With the World Cup football taking place in South Africa absorbing attention, its possible to miss two important meetings taking place at the same time. The first is the 36th G8 and G20 summits taking place in Canada in late June under the theme 'Recovery and New Beginning', and the second the 15th African Union Summit on 19–27 July in Kampala, Uganda, under the theme ‘Maternal, infant and child health and development in Africa’. This newsletter flags concern over these leaders keeping the promise: G8 leaders to their development and aid commitments and African leaders to the Abuja commitments on health, including for 15% of their budgets to go to health. In this issue, a 63rd World Health Assembly resolution points to the need for strengthened health systems to address the relatively slow progress in Africa towards the health MDGs. Geoffrey Njora cautions leaders on taking the advice of finance ministers’ to reverse on the commitments they made at Abuja. Médecins Sans Frontières call the G8 to account over the 'flatlining' of AIDS funding and Oxfam over the inadequate resources allocated for maternal health. African civil society through the Africa Public Health Alliance & 15% Plus Campaign are petitioning AU Heads of States on the grave concerns of African citizens to meet crucial commitments on health and social development in Kampala, in particular the 2001 Abuja pledge on health financing, while the Civil Society Forum on the African Charter on the Rights and Welfare of the Child call for the G8 and African leaders to meet their promises on funding health as we get closer to 2015. What governments deliver at these two summits is worth keeping an eye on- it affects millions of lives.
1. Editorial
African civil society through the Africa Public Health Alliance & 15% Plus Campaign are petitioning AU Heads of States through Malawi President Bingu wa Mutharika, Chairperson of the African Union on the grave concerns of African citizens that some Heads of State are being advised to repudiate crucial commitments on health and social development, in particular the 2001 Abuja pledge on health financing. They note that despite some recent progress, healthy life expectancy in Africa is at a low of 45 years resulting in un-fulfilled personal, national and continental potential and aspirations, and the loss of billions of dollars in productivity. They note that it would be a historic setback for African governments to drop health and social development commitments, or suggest in anyway that the health of African economies exists in isolation from the overall health of African citizens. Giving evidence to support the need for adequate health sector financing, the petition urges heads of state to ensure that the July 2010 AU Summit restates the Abuja commitments; and supports the AU Commission in working with governments and civil society to monitor and report on health gains, and ensure a 10th year review of the 2001 Abuja commitments by April 2011.
The author flags concern about the actions of some African finance ministers to reverse their Heads of state commitments, such as those made on 15% government funding to health in Abuja in 2001. South African, Rwandan and Egyptian finance ministers succeeded in deleting any reference to budgetary targets for education, health, agriculture and water from the report and resolutions of the annual meeting of the African Union and Economic Commission for the Africa Conference of Ministers of Finance, Planning and Economic Development held in Malawi in March 2010. Many consequences are seen to flow from this, if heads of state follow the same path. It could indicate an abandonment of the bold financing that has gone into reversing vulnerability to food insecurity, disease and denial of access to health care and education. It questions how Africa would, after reversing from its own commitments, hold the G8 and international community to their commitments to contribute 0.7% of their gross national product and to double development assistance to Africa. The dismissive nature with which the finance ministers have treated these targets begs the question of whether the MDGs and all the other decisions taken under the auspices of the African Union will go the same way.
The Civil Society Forum on the African Charter on the Rights and Welfare of the Child (ACRWC) has written this open letter to G8 Countries to urge them to meet their promises for external funding to African countries, noting that countries have failed to fulfil their promise for increased aid allocation to Africa – with assistance from France and Germany increasing by just 25%, while Italy is actually set to reduce its contribution by 6% this year. They also urge for continued commitment within Africa to pledges made by leaders. The members note that while domestic allocations are difficult to achieve with all the pressures on very limited resources, they are critical for the health sector if we are to meet the MDGs. The letter draws special attention to the need for investing in maternal, newborn and child health. ACRWC is urging African leaders to endorse the letter. They ask readers to circulate the letter through networks and for those connected, directly to the Africa leaders.
2. Latest Equinet Updates
Medical aid societies (MAS) in Zimbabwe cover a tenth of the population, and about 80% of income to private health care providers in Zimbabwe comes from MAS. They contribute more than 20% of the country’s total health expenditure. This paper outlines the flows of private capital that lie behind the growth of the profit medical aid and insurance health care sector in Zimbabwe. It was implemented within the Regional Network for Equity in Health in East and Southern Africa (EQUINET) by Training and Research Support Centre and SEATINI, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. The report proposes measures for improving the functioning of and equity in the sector and to address the current exposure of beneficiaries. Strengthening the regulatory environment will help to address legal ambiguities on investment of the industry’s ‘surplus’ funds, to ensure the multiple relevant laws from finance and health are known and applied by MAS/ insurance providers, and to fairly and firmly enforce the law. The sector should ensure timely scheme reporting as required by law and maintenance of a database with basic information on schemes, as well as registration of all schemes, avoiding increasing segmentation of the sector into small fragmented risk pools from individual schemes and encouraging (for example through enforcement of regulation on registration and liquidity requirements), mergers into larger and more viable risk pools. Regulatory and scheme policy measures should be introduced that require and implement cross-subsidies necessary for equity and ensuring benefits packages cover personal care and personal prevention services. Other measures include taking up the shortfalls in coverage of medicines on existing plans, checking the degree of vertical integration in each scheme and unbundling any monopolies across the sector that are limiting patient choice (e.g. paying only for selected linked services), and improving the outreach of consumer information on schemes, benefits packages and consumer rights to members and organisations servicing members (e.g. the labour movement and employer organisations).
This leaflet is a translation of EQUINET’s policy brief on trade and health. The summary information is shown here in Portuguese. O crescimento do comércio internacional tem conseqüências significativas para a saúde pública. A relação entre o comércio e a saúde não é simples, e não é unidirecional. Neste informe levantamos questões sobre porquê é que questões sobre o comércio têm que ser compreendidas e geridas com o intuito de promover a saúde e realçamos as principais preocupações em saúde pública decorrentes dos acordos sobre o comércio livre. Chamamos a atenção para as medidas que os governos e a sociedade civil na região podem tomar com vista a alcançar maior coerência entre o comércio e as políticas de saúde, de maneira a que o comércio internacional e as regras do comércio maximizem os benefícios para a saúde e minimizem os riscos em saúde, especialmente para populações pobres e vulneráveis.
3. Equity in Health
In this interview, Dr Colin Summerhayes, president of the Society for Underwater Technology, talks about how the world’s climate is changing and the expected consequences on health. He predicts that, as the rise in temperatures as a result of global warming will be quite slow over the next 30 years, we should not expect an instant change in health factors. He refers to the change as a ‘creeping catastrophe’. As well as increased morbidity and mortality from extreme weather events, such as heatwaves, droughts and floods, Summerhayes anticipates that climate change is likely to increase the burden of malnutrition, diarrhoea and infectious diseases. There is also likely to be a rising frequency of cardio-respiratory diseases because of changes in air quality and in distribution of some disease vectors. All of this could impose a substantial burden on health services. He notes that some scientists now believe there will be both contractions and expansions in the occurrence of malaria, with changes in transmission seasons.
Expressing concern at the relatively slow progress in attaining the Millennium Development Goals, particularly in sub-Saharan Africa, the World Health Assembly in this resolution reaffirms the commitments by developed countries to a target of 0.7% of gross national income on official development assistance by 2015, with an interim goal of 0.56% of gross national income for official development assistance by 2010. It urges United Nations member states to strengthen their health systems so that they deliver equitable health outcomes and achieve Millennium Development Goals 4, 5 and 6. It urges for policy review in areas that are limiting progress, including on the recruitment, training and retention of health workers, particularly in sub-Saharan Africa. Governments should reaffirm the values and principles of primary health care, including equity, social justice and community participation, as the basis for strengthening health systems. Health equity should be taken into account in all national policies that address the social determinants of health, and governments should consider developing and strengthening universal comprehensive social protection policies, including health promotion, disease prevention and health care, and further commit themselves to increased investment in financial and human resources.
Despite the establishment of a 'health inequities knowledge base', the precise roles for municipal governments in reducing health inequities at the local level remain poorly defined. The objective of this study was to monitor thematic trends in this knowledge base over time, and to track scholarly prescriptions for municipal government intervention on local health inequities. Of the total of 1,004 journal abstracts pertaining to health inequities that were analysed, the overall quantity of abstracts increased considerably over the 20 year timeframe. 'Healthy lifestyles' and 'healthcare' were the most commonly emphasised themes, but only 17% of the abstracts articulated prescriptions for municipal government interventions on local health inequities. This study has demonstrated a pervasiveness of 'behavioural' and 'biomedical' perspectives, and a lack of consideration afforded to the roles and responsibilities of municipal governments, among the health inequities scholarly community. Thus, despite considerable research activity over the past two decades, the 'health inequities knowledge base' inadequately reflects the complex aetiology of, and solutions to, population health inequities.
For this survey, school learners completed a self-administered questionnaire, in addition to having their height and weight measures taken, in 2008. The overall response rate was 71.6%. In summary, there were considerable variations across age, gender, grade, race and province for each of the risk behaviours. With regard to behaviours related to infectious diseases, 38% of learners had reported ever having had sex, with 13% of them reporting their age of initiation of sexual activity as being under 14 years old, while 63% always washed their hands before eating and 70% always washed their hands after going to the toilet. High levels of violence were indicated by the 15% of learners reported carrying weapons and 36% who reported they had been bullied in the month prior to the survey. Learners reported alcohol consumption was 50% for ever having drunk alcohol and 35% for having drunk alcohol in the past month, and 29% for having engaged in binge drinking in the month prior to the survey. The study makes specific recommendations to address the clusters of behaviours covered in this survey, based on the concept of intersectoral intervention development or solutions to limit the behaviours that place young people at risk for premature morbidity and mortality.
This book analyses the impact of social determinants on specific health conditions. It presents promising interventions to improve health equity for: alcohol-related disorders, cardiovascular diseases, child health and nutrition, diabetes, food safety, maternal health, mental health, neglected tropical diseases, oral health, pregnancy outcomes, tobacco and health, tuberculosis, and violence and injuries. Individual chapters represent the major public health programmes at WHO, reflecting the premise that health programmes must lead the way by demonstrating the relevance, feasibility and value of addressing social determinants. Each chapter is organised according to a common framework that allows a fresh but structured look at common, high burden public health problems. Levels in this framework range from the overall structure of society, to differential exposure to risks and disparate vulnerability within populations, to individual differences in health care outcomes and their social and economic consequences. Throughout the volume, an effort is made to identify entry-points, within existing health programmes, for interventions that address the upstream causes of ill-health. Possible sources of resistance or opposition to change are also consistently identified.
About 3,500 advocates, policymakers, development leaders, health care professionals, youth advocates, celebrities and media personnel from 140 countries attended the 2010 Women Deliver Conference, held from 7–9 June in Washington, DC, United States. The conference challenged the international community to dramatically reduce maternal and child mortality by committing US$12 billion in aid. Three messages emerged from the conference. First, maternal and newborn mortality rates are dropping, but the work is far from done. Second, investing in girls and women is not only the right thing to do, but it makes economic sense. Third, although solutions exist to achieve Millennium Development Goal 5, which aims to reduce maternal and infant mortality, what is lacking are the requisite political will and the equitable allocation of resources.
4. Values, Policies and Rights
Much to the frustration of gender activists, Swaziland's Supreme Court has reversed a February 2010 High Court ruling that allowed a married woman to register property in her own name. Activist Mary-Joyce Doo Aphane wished to register a house in her own name and challenged the country's 1968 Deeds Registry Act. She was granted a High Court order declaring the section unconstitutional. Yet three months later, the Supreme Court suppressed the High Court judgment. Although the Constitution grants men and women equal rights, in practice the old laws on the statute books still define gender relations in this absolute monarchy. According to the authors, not having property rights means many women are not able to leave abusive husbands because it would mean they have nowhere to live, no money and no family support. The Attorney General's office, which drafts legislation for parliamentary consideration, would not comment on its timeframe for revising the property law, and most gender activists remain sceptical that the deadline set by the Supreme Court will be met by parliament.
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5. Health equity in economic and trade policies
The Joint Africa-EU Strategy (JAES) launched by European and African leaders at the Lisbon summit of 2007 is argued to have so far failed to deliver on its key promise to fundamentally transform development and political cooperation between the continents. Three years of uncertain implementation reveals just how wide a gap separates the rhetoric and reality of the new strategic partnership. This policy brief shows how the Joint Africa-EU Strategy has struggled to integrate some pre-existing frameworks and transform the logic of elevated partnership. Both sides admit difficulties in the face of unfulfilled expectations of additional European Union (EU) funding. At the same time implementation of the agreement is clouded by dissonant discourses from both sides of the negotiation table. To complicate matters further, institutional complexity in Europe is met by an embryonic process of continental integration in Africa.
Health activists in Malawi have expressed concern at what they call government’s ‘secret conduct’ on the proposed anti-counterfeit law, which they fear could legislate against the generic drugs on which Malawi’s health care system heavily relies. In keeping with World Trade Organisation (WTO) and international trade agreement terms, countries in East and Southern Africa are introducing laws reportedly to crack down on infringement of trademark and intellectual property rights. According to this article, Malawi’s proposed law to that effect has already been examined by Cabinet on its way to becoming law. However, health activists have expressed concern that the law may cause drug stock-outs if generic medicines are treated as counterfeits, as has been raised in East African versions of counterfeit law. Government is allegedly denying health civil society access to the document, saying it is not for public consumption. Executive Director for the umbrella body Malawi Health Equity Network (MHEN), Martha Kwataine, said enacting a law against generic medical products will reverse Malawi’s efforts in improving health care and worsen drug stock outs in hospitals. ‘Once we have the new laws, it means we will be forced to buy the most expensive brand-name drugs,’ she added. ‘The big companies that are owners of the patents will be making huge profits at the expense of the lives of poor people in Malawi.’
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6. Poverty and health
This book aims to give a bird’s eye view of the situation of child poverty in Africa. It highlights the paradox of countries that have an abundance of natural resources, especially oil and diamonds, yet whose populations largely suffer from poverty, such as Angola, Equatorial Guinea and Nigeria. The book points to a symbiotic relationship between poverty and armed conflicts as Africa is slowly extricating itself from the intertwined problems of conflict, poverty, hunger and illiteracy. The book argues that improved governance and increased investments in key social sectors have created an unprecedented sense of optimism. Nevertheless, millions of African children still struggle on the margins. At least 600 million children under the age of 18 are surviving on less than US$1 a day worldwide and 40% of these children live in developing countries.
This is a synthesis report of eight case studies conducted across South Africa to investigate sanitation and the delivery of clean water. The findings and conclusions have been captured under four cross-cutting issues: public participation and politics; accountability and regulation; service levels, financing and affordability; and institutional approaches. The research showed that finding workable solutions and taking appropriate decisions can only be achieved through a thorough understanding of the local context and realities. There is no one-size-fits-all best-approach, and institutional models work best when they are developed on the basis of robust, comprehensive local assessment of what the key challenges are and how best to meet them. The author argues for a multi-jurisdictional water utility model, across more than one municipality, as having the potential to make the best use of available skills and resources and achieve economies of scale. Sufficient municipal capacity, consolidation of services, clear organisational objectives, and staff commitment and capability are identified as critical to success. The studies indicate that, internationally and nationally, there is a need to shift away from an excessive preoccupation with institutional approaches, which tend to rely on layers of capacity and governance that are generally quite rare or undeveloped, and rather focus on the basics of good operational practice.
A resolution at the 63rd World Health Assembly states that food-borne diseases continue to represent a serious threat to the health of millions of people in the world, particularly those in developing countries with poor nutritional status. It refers to the links between food safety, nutrition and food security, and acknowledges the instrumental role of food safety in eradicating hunger and malnutrition, in particular in low-income and food-deficit countries, while also acknowledging increasing evidence that many communicable diseases are transmitted through food, a risk that is increased by the growing global trade in food. It calls for closer collaboration between the health sector and other sectors, and increased action on food safety at international and national levels, across the full length of the food-production chain, to reduce significantly the incidence of food-borne disease.
7. Equitable health services
A consortium of AIDS organisations has given the South African government three months to deliver on promises to integrate tuberculosis (TB) and HIV services. A local AIDS lobby group, the Treatment Action Campaign (TAC), international medical charity Medicines Sans Frontiers (MSF) and the AIDS and Rights Alliance for Southern Africa (ARASA), a regional partnership of non-governmental organisations, were among civil society groups that issued the deadline at the South African TB Conference in Durban, which took place from 1–4 June 2010. MSF spokesperson Lesley Odendal called the three-month deadline 'generous' because TB and HIV care should have been integrated by 1 April 2010, according to newly adopted national antiretroviral (ARV) treatment guidelines, but the Department of Health has yet to issue an implemention plan. TAC Deputy Secretary General, Lihle Dlamini, noted that integrating TB and HIV care would lead to earlier diagnosis of TB, especially strains of the disease occurring outside the lungs, which are common in co-infected patients. It would also help health workers become more familiar with the potentially severe interactions between antiretroviral (ARV) and TB drugs.
Most cases of gender-based violence (GBV) reported to the Nairobi Gender Violence Recovery Centre between April 2009 and March 2010 occurred in the capital's city centre, according to the centre's annual report, which also recorded an increase in gang rapes. 'A disturbing trend of GBV in the reported year is the continued number of gang rapes where the number of perpetrators per act increased from [a range of] 2-11 [perpetrators] to 2-20,' Teresa Omondi, the centre's executive director said. The centre, at the Nairobi Women's Hospital, registered 2,487 GBV survivors between April 2009 and March 2010, 52% (1,285) of whom were women, 45% (1,125) children and 3% men (77). According to the centre, neighbours topped the list of perpetrators named by survivors. Husbands and friends came second and third. Others included boyfriends, fathers, other relatives (uncles, aunts and cousins), house helps, teachers and classmates.
The objective of this study is to measure socio-economic inequalities in access to maternal health services in Namibia and propose recommendations relevant for policy and planning. Data from the Namibia Demographic and Health Survey 2006-07 was analysed for inequities in the utilisation of maternal health. Regions with relatively high human development index were found to have the highest rates of delivery by skilled health service providers. The rate of caesarean section in women with post secondary education is about seven times that of women with no education. Women in urban areas are delivered by skilled providers 30% more than their rural counterparts. High-income households use the public health facilities 30% more than poor households for child delivery. The paper concludes that, in the presence of inequities, it is difficult to achieve a significant reduction in the maternal mortality ratio needed to realise the Millennium Development Goal 5 targets. This is not achievable if a large segment of society has inadequate access to essential maternal health services and other basic social services.
This study sought to identify the leading causes of mortality and premature mortality in Cape Town, South Africa, and its subdistricts, and to compare levels of mortality between subdistricts. It analysed Cape Town mortality data for the period 2001–2006 by age, cause of death and sex. The study found that the pattern of mortality in Cape Town reflects the quadruple burden of disease observed in the national cause-of-death profile, with AIDS, other infectious diseases, injuries and non-communicable diseases all accounting for a significant proportion of deaths. AIDS has replaced homicide as the leading cause of death. AIDS, homicide, tuberculosis and road traffic injuries accounted for 44% of all premature mortality. Khayelitsha, the poorest subdistrict, had the highest levels of mortality for all main cause groups. The study emphasises how local mortality surveillance helps to map out the differential needs of the population of Cape Town. Data used in the study may provide a wealth of data to inform planning and implementation of targeted interventions. Multisectoral interventions will be required to reduce the burden of disease.
The objective of this study was to assess primary health care (PHC) facility infrastructure and services, and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Structured interviewer-administered questionnaires and an anthropometric survey were administered. Of the 40 PHC facilities, 14 had been built or renovated after 1994. Only a quarter of PHC facilities had access safe drinking water and fewer had operational telephones. According to more than 80% of the nurses, problems with basic resources and existing cultural practices influenced the quality of services. Few households reported that they had enough food at all times, while the reported prevalence of diarrhoea was high at 34–38%. The study concluded that problems regarding infrastructure, basic resources and services adversely affected PHC service delivery and the well-being of rural people, and therefore need urgent attention.
The 63rd World Health Assembly raised concern that access globally to blood products is unequal and that access to these products by developing countries needs to be escalated. A major factor limiting the global availability of plasma-derived medicinal products is an inadequate supply of plasma meeting internationally recognised standards for fractionation, usually in developing countries, which lack blood components separation technology and fractionation capacity. The resolution of the Assembly calls for good practices to be implemented in recruiting voluntary healthy blood and plasma donors from low-risk donor populations and in testing and processing to be covered by relevant, reliable quality-assurance systems. Stringent regulatory control is vital in assuring the quality and safety of blood products, as well as of related in vitro diagnostic devices, and special effort will be needed to strengthen globally the technical capacity of regulatory authorities to assure the appropriate control worldwide.
The fight against tuberculosis (TB) is argued to have failed children: the share of paediatric TB is increasing, and children have not escaped the rising tide of drug-resistant strains, according to new research presented at the South African TB Conference, which was held from 1–4 June 2010. Dr Ntombi Mhlongo-Sigwebela, TB programme director at the University Research Company, a public health consultancy, told the conference in Durban that TB in children under four years of age now accounted for about 9% of all national TB cases annually. Dr Kalpesh Rahevar, a World Health Organization (WHO) medical officer, said inconclusive conventional TB skin tests (to determine whether a patient has a latent TB infection) and the inability to get sputum samples from young children made paediatric TB more difficult to diagnose and treat than in adults. Paediatric drug formulations and international treatment guidance for children were also inadequate, said Dr Ben Marais of the University of Stellenbosch, in Western Cape Province.
8. Human Resources
Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings. This literature review aimed to assess task-shifting for HIV treatment and care in Africa. Of a total of 2,960 articles, 84 were included in the core review, including research from ten countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks from doctors to nurses and other non-physician clinicians. Five studies showed that task-shifting allowed for expansion of health services, while two concluded task shifting was cost effective and nine reported equal or better quality of care. The review concludes that task shifting offers high-quality, cost-effective care to more patients than a physician-centred model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into health-care teams, and the compliance of regulatory bodies.
South Africa has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB), but a new study has found that many nurses have not been trained to handle this deadly, difficult-to-treat strain of the disease. The research, presented at the South African TB Conference, which was held from 1–4 June 2010 in Durban, found that only about 19% of the 16 health facilities surveyed in rural and urban areas of Limpopo and KwaZulu-Natal provinces had nurses with formal training in MDR-TB management. Dr Tsholofelo Mhlaba, of Health Systems Trust, a health research non-governmental organisation, said some nurses who had been trained to handle MDR-TB demonstrated similar levels of knowledge as those who were untrained. Some nurses tried to fill this knowledge gap with reading and internet research, but many considered MDR-TB a rare problem, even in KwaZulu-Natal, which has the highest incidence of drug-resistant TB in the country. Inadequate understanding of the disease led to poorly recorded patient histories and failure to follow up on people who had been in close contact with MDR-TB patients, such as household members.
This study aimed to identify the human resources for health (HRH) policy concerns and research priorities of key stakeholders in low- and middle-income countries; to assess the extent to which existing HRH research addresses these concerns and priorities; and to develop a prioritised list of core research questions requiring immediate attention to facilitate policy development and implementation. The study involved interviews with key informants, including health policy-makers, researchers and community and civil society representatives, in 24 low- and middle-income countries, and a literature search for relevant research reviews, from which research questions were prioritised. The questions ranked as most important at the consultative workshop were: To what extent do incentives work in attracting and retaining qualified health workers in underserviced areas? What is the impact of dual practice and multiple employment? How can incentives be used to optimise efficiency and the quality of health care? There was a clear consensus about the type of HRH policy problems faced by different countries and the nature of evidence needed to tackle them. The study concludes that co-ordinated action to support and implement research into the above questions could have a major impact on health worker policies and, ultimately, on the health of the poor.
This resolution of the 63rd World Health Assembly outlines a set of standards for the international recruitment of health personnel. The code of practice aims to establish and promote voluntary principles and practices for the ethical international recruitment of health personnel. It provides member states with ethical principles for international health worker recruitment that strengthen the health systems of developing countries. It discourages states from actively recruiting health personnel from developing countries that face critical shortages of health workers, and encourages them to facilitate the 'circular migration of health personnel' to maximise skills and knowledge sharing. It enshrines equal rights of both migrant and non-migrant health workers. The code sets the provisions for member states to monitor and report on the implementation of the code, for reporting back to the Assembly in 2012.
9. Public-Private Mix
According to this article, developing countries are put under increasing pressure to promote the private sector. It investigates how aid impacts on health in poor countries and the pressure donors put on developing countries to promote the private sector. Proponents of privatisation argue that, because the private sector is already significant, it will be key in scaling up, but this article indicates that privatisation says nothing about the right to health. Likewise, no evidence exists that conclusively demonstrates that the private sector is more efficient and can help reduce costs, and improvements in quality of care and accountability to patients have yet to be proven. A further evidence gap emerges when proponents claim that the private sector can help reach the poor. Public sector success stories, such as those of Bostwana, Cuba, Uganda and Eritrea still need to be studied further. Oxfam demands that external funders be honest, stop promoting unproven and risky private sector approaches, learn from countries that have achieved universal and equitable access, and prioritise rapidly expanding and strengthening free government healthcare.
This paper aimed to gauge the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Most of the doctors were male GPs aged 30–50 years who had been in practice for more than ten years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. The paper concluded that many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, which could potentially remove some of the current burden on the public health sector.
10. Resource allocation and health financing
This study analysed the relationship between the provision of general budget support (GBS) and Millennium Development Goal (MDG) performance, by disaggregating countries into 'high' and 'low' budget support recipients and assessing the extent to which selected MDGs have improved in each of these groups. It found that high GBS recipients have performed better, often significantly so, in all four MDGs assessed (covering primary enrolment, gender parity in education, child mortality, and access to water), as well as in terms of improvements in the Human Development Index (HDI), in the period 2002-2007. Correlation analysis also suggests that there is a positive relationship between budget support receipts and MDG performance (significant in the case of both education indicators and the HDI), but it is not always strong and other factors will also be important determinants of MDG performance. It also found that, even when quality of the policy environment, income level and aid dependency are controlled for, high GBS recipients have on average still performed better than other countries. The study cautions that it is an analysis of association, not causality. Nevertheless, the results overall do provide more comprehensive support for the view that countries receiving large amounts of budget support perform better than those receiving little or no budget support.
Aid analysts have welcomed some of the international development priorities of Britain's new coalition government, particularly the commitment to stick to the previous government's pledge to boost aid spending to 0.7% of national income by 2013. The new Secretary of State for International Development, Andrew Mitchell, stressed accountability and transparency of aid, alongside 'radical steps' to use the private sector more effectively to create wealth, in a 3 June speech to UK aid community representatives. He has also pushed reducing maternal and child mortality and empowering women, and continued support to education and healthcare, with malaria singled out for US$732 million a year until 2015. To make aid more effective, Mitchell proposes to redirect £100 million of aid from low-priority or poor-performing projects to programmes with a better success rate. A trend towards private sector involvement is being promoted, although Chapman said basic services, such as health and education, were best delivered by a more efficient public sector.
The Gates Foundation has announced that it will be devoting US$1.5bn to boosting women and children's health over the next five years. This has been interpreted as a change in direction from funding specific vaccines and the fight against particular diseases. Some campaigners have called for a new global fund for maternal and child health, like the Global Fund to fight AIDS, Tuberculosis and Malaria, which channels billions of pounds of taxpayers' money given by governments, including the United Kingdom. The Fund’s head, Dr Michel Kazatchkine, insisted his organisation was best placed to continue tackling the problems which led to mothers dying. He said: ‘It's very clear from recent analysis that the slow progress on MDG5 [Millennium Development Goal 5] has been because of AIDS. And at least one in five deaths at the time of childbirth is directly linked to HIV.’ However, abortion was not covered by the Gates funding, despite the fact that ‘unsafe abortion contributes to one in seven maternal deaths across the world’, according to Kazatchkine. ‘These women are already stigmatised, and they shouldn't be ignored.’ The Gates Foundation says it supports family planning, but it does not fund abortion or take a position on the issue.
This book provides comprehensive data on the volume, origin and types of aid and other resource flows to around 150 developing countries. The data show each country's intake of Official Development Assistance, as well as other official and private funds from members of the Organization for Economic Co-operation and Development’s Development Assistance Committee, multilateral agencies and other key external funders. Key development indicators are given for reference.
The authors identify two prerequisites for universal health coverage. The first is to ensure that financial barriers do not prevent people from using the services they need, such as prevention, promotion, treatment and rehabilitation. The second is to ensure that they do not suffer financial hardship because they have to pay for these services. Even with the recent increase in external funds for health in low-income countries, these countries still have to find almost 75% of their health funding in domestic sources. The way that countries raise those funds is critical. Direct payments that are required when people obtain care (e.g. user charges) prevent many people from seeking care in the first place, and may result in financial catastrophe, even impoverishment, for many. The authors recommend that, to improve universal coverage, systems need to raise the bulk of funds through forms of prepayment (e.g. taxes and/or insurance), and then pool these funds to spread the financial risk of illness across the population. Health financing systems with inbuilt incentives should ensure that these funds are used efficiently and equitably.
This article supplies basic information on external funding for the World Health Organization's (WHO) activities. The total amount of 'specified' voluntary contributions for the period of 2008 to 2009 is around US$2.3 billion dollars. The Total General Fund for WHO, including specified voluntary contributions, 'core' voluntary contributions and contributions to WHO's Framework Convention on Tobacco Control and the Stop TB Partnership Global Drug Facility, stands at $2,744,594,186 dollars. Unofficial sources within WHO have confirmed that these voluntary contributions form around 80% of WHO’s operating budget. The main external funders have been identified as (in descending order): the United States of America, the Bill and Melinda Gates Foundation, the United Kingdom of Great Britain and Northern Ireland, Rotary International, Norway, Canada, the European Commission, the Global Alliance for Vaccine Immunization (GAVI) and Hoffmann-La Roche. WHO confirmed that Roche's $84 million figure relates to in-kind contributions following the H1N1 pandemic response.
11. Equity and HIV/AIDS
This study used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. In the period 2002–2005, the HIV incidence rate among men and women aged 15–49 years was estimated to be 2 new infections each year per 100 susceptible individuals. The highest incidence rate was among 15–24 year-old women, at 5.5 new annual infections per 100 individuals, which declined to 60% to 2.2 There was evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth. The analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. It also underlines the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence.
This study assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence in Zimbabwe. Comprehensive review and secondary analysis was conducted of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour covering the period 1985–2007. Data from eastern Zimbabwe showed substantial rises in mortality during the 1990s, levelling off after 2000. Estimates of HIV incidence indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s. Household survey data showed reductions in numbers reporting casual partners from the late 1990s and high condom use in non-regular partnerships between 1998 and 2007. These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country. However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus and mortality rates remained at crisis level.
Developing countries like Malawi are calculating the cost of adhering to new World Health Organization (WHO) guidelines that recommend starting HIV-positive people on antiretroviral drugs (ARVs) sooner. Malawi is one of three African countries that have conducted WHO-supported feasibility studies to assess what adopting the new guidelines would mean, and has announced plans to roll out the new WHO guidelines by mid-2011, said Dr Frank Chimbwandira, head of the HIV and AIDS department in the Ministry of Health. According to the feasibility study, the number of people on treatment would rise by about 50%, which could double the cost of the national ARV programme in terms of additional personnel and equipment, and would probably also mean waiting lists at many clinics. Implementing the WHO guidelines would mean major changes to national treatment protocols: HIV-positive people would start taking ARVs at a much higher CD4 count of 350, regular CD4 count and viral load monitoring would be conducted, and potentially more expensive treatment regimens would be adopted - including phasing out the ARV, stavudine, which has been associated with increased side-effects.
In this report, Médecins Sans Frontières (MSF) notes that major funders now seem to be withdrawing HIV and AIDS funding to countries like Malawi, Mozambique, Zimbabwe, South Africa, Lesotho, Kenya, Uganda and the Democratic Republic of Congo. According to MSF, PEPFAR has flatlined its funding for 2009-2014 and as of 2008-9, further decreased its annual budget allocations for the coming years by extending the period to be covered with the same amount of money. The World Bank currently prioritises investment in health system strengthening and capacity building in planning and management over HIV-dedicated funding, thereby reducing their support for HIV and AIDS care. In addition, UNITAID is phasing out its funding for drugs and other medical commodity procurement through the Clinton Foundation. By 2012, funding for second-line anti-retrovirals (ARVs) and paediatric commodities should end in Zimbabwe, Mozambique, the Democratic Republic of Congo and Malawi. The Global Fund is also currently facing a serious funding shortfall. To compound the problem further, MSF adds that all current funding scenarios are inadequately reflecting demand, as none includes the additional resources required to implement the new World Health Organization guidelines on earlier treatment and improved drug regimens.
In this study, the main objectives were to establish the proportion of adolescents among children infected with human immunodeficiency virus (HIV) in Zimbabwe who receive HIV care and support, and what clinic staff perceive to be the main problems faced by HIV-infected children and adolescents. In July 2008, the researchers sent a questionnaire to all 131 facilities providing HIV care in Zimbabwe, requesting an age breakdown of the children (aged 0–19 years) registered for care and asking to identify the two major problems faced by younger children (0–5 years) and adolescents (10–19 years). Nationally, 115 (88%) facilities responded. Of the 98 (75%) that provided complete data, 196,032 patients were registered and 24,958 (13%) of them were children. The main problems for younger children were identified as malnutrition and lack of appropriate drugs (cited by 46% and 40% of clinics, respectively), while adolescents were most concerned about psychosocial issues and poor drug adherence (cited by 56% and 36%, respectively).
Two new studies have confirmed fears that the use of antiretroviral (ARV) drugs to prevent HIV could lead to drug resistance if inadvertently used by people who were already infected. The findings, presented at the International Microbicides Conference in the United States earlier in May, suggest that regular HIV testing would have to be an integral part of any prevention programme using ARVs. Prevention approaches incorporating ARVs are still being tested in clinical trials, but are thought to be among the most promising potential interventions against HIV. One approach, called pre-exposure prophylaxis (PrEP), would involve giving a daily dose of a single ARV drug to people who were HIV-negative but at high risk. This could be effective in preventing HIV, but if someone who is already infected is treated, this could raise the risk of developing resistant strains of the virus.
12. Governance and participation in health
The provision of aid directly to government, known as direct budget support, has recently been promoted as the best possible tool for improving the impact of aid and ensuring governments take the lead in implementing national development strategies. However, this paper argues that nothing in the theory of budget supports suggests that it can or should be used as an instrument for influencing political processes. Yet over the last decade, budget support has repeatedly been subject to delays and halts, sometimes for political reasons. While these are often due to administrative problems on the funder's side, the number of incidents of budget support being halted in response to digression from democratic norms by recipient countries is on the rise. This paper questions the theories and conditions underpinning budget support. It appears that external funders are quite prepared to use conditionalities. However, to date, there is little evidence to suggest that these conditionalities bring about democratic change in the recipient country. Rather than budget support becoming a viable instrument for fostering better political practice, it would appear that there is a tightening of selectivity criteria in deciding who gets budget support and that these incidents represent the weeding out of a few 'bad apples'.
Civil society organisations in Namibia have called for reforms in the country's public health system after a case of women who were allegedly sterilised without their consent has come to court. According to the coordinator of the AIDS Law Unit of the Legal Assistance Centre, Amon Ngavetene, the redress sought is for reform in the country's health system, and particularly training and supervision of medical staff on the rights of patients.
This publication is a response to the critical need for, and contribution of, collaborative partnerships with the World Health Organization (WHO) to achieve global health outcomes. It refers to WHO’s Constitution, the Eleventh General Programme of Work, 2006–2015 and the medium-term strategic plan 2008–2013, which describe collaboration and coordination as core functions of the Organization, while noting that the growth of health partnerships and other forms of collaboration have increased greatly in the past decade. It recommends that WHO develop a policy governing its engagement in, and hosting of, partnerships in a manner that avoids duplication of WHO’s core responsibilities in its partnership activities. Collaboration of WHO with stakeholders should be based on clear distinction of roles that creates added value, synergies and coordination among different programmes that support achievement of global and national health outcomes and reduce transaction costs. It calls upon United Nations member states to take the policy into account when seeking engagement by the Director-General in partnerships, in particular with regard to hosting arrangements.
Social enterprise – the use of market-based, civil society approaches to address social issues – has been a growing phenomenon for over twenty years. Gathering essays by researchers and practitioners from around the globe, this book examines, from a local perspective, the diverse ways in which social enterprise has emerged in different regions. Each chapter examines the conceptualisation, history, legal and political frameworks, supporting institutions, and latest developments and challenges for social enterprise in a given region or country. In the final chapter, the author presents a comparative analysis of the various models and contexts for social enterprise, showing how particular strengths in each environment lead to different enterprise initiative models.
Child-friendliness is a manifestation of the political will of governments to make the maximum effort to meet their obligations to respect, protect and fulfill children’s rights and ensure their wellbeing. This report has developed and used a Child-friendliness Index to assess the extent to which African governments are living up to their responsibilities to respect and protect children and to ensure their wellbeing. Three dimensions of child-friendliness were identified: protection of children by legal and policy frameworks; efforts to meet basic needs, assessed in terms of budgetary allocation and achievement of outcomes; and the effort made to ensure children’s participation in decisions that affect their wellbeing. Though child participation is important, it was not possible to obtain sufficient data on this dimension during the development of the Index. Mauritius and Namibia emerged as the first and second most child-friendly governments respectively in Africa, followed by Tunisia, Libya, Morocco, Kenya, South Africa, Malawi, Algeria, and Cape Verde. At the other extreme are the ten least child-friendly governments in Africa, the last being Guinea-Bissau preceded by Eritrea, Central African Republic, Gambia, São Tomé and Principe, Liberia, Chad, Swaziland, Guinea and Comoros.
This article sets out to discuss and analyze the described collapse of health services through a brief case study on provision of Emergency Obstetric Care in Northern Tanzania. The article argues that since the Alma Ata conference on Primary Health Care developments in global health initiatives have not been successful in incorporating population trust into the frameworks, instead focusing narrowly on expert-driven solutions through concepts such as prevention and interventions. The need for quantifiable results has pushed international policy makers and donors towards vertical programmes, intervention approaches, preventive services and quantity as the coverage parameter. Health systems have consequently been pushed away from generalised horizontal care, curative services and quality assurance, all important determinants of trust. The article proposes a new framework that places generalised services and individual curative care in the centre of the health sector policy domain. It concludes that an increased focus on quality and accountability to secure trust is an important precondition for enabling the political commitment to mobilise necessary resources to the health sector.
13. Monitoring equity and research policy
The 2009 General Household Survey entailed face-to-face interviews with a total of 25,361 households (including multiple households) across all nine provinces. It confirms a number of positive trends related to service delivery as established by previous surveys. However, although access to basic services continues to improve, there is some discontent with the quality of those services. In the case of housing, for example, 16.1% of those occupying state-subsidised housing said that the walls were weak or very weak and 14.9% regard their roofs as weak or very weak. Similarly, although 58% of users of water services said that the quality of such services was good, there has been a steady decline in levels of satisfaction since 2005. The survey also reveals that the number of people living in informal dwellings has dropped. In spite of the resolution to eradicate the use of bucket toilets, it has been found that as soon as bucket toilets were eliminated in a community, other newly formed communities started using the system for a lack of alternatives. Nationwide the percentage of households with no toilets or bucket toilets decreased from 12.6% in 2002 to 6.6% in 2009.
Open collaboration and sharing of information among scientists at scientific meetings can foster innovation and discovery. However, such sharing can be at odds with potential patenting and commercialisation objectives. This tension may be mitigated if certain procedures are followed in the context of scientific meetings. The article first discusses what makes a scientific finding patentable and then sets out four specific patent issues for scientists to consider before attending a scientific meeting and sharing their research. Finally, it provides recommendations on how scientists can best protect their intellectual property rights while sharing information at scientific meetings.
According to this article, epidemiologists and public health researchers are moving very slowly in the data-sharing revolution, and agencies that maintain global health databases are reluctant to share data too. Funders of public health research are beginning to call for change and developing data-sharing policies that are in the public interest. However they are not yet adequately addressing the obstacles that underpin the failure to share data, which include professional structures that reward publication of analysis but not of data, and funding streams and career paths that continue to undervalue critical data management work. Practical issues need to be sorted out too: how and where should data be stored for the long term, who will control access and who will pay for those services? The article offers goals for data sharing and a work plan for reaching them, and challenges respondents to move beyond well-intentioned, but largely aspirational, data-sharing plans.
14. Useful Resources
Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded) evidence, contextualisation, assessment of population impact and the changing nature of the threat. This article describes the steps that may be taken to develop a comprehensive tobacco control strategy: compilation of a list of potential interventions; modification of that list based on local needs and political constraints; streamlining the list by categorising interventions into broad groupings of related interventions to form the basis of a comprehensive plan; and refinement of the plan by comparing it to existing comprehensive plans. The proposed framework for adapting existing approaches to the local social and political climate may assist others planning for smoke-free societies. Additionally, this experience has implications for development of evidence-based health plans addressing other risk factors.
The East African Community (EAC) statistics database contains indices for a range of social sectors of countries in the region, including education, labour, culture, housing, environment and health. Population indices include life expectancy, mortality rates and demographic indicators. Health indices include public health expenditure per capita, expenditure on health to gross domestic product and public health expenditure to total budget. Statistics for immunisation rates and HIV prevalence are also supplied.
This tool, entitled 'Climate Change and Environmental Degradation Risk and Adaptation Assessment' (CEDRA), helps non-governmental organisations (NGOs) access and understand climate change and environmental degradation, and the science behind it, and compare this with local experience of environmental change. The tool was developed through NGO experience of problems as a result of changing weather patterns in countries like Afghanistan. CEDRA involves six steps: identifying environmental hazards, prioritising hazards that need to be addressed, selecting adaptation options, addressing unmanageable risks, considering new project locations, and a process of continual review, which should take place every year. It provides a check-list for each of the steps, with samples of questions that need to be asked, and underlines the involvement of beneficiary communities at every stage.
15. Jobs and Announcements
This year's conference will be held from 22nd -24th September 2010 in Kampala, Uganda. The theme of the conference is 'Global health challenges: Training, research, service delivery: Maximising benefits to the people'. The conference covers a range of sub-themes, including HIV and co-morbidities, reproductive and child health, non-communicable diseases, mental health, neglected diseases, health systems research, health management information systems, public policy and advocacy, leadership and governance, service delivery models (task shifting, recruitment and retention of staff), community participation and initiatives in health, occupational health, climatic change and its impact on health, and health care financing. Abstracts covering any of the sub-themes will be accepted.
The Commonwealth Foundation’s Civil Society Responsive Grants are intended for organisations planning a regional or international workshop or an exchange visit to another non-governmental organisation (NGO) or project. The grants support strengthening of civil society for sustainable development, democracy and intercultural learning within the Commonwealth countries, and may cover short training courses, workshops, seminars, conferences, cultural festivals, exchanges and study visits in other Commonwealth countries. They are targeted at Commonwealth developing countries. Generally, the Foundation awards g around £5,000, but NGOs can request funding up to £10,000. In rare cases, Grants of up to £20,000 can also be made. The grants support activities in four main areas: culture; governance and democracy; human development; and communities and livelihoods.
Funded by the Netherlands Ministry of Foreign Affairs, the Netherlands Fellowship Programme (NFP) offers an opportunity for non-governmental organisations (NGOs) in developing countries to gain skills and build their capacities internationally through training and education. Mid-career staff working in organisations in developing countries can apply for this fellowship programme. Applicants must be nominated by their organisations. Applicant should have at least three years of work experience. Further refresher courses are offered to NFP alumni developed for the purpose of prolonging the effect of the previous fellowship given. NFP has dedicated half of the budget to be spent on fellowships for female candidates and candidates from sub-Saharan Africa. Please note that there are different deadlines and different durations for various programmes of the fellowship, depending on which country you come from.
Applicants are invited to submit letters of intent for the World Health Organization's Grants Programme of its Implementation Research Platform for the years 2010-2011. Letters of intent should describe prospective implementation research studies that would assist the scaling-up of health interventions to accelerate progress on Millennium Development Goals 4, 5 and 6, and promote sustainability in the strengthening of health systems. The following three types of research studies will be considered: new implementation research studies; additional implementation research within ongoing studies; and analyses of relevant existing datasets and policy analyses from completed qualitative and quantitative studies or datasets collected as part of routine reporting systems, such as monitoring and evaluation. The size of the budget for each grant will be based on the scope and focus of research proposals. The maximum budget for any individual country proposal supported from this initiative should not exceed US$500,000.
'Beyond the Biological Basis of Disease: The Social and Economic Causation of Illness’ is the title of this on-site immersion course in social medicine, which is designed for 15 international medical students (clinical years) and 15 Ugandan medical students (3rd–5th year) from Gulu University. It intersects the study of clinical medicine in a resource-poor setting with social medicine topics such as globalisation, war, human rights, and narrative medicine, among others. Credit for away-rotations can also be arranged. Total student costs for the course are estimated at US$2,650, including a round trip to Uganda from the US, accommodation and food. The main objectives of the course are to: provide a structured global health immersion experience for medical students with dedicated supervision and teaching in clinical medicine and social medicine; study issues related to global health in a resource-poor setting with an emphasis on local and global context; foster critical analysis of global health interventions in resource-poor settings; facilitate the development of a clinical approach to disease and illness using a biosocial model through structured supervision and teaching; build an understanding and skill set associated with physician advocacy; and promote international solidarity and partnership in generating solutions to global health challenges facing societies throughout the world.
The theme of this year's African Union Summit is: ‘Maternal, infant and child health and development in Africa’. The agenda of meetings will be as follows: From 19–20 July 2010 the 20th Ordinary Session of the Permanent Representatives Committee (PRC) will be held. From 22–23 July 2010, 17th Ordinary Session of the Executive Council will be held. The Summit will conclude on 25–27 July 2010 with the 15th Ordinary Session of the Assembly.
The main goal of the International Development and Research Centre (IDRC) Internship Awards is to provide exposure to research for international development through a programme of training in research management and grant administration under the guidance of IDRC programme staff. Internships are designed to provide hands-on learning experiences in research programme management and in the creation, dissemination and utilisation of knowledge from an international perspective. The interns will first undertake a programme of research on the topic submitted when competing for the internship award. Thereafter, they will be expected to provide support to management and programme staff in some of the following areas: synthesis of project outcomes; production of publications and dissemination materials or activities on research results; participation in team meetings; research tasks to locate, review and synthesise relevant material; preparation of state-of-the-art reviews; preparation of correspondence, reports and presentations; assistance with the organisation of meetings, workshops and seminars; preparation of minutes; updating and maintaining databases; and maintenance of the website; and exchange with other institutions working on a broad range of issues related to programming.
The International AIDS Conference gathers together those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. It is a chance to assess where we are, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward. Given the 2010 deadline for universal access set by world leaders, AIDS 2010 will coincide with a major push for expanded access to HIV prevention, treatment, care and support, despite the current global economic crisis threatening to undermine public investments. The Conference aims to demonstrate the importance of continued HIV investments to broader health and development goals. AIDS 2010 is also an opportunity to highlight the critical connection between human rights and HIV – a dialogue begun in Mexico City in 2008. The AIDS 2010 programme will present new scientific knowledge and offer opportunities for structured dialogue on the major issues facing the global response to HIV.
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