In August 2002 Gro Harlen Bruntland, Director General (DG) of WHO, announced that she would not seek a second term as DG. This issue of the EQUINET newsletter compiles some of the debates and papers that have been presented around her record at WHO, the candidates for the new DG and the selection process itself. The political moment created by the election of a new DG stimulates debate about WHO’s priorities and role in international and global health, as the leadership qualities sought in a new DG should reflect those roles.
Bruntland’s achievements at WHO are notable. She raised the profile of health in the global agenda, including within economic and political forums and is reported to have restored WHO’s credibility with donors. She launched a number of global health campaigns. During her period as DG, WHO has reasserted itself as an international standard-setting body around areas such as tobacco control, pre-qualification for procurement of antiretrovirals, food safety standards, and essential drugs. Bruntland had some success at negotiating partnerships with foundations and the private sector.
Yet the debate on WHO priorities and the realities of health from the perspective of a southern African network indicate that there are many unresolved issues. Whatever the changes that were achieved at global level, they have not been felt at country level. Poverty and unavoidable and unfair inequalities in opportunities for and access to health are pronounced and persistent. Despite this WHO is not perceived to have been a strong public advocate for health equity or for protecting public health in economic and trade policies. Neither is there a perception of the powerful advocacy of primary health care or of forms of health financing that enhance access to health care in poor communities, in women and other vulnerable groups. In contrast, in an environment of rapid and powerfully driven market reforms and privatization, there is some criticism of WHO unwillingness to confront commercial interests over patient interests in access to medicines under TRIPs, or protect national authority rights to regulate private health providers under the WTO GATS agreement.
Hence even while the Macroeconomic Commission on Health raised the profile of the US$27bn shortfall in global resources for health, and the Global Health Fund (GHF) created one vehicle for responding to this shortfall, the impact of these global shifts has been weak. Beyond the insufficient and poorly sustained funding of the GHF, WHO has not yet made clear or put its international policy weight behind the public policy measures needed nationally and globally to ensure that health services and systems spend more on those with greatest need. This has left a number of issues poorly addressed, such as for example the attrition and loss in health personnel from public to private sectors and from low to high income countries; the collapse of primary care level services in some countries; the shift in the burden of caring for HIV/AIDS to poor households and inability to secure treatment access in many low income countries, or the still weak link between public health and the wider systems of rights and procedural justice needed to manage the contestation over scarce resources for health.
The nature of the issues to be addressed, and their significance in Africa make the policies of the next DG a matter of some concern for Africans. The public policy shortfalls identified above do not simply call for business as usual with a bit more focus on Africa. In the same way as poor people’s health needs demand a wider review of public policy generally, so too does meeting the needs of health in Africa demand critical review of wider global, international and national health policies for where they generate vulnerability and impede public health authorities in Africa making coherent responses to ill health.
This editorial does not scrutinize the candidates – there are links to articles about the candidates at the end of this editorial. While effort has been made to make the process of selection of the DG more open to public debate through journal papers and email lists, in fact the process is still tightly controlled within the 32 health ministers in the Executive Board. It would however be important to make two comments. The first is to note the presence as a candidate of Pascal Mocumbi, a southern African who has championed health equity for many years, both working on ways of providing incentives for health equity and articulating equity oriented policies, including as at the 1997 Kasane meeting that launched EQUINET. The second is to note that while individual attributes, perspectives and experience are clearly important, the challenges to be addressed by the new DG call for wider alliances for health. Here perhaps WHO has untapped potential: A number of partnerships for service delivery have been built by WHO.
Bruntland has mobilized resources and raised the political profile of health. The challenge for a new DG is to bring in new strategic alliances and constituencies that advance WHOs role as global advocate for public health and that bridge global opportunity with national practice. Beyond the technical and political support that has been raised, this implies tapping into the massive social support that exists for health rights and values.
LINKS:
(Please note that links to articles from The Lancet require a short and easy registration process)
* AND THE NOMINEES FOR DG ARE …
http://www.thelancet.com/journal/vol360/iss9348/full/llan.360.9347.news.23403.1
* NINE CANDIDATES LINE UP FOR TOP POST
http://bmj.com/cgi/content/full/325/7375/1259?ijkey=l5xSvpnNpSrp6
* WHO’S NEXT DG – THE PERSON AND THE PROGRAMME
http://www.thelancet.com/journal/vol360/iss9348/full/llan.360.9348.editorial_and_review.23505.1
* HAVE THE LATEST REFORMS REVERSED THE WHO’S DECLINE
http://bmj.com/cgi/content/full/325/7372/1107?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=World+Health+Organisation+and+Bruntland&searchid=1040232817123_11702&stored_search=&FIRSTINDEX=0&fdate=12/1/1998&resourcetype=1,2,3,4,10
* ELECTION PROCEDURES LOW AND SECRETIVE
http://www.thelancet.com/journal/journal.isa
* LETTER TO THE LANCET ON ELECTION PROCEDURES
http://www.afronets.org/afronets-hma/afro-nets.200210/msg00057.php
1. Editorial
2. Equity in Health
World Trade Organisation (WTO) talks held late last year failed to resolve the issue of access to generic medicines in developing countries after the United States blocked an agreement on granting easier access to the drugs. "Its a tragedy that there is no solution after one year of talks ... millions of people have died from [infectious] diseases this year. The rich countries don't realise how much this has affected poor countries," head of international affairs for treatment lobby group Act-Up Paris, Gaëlle Krikorian, told PlusNews.
In order to "save Africa from two catastrophes" - the HIV/AIDS epidemic and famine - "we would do well to focus on saving Africa's women," U.N. Secretary-General Kofi Annan writes in a New York Times opinion piece. Women account for 50% of the individuals infected with HIV worldwide and 58% of the HIV-positive people in Africa. According to Annan, AIDS is "attacking the capacity of these countries to resist famine by eroding those mechanisms that enable populations to fight back - the coping abilities provided by women."
Millions of people are on the brink of starvation in southern Africa, warns the United Nations this week, partly because attempts to limit the spread of HIV have failed. The HIV/AIDS epidemic has left millions of agricultural workers dead, land unfarmed, and families with no money to buy food, it says, and unless concerted action is taken now to stem the spread of AIDS many other regions could face similar crises in the future. According to a report by UNAIDS (the joint UN programme on HIV and AIDS) and the World Health Organisation, nearly one in five adults in Lesotho, Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe has HIV or AIDS, and 14 million people in the region are threatened by famine.
A new international coalition - the International HIV Treatment Access Coalition (ITAC) - has been launched to boost efforts to provide access to antiretroviral drugs to the growing number of people with HIV/AIDS in low- and middle-income countries who need them. According to WHO/UNAIDS estimates presented in a report launched by the Coalition, millions of people living with HIV/AIDS in low- and middle-income countries face death within the coming years unless they can access these life-saving medicines.
The HIV/AIDS epidemic in Africa could be turned around, despite the devastating toll on human lives, UN Secretary General's Special Envoy for HIV/AIDS in Africa Stephen Lewis, says. Lewis noted that defeating the disease would require a combination of political will and resources. "The political will is increasingly there; the money is not," he said. A key element that had emerged from his visit to Zimbabwe, Lesotho, Malawi and Zambia was the important role of the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria. The Global Fund was seen as the best way of financing the struggle against the pandemic, but it would soon face its "moment of truth", as a result of inadequate funding, Lewis warned.
The government's stance on the use of anti-retroviral drugs is increasingly softening, with Deputy President Jacob Zuma saying their use could improve the condition of people living with AIDS. This represents a major shift in the government's position, which had been that anti-retroviral drugs were toxic.
The measles vaccine is safe and highly effective, so why is this disease still the leading cause of death among African children? The governments of seven countries in southern Africa have implemented targeted measles elimination campaigns over the past five years with help from the World Health Organisation (WHO). How successful have they been?
African nations need a "massive infusion of funds" to save 38 million people from starvation, World Food Programme Director James Morris told a public meeting of the United Nations Security Council last month, adding that food aid was "crucial" in the fight against AIDS, Agence France-Presse reports.
The European Union has proposed that the World Health Organisation serve as an objective third party in an attempt to stop the "impasse" in negotiations among 144 World Trade Organisation members about how to improve developing nations' access to drugs used to fight public health crises, including HIV/AIDS, the AP/Nando Times reports. The United States' position that only certain types of diseases should be covered under the deal "blocked" ambassadors from meeting a self-imposed deadline of Dec. 31, 2002, according to the AP/Nando Times. The negotiations focus on how to allow developing nations to import generic versions of patented drugs to fight diseases such as AIDS, malaria and tuberculosis.
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3. Human Resources
Many decision-makers readily point to human resource problems as the chief bottleneck they face in attempting to scale up health systems. Yet time and again the reform agenda neatly skirts around the sensitive and difficult issues involved—not least because there are major gaps in the knowledge base required for a realistic workforce strategy. This editorial of the World Health Organisation Bulletin provides an overview of the role of human resources within the health sector, regardless of whether it is public or private. The editorial discusses the importance of human resources management within the health sector, and suggests that policy-makers and donors concerned with human resources problems may want to request those proposing a major new project or policy to make a systematic and formal ‘human resource impact assessment’ during its preparation. Such assessments would examine the likely effects of the proposed project or policy on the health workforce.
4. Public-Private Mix
Improving the quality of private health care provision in developing countries is of major importance to the livelihoods of poor people. This article was published in the ‘Bulletin of the World Health Organisation’ and summarises how the activities of the private health sector in low-income countries can be influenced so that national health objectives are met. The article begins with an overview of the characteristics of the private health sector in developing countries. It continues with a summary of how to improve both the supply and the demand for private health care. To close, the authors list the possibilities available to governments for improved stewardship of the private sector.
5. Resource allocation and health financing
Failure to provide adequate funding for the Global Fund to Fight AIDS, Tuberculosis & Malaria is not only crippling the battle against the HIV/AIDS pandemic, but also weakening commitment to fight the chronic killer malaria. The failures of both African governments and rich countries to meet their commitments to prioritize health costs lives and undermines the prospects for economic development. This posting from the lobby group Africa Action contains two recent documents on malaria, one a report card on progress in the Fight against Malaria since the African summit on malaria in Abuja in April 2000, and the other a background briefing on malaria in Africa, from the Roll Back Malaria program of the World Health Organisation and other international agencies.
In many developing countries, non-governmental organisations (NGOs) have taken the lead in responding to the HIV/AIDS crisis. As international funding to combat HIV/AIDS has increased, donors and government officials are looking for effective ways to distribute new funding to maximise impact. This report, by the Partners for Health Reform (PHR), examines the use of contracting NGOs as a mechanism to deliver HIV/AIDS services and programs in developing counties.
This Lancet article assesses the existing cost-effectiveness data for HIV/AIDS interventions and its implications for value-for-money strategies to combat HIV/AIDS in Africa. The researchers found that cost-effectiveness varied greatly between interventions. They argue that a strong economic case exists for prioritisation of preventive interventions and tuberculosis treatment. Where potentially exclusive alternatives exist, cost-effectiveness analysis points to an intervention that offers the best value for money. The article concludes that cost-effectiveness analysis is an essential component of informed debate about priority setting for HIV/AIDS.
South Africa has relatively abundant health sector resources, but national health status indicators are poor. How can resources be used more effectively to improve healthcare? How does the unequal distribution of resources contribute to the poor performance of health services?
6. Governance and participation in health
The Joint United Nations Programme on HIV/AIDS (UNAIDS) says South Africa's responses to the impact of the disease on young people, are paying off. Releasing its latest report on the epidemic, the UNAIDS said HIV prevalence among teenagers in South Africa shrank between 1998 and 2001.
"In the next 24 hours, over 30,000 children will die from preventable diseases on our planet earth. Today, while the world is writing a collective obituary of the future generation, we know why they are dying and we know who are responsible for these deaths. We also know how these deaths can be stopped. We urge you to join 'The Million Signature Campaign', - a march demanding health for all."
There has been intense public health debate in many parts of Africa to determine the most appropriate official policy towards traditional medicines for reproductive health care. The author of this editorial argues that because traditional practitioners work more closely with the grassroots compared to orthodox practitioners, traditional practitioners would be more able to advocate for changing behaviours that impact negatively on reproductive health in Africa.
More young South Africans are heeding safe sex campaigns and cutting their chances of getting AIDS or the HIV virus which causes it, a new survey said last month, heartening the nation worst hit by the pandemic. But despite the promising trend the survey highlighted high infection levels among young children. It also urged the government to act quickly to give people with HIV the anti-retroviral drugs which can slow the onset of AIDS.
7. Monitoring equity and research policy
Research on international development investigates new policies and strategies that can help in the fight against global poverty and for a better standard of living for all. But there is little point to this research if it is not communicated effectively to the people who have the ability to act on its recommendations and implement the necessary changes. Who are these people, what types of research are they interested in, and what are the best ways to communicate this research to them? In early 2002, id21, the Institute of Development Studies at the University of Sussex, set about addressing these questions by surveying, interviewing and collecting comments from over 1900 NGO and aid agency staff, politicians, policy-makers, students and researchers. The results of these surveys have now been analysed to produce a comprehensive set of insights into how development research and its effective communication can influence policy and help bring about social change. A summary of reports is available from http://www.id21.org/id21-info/impact/summary.pdf, while the full report is available from the URL provided below.
8. Useful Resources
DynaMed provides free access to medical reference information on 1,791 clinical topics via the Internet for health care professionals in developing countries. The database has information on over 2,000 diseases with a primary care focus. The information is updated daily through systematic literature surveillance.
Stanford University Libraries' HighWire Press began in early 1995 with the online production of the weekly Journal of Biological Chemistry (JBC), the most highly cited (and second largest) peer-reviewed journal. Scientists and societies rapidly saw the potential for new forms and features of scientific communication, and Science and Proceedings of the National Academy of Sciences soon joined JBC online. HighWire now (January 2003) produces 346 sites online, with many more planned. The journals HighWire supports focus on science, technology, and medicine (STM). Under the guidance of its publishing partners, HighWire's approach to online publishing of scholarly journals is not simply to mount electronic images of printed pages; rather, by adding links among authors, articles and citations, advanced searching capabilities, high-resolution images and multimedia, and interactivity, the electronic versions provide added dimensions to the information provided in the printed journals. The site has recently been redesigned to help researchers comprehensively search and gain access to the literature easily and to help librarians support their researchers and institutions with more complete and improved services.
ProCAARE-ART, a new electronic forum, aims to develop an information and communication network that supports the rational prescription, appropriate use, and adherence to antiretroviral therapy for those infected with HIV. Given the increasing access to antiretroviral drugs and the scaling up of treatment programs, the need to administer these drugs in a safe and effective manner is critical.
This handbook, produced by the International HIV/AIDS Alliance and downloadable in three parts, aims to provide practical, experience-based advice and examples for people and organisations working to improve access to HIV/AIDS treatment. The book explores care and treatment, providing an introduction to links between treatment and prevention and barriers to access to treatment. It discusses both the practical and ethical factors involved with treatment work, including a factsheet on antiretroviral (ARV) drugs, choosing, sourcing and supplying them.
TB-EDucate is a forum that provides the opportunity to ask questions, share comments, and exchange information with other subscribers. Discussions should be limited to questions, comments, and the exchange of information pertaining to tuberculosis health education and training issues.
Applying to the United States the kind of scrutiny that Nobel–prize winning economist Amartya Sen has devoted to developing countries, The Health of Nations demonstrates that growing inequality is undermining health, welfare, and community life in America. Harvard professors Ichiro Kawachi and Bruce P. Kennedy review the social costs of inequality, revealing that the United States and other wealthy countries with high levels of social inequality have lower general health than do more equitable societies, rich or poor. The Health of Nations makes an urgent argument for social justice as the necessary vehicle for the betterment of society, including improving the health of our bodies and our body politic.
The Global Health Initiative (GHI) of the World Economic Forum is developing a web-based networking tool, which is aimed at fostering new partnerships and greater private sector action against HIV/AIDS, TB and malaria. The GHI Networking Directory, available at http://www.weforum.org/globalhealth/directory , enables businesses and other users to easily identify useful contacts and potential partners in the battle against HIV/AIDS, TB and malaria. The directory lists NGOs working with the private sector, as well as companies that have existing programs or expertise to share. It also includes academic institutions and other organisations that provide technical assistance or advice. The target audience for this website is businesses and others wanting to start or improve programmes, usually in the workplace or in local communities. There are no fees involved with participating.
9. Jobs and Announcements
COHRED is looking for a Coordinator to lead the organisation into the next phase of its development. COHRED's vision is to attain a system of effective health research as a tool for development, based on values of equity and social justice and targeting the health problems of those most in need. COHRED works with numerous developing countries, research networks, UN agencies and other organisations to advocate for country-driven health research, based on the ENHR approach.
The Regional Network for Equity in Health in Southern Africa (EQUINET) and Oxfam GB are inviting expressions of interest from individuals or organisations based within the region for a programme of work on Equity issues in HIV/AIDS, Health Sector Responses and Treatment Access in Southern Africa between February and July 2003.
This is a call for applications for the HIV/AIDS Training Program for Medical Doctors in Africa for the year 2003. The HIV/AIDS Training Program is a one-month, full-time, non-resident course with a 10-person capacity. A total of 5 applicants from outside of Uganda and 5 applicants from Uganda will be selected. The course entails a comprehensive overview of HIV/AIDS related basic science, epidemiology, care and treatment, and prevention for adult and paediatric populations. The course includes clinical experience and classroom teaching with instruction provided by both national and international HIV/AIDS experts. The course includes examinations.
Four hundred participants of the I International Forum for the Advocacy of Peoples' Health, performed in Porto Alegre in January 2002, soon before the II World Social Forum (WSF), recommended the accomplishment of a II International Forum for the Advocacy of Peoples' Health preceding the III WSF in January 2003. This will allow a widened participation of all those interested, a preparation of the contributions on health issues for the III WSF, and, at the same time, to raise the health theme to a power in the several activities within the WSF itself. Conclusions of the I International Forum, available through the link below, summarize the objective and the motivation for this II Forum, where we want to build an International Agenda on the Defense of the Health Right, as well as to launch the basis for an international call for the accomplishment of the I World Forum for the Advocacy of Health in Porto Alegre – Brazil, in the first semester of 2004.
The Women’s Dignity Project (WDP) is seeking two interns to work with WDP for six-month to one-year internships in 2003 and 2004 (internships for shorter periods are generally not available). A modest stipend will be paid to interns, but the bulk of costs will be the responsibility of the intern. If interested, please contact the Executive Director of WDP at wdp@cats-net.com or at PO Box 79402, Dar es Salaam, Tanzania. The Women’s Dignity Project (WDP) was created to mobilize action for the prevention and management of obstetric fistula within a framework of health and gender equity, and human rights.
Incumbent will be working with the Global AIDS Program, US Centers for Disease Control and Prevention (CDC), South Africa. Incumbent will provide technical assistance to CDC and the HIV/AIDS, STD and TB Directorate within the National Department of Health (NDOH) in the development, implementation and evaluation of PMTCT communication strategies, integration of HIV counseling activities and the monitoring and evaluation of PMTCT programs at the national and provincial levels. The incumbent will work in close collaboration with the Deputy Director of Research, HIV/AIDS, STD and TB Directorate, and the Chief Directorate of MCWH and Nutrition.
The Africa Health Research Forum (AfHRF) aims to represent the African voice in health research in the continent and internationally; to serve as a platform for accelerating health research development in the African continent and in making the region an effective partner in the global health research system. To read more about
AfHRF's activities click on the link provided below.
The conference will be hosted by the Wits Institute for Social and Economic Research (WISER), the Gay and Lesbian Archives of South Africa (GALA) and the Graduate School for the Humanities and Social Sciences. For further details of the conference, including the call for papers (deadline for submission of abstracts 31 January 2003) visit the conference website:
http://wiserweb.wits.ac.za/conf2003