Fundamental revisions to the International Health Regulations in 2005 were meant to herald a new era of global health security and cooperation. Yet, 10 years later, the International Health Regulations face criticism, particularly after the west African Ebola epidemic. Several high-level panels are reviewing the International Health Regulations' functions and urging reforms. The Global Health Security Agenda, a multilateral partnership focused on preventing, detecting, and responding to natural, accidental, or intentional disease outbreaks, has similar capacity building aims, but operates largely outside the International Health Regulations.
Values, Policies and Rights
The International Health Regulations 10 years on: the governing framework for global health security
Gostin L: DeBartolo M; Friedman E: The Lancet 386(10009), 2222–2226, 2015
Universal health coverage: The strange romance of The Lancet, MEDICC, and Cuba
Waitzkin H: Social Medicine 9(2) 93 -97, 2015
As a key supporter of universal health coverage (UHC), The Lancet recently partnered with Medical Education Cooperation with Cuba (MEDICC), a non-governmental organisation based in the United States, to produce a Spanish-language translation of The Lancet’s series on UHC in Latin America. This translation was launched as part of Cuba Salud 2015, an international health conference held during April 2015 in Havana, Cuba. Despite its often ambiguous definition, UHC is often used to refer to a financial reform extending insurance coverage in varying degrees to a larger part of a country’s population. This is different to “healthcare for all” (HCA) – a healthcare delivery system that provides equal services for the entire population regardless of an individual’s or family’s financial resources. UHC as a more limited insurance concept has received wide criticism because it does not necessarily create a unified, accessible system; because it usually encourages a role for private, for- profit insurance corporations; and because it involves tiered benefits packages with differing benefits for the poor and non-poor. Although the UHC orientation has become “hegemonic” in global health policy circles, its ideological assumptions have not been confirmed empirically. The authors urge that the Lancet and MEDICC Review provide “equal time” for critiques of UHC and presentations of endeavours to achieve HCA.
Integrated community case management in Malawi: an analysis of innovation and institutional characteristics for policy adoption
Rodríguez D; Banda H; Namakhoma I: Health Policy and Planning 30 (suppl 2): ii74-ii83, December 2015
In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation and of the institutions involved in the policy process. iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children’s Fund (UNICEF) and implementing organisations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organisational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channeling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development.
Resolutions of the 62nd Health Ministers Conference
East, Central and Southern African Health Community, Mauritius, 4th December 2015
The 62nd ECSA Health Ministers’ Conference (HMC) was held at InterContinental Resort Balaclava Fort, Republic of Mauritius under the theme: Transitioning from Millennium Development Goals to Sustainable Development Goals with the following sub-themes; Enhancing Universal Health Coverage Through Innovations in Health Financing for Risk Protection; Surveillance and Control of Emerging Conditions: (NCDs and Trauma); Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training Using the ECSA College of Health Sciences Model. The Conference passed Resolutions on: Transitioning From MDGs to SDGs in the ECSA Region; Enhancing UHC through innovation in Health Financing for Risk Protection; Surveillance and Control of Non- Communicable Diseases and Trauma; Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training using the ECSA College of Health Sciences Model; Global Health Diplomacy and Strengthening Ministries of Health Leadership and Governance Capacity for Health in the ECSA-HC Region; and Strengthening the Use of Evidence in Health Policy.
Buen Vivir: Today's tomorrow
Gudynas E: Development 54(4), 441–447, 2011
Eduardo Gudynas looks at the main trends of the discourse around Buen Vivir in South America as a political platform for different visions of alternatives to development. He notes that any alternative to development must open paths to move beyond the modern Western culture. Buen Vivir, he argues gives that opportunity. Buen Vivir or Vivir Bien, are the Spanish words used in Latin America to describe alternatives to development focused on the good life in a broad sense. The term is actively used by social movements, and it has become a popular term in some government programs and has even reached its way into two new Constitutions in Ecuador and Bolivia. It is a plural concept with two main entry points. On the one hand, it includes critical reactions to classical Western development theory. On the other hand, it refers to alternatives to development emerging from indigenous traditions, and in this sense the concept explores possibilities beyond the modern Eurocentric tradition. The richness of the term is difficult to translate into English. It includes the classical ideas of quality of life, but with the specific idea that well-being is only possible within a community. Furthermore, in most approaches the community concept is understood in an expanded sense, to include nature. Buen Vivir therefore embraces the broad notion of well-being and cohabitation with others and with nature.
iCCM policy analysis: strategic contributions to understanding its character, design and scale up in sub-Saharan Africa
George A; Rodríguez D; Rasanathan K; Brandes N; Bennett S: Health Policy and Planning 30 (suppl 2): ii3-ii11, 2015
Pneumonia, diarrhoea and malaria remain leading causes of death for children under 5 years of age and access to effective and appropriate treatment for sick children is extremely low where it is needed most. Integrated community case management (iCCM) enables community health workers to provide basic lifesaving treatment for sick children living in remote communities for these diseases. While many governments in sub-Saharan Africa recently changed policies to support iCCM, large variations in implementation remain. As a result, the collaboration represented in this supplement examined the policy processes underpinning iCCM through qualitative case study research in six purposively identified countries (Niger, Burkina Faso, Mali, Kenya, Malawi and Mozambique) and the global context. The authors introduce the supplement, by reviewing how policy analysis can inform: (a) how to frame iCCM and negotiate its boundaries, (b) how to tailor iCCM for national health systems and (c) how to foster accountability and learning for iCCM. In terms of framing, iCCM boundaries reflect how an array of actors use evidence to prioritise particular aspects of child mortality (lack of access to treatment), and how this underpins the ability to reach consensus and legitimate specific policy enterprises. When promoted at national level, contextual health system factors, such as the profile of CHWs and the history of primary health care, cannot be ignored. Adaptation to these contextual realities may lead to unintended consequences not forseen by technical or managerial expertise alone. Further scaling up of iCCM requires understanding of the political accountabilities involved, how ownership can be fostered and learning for improved policies and programs sustained. Collectively these articles demonstrate that iCCM, although often compartmentalised as a technical intervention, also reflects the larger and messier real world of health politics, policy and practice, for which policy analysis is vital, as an integral component of public health programming.
Interview with Jean Pierre Bekolo
Simo D: Goethe-Institut e.V., 2015
Memory and African identity are of primordial importance to Jean Pierre Bekolo, who through his films, highlights the desire to “write from a particular place and not for an audience” because one can be easily manipulated by the expectations of an audience. Bekolo spends time in Europe, US and Africa. Travelling becomes a substantial part of his creative process.
Each of his movies stands out as a phase or the break with a phase of his artistic development: Quartier Mozart symbolises origins, family and identity, Aristotle’s Plot represents the identity of an African cineaste, while Les Saignantes is speculation or science fiction. Despite his numerous sojourns, Bekolo’s energy is always focused on Africa and Cameroon in particular, where he believes cinema has to go beyond representation and shed more light on questions which will lead to change, a concept noticeable in his latest movie Le President. Bloke, who describes himself as not just an artist but ‘a radiologist of the society’ emphasises the role that film and fiction has to play in affecting change, ‘we must not forget the aesthetic dimension, because the beauty and the real have a link: aesthetic and ethics.’
Evaluating Universal Health Coverage as a Sustainable Development Goal
Chapman A: Health and Human Rights Journal, Blog, September 2015
The Sustainable Development Goals (SDGs) identify achieving universal health coverage (UHC) as one component of the omnibus health goal, “to ensure healthy lives and promote well-being for all at all ages.” The components of UHC specified in goal 3.8 of the SDGs reflect World Health Organisation’s policy documents and include financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all. On the positive side, UHC can be considered to be an expression of the right to health. Indeed, several health and human rights advocates had earlier proposed replacing the various health-related goals in the MDGs with the single overarching health goal of UHC in the SDGs, provided that it specify that international assistance is essential, not optional, for countries otherwise unable to pursue UHC. Significant progress toward UHC, consistent with the requirements of the right to health, would have the potential of enabling the one billion people currently estimated to not have access to the health services they need each year to obtain them. The author argues, however, that not all potential paths to a universal health system are consistent with human rights requirements, even ones that result in some expansion of health coverage. For that reason it is important that health and human rights advocates and scholars identify the essential features of UHC and policies for advancing toward this goal from a human rights perspective.
Let’s Walk Our Talk: Making Concrete Commitments on Financing the Sustainable Development Agenda
Schmidt H; Barnhill A: PLoS Med 12(9), 8 September 2015, doi:10.1371/journal.pmed.1001872
Despite criticism, the MDGs are widely praised for having galvanised national and international development efforts in unprecedented ways. Currently proposed successor Sustainable Development Goals (SDGs) seek to address newly emerged policy issues and include a call to significantly reduce the burden of non-communicable diseases (NCDs). NCDs directly impact health inequality and poverty. Their recognition is timely and to be welcomed categorically. However, ambiguity in the SDGs’ current guidance risks that states’ efforts to reduce NCDs exacerbate socioeconomic and health inequalities, rather than reduce them. The authors urge that more attention needs to be given to improving the situation of the worst off and make three concrete proposals towards this end. Existing policy guidance highlights cost-effective interventions for NCDs, but focusing just on cost-effectiveness risks exacerbating socioeconomic and health inequalities rather than reducing them. The authors suggest that in implementing the SDGs, targets and interventions that benefit the worst off should be prioritised. The United Nations should develop practical guidance to assist policy makers at the country level with incorporating equity considerations.
MSF seeks international probe into Kunduz hospital hit, possible war crime
Raja K: Third World Network (TWN) Info Service on Health Issues, 8 October 2015
Medecins Sans Frontieres (MSF) has called for an investigation by an international humanitarian fact-finding commission into a US airstrike on its hospital in the Afghanistan city of Kunduz and for one of the States, party to the Additional Protocols to the Geneva Conventions, to invoke it. MSF said the attacks took place despite the fact that it had provided the GPS coordinates of the trauma hospital to Coalition and Afghan military and civilian officials as recently as Tuesday, 29 September. The attack continued for more than 30 minutes after MSF first informed US and Afghan military officials in Kabul and Washington that it was a hospital that was being hit. The International Humanitarian Fact-Finding Commission was established under the Additional Protocols to the Geneva Conventions and was officially constituted in 1991 to investigate allegations of violations of international humanitarian law. According to the Commission's website, some 76 countries have recognised the Commission, which is based in Bern, but so far, it has not yet been called upon to conduct any investigation. In her remarks to the media, MSF President Liu said that international humanitarian law is not about ‘mistakes'. "It is about intention, facts and why....This was not just an attack on our hospital - it was an attack on the Geneva Conventions. This cannot be tolerated. These Conventions govern the rules of war and were established to protect civilians in conflicts - including patients, medical workers and facilities. They bring some humanity into what is otherwise an inhumane situation."