A concern for health equity is not new in global health. Equity was central to the World Health Organization (WHO) 1946 constitution, and to the work that culminated in the Declaration of Alma Ata in 1978. Despite this, the health agenda has mostly focused on securing progress on priority challenges. This has contributed to substantial advances in average life expectancy in most parts of the world. Yet the global health community has often seemed unable to counter the widening inequities brought by uneven progress.
The recently completed World Health Assembly has the potential to be a turning point in addressing health inequities. Two resolutions were passed, fundamentally grounded in a concern for equity and social justice - one on 'primary health care, including health systems strengthening' (available at http://apps.who.int/gb/ebwha/pdf_files/A62/A62_R12-en.pdf) , and another on 'reducing health inequities through action on the social determinants of health' (available at http://apps.who.int/gb/ebwha/pdf_files/A62/A62_R14-en.pdf).
Around 50 countries spoke in strong support of the resolution on primary health care, and almost 40 countries intervened in support of acting on the social determinants. There was a constructive consensus in favour of both texts, with discussion centred on the strength and tone of the resolutions. Throughout the Assembly, multiple references were made to the importance of social justice and fairness in the plenary and across the agenda items.
The events that sparked these resolutions from WHO - the convening of the Commission on Social Determinants of Health in 2005 and the groundswell of support from countries for the renewal of primary health care, leading to the 2008 World Health Report - reflect an increasing understanding and intolerance for widening health inequities in the modern era. There is increasing support for the idea that health equity should be seen as a key development goal and as a measure of the progress of the global community.
Such consensual support would have been unthinkable until relatively recently and has strongly built on the explosion in knowledge of health inequities, both within and between countries, in the last twenty years. The broad range of civil society and academia have made important contributions in terms of advocacy, the generation of knowledge and the demonstration of innovative strategies to address the social determinants. The Commission's damning diagnosis - 'social injustice is killing people on a grand scale' - owes much to this work.
So what now? The twin resolutions call for a broad range of actions based on the values of Alma Ata from the international community, member states and the WHO secretariat. The Assembly's understanding of both primary health care and addressing the social determinants of health emphasises the key role of multi-sectoral action, beyond the necessary but insufficient functioning of health systems, if health inequities are to be reduced. Achieving such action issues a difficult challenge to health leaders at global, national and local levels.
Anyone who believes in health equity should be encouraged by these developments. Of course, the resolutions by themselves will not achieve health for all. But they provide a powerful endorsement of the report of the Commission and of the need for renewal of primary health care. The challenge in implementing these resolutions, to contribute towards improved health equity, is one to which civil society can continue to make a vital and essential contribution.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat admin@equinetafrica.org. For further information on this issue please visit http://www.who.int/topics/primary_health_care/en/ for PHC and http://www.who.int/social_determinants/en/index.html for SDH.
1. Editorial
2. Latest Equinet Updates
Parliaments can play a key role in promoting the right to health in east and southern Africa. To better understand and support the practical implementation of this role, this report presents the findings of a questionnaire administered to parliamentary committees on health from 12 countries in the region. Knowledge of international human rights and related laws pertaining to the right to health was found to be limited. Parliamentarians were more likely to be familiar with Trade-related Aspects of Intellectual Property Rights (TRIPS) applications and with the provisions of the Abuja Declaration than with rights agreements such as the International Covenant on Economic, Social and Cultural Rights (ICESCR), its General Comment 14 or the African Charter on Peoples and Human Rights. Important gains could be made if parliamentarians were able to analyse, interpret and integrate these agreements into their work.
The main challenges facing parliamentarians appear to be: how to deal with policy choices under conditions of severe resource constraints and, particularly, the application of the concept of progressive realisation of the right to health; how to balance individualist concepts of rights with rights claims that benefit groups so that it is not simply a question of those who shout the loudest getting access to decision making processes; and how to structure engagement with civil society to preference groups who are most marginalised – a pro-poor application in human rights practice.
In the DR Congo, where the national HIV prevalence is around 5%, testing and treatment services are more available in urban than rural areas, despite the latter being more affected by the epidemic. In Bunia and Aru, North eastern DRC, people living with HIV and AIDS (PLWHA) cannot access testing or treatment services unless they travel to Bunia town, some distance away. Discrimination from community members towards PLWHA is further identified as a reason for people not coming for HIV testing, and for discouraging other prevention activities. The Pan African Institute of Community Health (IPASC) used a participatory reflection and action (PRA) approach with the concerned rural communities to examine and act on negative perceptions within the community around HIV testing and treatment, to support improved demand for and uptake of these services, to make more effective use of available resources and services. The PRA work showed that a major lesson learned for Primary Health Care responses to AIDS is that communities are able to make significant changes in barriers to testing and treatment if organised to do so, particularly using participatory processes. Community based sensitisers are an important resource in the community to produce change in those attitudes that discourage early testing and treatment, supported by actions that address disabling conditions within the community and that build cohesion around addressing wider service problems. PHC interventions for AIDS that do not invest in these dimensions in an empowering way undermine the effective use of other resources and the necessary synergy between communities and health services needed to manage a chronic condition such as AIDS.
This workshop was designed to provide the Ministry of Health in Mozambique with support on practical approaches to achieving a more equitable distribution of public health sector resource allocation outlays. Based on communication with officials of the Mozambican Ministry of Health, there have been concerns around the inequitable distribution of public health care resources, with areas of higher socio-economic status and relatively lower levels of disease burden receiving higher health care allocations. The key problems for the Ministry of Health were: how to empirically show that the current resource allocation outlays are inequitable and how to design a formula that allows for the shift of resources to ensure a more equitable distribution.
3. Equity in Health
There is overall consensus that recent decades have seen an increase in inequities in general and in health in particular. Some less-developed countries are showing deteriorating health outcome averages (in some cases due to the HIV/AIDS pandemic), as a result of the widening gap between poor and rich. The epidemiological transition has been quoted as one contributing factor. What is missing is consensus around what the solutions are. There have been justified criticisms that private foundations – the big health spenders – are too technocratic and disease-specific to make an impact. The way forward is argued to need more comprehensive government leadership, acting beyond the health sector, through comprehensive approaches and processes that deal with diseases in an equitable and effective way.
Several misunderstandings have arisen about the Millennium Development Goals (MDGs). The biggest is that every country must achieve the same numerical targets (for example, halve poverty by 2015), which is incorrect because global performance is an average of all countries’ performance, so some countries will perform above and below average in order to achieve them. A one-size-fits-all approach will not work, as different countries have followed different approaches and strategies for achieving social and economic progress, with varying costs. Unless disparities within countries are addressed, the MDGs will not be met by 2015. To formulate a homegrown MDG-based national development strategy to address inequality and to achieve the MDGs, the author proposes four practical steps: tailor the global targets to make them context-sensitive, set intermediate targets for political accountability, translate targets into specific programmes and policies, and cost programmatic and policy interventions.
Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, earth's average surface temperature rises are likely to exceed the safe threshold of 2°C above preindustrial average temperature. Rises will be greater at higher latitudes, with medium-risk scenarios predicting 2–3°C rises by 2090 and 4–5°C rises in northern Canada, Greenland, and Siberia. This report outlines the major threats – both direct and indirect – to global health from climate change through changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population growth and migration.
Deaths of children aged under five years old have dropped by 27% globally since 1990, according to the latest World Health Organization (WHO) estimates. But, in WHO’s first progress report on the health-related Millennium Development Goals, released in the World Health Statistics 2009, other results are mixed. Areas where there has been little or no movement are notably maternal and newborn health. In many African countries – and in low-income countries generally – progress has been insufficient to reach the Millennium Development Goal target that aims for a two-thirds reduction in child mortality by the year 2015. ‘While data is patchy and incomplete, it appears that the regions with the least progress are those where levels of maternal mortality are the highest. The challenges ahead are those presented by weak health systems, those associated with noncommunicable chronic conditions and emerging health threats such as pandemics and climate change,’ said WHO.
Recent claims have been made that system-wide approaches, and primary health care for all, are universally agreed-upon goals. So why haven’t these goals been fulfilled? Certainly much of the problem has been lack of real commitment to a comprehensive approach to reducing health risks and improving primary care. The prevailing neoliberal economic model of development, the so-called 'Washington Consensus', which -emphasised liberalisation, privatisation and fiscal austerity, displaced ‘Primary Health Care for All’ with ‘Primary Health Care for Some’.
4. Values, Policies and Rights
This paper assesses whether ratification of human-rights treaties is associated with improved health and social indicators. Data for health (including HIV prevalence, and maternal, infant, and child [<5 years] mortalities) and social indicators (child labour, human development index, sex gap, and corruption index), gathered from 170 countries, showed no consistent associations between ratification of human-rights treaties and health or social outcomes. Established market economy states had consistently improved health compared with less-wealthy settings, but this was not associated with treaty ratification. The paper suggests more stringent requirements for ratification of treaties, improved accountability mechanisms to monitor compliance of states and financial assistance to support the realisation of the right to health.
The People’s Health Movement (PHM) has initiated a Global Right to Health Care (RTHC) Campaign to be developed in collaboration with various networks, coalitions and organisations sharing a similar perspective. This campaign will document violations of health rights, present country level assessments of the right to health care and advocate for fulfillment of commitments to the right to health care at the national, regional and global levels. The campaign has three phases of action: Phase 1 is concerned with the production of diagnostic assessment reports on the RTHC in more than 20 countries; Phase 2 is concerned with the development and interactions of regional assemblies to share results and enable a dialogue between PHM and partners; and Phase 3 looks to the issue of global expansion by implementing Phase 2 conclusions and recommendations and drafting and submitting time-bound resolutions on health rights. To get involved, contact Claudio Schuftan at the email address provided.
African governments are failing to offer even the most basic healthcare that could save lives, speakers warned a civil society meeting in the Kenyan capital, Nairobi. Delegates spoke particularly of the failure to uphold women's right to sexual and reproductive health services, calling for a response that takes into consideration the need to empower women. They noted that there is often no access to medical screening and treatment services for illnesses like cervical cancer, which affect large numbers of women but are rarely offered free of charge in pubic health centres.
Two Norwegian companies have tested their products in developing countries in the past decade: in Africa, A-Viral tested AIDS medications in 300 HIV-positive persons in Uganda in 1997–1998 and NorChip tested equipment for diagnosing cervical cancer in 340–350 women in civil war-devastated Congo in 2003. This report presents the patients' stories and examines the ethics of the companies' practices. The patients NorWatch spoke with had a near-total lack of knowledge about what kind of project they had participated in. Also, they all said – independently of each other – that they did not receive a copy of the agreement they entered into with the pharmaceutical company. The company’s briefing of the patients was condemned by Norway’s National Committee for Medical and Health Research Ethics (NEM). ‘The patients’ information is, in our judgment, too inadequate and would not have been recommended here,’ it wrote in 2002.
This study reports on the prevalence and circumstances of sexual violence in girls in Swaziland, and assesses the negative health consequences. It obtained data from a nationally representative sample of 1,244 girls and women aged 13–24 years from selected households in Swaziland between, with a two-stage cluster design. It found that 33.2% of respondents reported an incident of sexual violence before they reached 18 years of age, mostly by men or boys from the neighbourhood and boyfriends or husbands. Sexual violence was associated with reported lifetime experience of sexually transmitted diseases, pregnancy complications or miscarriages, unwanted pregnancy and depression. Knowledge of the high prevalence of sexual violence against girls in Swaziland and its associated serious health-related conditions and behaviours should be used to develop effective HIV and sexually transmitted diseases prevention strategies.
This paper suggests that the extent to which conflict restricts women’s freedom of movement depends on a number of factors, including the stage of conflict, whether the women are displaced, whether they are directly or indirectly affected by the conflict and the cultural norms of the conflict-affected area. In times of political, economic and social uncertainty, there is a strong tendency to revert to traditional values, which appear to offer protection for women and girls, but which restrict their mobility. Some of the negative impacts of conflict on women‘s health and education include: lowered access to reproductive health care facilities; lack of access to education because of conflict, household and domestic tasks or cultural norms and higher teenage pregnancy rates. Girls who are disabled, disfigured or severely mentally affected by the crisis are also likely to be kept at home.
5. Health equity in economic and trade policies
The World Trade Organization’s TRIPS Agreement and the TRIPS-plus provisions in free trade agreements (FTAs) have had an adverse impact on prices and availability of medicines, making it difficult for developing countries (DCs) and least-developed countries (LDCs) to meet their obligations to fulfill the right to health, the UN Special Rapporteur on the right to health, Anand Grover, has said. Similarly, lack of capacity coupled with external pressures from developed countries has made it difficult for DCs and LDCs to use TRIPS flexibilities to promote access to medicines. He recommended that DCs and LDCs should not introduce TRIPS-plus standards in their national laws, nor should they enter into TRIPS-plus FTAs that may infringe upon the right to health. He recommended that they should review their laws and policies and consider whether they have made full use of TRIPS flexibilities or included TRIPS-plus measures and, if necessary, amend their laws and policies to make full use of the flexibilities.
The repeated practice of European Community (EC) customs officials seizing shipments of medicines while in transit to developing countries on grounds of alleged intellectual property violations has once again come under sharp criticism in the World Trade Organization (WTO). Protest by developing countries came at a formal session of the TRIPS Council on 8 June. The developing countries expressed concern over the European Union's (EU) commitment to the Doha Declaration on TRIPS and Public Health and the flexibilities inscribed in the TRIPS Agreement. They said that the EU was confusing legitimate generic medicines with counterfeit fakes. Furthermore, the EU was also undermining poor countries' ability to obtain cheaper generic medicines. India called upon the EC to urgently review their legislation and the actions of their national authorities and bring them in conformity with the letter and spirit of the TRIPS Agreement, the rules-based WTO system and the Doha Ministerial Declaration on Public Health.
The World Health Organization’s report and draft resolution, Principles and Elements of National Legislation against Counterfeit Medical Products, presented at their annual meeting in January emphasises counterfeit medical products as the central health problem pertaining to quality, safety and efficacy of medicines, while paying scant attention to equally significant public health problems of falsely labelled, spurious and substandard drugs. This article discusses the ramifications of the International Medical Products Anti-Counterfeiting Taskforce (IMPACT), which wrote the report and resolution, and concludes that all role players should consider the negative implications of anti-counterfeiting actions, such as how the seizure of suspected intellectual property-infringing medicines in transit will affect access to medicines and the right to health, plus anti-counterfeiting legislation in various countries.
Counterfeit medicines were left off this year’s World Health Assembly agenda in May, and some countries suggested that the World Health Organization (WHO) was overstepping its mandate into intellectual property enforcement rather than public health. ‘WHO will not do the work of WIPO [World Intellectual Property Organization] or the WTO [World Trade Organization]’, by becoming involved in IP, WHO’s director general, Margaret Chan, has said. Nevertheless counterfeit medicines were felt by others to be an isssue, and appear in the medium-term strategic plan, which outlines WHO’s expected activities for the years 2008–2013.
On June 4, in Brussels, the European Union (EU) signed an interim economic partnership agreement with Botswana, Lesotho, Mozambique and Swaziland against the wishes of Angola, Namibia, and South Africa. This has made imminent an acrimonious break-up of Africa's oldest customs union, the Southern African Customs Union (SACU). Such an eventuality also raises doubts over the merger, scheduled for next year, of SACU and the Common Market of Eastern and Southern Africa (COMESA) into a single customs union under the Southern African Development Community (SADC). Signing any agreements that result in reductions in customs revenue could devastate the treasuries of the countries concerned. Lesotho earns about 60% of its state revenue through the SACU revenue-sharing arrangement, while Swaziland earns as much as 70%. Compensating for such loss through taxation could lead to a doubling of value-added tax rates and a tripling of corporate taxes.
Intellectual property (IP) issues were raised at the 124th Session of the World Health Organization’s (WHO) Executive Board in January in respect of the following technical and health matters: pandemic influenza preparedness (sharing of influenza viruses, access to vaccines and other benefits); the role and responsibility of WHO in health research; counterfeit medical products; and a global strategy and plan of action for the Intergovernmental Working Group on Public Health, Innovation and IP. A draft of the ‘WHO Strategy on Research for Health’ was presented.
India’s status as a top world supplier of generic medicines could be threatened by a free trade agreement its government is negotiating with the European Union (EU), according to this study. A draft of the proposed agreement put forward by EU officials recommends that it should incorporate a wide range of intellectual property issues. But at least two of the provisions in the draft could hamper access to affordable medicines for developing countries. One provision could require India to forbid the manufacture of generic versions of patented drugs for up to five years after the patents in question expire. Another provision would offer protection to test data submitted for the approval of branded medicines for a certain length of time (the precise duration has not yet been specified by EU officials). In effect, this would bar makers of generic drugs from using that data. The study notes that the EU recommendations go beyond the scope of the World Trade Organisation’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement.
The Southern and Eastern African Trade, Information and Negotiations Institute (SEATINI) has issued a statement in response to the Common Market for Eastern and Southern Africa (COMESA) meetings and the 13th Summit of Heads of State and Government held from 28 May to 8 June 2009. It recommends that a moratorium be put in place on economic partnership agreements (EPA) negotiations until east and southern African (ESA) countries have instituted adequate institutional mechanisms to deal with trade liberalisation. ESA countries should instead focus on developing their regional markets. In light of the current global recession, they must reverse most of the commitments they have agreed under the International Monetary Fund/World Bank structural adjustment policies, the World Trade Organisation and the so-called interim EPAs to allow them to implement favourable home-grown policies that are in tandem with their development priorities.
This report provides impact assessments for the current round of world trade talks and the new wave of bilateral European Union trade deals. It shows how past trade liberalisations caused huge job losses in both Africa and Latin America, which continue to stifle hopes for sustainable development. Nevertheless, some politicians are still calling for the swift conclusion of the Doha round of negotiations at the World Trade Organization, although millions of jobs are at risk. The paper considers that free trade is no answer to the current economic crisis and rather undermines the possibility of decent work and of achieving sustainable development. It calls on states to retain the policy space and tools of control in order to govern markets, manage international trade and provide decent work for all. A new economic model should be made to prioritise the economic, social, political and health rights of people over the profits of transnational capital.
6. Poverty and health
This first edition of the biennial Global Assessment Report on Disaster Risk Reduction (DRR) aims to review and analyse the natural hazards threatening humanity and seeks to provide new evidence on how, where and why disaster risk is increasing globally. It found that economic development increases a country’s exposure at the same time as it decreases its vulnerability, but this trend was more pronounced in low- and middle-income countries with rapidly growing economies. More than two thirds of the mortality and economic losses from internationally reported disasters were related to climate change and natural disasters. The translation of poverty into risk is conditioned by the capacity of urban and local governments to plan and regulate urban development, enable access to safe land and provide protection for poor households. Community- and local-level approaches can increase the relevance, effectiveness and sustainability of DRR across all practice areas, reduce costs and build social capital.
The International Baby Food Action Network, through its campaign called ‘One Million Campaign: Support Women to Breastfeed’, submitted a petition to the President of World Health Assembly, Mr. NS de Silva, which was signed by more than 45,000 people from 161 countries. The petition demanded concrete support systems for breastfeeding women and urged the Assembly to adopt a resolution in 2010 to deal with four key issues: to prepare a specific plan of action on infant feeding, which is budgeted and coordinated in the same way as action plans for immunisation; to ensure the end of promotion of baby milks and foods intended for children under two years old in a time-bound manner, that is, by 2015; to end partnerships in the area of infant and young child feeding and nutrition with commercial sector corporations that present conflicts of interests; and to create support and maternity entitlements for women both in the formal and informal sectors, so that mothers and babies can stay close to each other for six months at least.
On the occasion of the Day of the African Child, 16 June 2009, the Africa Public Health Alliance and 15%+ Campaign called on African governments to end the ‘5 by 5 Tragedy’ by stopping the estimated five million African children under the age of five from dying annually of preventable, manageable or treatable health causes. The campaign blames the existing situation on a failure of government policy on child health and protection in particular, and health development and financing in general. [To] meet the Millennium Development Goal 4 on reversing and ending child mortality, African governments are called on to meet their pledge to allocate 15% of national budgets to health, and significantly increase per capita investment in health. Strategic investment in vaccinations, health systems, human resources for health and social determinants of health, such as clean water, sanitation, food security and nutrition, must also be implemented.
As Africa marked the Day of the African Child on 16 June, the Kenyan government launched an eight-year strategy aimed at delivering efficient and effective health services to improve the lives of women and children. ‘It [the strategy] aims at contributing to the reduction in health inequalities and reversing the downward trend in health-related indicators with a focus on child survival and development,’ Beth Mugo, the Minister for Public Health and Sanitation, said in Nairobi when she launched the ‘Child Survival and Development Strategy 2008–2015’. The ministry developed the strategy with other line ministries as well as representatives of civil society, academia, the donor community and general population. Kenya has one of the highest numbers of newborn deaths in Africa, with a neo-natal mortality rate of 33 per 1,000 live births – approximately 43,600 deaths every year.
7. Equitable health services
The World Health Organization (WHO) has launched an eight-point plan to respond to extensively drug-resistant tuberculosis (XDR-TB): strengthen the quality of basic TB and HIV/AIDS control; scale up programmatic management of multi-drug-resistant TB (MDR-TB) and XDR-TB; strengthen laboratory services; expand MDR-TB and XDR-TB surveillance; develop and implement infection control measures; strengthen advocacy, communication and social mobilization; pursue resource mobilisation at all levels; and promote research and development of new tools. Additional considerations included: conducting adherence research; building the evidence-base for infection control practices; supporting communities affected by TB; enhancing public health response, while addressing the social determinants of health; embracing palliative care; and advocacy for research.
The researchers in this paper identify a gap between what most international health organisations say they are doing to strengthen health systems, and the reality on the ground. Although global health actors claim to be strengthening health systems, the authors argue that they engage almost exclusively with activities that match their own specific aims; tend to concentrate on single diseases, and focus on strengthening elements of health systems essential to their own programmes. Part of the problem, say the researchers, is that the term 'health system strengthening' is being used for any capacity building. They call for a definition that is both shared and consistently applied.
Scale-up of vertical HIV transmission prevention has been too slow in sub-Saharan Africa. We describe approaches, challenges, and results obtained in Kinshasa. Staff members of 21 clinics managed by public servants or non-governmental organizations were trained in improved basic antenatal care (ANC) including nevirapine (NVP)-based HIV transmission prevention. Program initiation was supported on-site logistically and technically. Aggregate implementation data were collected and used for program monitoring. Contextual information was obtained through a survey. Among 45,262 women seeking ANC from June 2003 through July 2005, 90% accepted testing; 792 (1.9%) had HIV of whom 599 (76%) returned for their result. Among 414 HIV+ women who delivered in participating maternities, NVP coverage was 79%; 92% of newborns received NVP. Differences were noted by clinic management in program implementation and HIV prevalence (1.2 to 3.0%). Initiating vertical HIV transmission prevention embedded in improved antenatal services in a fragile, fragmented, severely resource-deprived health care system was possible and improved over time. Scope and quality of service coverage should further increase; strategies to decrease loss to follow-up of HIV+ women should be identified to improve program effectiveness. The observed differences in HIV prevalence highlight the importance of selecting representative sentinel surveillance centers.
The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. Design: We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis. METHODS: Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA. RESULTS: From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001). CONCLUSIONS: Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
A new trial to test the efficacy of a tuberculosis (TB) booster shot for babies is about to start in South Africa. Almost 2,800 infants will participate in the two-year trial, in which researchers from the South African Tuberculosis Vaccine Initiative (SATVI) hope to prove that a new vaccine can act as a booster shot to improve the efficacy of the only existing inoculation against TB, the Bacille Calmette-Guerin (BCG) vaccine, in use for nearly 90 years. An effective TB vaccine could help save some of the two million people who die annually from the disease, a quarter of whom are co-infected with HIV. The vaccine has been tested in HIV-infected adults in South Africa, the UK and Senegal, but because this will be the first test in infants, only HIV-negative infants will be enrolled. However, ethical issues have been raised by some about whether it is acceptable to test vaccines on poor African children.
8. Human Resources
This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors in rural and remote areas. A comprehensive search identified 1,261 references and, of these, 110 articles were included. Available evidence was classified into five intervention categories: selection, education, coercion, incentives and support. The review argues for the formulation of universal definitions for the above categories to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.
In January, 2009, the World Health Organization’s (WHO) Executive Board considered the adoption of a global code of practice to address the movement of health workers from developing countries, the ‘WHO Draft Code of Practice for the International Recruitment of Health Workers’. This attention to brain drain is welcome, but the initiative does not begin to adequately address the consequences or roots of health-worker migration from sub-Saharan Africa to the rich developed world, especially to the United Kingdom, United States and Canada. The movement of skilled health workers constitutes a major transfer of riches from poor societies to the affluent, and the only appropriate redress is a bilaterally managed scheme of direct reimbursement of the value lost, along the lines proposed by Mensah and colleagues in 2005.
This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities, including a facility manager or counselling supervisor, and through focus group discussions with health care workers at each facility. The study found that lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers, providing up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers.
9. Public-Private Mix
Although the Bill and Melinda Gates Foundation’s contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. This paper is an analysis of 1,094 global health grants awarded between January 1998 and December 2007, totalling US$895 billion, of which $582 billion (65%) was shared by only 20 organisations. In total, $362 billion (40% of all funding) was given to supranational organisations such as the World Health Organization, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria. Of the remaining amount, 82% went to recipients based in the United States. Just over a third ($327 billion) of funding was allocated to research and development (mainly for vaccines and microbicides) or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.
At this stage, very little is known about the details of the South African government’s national health insurance (NHI) proposals, as all discussions are being held behind closed doors. However, key elements of the proposals are reported to include implementing a dedicated payroll tax for healthcare and establishing an administrative infrastructure to oversee these funds. The author, who is the head of strategy and risk management at Discovery Health (a private health services provider in South Africa) makes four proposals: transparent and vigorous public debate, based on hard evidence, is needed; healthcare reform, including NHI, must uplift the standards of public healthcare and improve the quality and accessibility of decent healthcare for all South Africans; healthcare reform must be rooted in South Africa’s economic realities; and South Africa’s private healthcare system should be seen as part of the solution, not part of the problem.
Major public health funders have alighted upon an industry-favoured approach of guaranteeing certain prices to industry to make vaccines available to least-developed country markets. The pilot project, the AMC Approach, announced on 12 June, provides nearly US$3 billion to make (presumably patented) vaccines against pneumococcal disease available sooner to the world’s poorest countries. There will be a commitment by industry to continue offering the vaccines at “lower and sustainable” prices after the funding runs out, the Global Alliance for Vaccines and Immunization (GAVI) said. The current pneumococcal vaccine is sold for more US$70 per dose in industrialised countries, while the new project will make the ‘long term’ price for developing countries US$3.50, GAVI added. It hopes to assist up to 60 of the world’s poorest countries to introduce these vaccines by 2015, well ahead of the time it might take without subsidising industry. A World Health Organization working group is set to discuss the issue from 29 June to 1 July.
10. Resource allocation and health financing
International donors must continue meeting their commitments to HIV/AIDS, even in the face of the economic downturn, United Nations (UN) Secretary-General Ban Ki-Moon has urged. In 2006, the Assembly pledged to achieve universal access to comprehensive HIV prevention, treatment, care and support by 2010. UNAIDS has said that achieving these targets in the timeframe would require an estimated US$25 billion. In 2008, the Global Fund to Fight AIDS, Tuberculosis and Malaria was forced to cut funding by 10% and the World Bank projects that the global recession could place the treatment of more than 1.7 million at risk by the end of 2009. ‘I fear that many governments are resigned to reducing programmes and diminished expectations,’ said Miguel D'Escoto, President of the UN General Assembly. ‘But it is precisely when times are difficult that our true values and the sincerity of our commitment are most clearly evident. If we allow cuts now, we will face increased costs and great human suffering in the future.’
Donor funding has fuelled a vast increase in service delivery, medical research and clinical trials throughout the developing world, yet, with pressures to spend funds quickly and achieve results, projects may not pay sufficient attention to internal monitoring and security systems to protect against embezzlement. This U4 Brief analyses how this type of corruption occurred in a donor-funded project, and what can be done to minimise the risk. While not widely publicised, many organisations have dealt with the frustrations of financial mismanagement, embezzlement and theft. Recommendations include tighter financial controls, better management policies and channels for disclosure. For projects that are just beginning, establishing a sound financial system should be a priority. Changes in policies, procedures and reporting can help promote a culture of compliance and avoid corruption.
This study aimed to provide a comprehensive assessment of development assistance for health (DAH) from 1990 to 2007. It used several data sources to measure the yearly volume of DAH in 2007 United States dollars, and created an integrated project database to examine the composition of this assistance by recipient country. It found that DAH grew from $5.6 billion in 1990 to $21.8 billion in 2007. DAH has risen sharply since 2002 because of increases in public funding, especially from the USA, and on the private side, from increased philanthropic donations and in-kind contributions from corporate donors. Although the rise in DAH has resulted in increased funds for HIV/AIDS, other areas of global health have also expanded. The influx of funds has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and the Global Alliance for Vaccines and Immunization having a central role in mobilising and channelling global health funds.
Over the past decade, an increasing number of developing country governments, working with donors and NGOs, have been implementing cash transfer programmes — regular transfers of cash to individuals or households. These programmes are united by common assumptions: that income poverty has a highly damaging impact on people’s health and nutrition, and that cash empowers poor individuals and households to make their own decisions on how to improve their lives. This report examines three key questions: What contribution can cash transfers make to reducing child mortality? What are the broader economic benefits of investing in cash transfers? How can child-focused cash transfers be affordable in developing countries? The report argues that cash transfers have a critical role to play in accelerating reductions in child mortality, as well as broader economic benefits. It estimates current costs and finds that child and maternity benefits are possible on a large scale, even in developing countries.
According to the Human Sciences Research Council’s (HSRC) Olive Shisana, ‘The NHI [national health insurance] system presents itself as an ideal mechanism for achieving equitable access to quality health services in South Africa: firstly, because it satisfies the fundamental principles of a unitary health system enshrined in our constitution; secondly, because it promotes redistribution and sharing of health care resources between the public and private sectors thus meeting our transformation agenda; and thirdly, because research evidence suggests that South Africans are generally willing to contribute to a financing system that caters for them and those unable to contribute.’ If NHI can overcome the inefficiencies of the private sector with its failing medical aid funding arrangement, and if it can address the quality-of-service issues of the public sector, it will indeed be a winning formula.
The author of this paper argues that there are a number of critical aspects which must be considered when reflecting on a national health insurance (NHI) scheme in South Africa. The benefit package ideally should cover a comprehensive package of primary and preventative benefits, with the main aim of providing the most benefits for the most people, given the pool of funds available. Experts will have to cost this package, which will be challenging because using public sector data will be difficult because ICD 10 coding (diagnosis codes) are not routinely used and collected, and the tariff schedule used in the public sector is not reflective of the actual costs of providing the benefit as it does not take into account costs such as infrastructure. Another key aspect is revenue collection. Assuming that the costing had been accurately done, and that a reasonably comprehensive benefit package was affordable, the author suggests that an earmarked tax from payroll seems the most logical manner in which to collect these funds. Critical to this process will be buy-in from labour and employers alike.
Participants at the Abuja Consultation recommend that the High Level Task Force recognise the right of all people to essential health care, pursue policies that will reduce inequity and social disparities, promote democratic and pro-poor reforms to the governance of the global economy as a means of creating a long-term and sustainable foundation for health financing, and add (not substitute) ‘innovative financing’ to existing commitments of governments, which must be fulfilled. The Task Force should also improve the efficiency, impact and accountability of current development assistance for health and place transparency and accountability at the heart of all proposed solutions. The health financing agenda must be moved forward according to principles of progressive finance, optimal pooling of finance, equitable and needs-based budgeting and expenditure, accountable planning and financial management, and the full engagement of civil society.
This briefing proposes that while prospects for developing countries are often shaped by domestic and regional politics and aid, it is necessary to looks at beyond aid at issues like trade, migration, investment, environmental issues, security and technology. The authors explore the progress made towards policy coherence and conceptualise a three-phase cycle: phase 1 includes setting and prioritising objectives, which requires political commitment and policy statements; phase 2 looks at policy coordination and the implementation mechanisms by establishing formal mechanisms at inter-ministerial level for coordination and policy arbitration; and phase 3 is about effective systems of monitoring, analysis and reporting. The paper concludes by recommending that the Beyond Aid agenda could help drive faster progress towards partnerships for community development and policies that are more ‘development-friendly’, in practice as well as on paper.
11. Equity and HIV/AIDS
A new report released before The High-Level Forum on Advancing Global Health in the Face of Crisis, which took place on 15 June 2009, suggests that the response to AIDS is an opportunity to improve health systems worldwide. Other areas that contribute to health solutions, such as human rights, the law and education, need to be embraced to maximise outcomes, and health equity must be addressed. The report argues that the main issues that need to be addressed are: the shortfall in health resources, despite increases in investment in global health; the need to strengthen community services, despite the beneficial effects from an increase in AIDS resources being spent on health and community systems; the need to link AIDS treatment and HIV prevention to other health issues, such as sexual reproductive health, tuberculosis and safe motherhood. A lesson learned is that social determinants, such as gender inequality, lack of education and poverty, must be addressed when addressing global health needs.
A three-day summit on HIV and AIDS in May this year called on governments to depoliticise the fight against HIV and AIDS and take the lead in fighting the scourge rather than leave it to donors and lobbyist. the Global Citizens Summit held in Nairobi represented citizens from 32 nationals among them National AIDS Control Council representatives (commissioners) from seven countries in Africa and donors from Europe and the Americas. There were calls to ensure that citizens take their rightful place in the fight. Two recommendations that came from the meeting were: expand and diversify testing options (door to door, self testing and male-targeted testing) and make HIV testing a universal agenda. National governments must also provide incentives to promote care and support initiatives for citizens, such as tax exemptions for caregivers, social protection for caregivers and people living with HIV and AIDS (PLWHAs), and micro-enterprise funds targeted at caregivers and PLWHAs. Nutrition should be made part of treatment – both national governments and donors should aim to promote food sovereignty at the household level.
Research conducted by civil society activists in various countries, including Uganda and Zimbabwe, shows that efforts to prevent vertical transmission are failing to reach the very group they were designed for – HIV-positive pregnant women. One of the key reasons for this is that the national programmes have been narrowly focused on providing antiretroviral prophylaxis and not on the other essentials – prevention, counselling, care and treatment for women and children. ‘On paper, the existing global programme is a model of sound design, human rights principles and a comprehensive approach’, the researchers noted. ‘In practice, it is a shameful demonstration of double standards and another instance of women's programming for which everyone and no one at the United Nations is in charge.’ In every country, the researchers found rampant fear of stigma among women and discrimination by health care workers.
Between 2007 and 2008, UNAIDS and the World Bank partnered with the national AIDS authorities of Kenya, Lesotho, Swaziland, Uganda and Mozambique to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings. The recently released reports reveal that few prevention programmes are based on existing evidence of what drives HIV and AIDS epidemics in the five countries surveyed. For example, in Mozambique, 19% of new HIV infections resulted from sex work, 3% from injecting drug use, and 5% from men who have sex with men (MSM), yet there are very few programmes targeting sex workers, and none aimed at drug users and MSM. The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13% of its national AIDS budget on prevention, whereas Uganda spent 34%, despite having an HIV infection rate of only 5.4%.
The war against HIV/AIDS, which has too often been fought in plush offices and conference centres, needs to be reclaimed by people in developing countries, who are most affected, or it will continue to be a losing battle. This was the message from the Global Citizens Summit in Nairobi, Kenya from 27-29 May 2009, organised by international anti-poverty agency ActionAid, and attended by a broad range of organisations in the field of HIV and AIDS to discuss using social mobilisation to ‘repackage’ the HIV response. ‘The fight against HIV did not originate in boardrooms’, said ActionAid. ‘It was citizens rising up to make their voices heard and to put AIDS on the agenda. We need to go back there.’ Participants pointed out that although community-based organisations did the lion's share of HIV-care work, they received only a fraction of global AIDS funding.
Despite the estimated 22.4 million HIV-infected adults in Africa, culturally appropriate ‘prevention with positives’ guidelines have not been developed for this region. In order to inform these guidelines, the authors of this study conducted 37 interviews with purposefully selected HIV-infected individuals in care in Uganda. Participants reported increased condom use and reduced intercourse frequency and numbers of partners after testing HIV-positive. Motivations for behaviour change included concerns for personal health and the health of others, and decreased libido. Interventions addressing domestic violence, partner negotiation, use of lubricants and alternative sexual activities could increase condom use and/or decrease sexual activity and/or numbers of partners, thereby reducing HIV transmission risk.
A one billion rand (US$123 million) shortfall in South Africa's public sector antiretroviral (ARV) programme could jeopardise treatment programmes as soon as September, a health expert has warned. Mark Heywood, deputy chairman of the South Africa National AIDS Council (SANAC), commented on the lack of funding at the relaunch of the National AIDS Charter on 18 June. Among the additions to the charter were an increased focus on vulnerable groups, and the inclusion of traditional leaders and their role in the epidemic. ‘We've made major strides, and one of the strengths of the charter was that it guided our progress on the national strategic framework at a time when people were still stoned to death [...] when kids were still taken out of school and people were chased out of their homes for being HIV-positive,’ Heywood said. ‘But […] we don't actually have ARV treatment for most of the people who need it.’ An estimated 700,000 people are on treatment in South Africa, but an estimated 1,000 die daily as a result of AIDS.
Increasing emphasis is being placed on the need for 'structural interventions' (SIs) in HIV prevention internationally. There is great variation in how the concept of an SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. This paper clarifies and elucidates what constitutes an SI, with particular reference to the structured distribution of power and to the role of communities. It summarises the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy and illustrates the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of: attending to local complexities in the micro and macro-level structures that produce vulnerability; and clarifying the meaning and role of communities within SIs.
12. Governance and participation in health
Climate change and the current global economic crisis bring an unprecedented opportunity to transform global governance, which must start giving priority to human development and citizen engagement, civil society organisations said at the launch of Platform HD2010 in New York on 5 June, a partnership that will include civil society in addressing the current global crises in the poorest countries. The partnership’s recommendations will contribute to the 20-year review of the United Nations Development Programme’s (UNDP) Human Development Report. Civil society representatives have called on the UNDP to create and expand opportunities for citizen engagement in development initiatives and to work together in addressing the concerns of the poor, who have been the hardest hit by the current economic and climate crises. The partnership will also contribute to the ten-year review of the Millennium Declaration and the Millennium Development Goals, both of which are taking place next year.
Non-state actors (NSAs) are systematically neglected in European Union (EU) development assistance programmes, according to this report. It identifies EU practices that are violating its European Consensus on Development policy statement. It found that, despite the European Community’s (EC’s) attempts, NSAs' involvement has been limited and falls short of the sustained and structured dialogue envisaged by the EU legislation and the Commission’s own guidelines. The EC often does not commit enough time and resources to ensure that its delegations involve relevant NSAs throughout the whole process. EC's development aid programmes are reported to often engage NSAs solely as service providers or short-term consultants, without the follow-up and impact needed for sustainability and effectiveness.
Thirty-two delegates participated in the global workshop that marked the first research phase of the Global Development Network’s (GDN’s) UK Department for International Development-funded project, ‘Strengthening Institutions to Improve Public Expenditure Accountability’, in Washington DC on 18–20 May. For the first year of the project, partners will conduct programme budget and benefit incidence analysis in the three programme sectors: education, health and water. Next year, partners will receive technical training on the subsequent programme analytical activity – cost effective analysis – and start implementing their communication plans in order to inform policymakers on their findings and budget reform proposals. Participating in the meeting were fifteen partner institutions, including from Kenya, Tanzania and Uganda.
The Global Development Network (GDN) and the African Economic Research Consortium (AERC) jointly organised a workshop for their United Nations Development Programme-funded project in Cape Town, South Africa, on 7–8 May 2009: Institutional Capacity Strengthening of African Public Policy Institutes to Support Inclusive Growth and the Millennium Development Goals. This was the third event for the project, following the workshop in Kuwait (February 2009) and the initial planning meeting held in Accra (June 2008). The objective of the project is to provide support to enhance knowledge management capacity for African Policy Research Institutes and networks with a particular focus on tackling the issues of poverty and hunger within the global Millennium Development Goals framework. It will seek to strengthen multi-disciplinary research capacity on poverty analysis and contribute to bridging the gap between research and policy on poverty reduction and sustainable development. Papers from the workshop are expected to be finalised by the end of July 2009. Policy briefs, based on the final papers, will be produced by the relevant institutions. The group also chalked out a dissemination strategy for the project. A concluding workshop has been scheduled for Kenya, in September 2009.
This brief explores the relevance of civil society budget analysis and advocacy and its potential as a tool to hold governments accountable for their maternal mortality reduction commitments. It discusses three recent examples of civil society groups engaged with budget analysis and advocacy, including Women’s Dignity in Tanzania. Lack of real progress in reducing maternal mortality is unquestionably linked to the failure of governments to make maternal health a budgetary priority. Even though resources to address this issue exist, they are not necessarily being allocated correctly or spent effectively. Governments need to prioritise funding for family planning and prenatal care, skilled care during pregnancy and childbirth, and essential lifesaving interventions. In addition, citizens must actively monitor government spending on maternal health.
The past two decades have seen dramatic shifts in power among those who share responsibility for leading global health. In 1990, development assistance for health – a crude, but still valid, measure of influence – was dominated by the United Nations (UN) system (the World Health Organization, the United Nations Children’s Fund and the United Nations Population Fund) and bilateral development agencies in donor countries. Today, while donor nations have maintained their relative importance, the UN system has been severely diluted. This marginalisation, combined with serious anxieties about the unanticipated adverse effects of new entrants into global health, should signal concern about the current and future stewardship of health policies and services for the least advantaged peoples of the world.
How can the recent change in global health policy to provide ‘health for all’ be translated into action, in order to achieve some real and sustained impact on the ground and successfully reduce inequities in health? The authors have three suggestions. Ask what is needed: the answers to what is really needed cannot be found in Geneva or Washington, but ultimately lie with the people and communities themselves. Put the money where the needs are: if we know what people are suffering from and match available human and financial resources accordingly, even a little money can go a long way. Work together: initiatives like the recently launched International Health Partnership aim to strengthen health systems and to ensure that resources invested are spent in equitable and sustainable manner. This represents a shift from vertical, disease-specific models of funding, to horizontal system-building according to long-term strategies.
13. Monitoring equity and research policy
Have disease-specific global health initiatives (GHIs) burdened health systems that are already fragile in poor countries or have they been undermined by weak health systems? This study reviews and analyses existing data and 15 new studies that were submitted to the World Health Organization for the purpose of writing this report. It makes some general recommendations and identifies a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money and outcomes in global public health, then these opportunities should not be missed.
The use of attitude questions is very common in comparative surveys as it allows researchers to gauge the perspectives of respondents toward social issues and explain cross-country differentials in attitudes. Comparative studies implicitly assume that equivalently worded items are measuring the same construct in different settings. However, the results of these studies might be questionable if the measurement invariant assumption is violated and different groups of respondents do not have a shared understanding of the attitude items. This paper uses item response theory to compare the measurement of items and to test whether equivalently worded attitude questions about family dissolution are understood in the same way across various communities in India, Malaysia, Pakistan and the Philippines. The paper also examines the interaction between the respondent's gender, the sex of the spouse leaving the marriage and the responses to the attitude questions about acceptability of family dissolution.
14. Useful Resources
This assessment guide leads you through a five-step process to document aspects of the denial of the right to health care in your country. It suggests how to lobby and set up activist strategies for addressing the violations you identify. The steps, in brief, aim to answer the following questions. Step 1: What are your government’s commitments? Step 2: Are your government’s policies appropriate to fulfill these obligations? Step 3: Is the health system of your country adequately implementing interventions to realize the right to health and health care for all? Step 4: Does the health status of different social groups and the population as a whole reflect a progression in their right to health and health care? Step 5: What does the denial or fulfillment of the right to health in your country mean in practice? In this final step, you should systematically contrast the obligations outlined in Step 1 with the realities documented in Steps 2, 3 and 4, and briefly highlight the main areas of denial of health rights in your country.
Primary health care is at the heart of the plans to transform the health services in South Africa. This document provides an integrated package of essential primary health care services available to the entire population will provide the solid foundations of a single, unified health system. It as the driving force in promoting equity in health care. The document sets out the norms and standards that are to be made available in the essential package of primary care services, for individuals to see what quality of primary care services they can expect to receive. It also acts as guidance for provincial and district health authorities to provide these services. The document contains norms and standards for clinic and community services. A noorm is defined as a statistical normative rate of provision or measurable target outcome over a specified period of time.
A standard is defined as a statement about a desired and acceptable level of health care. Standard setting takes place within specific dimensions of quality -- acceptability, accessibility, appropriateness, continuity, effectiveness, efficiency, equity, interpersonal relations, technical competence and safety. The most important dimensions have been chosen for each service.
Clinical trial reports usually give estimates of treatment effects, their confidence intervals and p values. But what do these terms mean? The statistical methods and their technical meaning are well established. However, there is less clarity about the concise interpretative wording that authors should use, especially in the abstract and conclusions and by others in commentaries. This article offers guidance and assumes that one short sentence needs to capture the essence of a trial's findings for the primary endpoint. It explains technical terms simply and aims to help researchers to achieve this objective in their writing.
15. Jobs and Announcements
The Broker is hosting the debate on 'Health for All' following up on the special report published in Issue 12, which argues that there is an urgent need to improve universal access to health care by means of a radical new approach to health. All contributions to this debate are now available online at the address given below. For those of you who didn't have time yet to respond, please feel free to join the discussion now. You can add comments directly to individual contributions online.
The draft code sets out guiding principles and voluntary international standards for recruitment of health workers, to increase the consistency of national policies and discourage unethical practices, while promoting an equitable balance of interests among health workers, source countries and destination countries. Consistent with contemporary international legal practice, the initial draft of the code also aims to establish an international procedural structure to foster national dialogue, commitment and action on health worker migration. It does not aim to comprehensively address and resolve all of the complex substantive issues raised by the international recruitment of health personnel. Rather, its goal is to provide a straightforward framework and platform on which to launch negotiations. World Health Organization member states may potentially consider and elaborate more detailed national and international commitments in the final version of the code or in future international instruments. Feedback comments are invited on the World Health Organization paper on the code.
The Erasmus Observatory on Health Law will be hosting the upcoming International Conference on Healthcare and Trade on the 10th and 11th of December, 2009. The conference will focus on the influence of the law of both the European Union and the World Trade Organization on trade in health services, health insurance services and health goods (pharmaceuticals). The application of the European Community Treaty, the General Agreement on Trade and Services (GATS) and the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to national regulation of health services, health insurance services and pharmaceuticals raises questions of applicability of, compatibility with and possible exceptions to the provisions of these instruments. Further research and discussion in this area is ongoing. The conference aims to contribute to the discussion, attempting to formulate both legal and economic answers. Please refer to the programme and the application form attached to this news item.
The Bulletin of the World Health Organization would appreciate assistance from Bulletin readers to address the question: What is a fair test of a health-care policy? There are three ways in which you can do this: provide examples of randomised evaluations of health-care policies, provide examples of compelling evidence from non-randomised evaluations of health-care policies and provide early examples of treatment evaluations If you are aware of examples relevant to any of the three categories described above, please send copies of them, identifying the key passages and providing a translation if the text is not in English, by post, facsimile or e-mail. Postal address: Bulletin of the World Health Organization Project, c/o James Lind Initiative, Summertown Pavilion, Middle Way, Oxford OX2 7LG, England. Fax: +44 1865 516 311. Your help will be acknowledged explicitly unless you instruct otherwise.
The Global Development Network (GDN) has undertaken a research project entitled ‘Promoting Innovative Programs from the Developing World: Towards Realizing the Health Millennium Development Goals in Africa and Asia’. The study involved 20 different health interventions in 20 emerging and developing countries. Each of the studies was carried out by local researchers mentored by an international team of 10 economists and 10 public health officials. The purpose was to use state-of-the-art technology to evaluate the impact of each of these interventions and, in particular, to determine how the more successful ones could be replicated or, scaled up. With the successful completion of the project, the research will be shared with a vast range of stakeholders in workshops around the world.
This conference on strengthening parliaments and governance in the developing world is the third in a series of annual conferences organised in association with the Department for International Development (DFID), the World Bank Institute and the Commonwealth Parliamentary Association. The conference brings together ministers, senior parliamentarians, donors and experts to discuss topical issues affecting parliaments in the developing world. To find out more information, visit the website address provided here.
The Global Development Network (GDN) is now accepting submissions for the 2009 Annual Global Development Awards and Medals Competition for the Japanese Award for Most Innovative Development Project. A competitive grant programme administered by GDN, the competition provides an opportunity for organisations to expand their on-going field work in any development related project. Finalists are invited to attend the Annual Global Development Conference, held each year in a different country, to showcase their project proposals before an eminent jury for the final round. This year the Annual Conference will be held in Prague from January 16-18, 2010. The winning proposal will receive a cash award of US$30,000 and the runner-up organisation will receive US$5,000.
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