As an emerging field of practice, there is little academic work that has comprehensively examined and synthesized the theorization of Global Health Diplomacy (GHD), nor looked at why specific health concerns enter into foreign policy discussion and agendas. With the objective of uncovering the driving forces behind and theoretical explanations of GHD, we conducted a critical literature review. …. We found a lack of rigorous theorizing about GHD and fragmentation of the GHD literature which is not clearly structured around key issues and their theoretical explanations. To address this lack of theoretical grounding, we link the findings from the GHD literature to how theoretical concepts used in International Relations (IR) have been, and could be invoked in explaining GHD more effectively. To do this, we develop a theoretical taxonomy to explain GHD outcomes based on a popular categorization in IR, identifying three levels of analysis (individual, domestic/national, and global/international) and the driving forces for the integration of health into foreign policy at each level.”

New EAT foundation Launched

http://eatforum.org/article/new-eat-foundation-launching-today-will-change-the-way-we-feed-the-

world/

What’s in a name… “A new foundation launches today with the ambition to reform the global food system, enabling us to feed a growing global population with healthy food from a healthy planet. The EAT Foundation is a major new initiative co-founded by the Wellcome Trust, the Stordalen Foundation and Stockholm Resilience Centre. The three organisations will use their unique range of experience in health, science, policy and sustainability, to convene experts and decision makers who together can transform the way we eat. The Wellcome Trust and the Stordalen Foundation will each invest £3 million in EAT Foundation over the next 3 years to support policy and science. The science activity of the foundation will be coordinated by Stockholm Resilience Centre, which has an international reputation for excellence in sustainability science and environmental stewardship.”

The third EAT Stockholm Food Forum (13-14th of June) will “bring together some of the world’s brightest people in the fields of science, politics, business and civil society to shift food systems towards greater sustainability, health, security, and equity within the boundaries of our planet. This year, the forum will cover consumption and production patterns, technology and innovation.”

Politics – The UN fades into irrelevance in the war on drugs

I Dunt; http://www.politics.co.uk/blogs/2016/03/15/the-un-fades-into-irrelevance-in-the-war-on-

drugs

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Very damning piece on the preparations for the upcoming UN summit on drug policy (UNGASS 2016), in April. Must-read.

Read certainly also, on Open Democracy, The United Nations is supposed to be negotiating a solution to the ‘world drug problem’, and it’s not going well . “Nearly 200 civil society organisations are expressing serious concerns with the preparations for the upcoming United Nations General Assembly Special Session on drugs.” Check out also their statement, The UNGASS outcome document: diplomacy or denialism?

An excerpt from the Politics piece: “This April, the UN General Assembly Special Session on drugs will convene in New York – seen by many as a possible breaking point for the global drug control system, and the first session to be held on this theme for two decades. The UNGASS is actually happening two years early, because the governments of Mexico, Colombia and Guatemala have called for it in advance. This time, the UNGASS is expected to be a crucial moment in which dissenting countries could break the UN consensus over the ‘war on drugs’ and the model of prohibition, proposing alternative approaches towards harm reduction and decriminalisation instead. … The Commission on Narcotic Drugs, the UN preparatory body for the UNGASS, is meeting in Vienna this week with the main focus of finalising the outcome document for the UNGASS. Nearly 200 civil society organisations, representing drug policy experts and involved communities, have released a statement,“Diplomacy or denialism?”, expressing serious concerns over the current negotiations around the outcome document, and the failure of governments in recognising the damaging consequences of the current prohibitionist drug control system.”

Developing world bioethics - Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale

Hayley MacGregor &Gerald Bloom; Developing world bioethics;

Well worth reading. “This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes. We focus on situations where ‘country ownership’ of HSR is relatively well established and where there is significant involvement of local researchers and close ties and relationships with policy makers are often present. We frame our discussion around two country case studies with which we are familiar, namely China and South Africa and discuss the implications for conducting ‘embedded’ research. We suggest that reflexivity is an important concept for health system researchers who need to think carefully about positionality and their normative stance and to use such reflection to ensure that they can negotiate to retain autonomy, whilst also contributing evidence for health system change. A research process informed by the notion of reflexive practice and iterative learning will require a longitudinal review at key points in the research timeline. Such review should include the convening of a deliberative process and should involve a range of stakeholders, including those most likely to be affected by the intended and unintended consequences of change.”

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60th session of UN Commission on the Status of Women in NY

UN News centre – Upcoming UN forum to focus on women’s empowerment,

sustainable development

UN News centre ;

“Advancing the 2030 Agenda for Sustainable Development, particularly gender equality and the empowerment of all women and girls”, is the focus of the United Nations Commission on the Status of Women (CSW), which began its 60th session in New York this week.

Guardian - Activists call on world leaders to make gender equality pledge a reality

http://www.theguardian.com/global-development/2016/mar/14/world-leaders-gender-equality-

pledge-reality-un-commission-on-the-status-of-women-sustainable-development

Ahead of the meeting this was the request from activists: “World leaders must back up their pledge to end gender inequality with concrete commitments on how they plan to empower women, said activists preparing for the UN Commission on the Status of Women. The annual CSW meeting to review progress on women’s empowerment, which begins in New York on Monday, is the first since the UN general assembly adopted the sustainable development goals (SDGs), the roadmap for ending poverty, inequality and conserving the environment over the next 15 years that was agreed in September. Goal five specifically calls on governments to end all forms of discrimination against women and girls, end violence and harmful practices, recognise the unpaid care work that falls disproportionately on women, get more women into leadership positions, and ensure women can uphold their reproductive rights. Campaigners want the outcome agreement – signed by UN member states at the end of two weeks of negotiations – to show strong commitments on how the SDGs will be implemented and financed….”

For more info, see also UN Women. The meeting continues next week.

You might also want to read (both in the Guardian ) Empowering women will mean little without decent jobs, UN panel warned & UN Women's head: 'Historic shift' needed to find concrete ways to end gender inequality.

SDGs – Indicators agreed in New York last week

Last week, the global SDG indicator framework was agreed in New York.

First a few general pieces, then some more viewpoints on the rather shabby UHC indicator selected.

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UN - Last missing piece completes architecture of 2030 Agenda for Sustainable

Development

https://www.un.org/development/desa/en/news/statistics/piece-architecture-2030-

agenda.html#more-19540

“As the final piece of the architecture for implementing the 2030 Agenda for Sustainable Development, the proposed global indicator framework for the Sustainable Development Goals (SDGs) was agreed by the 47th session of the United Nations Statistical Commission which closed today. “Completing the indicator framework is of course not the end of the story – on the contrary, it is the beginning,” highlighted UN DESA’s Under-Secretary-General Wu Hongbo in remarks delivered by UN Assistant Secretary-General for Economic Development Lenni Montiel during the session. United Nations Statistical Commission agrees on global indicator framework for monitoring progress towards achieving Sustainable Development Goals. Agreed as a practical good starting point, the set of 230 global indicators proposed by the Inter-Agency and Expert Group on SDG indicators (IAEG-SDGs) is a robust framework intended for follow-up and review of progress at the global level towards achieving the 17 SDGs, according to the report of the Statistical Commission. Acknowledging that the development of a high-quality indicator framework is a technical process that will need to continue over time, “refinements and improvements will be needed over the years, as knowledge improves and new tools and data sources become available,” emphasized Mr. Wu. Moving forward, the IAEG-SDGs will work on the basis of the initial indicator framework, to review and refine the indicators as needed and to further develop the necessary methodologies.” See also IISD coverage.

As a reminder, you find the agreed list of indicators here (Annex IV).

CGD – 230 Indicators Approved for SDG Agenda

Casey Dunning; http://www.cgdev.org/blog/230-indicators-approved-sdg-

agenda?utm_source=160315&utm_medium=cgd_email&utm_campaign=cgd_weekly&utm_&&&

Must-read on the agreed SDG indicators & what needs to follow now. “… The Sustainable Development Solutions Network (SDSN) has created a preliminary SDG Index and SDG Dashboard using only indicators with significant country coverage, technically sound methodologies, and frequent updates. An application of this criteria left the SDSN with 39 viable indicators. Adopting so many indicators — viable and otherwise — could end up harming the larger SDG agenda to “Leave No One Behind.” …. …. If the UN and its member states are prepared to advance an agenda with 17 goals, 169 targets, and 230 indicators, they must also be prepared to bring the same level of ambition and resolve to monitoring and implementation.”

See also Global Policy Watch, “…In its decision on the indicator framework, the 47th Statistical Commission recognizes that it is a preliminary list and initial step that will evolve over time. Turning to implementation, the IAEG-SDGs is meeting in Mexico, 31 March to 1 April 2016 to classify the indicators into the three tiers – in terms of the existence of an established methodology and the availability of data – starting with those in Tier III referenced here, for which there is a no internationally agreed methodology.”

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UN ECOSOC - Theme of the 2016 high-level political forum on sustainable

development, convened under the auspices of the Economic and Social Council:

“No one left behind” (24 July -27 July 2016 )

http://www.un.org/ga/search/view_doc.asp?symbol=E/2016/L.11

“The Economic and Social Council decides that the theme of the 2016 high level political forum on sustainable development, convened under its auspices, will be “Ensuring that no one is left behind” and that the present decision is without prejudice to decisions regarding the themes for future meetings of the forum.”

Health Affairs - The MDG To SDG Transition: Implications For Health Care Systems

A Hatefi, D Jamison et al; http://healthaffairs.org/blog/2016/03/16/the-mdg-to-sdg-transition-

implications-for-health-care-systems/

Must-read!!! “Public health, health promotion, prevention, and controlling risk factors through a broad range of policy interventions, both within and outside the health sector, must be an important focus in the era of SDGs. However, delivering on the broad and ambitious SDG 3 will require an expansion in thinking to encompass the quality and efficiency of accessible care across the continuum of services — from community outreach, to primary and specialty clinics, to hospitals, and back to home or sub-acute settings….”. In short: “integrating hospital services into HSS is critical to achieving the SDGs”. The authors zoom in on implications for maternal & child health, NCDs, UHC, surgical care & infectious disease epidemics. They then also offer four areas in which the international community can provide support.

Check out also B Lomborg’s view (see Project Syndicate) - The Right Targets for Global Health Investment. “Targeted investments in health systems would lead to greater gains. …”

Devex – How should we measure access to health care?

https://www.devex.com/news/how-should-we-measure-access-to-health-care-87862#.VuLZBX-

DezM.twitter

On the sorry UHC indicator chosen – and some possible reasons for this, see this piece. Also reflects the concerns of WHO, WB & civil society. (must-read)

HHR (blog) - The Problems with the Proposed Indicators for Monitoring Universal

Health Coverage in the Sustainable Development Goals

Audrey Chapman ; http://www.hhrjournal.org/2016/03/the-problems-with-the-proposed-

indicators-for-monitoring-universal-health-coverage-in-the-sustainable-development-

goals/?platform=hootsuite

“Writing in 2014, Alicia Ely Yamin and Vanessa Boulanger showed how the global approach to women’s sexual and reproductive health was skewed by the selection of targets and indicators chosen to measure Millennium Development Goal 5.1The narrow focus of these targets and

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indicators on maternal healthcare and on maternal mortality in particular was converted into national planning tools and priorities for international aid. In the process, broader dimensions of gender equality and women’s sexual, reproductive, and health rights were sidelined. I fear that the same type of narrowing, counterproductive to human rights, is happening with the measurement of universal health coverage for the Sustainable Development Goals….”

The author of this piece is worried that ‘the same type of narrowing, counterproductive to human rights, is happening with the measurement of universal health coverage for the Sustainable Development Goals’ (i.e. as happened in the past with .

Save the Children (report) – From agreement to Action: delivering the SDGs

R Hinds et al; http://www.savethechildren.org.uk/resources/online-library/agreement-action

From Agreement to Action provides guidance and recommendations for governments, international actors and other stakeholders as they develop their implementation plans, and identifies five areas of action: national plans; governance and institutions; a commitment to leave no one behind; democratising data; improving accountability.

Lancet (Comment) –Sustainable development and global mental health—a Lancet Commission

V Patel et al ; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00208-7/fulltext

There is a “growing importance of mental health in the global discourse on development, as indicated by the adoption of WHO's Comprehensive Mental Health Action Plan 2013–2020,5 the explicit inclusion of mental health in the targets of the Sustainable Development Goals (SDGs), and the forthcoming high-level meeting on mental health co-hosted by the World Bank and WHO on April 13–14, 2016”. Despite this momentum, most people affected by mental health problems globally continue to be denied at least one of the two rights recommended in the 2007 Lancet call to action (i.e. the right to evidence-based care and the right to dignity.).

“…In response to this neglect, The Lancet and its sister journal The Lancet Psychiatry has assembled leaders from around the world to prepare a Commission on Global Mental Health to be published on World Mental Health Day in 2017, marking the 10th anniversary of the first Lancet Series. … …The overarching objectives of the Commission are to synthesise the knowledge that is ripe for wider implementation, as well as identify innovations and opportunities that can overcome some of the structural barriers to scaling up effective interventions. Four principles will guide the work of the Commission.”

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World TB Day coming up – 24 March

World TB Day 2016 is coming up.

Lancet (Editorial) – Unite to end tuberculosis

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30005-8/fulltext

“March 24 marks World TB Day. This year, the theme is “Unite to end tuberculosis”. WHO calls on governments, civil society, and the private sector to unite to end the tuberculosis epidemic—a much needed approach to tackle this deadliest of diseases. Although 43 million lives were saved through effective diagnosis and treatment between 2000 and 2014, more than 9 million cases of tuberculosis and 1·5 million deaths (0·4 million deaths in HIV-positive individuals) occur annually…. Today's Lancet offers an up-to-date overview of the latest developments in tuberculosis diagnostics, treatments, and policies. … … the key risk factors associated with tuberculosis not only include HIV, poverty, and overcrowding, but also undernutrition, alcohol misuse, tobacco smoking, diabetes, and indoor air pollution—factors that are also major contributors to the global burden of non-communicable diseases (NCDs). A united approach is indeed required to deliver on the promise to end tuberculosis. A convergence between infectious diseases and NCDs—on the basis of their increasingly shared risk factors—could enable a renaissance not only in tuberculosis research but also in the energy and consistency of tuberculosis prevention and treatment programmes.”

Check out also the Lancet Comment, Why are people living with HIV still dying of tuberculosis? There are also a number of Lancet Letters on TB control.

Lancet World Report – Changing the game for multidrug-resistant tuberculosis

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30014-9/fulltext

“Promising new drugs and shorter regimens for the treatment of multidrug-resistant tuberculosis are beginning to emerge. Bharathi Ghanashyam reports ahead of World TB Day.”

International Journal of Tuberculosis and Lung Disease (IJTLD) - Costs for TB and

MDR-TB: time to convene a WHO Emergency Committee on TB?

N Billo;

http://www.ingentaconnect.com/search/article?option1=fulltext&value1=Nils+E+Billo&sortDescend

ing=true&sortField=default&pageSize=10&index=2

“…It may be timely to call for a WHO Emergency Committee on TB to obtain true long-term political commitment from governments, full support from the WHO, other global health agencies and the donor community. Should we accept having to mourn 4400 victims of TB every day, and possibly more in the future, many of them cases of MDR-TB?” Indeed, what has been tried so far doesn’t seem to work: “The WHO and the Stop TB Partnership publish regular global TB reports and global plans to stop TB. These reports don’t, however, seem to have been able to raise sufficient attention among policy makers, politicians and donors to create a robust, long-term mechanism to provide the funding essential to support TB programmes and the development of new tools, particularly a preventive vaccine. Immediate action and continued attention is needed, as has been

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the case for other health emergencies such as smallpox, AIDS, Ebola and the recent Zika virus emergency….”

Ebola

WHO – WHO statement on end of Ebola flare-up in Sierra Leone

http://www.who.int/mediacentre/news/statements/2016/end-flare-ebola-sierra-leone/en/

Another milestone in the Ebola fight in West-Africa: “…WHO joins the government of Sierra Leone in marking the end of the recent flare-up of Ebola virus disease in the country. As of today, 17 March, 42 days have passed, two incubation cycles of the virus, since the last person confirmed to have Ebola virus disease in the country tested negative for a second time. …”

“…However, WHO continues to stress that Sierra Leone, as well as Liberia and Guinea, are still at risk of Ebola flare-ups, largely due to virus persistence in some survivors, and must remain on high alert and ready to respond.”

Read also Guinea, Liberia and Sierra Leone "effectively managing" Ebola flare-ups (WHO): “Health authorities from Guinea, Liberia and Sierra Leone and representatives of partner organizations have expressed confidence in the capacity of the 3 Ebola-impacted countries to effectively manage residual risks of new Ebola infections—pointing to the rapid government-led containment of recent flare-ups of the disease. The review of prevention, detection and response capabilities of the three countries, as well as progress in expanding clinical care and screening for survivors came at a meeting 1 – 2 March in Conakry, Guinea, convened by WHO and attended by some 80 participants. WHO, partners and Ministry of Health staff from the three countries have been meeting regularly throughout the epidemic to assess tactics, tools, research and operations and chart strategies accordingly….”

Setback

Sadly, there’s also a setback: As if to confirm the potential of further flare-ups, sadly, WHO confirmed “that two people have tested positive for Ebola in N'zérékoré Prefecture, in Guinea. “

African Affairs (Briefing): Ebola – Myths, realities and structural violence

A Wilkinson & M Leach; http://afraf.oxfordjournals.org/content/114/454/136.full.pdf

Must-read. “The scale of the (Ebola) disaster has been attributed to the weak health systems of affected countries, their lack of resources, the mobility of communities and their inexperience in dealing with Ebola. This answer, however, is woefully de-contextualized and de-politicized. This briefing examines responses to the outbreak and offers a different set of explanations, rooted in the history of the region and the political economy of global health and development.”

A key paragraph: “…The Ebola crisis should be a “game changer” for development. The inequalities that created and deepened this crisis are not sustainable. Talk of rebuilding weak health systems and

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fragile states must now be accompanied by talk of tackling these multiple inequalities. Resilient health systems are not just ones that are well equipped and staffed; they are built on foundations of inclusive economies and inclusive institutions.””

Meanwhile, Dr Margaret Lamunu was honoured as WHO woman of the year for her extraordinary contribution to the Ebola response.

Lancet Global Health (blog) - The vaccinated dog is the soldier in the fight against rabies

M Eloit; http://globalhealth.thelancet.com/2016/03/16/vaccinated-dog-soldier-fight-against-rabies

« Rabies still causes the death of tens of thousands of people every year. Knowing that dog bites are responsible for more than 95% of all human rabies cases, the eradication of canine rabies is the only way to end the disease's animal-human transmission cycle. To tackle this burden, mass dog vaccination in at risk areas is consequently one of the three key actions highlighted by the World Organisation for animal health (OIE) and the World Health Organization (WHO) in the Global framework to eliminate rabies worldwide in December 2015. » … “The new global framework, which resulted from fruitful discussions engaged with by nearly 300 participants – including experts, donors, as well as veterinary and public health officials - during the WHO/OIE Conference on rabies last December, identifies actions needed to achieve effective rabies elimination and promises to be a milestone in its success. …

“…The report of this Global conference organised by OIE and WHO in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and with the support of the Global Alliance for Rabies Control (GARC), has been published this week. This document concludes the conference report and provides a coordinated approach and vision for the global elimination of the disease. “

Oxfam (report) – Ending the Era of Tax Havens: Why the UK government must lead the way

http://policy-practice.oxfam.org.uk/publications/ending-the-era-of-tax-havens-why-the-uk-

government-must-lead-the-way-601121

“The gap between the rich and the rest is growing. Tax havens are at the heart of the inequality crisis, enabling corporations and wealthy individuals to dodge paying their fair share of tax. This prevents states from funding vital public services and combating poverty and inequality, with especially damaging effects for developing countries. The UK heads the world’s biggest financial secrecy network, spanning its Crown Dependencies and Overseas Territories and centred on the City of London – but this in fact provides an unparalleled opportunity to help end the era of tax havens. As the UK Prime Minister prepares to host the anti-corruption summit in May, this briefing paper outlines how tax havens fuel the inequality crisis which leaves poor countries without the funds they need, the UK’s role in the global tax haven system, and what the government can do about it.”

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Fat chance it will happen, though.

Zika

WHO – Zika situation report 17 March

http://www.who.int/emergencies/zika-virus/situation-report/17-march-2016/en/

For the latest update.

The Lancet (study) – Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study

S Cauchemez et al; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00651-

6/fulltext

If you’re in this business, chances are you heard about this new Lancet study by now. See also the related Lancet Comment.

Coverage in the Guardian (by Sarah Boseley), Study supports Zika link to microcephaly : “…About one in 100 women infected by the Zika virus in early pregnancy may be at risk of having a baby with microcephaly, according to a new study of an epidemic that occurred in French Polynesia. The study … offers further evidence that the virus is implicated in microcephaly – a condition in which babies’ brains do not develop properly, resulting in abnormally small heads. “Our analysis strongly supports the hypothesis that Zika virus infection during the first trimester of pregnancy is associated with an increased risk of microcephaly,” says Dr Simon Cauchemez, co-author of the study from the Institut Pasteur in Paris. “We estimated that the risk of microcephaly was 1 in 100 women infected with Zika virus during the first trimester of pregnancy. The findings are from the 2013-14 outbreak in French Polynesia and it remains to be seen whether our findings apply to other countries in the same way.” Although the risk that they calculate through mathematical modelling – 1% – is low by comparison with a virus such as rubella which causes birth defects in 50% of women infected in early pregnancy, the attack rate of the Zika virus itself is very high. …”

WHO : Damn the mosquitoes - Full speed ahead!

P Alonso (director of the Global Malaria programme)

http://www.who.int/mediacentre/commentaries/vector-control/en/

On 14 and 15 March, an extraordinary meeting of the Vector Control Advisory Group was held. This group of external experts from the top echelons of academia and research reviewed the

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latest data, some of it unpublished, and provides recommendations to WHO on at least 3 experimental technologies: (1) A new tool led by Monash University (Australia) is infecting mosquitoes with Wolbachia bacteria, which reduce their ability to transmit dengue viruses to humans. Since the mosquito that carries dengue also carries Zika virus, it may protect against Zika, too. (2) A British biotech company is modifying the genes of male mosquitoes so that their offspring cannot reach adulthood. (3) Another approach involves releasing sterilized male mosquitoes so that fertilized eggs do not hatch into larvae and, as a result, cannot reach the biting, adult stage. The technology is called sterile insect technique. … If the advisory group concludes that any of the technologies appears promising and ready for use, WHO will recommend to fast-track their deployment. But we are not waiting for a magic bullet, since we already know what works -- vector control. In lay terms: killing mosquitoes or eliminating their habitats. At present, we have no alternative: there is no vaccine; no treatment; and we do not even have good diagnostic tests. WHO has established a vector-control group composed of experts from across the Organization to monitor and support the work of member countries in 6 regions, all of which are home to the Aedes aegypti mosquito. Luckily, we know how to get the job done. This week, WHO will release emergency guidelines for vector control and entomological surveillance – including monitoring of insecticide resistance. They include a list of measures we can -- and must -- take now: …”

On Thursday, a 3-day WHO global review of zikavirus, microcephaly, GBS, pregnancy and breastfeeding also started.

As you already know, “Vaccines currently in development will not be ready for the current Zika outbreak in Latin America” ( Marie-Paule Kieny, assistant director general at the World Health Organization - she “told a press conference that the most advanced candidates were still a few months from entering early clinical trials, adding that a particular priority was to develop a vaccine that was safe for pregnant women.”

Lancet (World Report ) –WHO meeting thrashes out R&D strategy against Zika

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30012-5/fulltext

“WHO convened a multidisciplinary consultation last week to identify the tools and interventions needed to outsmart the Zika epidemic. John Maurice reports from Geneva.”

“…There was a clear consensus among meeting participants that a vaccine against Zika was sorely needed, mainly to protect women of childbearing age, especially pregnant women...

…A more urgent need than a vaccine, many participants agreed, is for a reliable, point-of-care diagnostic test. … … … Towards the end of the meeting, delegates representing the major regulatory agencies in the USA, Europe, and Brazil, committed to putting Zika-related products on a regulatory fast-track. They also agreed that instead of waiting, as they usually do, for manufacturers to approach them, they would take the initiative and approach companies working on promising products”.

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Some other Zika reads from this week or from late last week then:

The Hill - CDC chief to GOP: Zika funding 'urgently needed' – (from late last week – in the US): “Top federal health officials want Congress to know they urgently need more money to fight the Zika virus — and that time is running out. In media interviews and briefings on Thursday, Centers for Disease Control and Prevention (CDC) Director Tom Frieden stressed that funding from Congress is “crucially important and urgently needed." An all countries affected have to ‘prepare for a long fight’. Also: “…As the weeks and months go by, we learn more and more about how much we don't know, and the more we learn the worse things seem to get,” [Fauci] said.

Guardian - Microcephaly case in Cape Verde possibly linked to Zika virus “Cape Verde has identified its first case of the neurological disorder microcephaly thought to be linked to the Zika virus, in what would be a first for Africa.”

Cuba reports first case of Zika contracted in the country (Reuters)

Reuters - Infrastructure inequality is catalyst for Brazil's Zika epidemic

UN News - Water and sanitation likely to be best answer to Zika virus, say UN experts

FDA says GMO mosquito likely OK to fight Zika in Florida (from last week): “…The U.S. came one step closer today to getting its first genetically modified mosquito to fight the Zika virus. The Food and Drug Administration has released a draft of its environmental impact study of OX513A, a male Aedes aegypti mosquito genetically modified to pass on a lethal gene to his offspring. According to the FDA, the release of this GMO male in a Key West suburb as part of a field trial will have "no significant impact" on the health of the local environment or the people who live in it.” … The federal government has given preliminary approval for a trial to deploy genetically altered mosquitoes in the US as a method of fighting the Zika virus.”

Global health events of the week

The Economist’s sustainability summit (March 15-16 London)

http://www.economist.com/events-conferences/emea/sustainability-summit

Check out the corporate sponsors .

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Human Rights council Geneva – 31st session

http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=17083&LangID=E

The Human Rights Council holds its thirty-first regular session from 29 February to 24 March 2016 in Geneva. We already covered some of the (global health/right to health related) sessions in previous IHP newsletters.

Last week, The Global Fund (also) made a strong appeal to address human rights issues as a key component of efforts to end epidemics such as AIDS, tuberculosis and malaria.

Lancet (Offline) – “We can do something and we can succeed”

Richard Horton; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00702-9/fulltext

“It is sometimes noted, ruefully, that global health is an affectation of western nations. The flourishing of departments of global health in Anglo-American universities has not been matched by a reciprocal response in countries claimed to be the subject of global health's concerns. The insistent (and awkward) question won't go away. Why should a country care about global health? The seventh meeting of The Lancet Palestinian Health Alliance (LPHA), held in Amman (Jordan), and in Ramallah (State of Palestine), sought to provide an answer. …”

More in particular the Offline contribution also reflects on this question: what’s the importance of global health for Palestinians?

Coming up :

In April, the Paris Agreement will be signed in New York (see Huffington Post ). “In a little over a month, heads of state and governments will gather in New York to sign the Paris Agreement. Countries will then have one year to ratify the agreement, which will enter into force after it is ratified by at least 55 countries, representing at least 55 percent of global greenhouse gas emissions….”

As for the next Geneva Health Forum (April 19-21) (on sustainable and affordable innovations in health care), you can check the agenda here.

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Global governance of health

ICM – Independent Commission on Multilateralism

https://www.icm2016.org/what-is-icm

“Over the course of two years, the Independent Commission on Multilateralism will analyze the multilateral system through the lens of sixteen issue areas, and each will be the focus of expert-level discussions. …” Occasionally, papers will be posted & circulated. A final report is scheduled for the end of 2016.

You might want to check out this recent paper, The 2030 Agenda for Sustainable Development and Addressing Climate Change.

Global Policy - Accountability in International Governance and the 2030 Development Agenda

J Ocampo et al; http://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12322/abstract

“After revisiting the concept of accountability in national governance, this paper analyzes the challenges of its application to international governance, including an assessment of some of the modalities it has assumed. It then proposes a bottom-up multilayered and multistakeholder accountability framework for the 2030 Development Agenda: national follow-up processes at the base of the pyramid, consultations and possibly peer reviews at the regional level, a global accountability system led by the High-Level Political Forum (HLPF) and supported by the ECOSOC system, United Nations and other international organizations, and active participation by civil society and the private sector with their own accountability frameworks in place.”

UNA-UK - Beneficiary engagement in the SDG era

Jonathan Glennie; http://www.sustainablegoals.org.uk/beneficiary-engagement-sdg-era/

“The international community now agrees that successful aid intervention requires the involvement of communities and beneficiaries in the decision-making process. But what should this involvement look like, and how can it be achieved? “ (Always worth reading, Glennie … )

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Brookings (blog) – Changing views of how to change the world

Homi Kharas; http://www.brookings.edu/blogs/future-development/posts/2016/03/10-how-to-

change-the-world-kharas#.VuZuqCCjDWU.twitter

The new ‘Theory of Change’ in the post-2015 era, according to H Kharas at least. “World leaders concluded three large agreements last year. Each represents a vision of how to change the world. The Addis Ababa Action Agenda on financing for development agreed to move from “billions to trillions” of cross-border flows to developing countries.The agreement on universal sustainable development goals (SDGs) sets out priorities (albeit a long list) for what needs to change. The Paris Agreement on climate change endorses a shift to low-carbon (and ultimately zero carbon) economic growth trajectories. There is a common thread to these agreements. They each reflect a new theory of how to change the world that is not made explicit but has evolved as a matter of practice. Understanding this new theory is crucial to successful implementation strategies of the three agreements. …. …. In short: “Markets, data, and innovation can change the world.”

Or: (1) “Use market forces to drive business towards scalable investments that simultaneously generate sustainable solutions to development challenges; (2) Create more data from more sources with more disaggregation, and make these more easily transparent and accessible, to drive towards evidence-based reforms and accountability; (3) Encourage innovations (technical, organizational, and business-model) to drive the world away from business-as-usual”.

Not that we fully agree.

Guardian – Do international NGOs still have the right to exist?

D Doane; http://www.theguardian.com/global-development-professionals-

network/2016/mar/13/do-international-ngos-still-have-the-right-to-exist

Interesting and somewhat provocative piece.

The European Journal of Public Health - A Global Charter for the Public’s Health—the public health system: role, functions, competencies and education requirements

M Lomazzi;

http://eurpub.oxfordjournals.org/content/early/2016/03/07/eurpub.ckw011.full?ijkey=zUWCB5aGv

E3uSaf&keytype=ref

“…The World Federation of Public Health Associations (WFPHA) has developed the A Global Charter for the Public’s Health (GCPH) as the main output of its collaboration plan with the WHO to adapt today’s public health to its global context in the light of and in conjunction with the Sustainable

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Development Goals (SDGs). GCPH brings together the best of all the existing models and provides a comprehensive, clear and flexible framework that can be applied globally and within individual countries, whether low, middle or high income. The WFPHA has engaged with its over 100 national public health associations to discuss the new roles that global public health professionals have to assume and the needed changes with regard to education and recruitment of public health personnel. A literature review and widespread consultation formed part of this initiative …”

Foreign Affairs - When Exceptions Become the Norm - HIV Exceptionalism Does More Harm than Good

A Benton; Foreign Affairs;

A puzzling sentence: “Once exceptionalist public health policies take over, it is difficult to undo them. …”

UHC

WB (study) - Health Financing Policy: The Macroeconomic, Fiscal, and Public Finance Context

C Cashin; http://r4d.org/knowledge-center/health-financing-policy-macroeconomic-fiscal-and-

public-finance-context?utm_source=R4D+Insights&utm_campaign=401ed6236d-

R4D_Insights_Mar_16&utm_medium=email&utm_term=0_df5bdbfdee-401ed6236d-82802133

“From the World Bank and authored by R4D Senior Program Director Cheryl Cashin, a new study, "Health Financing Policy: The Macroeconomic, Fiscal, and Public Finance Context" outlines the key components of the macroeconomic, fiscal, and public financial management context that need to be considered for an informed health financing discussion at the country level. The study is organized around four sets of questions that are key to placing the health financing dialogue in the context of a country’s macroeconomic and fiscal context. Each section points to measures, resources, and analytical tools that are available to assist in answering these questions for a specific country. The study draws on case studies from 11 countries moving toward or sustaining universal health coverage conducted as part of the Japan–World Bank Partnership Program on UHC as well as from other country examples.”

Resyst – Overview of financing research

http://resyst.lshtm.ac.uk/research/financing

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Check it out.

Financing health in Africa – No UHC without learning

B Meessen et al; http://www.healthfinancingafrica.org/home/no-universal-health-coverage-

without-learning

“We are entering into the last year of our project ‘Universal Health Coverage in Francophone Africa’. In this blogpost, we present the latest developments, share some early insights from the year 2 and present our plan for year 3. We have made significant progress in our understanding of how to document the learning capacities of ‘UHC systems’.”

WHO Bulletin – Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries

C Goeppel et al; http://who.int/bulletin/online_first/BLT.15.163832.pdf

Early online. The authors assess universal health coverage for chronically ill, older adults in China, Ghana, India, Mexico, the Russian Federation and South Africa.

Lancet (Editorial) – Patient safety is not a luxury

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30003-4/fulltext

“Globally, patient safety needs to be integrated into the foundation of quality care—safety is not a special programme.”

Finally, a policy brief from a while ago (Nov 2015)( Alix Beith, Naomi Beyeler, and David Evans )- What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage?

Planetary health

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Vox – Is it worth trying to "reframe" climate change? Probably not.

http://www.vox.com/2016/3/15/11232024/reframe-climate-change

But it’s certainly worth reading this Vox piece on framing of climate change (based on new research).

Euractiv - Climate deal relegated to ‘other items’ in Council agenda

http://www.euractiv.com/section/climate-environment/news/climate-deal-relegated-to-other-

items-in-council-agenda/

Not very good news for the (European) follow-up of the Paris Agreement. But as you know, the EU leaders have other worries now…

Reuters – Mosquitoes' rapid spread poses threat beyond Zika

http://www.reuters.com/article/us-health-zika-mosquitoes-insight-

idUSKCN0WF06W?ct=t(RSS_EMAIL_CAMPAIGN)

“As the world focuses on Zika's rapid advance in the Americas, experts warn the virus that originated in Africa is just one of a growing number of continent-jumping diseases carried by mosquitoes threatening swathes of humanity.”

WHO (report) –Burning Opportunity: clean household energy for health, sustainable development and the wellbeing of women and children (Executive summary)

http://who.int/indoorair/publications/burning-opportunities/en/

Executive summary of a new report on indoor air pollution (full report will be available end of March). “ Household air pollution is the single most important environmental health risk worldwide, and women and children are at particularly high risk from exposure. This global report provides new data on the still-pervasive use of polluting fuels for home cooking, lighting and heating, as well as an in-depth look at the impacts on women and children.”

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Infectious diseases & NTDs

Thomson Reuters – People with HIV in Asia ejected from hospitals, women sterilised-study

http://news.trust.org/item/20160315125313-600q2/?source=fiOtherNews2

“Some health workers in Asia are refusing to perform surgery and provide services for people living with HIV, and are even expelling patients from hospitals and forcing women to undergo sterilisation, according to grassroots organisations. In China and Vietnam, discrimination took the form of changing the recommended option for treatment from surgery to topical or oral medication, said the four-country study supported by Asia Catalyst, which provides management training for community-based health organisations.”

Guardian – Campaigners demand better care for rape survivors in hours after attack

http://www.theguardian.com/global-development/2016/mar/15/campaigners-demand-better-care-

for-rape-survivors-in-hours-after-attack

‘Every Hour Matters’ raises awareness of the importance of preventing HIV infection and pregnancy in the immediate aftermath of rape.

Premium Times (Nigeria) – AU approves Nigeria’s Centre for Disease Control as regional hub

http://www.premiumtimesng.com/news/top-news/200085-au-approves-nigerias-centre-disease-

control-regional-hub.html

The AU will name Nigeria as one of 5 regional centres of the African CDC.

Vice news – Liberia Closes Local Red Cross Amid Graft Investigation Into Ebola Funds

https://news.vice.com/article/liberia-closes-local-red-cross-amid-graft-investigation-into-ebola-

funds

“…In the (Ebola) epidemic's aftermath, authorities have begun to scrutinize how that money has been spent and allocated. Concerns over potentially misappropriated funds boiled over in Liberia

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this week when the government shut down the local chapter of the Red Cross on Thursday. The humanitarian organization played a critical role in the fight against Ebola, and was directly involved in the effort of managing extremely contagious corpses and burial needs. But it was also engulfed by scandal, as its general secretary and head of programs were accused misusing some $1.8 million in funds meant for the Ebola response. Both were suspended in November. Though an investigation into graft allegations is still underway, President Ellen Johnson Sirleaf dissolved the chapter's national board on Tuesday. …”

BMJ news – South Africa’s sex workers will receive HIV prevention and treatment

http://www.bmj.com/content/352/bmj.i1593?etoc=

“South Africa is to supply sex workers with pre-exposure prophylaxis (PrEP) and treat those who test HIV positive with antiretroviral medication without waiting for their CD4 counts to drop, the country’s deputy president, Cyril Ramaphosa, has said. The proposals are part of a comprehensive plan for sex workers that was announced last week. …”

Project Syndicate - The Politics of Polio Eradication

J Kennedy et al; http://www.project-syndicate.org/commentary/immunization-

campaigns-need-political-support-by-jonathan-kennedy-and-domna-michailidou-2016-

03

“…The lesson is clear. Successful immunization campaigns must secure the support of de facto political leaders – whether of an internationally recognized state or of a vilified militant organization. As objectionable as working with groups like the Islamic State might be, it is important to remember that the main objective of efforts like the campaign to eradicate polio is to improve the health of people wherever they may live.”

Not sure we fully agree.

Check out also U.S.made dengue vaccine 100 percent effective in small study (Reuters). See also Nature, Dengue vaccine aces trailblazing trial.

NCDs

The UK announced a tax on sugary drinks this week – which puts it at the forefront of the global fight to reduce obesity & diabetes. See also Vox, “ Britain is fighting childhood obesity with a new

soda tax. But will it work? “

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Scidev.net – Spotlight : Mental health in the developing world

Scidev.net ;

“Mental illness is a huge but overlooked challenge in the developing world — despite a high burden few people get the help they need and many are treated inhumanely. What is the evidence for the gap between needs and proper treatment, how does social stigma hinder care and in what ways does culture matter? This Spotlight presents an in-depth analysis including opinions, facts and figures, and key resources. It features commentary by World Psychiatric Association president Dinesh Bhugra, migration specialists Mohamed Elshazly and Sarah Harrison, and Nepal Mental Health Foundation founder Jagannath Lamichhane. It contains interviews on issues from the role of cinema and religious leaders to training health staff in fragile states to working with Syrian refugees, featuring psychiatrists from India, Nigeria and Somalia including Oye Gureje and Vikram Patel.”

Lancet (Correspondence) –E-cigarettes are less harmful than smoking

David Nutt et al ; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00253-6/fulltext

“The Lancet Editorial criticising Public Health England's review of electronic cigarettes (e-cigarettes) focused on three supposed short-comings of our paper: a lack of hard evidence, no formal criteria used, and so relied on the opinions of participants, and potential bias arising from the selection of participants and the declared conflicts of interest of some authors. As authors of the original paper, we believe that these three criticisms have over-generalised the evidence issue, did not respect the knowledge and experience of the experts selected, and did not take into account the many measures used to minimise potential bias….”

Sexual & Reproductive / maternal, neonatal & child health

Guardian – Antibiotics becoming ineffective at treating some child infections

http://www.theguardian.com/society/2016/mar/15/antibiotics-becoming-ineffective-at-treating-

some-child-infections

“The results of the (BMJ) study, that antibiotic resistance in children treated with commonly used antibiotics is high and can persist for up to six months, are worrying.” See the BMJ study & the related BMJ editorial (recommended- by Grant Russell). “An emerging global problem that will change clinical management.

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Health Research Policy & Systems - Maternal and Newborn Health Research and Advocacy Fund, Pakistan

http://health-policy-systems.biomedcentral.com/articles/supplements/volume-13-supplement-1

Check out this supplement. “This collection of articles was produced and funded as an output of the Maternal and Newborn Health Research and Advocacy Fund (MNH RAF) project in Pakistan.”

US Dep of State – Secretary Kerry Launches U.S. Global Strategy To Empower Adolescent Girls

State;

“U.S. Secretary of State John Kerry announced $47 million in new initiatives during the launch of the U.S. Global Strategy to Empower Adolescent Girls at the Department of State today. In his remarks, Secretary Kerry said that $40 million from PEPFAR’s $85 million DREAMS Innovation Challenge will help girls access and remain in secondary school. This is an important part of PEPFAR’s work to prevent HIV/AIDS in adolescent girls and young women, since access to education can decrease the likelihood of infection. The remaining $7 million will go to empowering adolescent girls in Afghanistan, where the United States will fund efforts to change perceptions about early and forced marriage at the district and community level….”

NPR Goats & Soda – The Strange And Surprising Debate Over How To Help A Malnourished Kid

http://www.npr.org/sections/goatsandsoda/2016/03/13/469943364/the-strange-and-surprising-

debate-over-how-to-help-a-malnourished-kid

“It used to be common knowledge: Malnourished kids need more protein to thrive. Then came a scathing paper in the Lancet in 1974 called "The Great Protein Fiasco." Filled with sarcasm, it argued that the nutrition community's fixation on protein was a waste of time and money. "There is mounting recognition that the emphasis which has been given to the role of protein in human undernutrition, resulting in the claim that there is a global protein 'gap,' 'crisis,' or 'problem,' is wrong," wrote author Donald McLaren, then a clinical nutrition professor at the American University's School of Medicine in Beirut. The paper hit the field hard, says Richard Semba… Protein researchers weren't even invited to the next world food conference. And for the following decades, malnutrition researchers focused on vitamins, minerals and calories. It may be time for another pendulum shift, suggest Semba's latest findings. For a study published last month, he and colleagues visited rural villages in southern Malawi, where they found that chronically malnourished young children were low in all essential amino acids. Vitamins remain essential, he says. But the new results, along with other accumulating evidence, suggest that protein needs to be a bigger part of the picture. …”

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Humanosphere – Decades-old U.S. law still limits international women’s reproductive rights

Tom Murphy; http://www.humanosphere.org/global-health/2016/03/decades-old-u-s-law-still-

limits-international-womens-reproductive-rights/

A piece related to last week’s International Women’s Day: “…Celebrations for International Women’s Day were marked with some very good news for women’s health. More women than ever are using birth control, a trend that could lead to a cut in projected population growth by 1 billion people over the next 15 years. There was also a stark reminder about women’s reproductive rights. A U.S. law dating back to 1973 prevents U.S. foreign aid money from supporting abortions abroad. Campaigners used the day to call attention to the fact that the rule, as it is applied right now, prevents women who have been raped in conflict from accessing an abortion if impregnated.”

Access to medicines

FT – GSK in search for new chief as Witty announces retirement

http://www.ft.com/intl/cms/s/0/b0bc9c76-ec10-11e5-888e-2eadd5fbc4a4.html#axzz439RYM3P9

“GlaxoSmithKline began its long goodbye to Sir Andrew Witty on Thursday by announcing he would retire as chief executive in March 2017 after nine years in the job.”

Lancet (Correspondence) - Ketamine—the real perspective

P Taylor; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00681-4/fulltext

“We would like to highlight the medicinal value of ketamine. In November, 2015, WHO's Expert Committee on Drug Dependence (ECDD) reviewed ketamine among drugs “with potential for dependence, abuse and harm to health”, to make recommendations to the UN Commission on Narcotic Drugs (CND) on the need for their international control. The ECDD recommended unequivocally that ketamine should not be placed under international control as they concluded that ketamine abuse does not pose a global public health threat and that such control would limit access for those who most need it as a life-saving anaesthetic.”

BMJ (Analysis) –Propaganda or the cost of innovation? Challenging the high price of new drugs

N Ghinea et al ; http://www.bmj.com/content/352/bmj.i1284

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“Concern is growing about the implications of rising drug prices for individuals and health systems around the world. With little transparency around the costs of drug development,Narcyz Ghinea and colleagues call for greater accountability from drug companies to ensure a fair price for new medicines.”

Human resources for health

OECD (report) - Health workers with right skills in right places needed

http://www.oecd.org/newsroom/health-workers-with-right-skills-in-right-places-needed.htm

“The number of doctors and nurses has reached record levels in the OECD. Countries should now reform their training and employment strategies to better respond to people’s changing health needs and also reduce their reliance on foreign-trained health workers from developing countries, according to a new OECD report, “Health Workforce Policies in OECD countries: Right Jobs, Right Skills, Right Places”.

Check out also Devex, What to know about the European Medical Corps (not open access though).

Miscellaneous

CGD (blog) – A Lot of Vision, A Little Time: Gayle Smith’s First Major Policy Speech

http://www.cgdev.org/blog/lot-vision-little-time-gayle-smiths-first-major-policy-speech

ON (new) USAID Administrator Gayle Smith’s first major policy speech.

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CGD (blog) - Six Questions African Policymakers Must Answer Now

N Okonjo-Iweala; http://www.cgdev.org/publication/ft/six-questions-african-policymakers-must-

answer-

now?utm_source=160315&utm_medium=cgd_email&utm_campaign=cgd_weekly&utm_&&&

“The “Africa rising” story of the past decade, fueled by 5 percent average annual growth, is in danger of faltering, due to the impact of global uncertainty, depressed commodity prices, and weakly performing economies like China. Don’t be lulled by the IMF’s 2016 forecast: yes 4 percent growth will outperform global expectations, but continued commodity price volatility and global uncertainty are giving rise to a fresh bout of Afro-pessimism. To change the narrative, and — more importantly — the reality it describes, African policymakers must urgently answer these six questions.”

World Happiness report 2016

http://worldhappiness.report/

Check out where you country is situated.

Guardian – To end poverty, put science at the heart of development

http://www.theguardian.com/global-development/2016/mar/16/to-end-poverty-put-science-at-

the-heart-of-development

By Sue Desmond-Hellmann, CEO of the Gates Foundation, & Nick Hurd, parliamentary under secretary of state at the U.K.'s Department for International Development.

“The Department for International Development (DfID) and the Bill & Melinda Gates Foundation have signed a partnership aimed at using research, technological innovation and knowledge-sharing to transform the lives of the poorest people….”

Devex - Cotonou redefined: An end to aid dependency?

https://www.devex.com/news/cotonou-redefined-an-end-to-aid-dependency-

87817?utm_content=bufferb63be&utm_medium=social&utm_source=twitter.com&utm_campaign=

buffer

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“The oldest and most wide-reaching agreement between European donor countries and recipient nations is officially up for review. The Cotonou Partnership Agreement between the European Union and 79 countries, mostly former colonies, of the Africa, Caribbean and Pacific group of states governs some 30.5 billion euros ($33.3 billion) in aid over the 2014-2020 period of the 11th European Development Fund. It also contains pillars to encourage political cooperation and promote trade. The new CPA will take effect in 2020, with an initial memorandum of understanding due in 2018, according to ACP Secretary General Dr. Patrick Ignatius Gomes.”

Research

HP&P – Measuring implementation strength: lessons from the evaluation of public health strategies in low- and middle-income settings

J Hargreaves et al; http://heapol.oxfordjournals.org/content/early/2016/03/09/heapol.czw001.abstract

« Evaluation of strategies to ensure evidence-based, low-cost interventions reach those in need is critical. One approach is to measure the strength, or intensity, with which packages of interventions are delivered, in order to explore the association between implementation strength and public health gains. A recent systematic review suggested methodological guidance was needed. We described the approaches used in three examples of measures of implementation strength in evaluation. These addressed important public health topics with a substantial disease burden in low-and middle-income countries; they involved large-scale implementation; and featured evaluation designs without comparison areas. … »

Health research policy & systems –Evidence for Health I: Producing evidence for improving health and reducing inequities

A Anderman, T Pang et al; http://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0087-2

A three article series. Check out also Part 2 and Part 3.

Journal of global health –Moving global health forward in academic institutions

D Wernli, I Kickbusch et al; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766794/

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“Global health has attracted growing attention from academic institutions. Its emergence corresponds to the increasing interdependence that characterizes our time and provides a new worldview to address health challenges globally. There is still a large potential to better delineate the limits of the field, drawing on a wide perspective across sciences and geographical areas. As an implementation and integration science, academic global health aims primarily to respond to societal needs through research, education, and practice. From five academic institutions closely engaged with international Geneva, we propose here a definition of global health based on six core principles: 1) cross–border/multilevel approach, 2) inter–/trans–disciplinarity, 3) systems thinking, 4) innovation, 5) sustainability, and 6) human rights/equity. This definition aims to reduce the century–old divide between medicine and public health while extending our perspective to other highly relevant fields. Overall, this article provides an intellectual framework to improve health for all in our contemporary world with implications for academic institutions and science policy….”

With a big focus on the term ‘Academic Global Health’ – “to focus on the key role of academic institutions including university hospitals in the global health system”.

JAMA (viewpoint) – Does the Country of Origin Matter in Health Care Innovation Diffusion?

M Harris et al; http://jama.jamanetwork.com/article.aspx?articleid=2503181

“There is no shortage of US health care research centers advocating the adoption of innovations from other countries. The Institute for Healthcare Improvement (Boston, MA), the Commonwealth Fund (New York, NY), Innovations in Health at Duke University (Durham, NC), and the Network for Excellence in Healthcare Innovation (Cambridge, MA) are all promoting innovations from low-, middle-, and high-income countries for potential adoption into the United States. However, does it matter to patients if a proposed innovation is from India, rather than from, say, Sweden; or from Rwanda, rather than from, say, the United Kingdom? Very little is known about whether and how the country of origin of a proposed innovation matters in its diffusion. ….”