EQUINET NEWSLETTER 160 : 01 June 2014

1. Editorial

Antibiotic Resistance – are we driving our own extinction?
Constance Georgina Khaendi Walyaro, Citron Wood Foundation

Antibiotics have been used for over 3,000 years.

Without fully understanding how they worked, many early civilizations used mould and other microbes to treat infected wounds and diseases, attributing their healing power to a magic that drove away the evil spirits that caused disease. In the 20th century advances in science brought new understanding of the role that certain organisms could play in controlling other disease causing organisms. This brought over a century of advances in the use of antibiotics such as penicillin, with significant gains in human survival. Yet today we face a new threat of microbes that are resistant to the array of antibiotics that we have developed in the past century, and our use of antibiotics appears to have made us vulnerable to the onslaught of even more virulent forms of organisms.

For most of the last century, antibiotics were regarded as ‘miracle drugs’. They were used to suppress many life-threatening infections and allowed for advances in other areas, such as surgery, by controlling the risk of infection. Some estimate that they contributed with public health gains to an average of 20 years greater life expectancy in the past century.

However, in this century we appear to be losing the battle against infectious diseases through strategies that rely on antibiotics. It has been more than 20 years since a qualitatively new class of antibacterial medicines have been discovered. More importantly, however, bacteria are fighting back. They have become more virulent in every region of the world and more resistant to the medicines used. The emergence of drug-resistant “super-bugs” has led to diseases that are more difficult and costly to treat, such as in the case of multi drug resistant TB.

How did we get into this position? Many reasons have been given, including poor infection-control practices and the misuse of antimicrobial medicines. Antibiotics were overprescribed without checking whether they were really needed. It was recently estimated that almost half of all current antibiotic prescriptions are unnecessary. Some people stopped taking them when their symptoms disappeared - even if still infected. Antibiotics have been mixed with animal feeds to boost livestock growth, contributing to a build-up of antibiotics and in response leading to more virulent bacteria in the food chain. As we used antibiotics more widely, so bacteria themselves evolved into forms that resisted their effect. Without adequate surveillance to track the impacts of this wide use of antibiotics, resistance silently grew.

According to the World Health Organization (WHO), antibiotic resistance (ABR) has now reached significant levels in all regions of the world. We still lack adequate accurate data on the current global situation. However, a 2014 WHO global report provides a picture from current evidence that is extremely worrying (http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1). The report indicates that in all regions there are high rates of resistance in the bacteria that cause common health problems such as urinary tract infections, pneumonia, diarrhoea and so on. Multi drug-resistant TB is spreading and there are also reports in some countries of resistance to the artemisinin used to treat malaria. In some parts of Africa, as many as 80 percent of the Staphylococcus aureus infections that cause common skin and wound infections are reported to be resistant to methicillin (MRSA).

These trends challenge disease control programmes that rely on treatment. They also challenge health systems. With growing resistance, when treatment with standard first-line antibiotics is no longer effective, more costly stronger second line drugs are used. However, these may not be available in resource-constrained settings. They also have severe side-effects which require monitoring during treatment - further increasing costs to services and communities. ABR adds new pressures on already strained health and development resources. Patients who cannot afford treatment may drop out of healthcare services and the bacteria spread further, especially for poor households, in a vicious cycle of virulent disease, costly care and falling survival.

What then can we do?

The key intervention is to reduce the environments in which infectious organisms breed, through improved living conditions and public health measures. Investing in safe water, improved sanitation, better housing, food preparation and waste management provides a sustainable, pro-poor approach with wider benefits, as do prevention measures such as vaccination.

At the same time WHO also advocates for a comprehensive master plan to combat ABR and to guarantee all - regardless of their economic status - uninterrupted access to antibiotics and other essential medicines of assured quality when needed. On the one hand new affordable medicines, diagnostic and surveillance tools are needed from platforms that foster innovation. However technology is not on its own a solution. We need guidelines and regulations that promote rational use of antibiotics in both human and animal medicine, including when not to use them. Antibiotics should be used only for treatment of diseases and completely banned as growth or food supplements. We need to educate the public to use antibiotics only when prescribed by a doctor, to complete the full prescription - even if people feel better, and to never share antibiotics with others or use leftover prescriptions.

We also need to better understand the scale and spread of the problem to raise awareness and plan for it in our region. In 1998, WHO Member States endorsed the Integrated Disease Surveillance and Response (IDSR) strategy. Yet, surveillance of ABR is still currently inadequate and poorly co-ordinated, and public health laboratories lack full capacities to test for antimicrobial susceptibility. The WHO Regional Office for Africa (AFRO) reports that only a few African countries carry out surveillance of drug resistance for many common and serious conditions. WHO AFRO has in response published a guide to facilitate the establishment of laboratory-based surveillance for priority bacterial diseases and some countries have set up collaborations for national and regional ABR surveillance. There is however no formal regional framework for collaborative surveillance and information sharing, and limited public reporting. This not only hinders efforts to track and control the emergence of drug resistant micro-organisms, but also to assess the effectiveness of policies and activities to manage the problem. We need better standards, capacities, tools and social literacy to determine, monitor and control ABR in humans, animals and in the food chain.

In the face of rising food prices, unemployment, inaccessible services and other problems, ABR can seem a distant problem. But it is not distant, and we can no longer assume the effectiveness of the medicines we have used for treating common microbial diseases. We need to act now to remedy the practices that have led to the emergence of this new threat to human survival.

Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org.

2. Latest Equinet Updates

Call For Applicants One Day Post GSHSR International Workshop On Participatory Action Research In People Centred Health Systems, Fountains Hotel, Cape Town, 4 October 2014
Open to applicants from all regions globally. Call Closes on 30 June 2014

This call invites applicants from all regions globally to participate and share experiences in an International Workshop on ‘Participatory action research in people centred health systems’ being held on 4th October in Cape Town South Africa, following the Global Symposium on Health Systems Research (30th Sept–3rd October). It is hosted by TARSC and pra4equity network in the Regional Network for Equity in Health in east and southern Africa (EQUINET) and Asociación Latinoamericana de Medicina Social (ALAMES).

Further details: /newsletter/id/39006
Call For Applicants Three Day EQUINET Workshop On Participatory Action Research for the pra4equity network, October 4-6 Fountains Hotel Cape Town
Ooen to applicants from east and southern Africa. Call Closes on 30 June 2014

This call invites applicants from east and southern African countries to participate and share experiences in a three day skills workshop of the EQUINET pra4equity learning network on an ‘Participatory action research in people centred health systems’ being held on 4-6 October in Cape Town South Africa, following the Global Symposium on Health Systems Research (30th Sept–3rd October). It includes at the same venue on the first day (4 October) the one day post GSHSR workshop on PAR hosted by EQUINET and ALAMES (for which there is a separate call open to all regions), and the following two days (5-6 October) the skills training for the east and southern African delegates, hosted by EQUINET.

Further details: /newsletter/id/39007

3. Equity in Health

Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need
Amara AH, Aljunid SM: Globalization and Health 10(24): 3 April 2014

With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic non-communicable diseases (NCDs). This study reviewed the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries. Major search engines and refugee agency websites were systematically searched between June and July 2012 for articles and reports on NCD prevalence among urban refugees. Most studies were conducted in the Middle East and indicated a high prevalence of NCDs among urban refugees in this region, but in general, the prevalence varied by refugees’ region or country of origin. Hypertension, musculoskeletal disease, diabetes and chronic respiratory disease were the major diseases observed. In general, most urban refugees in developing countries have adequate access to primary health care services. Further investigations are needed to document the burden of NCDs among urban refugees and to identify their need for health care in developing countries.

World Health Statistics 2014: Large gains in life expectancy
World Health Organisation, Geneva May 2014

WHO’s annual statistics report shows that low-income countries have made the greatest progress, with an average increase in life expectancy by 9 years from 1990 to 2012. The top six countries where life expectancy increased the most were Liberia which saw a 20-year increase (from 42 years in 1990 to 62 years in 2012) followed by Ethiopia (from 45 to 64 years), Maldives (58 to 77 years), Cambodia (54 to 72 years), Timor-Leste (50 to 66 years) and Rwanda (48 to 65 years). A boy born in 2012 in a high-income country can expect to live to the age of around 76 – 16 years longer than a boy born in a low-income country (age 60). For girls, the difference is even wider; a gap of 19 years separates life expectancy in high-income (82 years) and low-income countries (63 years). Wherever they live in the world, women live longer than men. The gap between male and female life expectancy is greater in high-income countries where women live around six years longer than men. In low-income countries, the difference is around three years. World Health Statistics is the definitive source of information on the health of the world’s people. It contains data from 194 countries on a range of mortality, disease and health system indicators including life expectancy, illnesses and deaths from key diseases, health services and treatments, financial investment in health, as well as risk factors and behaviours that affect health.

4. Values, Policies and Rights

Brainstorming for the Sustainable Development Goals and beyond
Iqbal S: CODESRIA Newsletter, May 2014

With the development community, governments, policymakers, researchers and international organisations hard at work on the Sustainable Development Goals (SDGs), this report analyses the background of identifying development goals.

How can health remain central post-2015 in a sustainable development paradigm?
Hill P, Buse K, Brolan CE, Ooms G: Globalization and Health 10(18): 3 April 2014

In two years, the uncompleted tasks of the Millennium Development Goals will be merged with the agenda articulated in the 2012 United Nations Conference on Sustainable Development. This process will seek to integrate economic development (including the elimination of extreme poverty), social inclusion, environmental sustainability, and good governance into a combined sustainable development agenda. The first phase of consultation for the post-2015 Sustainable Development Goals reached completion in the May 2013 report to the Secretary-General of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. Health did well out of the Millennium Development Goal (MDG) process, but the global context and framing of the new agenda is substantially different, and health advocates cannot automatically assume the same prominence. This paper argues that to remain central to continuing negotiations and the future implementation, four strategic shifts are urgently required. Advocates need to reframe health from the poverty reduction focus of the MDGs to embrace the social sustainability paradigm that underpins the new goals. Second, health advocates need to speak—and listen—to the whole sustainable development agenda, and assert health in every theme and every relevant policy, something that is not yet happening in current thematic debates. Third, the authors assert that we need to construct goals that will be truly “universal”, that will engage every nation—a significant re-orientation from the focus on low-income countries of the MDGs. And finally, health advocates need to overtly explore what global governance structures will be needed to finance and implement these universal Sustainable Development Goals.

5. Health equity in economic and trade policies

Extractive Industries, Revenue Allocation
Yanguas JA, Acosta AM: UNRISD working paper number 4, 2014

The authors have done a comparative study of revenue allocation in mineral-rich contexts, looking at existing criteria and reform modalities adopted to allocate and use EI revenues and examining the political bargains that enabled such distribution. The authors contend that two factors are crucially important - and explanatory of - devolution of revenues to subnational jurisdictions: the bargaining power of subnational actors as well as their connectedness to the central politics.

Local production of pharmaceuticals in Africa and access to essential medicines: 'urban bias' in access to imported medicines in Tanzania and its policy implications
Mujinja PGM, Mackintosh M, Justin-Temu M, Wuyts M: Globalization and Health 10(12): 10 March 2014

International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap. This article uses WHO/HAI data from Tanzania for 2006 and 2009 on prices and sources of a set of tracer essential medicines. It employs innovative graphical methods of analysis alongside conventional statistical testing. Medicines produced in Tanzania were equally likely to be found in rural and in urban areas. Imported medicines, especially those imported from countries other than Kenya (mainly from India) displayed 'urban bias?: that is, they were significantly more likely to be available in urban than in rural areas. This finding holds across the range of sample medicines studied, and cannot be explained by price differences alone. While different private distribution networks for essential medicines may provide part of the explanation, this cannot explain why the urban bias in availability of imported medicines is also found in the public sector. The findings suggest that enhanced local production may improve rural access to medicines. The potential benefits of local production and scope for their improvement are an important field for further research, and indicate a key policy area in which economic development and health care objectives may reinforce each other.

Our Land, our Business campaign
CODESRIA Newsletter May 2014

The authors assert that the World Bank is a structural driver of the land grabs that is dispossessing and impoverishing rural communities across the globe and a central player that is using its financial and political might to force developing countries to follow a pre-prescribed model of development, based on the neoliberal principles of privatization, deregulation, low corporate taxation and ‘free market’ fundamentalism. At the demand of the G8 in 2012, and with funding from the Gates Foundation, the UK, US, Dutch, and Danish governments, the World Bank is now reported to be developing a new instrument to benchmark the business of agriculture (BBA). Started in late 2013, pilot studies are now underway in 10 countries, to be scaled up to 40 countries in 2014.The BBA builds on the Doing Business model and adapts it to agriculture. Despite a language that claims concerns for small- farmers, the goal of this new agriculture-focused ranking system is argued to aim at further opening countries’ agricultural sectors to foreign corporations. CODESRIA report the launch of a campaign to stop the Doing Business ranking. This is the ask of the OUR LAND, OUR BUSINESS campaign.

6. Poverty and health

Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers
Chersich MF, Bosire W, King’ola N, Temmerman M, Luchters S: Globalization and Health 10(22): 3 April 2014

The authors investigate links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa. A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression. Participants had high levels of hazardous and harmful drinking, while 36% abstained from alcohol. Hazardous and harmful drinkers had more unprotected sex and higher partner numbers than abstainers. Sex while feeling drunk was frequent and associated with lower condom use. Occurrence of condom accidents rose step-wise with each increase in AUDIT category. Compared with non-drinkers, women with harmful drinking had 4-fold higher sexual violence and 8 times higher odds of physical violence. Unsafe sex, partner violence and HIV incidence were higher in women with alcohol use disorders. This prospective study, using validated alcohol measures, indicates that harmful or hazardous alcohol can influence sexual behaviour. Possible mechanisms include increased unprotected sex, condom accidents and exposure to sexual violence.

7. Equitable health services

Chile and Costa Rica: Different Roads to Universal Health in Latin America
Hernández LO, Salgado DP: MSP Occasional Paper May 2014

There are many roads to ‘universal health’, and many different outcomes. This paper compares the experiences of Chile and Costa Rica, countries that have come to epitomize opposite approaches to health policy in Latin America. Chile represents the Universal Health Coverage (UHC) model promoted by global health agencies, which focus on public-private insurance schemes covering a limited package of services. Costa Rica represents a Universal Health System (UHS) approach that provides and funds all medical and preventive services to citizens through a single public entity. The authors demonstrate how the insurance-based health system in Chile has underperformed on most accounts when compared to the publicly financed and operated model in Costa Rica. Although both countries have seen major advances in primary care, Chile’s health ‘market’ has led to inefficient use of resources, with higher administrative costs and more irrational medical procedures resulting from oligopolies and collusion among private providers. In terms of affordability, Chileans incur significant out-of-pocket health payments and are more likely to face catastrophic health expenditures. Both countries have good scores on access to basic care, but people in Chile generally face more access barriers, including distance to facilities, wait times and cost. Finally, Costa Ricans continue to be largely satisfied with the quality of their healthcare services, more so than Chileans.

Making fair choices on the path to universal health coverage
WHO Consultative Group on Equity and Universal Health Coverage, May 2014

This report addresses the critical choices of fairness and equity that arise on the path to UHC. Accordingly, the report is not primarily about why UHC ought to be a goal, but about the path to that goal. The report may differ from others in the direct way it addresses fundamental issues and difficult trade-offs. This approach was facilitated by the involvement of philosophers and ethicists in addition to economists, policy experts, and clinical doctors.

New momentum to act against antibiotic resistance
Alas M, Ling CK: TWN Info Service on Health Issues, May14/06

Governments at the recent World Health Assembly have committed to a higher level of action to combat antibiotic resistance that is an increasing public health threat across the world. On 24 May, a resolution was approved by health ministers on “Combating antimicrobial resistance, including antibiotic resistance” after an important exchange of country positions and one amendment put forward by Mexico with regard to conflict of interests. India supported the antimicrobial resistance (AMR) resolution subject to the understanding that its concerns would be included in the proposed global plan of action. These included financial access of developing countries patients to new antibiotics, news ways of funding research and development based on the delinkage principle in the context of developing countries, and the special needs of developing countries and their capacity building to take on relevant activities. India’s proposal was in lieu of making changes in the resolution text itself which was its first preference. The United Kingdom in its statement also acknowledged the legitimate concern of developing countries on access to antibiotics, and the importance of support for technical capacities and affordable drugs. All Member States agreed on the importance and magnitude of antimicrobial resistance and broad support was heard in the statements made by all delegations on the paramount need to take action. Both developing and developed countries agreed that this is of global magnitude and urged the WHO to develop the action plan and for Member States to build up their own national plans. Developing countries stressed on the urgency of the problem but also on the importance of ensuring access to new antibiotics for developing countries and the mobilization of resources so that they can implement action plans and surveillance.

Further details: /newsletter/id/38992

8. Human Resources

Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa
Hatcher AM, Onah M, Kornick S, Peacocke J, Reid S: Human Resources for Health 12(14): 2014

In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers’ concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. The sample population comprised 685 doctors and dentists (response rate 44%). Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Despite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas.

9. Public-Private Mix

Private hospital market flat - research
Visser A: BDlive: 10 March 2014

New research on market concentration of private hospitals, medical schemes and administrators is reported to show that contrary to concerns over growing concentration, the market for private hospitals in South Africa has in fact remained flat since 2003.

Undernutrition in Tanzania – is private sector growth the answer?
Steve Lewis, Eldis, May 2014

A recent RESULTS report on nutrition and education in Tanzania, “You can’t study if you’re hungry…” found that levels of undernutrition are worryingly high, at 42% of all children under five, and, surprisingly, that buoyant economic growth levels are having little impact on nutrition figures. In Tanzania, a lack of essential nutrients in the average child’s diet is one of the key determinants of undernutrition. So it is not necessarily a lack of food, but a lack of nutritious and varied food. Micronutrient deficiency is widespread in Tanzania and contributes to the high level of stunting. Yet, Tanzania’s Gross Domestic Product (GDP) Annual Growth Rate averaged 7% from 2002 until 2013, reaching an all-time high of 11% in 2007. But the sectors which have driven Tanzania’s economic growth are mainly those which are capital intensive and urban. So while the urban middle class are expanding there is little benefit in rural areas. The fastest growing economic sectors are communications, financial services, construction, and a new natural gas sector. In a meeting with Tanzanian MPs on the Parliamentary Group for nutrition the MPs who were especially concerned were from the area of the country described as the ‘agricultural growth corridor’. Precisely the rural areas of the country that have been targeted for private sector growth are those constituencies with highest rates of stunting. One MP said that the emphasis on export-led growth means that parents are now so busy that they do not have the time to focus on the adequate nutrition of their children.

10. Resource allocation and health financing

Fiscal Capacity and Aid Allocation: Domestic Resource Mobilization and Foreign Aid in Developing Countries
Bhushan A, Samy Y: UNRISD working paper number 7, 2014

In their paper on Fiscal Capacity and Aid Allocation: Domestic Resource Mobilization and Foreign Aid in Developing Countries the authors look into the interaction between fiscal performance and donor aid allocation. The analysis reveals that there is hardly any correlation between overall aid and fiscal performance and capacity. Furthermore, the authors point to gaps in terms of external funders delivering on their commitments to align with recipient country priorities and providing aid through country Public Finance Management systems - despite promises to pay greater attention to DRM efforts of recipient countries.

11. Equity and HIV/AIDS

Age-disparate relationships and HIV incidence amongst rural South Africa women
Harling G: Global Health and Population, Harvard School of Public Health: Conference on Retroviruses and Opportunistic Infections 2014

Sex with older men is not placing women under 30 at higher risk of HIV infection in rural South Africa, and relationships with older men may even be protecting women over 30 from infection, according to results from a eight-year study presented at the 21st Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

MPs pass Bill that will make men test for HIV alongside their wives
Nalugo M, Ayebazibwe A: Daily Monitor May 14 2014

If President Museveni assents to the new HIV/Aids Prevention and Control Bill, 2010, passed by Parliament in May, it will be criminal for a person to ‘willfully’ or ‘intentionally’ infect another with the HIV/Aids virus.
Under Clause 41(1), a person who knowingly transmits HIV/Aids to another shall, on conviction, be liable to a fine of not more that Shs4.8 million or imprisonment for a term not exceeding 10 years or both. Additionally, Clause 14 of the BIll makes it mandatory for men to test alongside their pregnant partners with a view of placing an obligation on both parents to be responsible and protect the unborn child from acquiring the disease. The Bill also establishes a fund, the HIV Trust Fund, which will help boost the fight against the pandemic. The proposed fund imposes an obligation on the government to make quarterly contributions to ministry of Health. Government will contribute 2 per cent to the fund off levies from beer, bottled water and soft drinks.

Strengthening the enabling environment for women and girls: what is the evidence in social and structural approaches in the HIV response?
Hardee K, Gay J, Croce-Galis M, Peltz A: Journal of International Aids Society 17(1): 7 January 2014

There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women’s employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows’ ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.

12. Governance and participation in health

'Irrelevant' WHO outpaced by younger rivals
Richter J: BMJ: 12 May 2014

The author reports her concern that WHO’s so-called reform will side-line those who work in the spirit of ‘Health for All’ and expand the influence of business corporations and venture philanthropies over global public health matters as well as reinforce the trend towards fragmented, plutocratic, global governance. In October 2013, after a change of terminology, WHO presented a Discussion paper on WHO engagement with non-State actors and draft outline of WHO’s plan to ensure Due diligence, management of risks & transparency at an informal consultation with Member States, NGOs and commercial actors. WHO leadership quashed considered criticisms by NGOs. Member States and public interest NGOs found both papers wanting and requested changes. The successor of the October papers, the Background document, was discussed in March 2014 in a second consultation, open to Member States only. Ten days before the 2014 World Health Assembly, the WHO Secretariat issued the latest version of the policy Framework on engagement of non-State actors (A67/6). The author observes that the previous shortcomings were not addressed and expresses concern that the reform will open the floodgates to corporate influence on global and national decision-making processes in public health matters.

Public Health a Major Priority in African Nations
The Kaiser/Pew Global Health Survey, May 2014

Concerns about public health are widespread in sub-Saharan Africa, and there is considerable support in the region for making public health challenges a top national priority. In particular, people want their governments to improve the quality of hospitals and other health care facilities and deal with the problem of HIV/AIDS. A Pew Research Center survey, conducted March 6, 2013 to April 12, 2013 in six African nations, also finds broad support for government efforts to address access to drinking water, access to prenatal care, hunger, infectious diseases, and child immunization. A median of 76% across six countries surveyed say building and improving hospitals and other health care facilities should be one of the most important priorities for their national government. The percentage of the public who holds this view ranges from 85% in Ghana to 64% in Nigeria. Similarly, a median of 76% believe preventing and treating HIV/AIDS should be one of government’s most important priorities, ranging from 81% in Ghana to 59% in Nigeria. A median of at least 65% also say the other issues included on the poll — ranging from access to drinking water to increased child immunization — should be among the most important priorities. In fact, majorities hold this view about all seven issues in all six nations.

WHO Drafting Group established on “non-state actors” engagement
Gopakumar KM, Shashikant S: TWN Info Service, May14/05

A drafting group has been set up to finalize the draft framework for the World Health Organization’s engagement with non-state actors (NSA framework). This decision made by WHO Member States at the 67th session of the World Health Assembly (WHA) was due to the divergent opinions with regard to the way forward on the NSA framework. The session is meeting from 19 to 24 May at the WHO headquarters in Geneva. Many developing countries such as Brazil, Bolivia, India, Pakistan, and the Union of South American Nations (UNASUR) expressed the view that the draft policy does not contain details to address concerns related to conflict of interest issues, modalities in accepting resources from NSAs, or staff secondment from NSAs.

Further details: /newsletter/id/38996

13. Monitoring equity and research policy

Handbook on Health Inequality Monitoring: with a special focus on low- and middle-income countries
World Health Organization, Geneva, 2013.

The Handbook on health inequality monitoring: with a special focus on low- and middle-income countries is a user-friendly resource, developed to help countries establish and strengthen health inequality monitoring practices. The handbook elaborates on the steps of health inequality monitoring, including selecting relevant health indicators and equity stratifiers, obtaining data, analysing data, reporting results and implementing changes. Throughout the handbook, examples from low- and middle-income countries are presented to illustrate how concepts are relevant and applied in real-world situations; informative text boxes provide the context to better understand the complexities of the subject. The final section of the handbook presents an expanded example of national-level health inequality monitoring of reproductive, maternal and child health.

Mutual learning and reverse innovation - where next?
Crisp N: Globalization and Health 10(14): 28 March 2014

The papers argues for mutual learning in global health systems. The author argues that it is increasingly recognized that innovation needs to be sourced globally and that we need to think in terms of co-development as ideas are developed and spread from richer to poorer countries and vice versa. The Globalization and Health journal’s ongoing thematic series, “Reverse innovation in global health systems: learning from low-income countries” illustrates how mutual learning and ideas about so-called "reverse innovation" or "frugal innovation" are being developed and utilized by researchers and practitioners around the world. The path to truly “global innovation flow”, although not fully established, is argued to be under way. Global health learning laboratories, where partners can support each other in generating and sharing lessons, have the potential to construct solutions for the world. At the heart of this dialogue is a focus on creating practical local solutions and, simultaneously, drawing out the lessons for the whole world.

14. Useful Resources

Access to justice and extractive industries
Speakers: Aidan Davy, Richard Meeran, Juan Pablo Sáenz, Jake White, Thursday 13 March 2014

On March 13, a panel of international legal and industry experts discuss the fraught world of environmental justice, human rights, minerals and mining and explain why it should be of concern to us all and launch a global map of environmental (in)justice. The full video of the event is available to watch

In Dakar, a graffiti festival connects artists, cultures and ideas

For 10 days in April, graffiti artists from around the world gathered in Dakar, Senegal for the fifth annual Festigraff, the Festival international de Graffiti en Afrique/Senegal. While the term “graffiti” can carry a negative connotation, spray can art is Dakar’s most ubiquitous urban art expression, ranging from vandalism to approved and encouraged art. As in many West African urban areas, in Dakar, walls are everywhere, but what’s different here is how people use them: Each wall is an opportunity, a potential canvas. One can hardly walk, stroll or drive through nearly any district or community without catching some form of graffiti or wall art, on buildings, along highways, even commissioned on personal homes. Graffiti is an essential aspect of Dakar’s colourful landscape. The festival taps into this established art culture of using spray paint to create vertical wall art and drills down deep in this mode: Through the creation of new art murals and graffiti works, street parades, training young artists, conferences, roundtables and community concerts, the festival networks artists and builds off of community acceptance and appreciation. This year at the Biscuiterie de Médina, the festival created a graffiti village, where artists painted walls, vendors set up shops and music blared, creating a creative community of artists, art lovers and art in a tightly knit space. “We must be precise in differentiating between graffiti as its done abroad and its role here in Senegal,” Ati explains. “Here, it’s a message to speak with the people: Speaking against violence, speaking for good education, speaking for good citizenry, speaking so that we know our history, speaking to listen less to politicians and seeking more to address the real problems in Senegalese life…We use our spray to speak for those who can’t.”

Urban lecture series: How can we transcend slum urbanism in Africa?
Edgar Pieterse, 14 May 2014

Edgar Pieterse in this lecture argues that data about economic incorporation into the labour market and living conditions demonstrate that the majority of African urban dwellers live in conditions of vulnerability, and that economic insecurity reinforces slum living and makes it difficult for states to access sufficient tax revenues to address a variety of urban pressures. Pieterse poses the question: “if we acknowledge this tough reality, how can we formulate policy agendas that can break this cycle of exclusion and injustice?” The lecture provides a macro framework to develop alternative modalities of urban management and governance rooted in ethical values and practical experiences.Pieterse puts forward the concept of the underlying logics of slum urbanism, which in turn manifests in an overall urban form that can be characterized as ‘extreme splintered urbanism’—a pattern of urban development that manifests in sharp urban divides, the privatization of key urban services and infrastructure linked to large-scale slum neglect over long periods of time. In response the concept of Urban Operating Systems is introduced to identify the macro entry points for transforming urban systems over 2-3 decades. The operating systems are: infrastructure, economy, land markets and the governance. Alternative approaches to each are identified as a provocation for further research and praxis.

15. Jobs and Announcements

14th CODESRIA General Assembly: Creating African Futures in an Era of Global Transformations: Challenges and Prospects
Dakar, Senegal, 15-19 December 2014

The Council for the Development of Social Science Research in Africa will hold its 14th General Assembly from 15th to 19th December 2014 in Dakar, Senegal under the theme ‘Creating African Futures in an Era of Global Transformations: Challenges and Prospects.’ CODESRIA’s general assemblies are the largest gatherings of African social scientists. This one will be no exception, with intellectuals from all social science disciplines, the humanities and law, gathering to explore and propose ideas that can lead to a continent that is more peaceful, democratic, prosperous and inclusive in the context of on-going global transformations, The celebration of fifty years of independence a few years ago was taken in many countries as an opportunity to re-examine the dreams of independence against the hard realities of life in Africa today. The number of Africans who live amidst violence (physical, structural and symbolic) and poverty is huge. Twenty years after the Rwandan genocide and the end of apartheid, the question of how to reverse the trends that, if unchecked, may lead to the further devaluation of life and greater threats to human freedom, dignity, and well-being on the continent must be posed. Given this, there is a critical need to reinvent a future for ourselves and re-define the social, cultural, moral, ethical and institutional foundations of citizenship and belonging at the local, national and continental levels, in a free, united, democratic and prosperous Africa that is at peace with itself and with the world.

Africa speaks: Request for a video clip
Final call: closing date 30 June 2014

The Third Global Symposium on Health Systems Research (HSR) is to be held from 30 September – 3 October 2014 in Cape Town, South Africa (http://hsr2014.healthsystemsresearch.org/). This is the first time this Symposium has been held in Africa. The theme of the 2014 symposium is: the science and practice of people–centred health systems. The involvement of people both in their own health decisions and in those concerning the development of a health system is a vital platform for effective service delivery and for ensuring the health system offers wider value in society.
The opening plenary (on 30th September 2014) will have a specific African focus – and its theme is governance and health in Africa. As part of this opening ceremony the organisers would like to feature different voices from the African continent and provide African stakeholders with an opportunity to share their perspective on the theme of the symposium. They would like you to identify a stakeholder whose voice you feel would be important to feature in the opening plenary and to record a short interview with them. It could be someone you work closely with – such as a health worker, a researcher, a community member or a client or user of the health service. Someone that you feel represents a critical constituency from the African continent. Depending on the volume and quality of material received we will seek to project the clips at other moments during the conference, and also post them on the conference website.

Further details: /newsletter/id/39013
Call for applicants: Amnesty International South Africa Executive Director
Closing date: 5th June 2014

Amnesty International South Africa is seeking a high-profile, inspirational and experienced Director who is able to lead and grow our operations in South Africa and represent the organization externally to deliver positive change in the human rights situation nationally, regionally and globally. See further information at the website.

Call for papers on participatory visual methodologies
Deadline for manuscript submission: 15 October 2015.

Global Public Health invites the submission of full-length articles for a special journal issue on the theme Participatory Visual Methodologies and Global Public Health, co-edited by Claudia Mitchell and Marni Sommer, Send note of intention to submit & working title to evasquezgph@gmail.com

Call for papers: World Health & Population (WHP)
Deadline: 9 June 2014

Attacks on Healthcare Workers in Conflict Zones – Fall 2014. World Health & Population (WHP) is publishing a theme issue on the nature and impacts of attacks on health workers, facilities, transports and patients in times of armed conflict or civil unrest – and strategies for protection. WHP welcomes submissions for the theme issue in the form of empirical studies, evaluations and policy analysis including the broad range of issues as listed below:
• Studies exploring the vulnerabilities of healthcare in situations of armed conflict or civil unrest
• Studies on the short, intermediate and long term impacts of violence on health systems
• Strategies for supporting the safety and well-being of civilian health and human resources in
situations of armed conflict or civil unrest
• Policies and actions at the national, regional and global level that can promote the respect and protection of healthcare.

Call for Proposals: Health Policy and Research Organizations
Deadline: Wednesday, June 11, 2014 at 17:00 GMT

The Innovating for Maternal and Child Health in Africa program is launching a call for proposals for the selection of Health Policy and Research Organizations. This program is funded by Canada’s Global Health Research Initiative, a collaboration ofForeign Affairs, Trade and Development Canada, the Canadian Institutes of Health Research, and IDRC. Organizations (or the lead organization of a consortium) must:
• be a non-partisan, not-for-profit organization legally founded and registered as an independent entity in the country of operation. Only non-partisan and not-for-profit organizations can be included in a consortium.
• be an African organization. United Nations agencies and international organizations based in Africa or overseas are ineligible to be the lead organization or to be part of a consortium.
• support a health policy development and implementation mandate through knowledge brokering, analysis, and research.
• work in at least one of the targeted countries and demonstrate willingness and capacity to expand their work in all the other targeted countries in the selected HPRO region (East or West).

Invitation for letters of interest: Improving the careers of women research scientists in infectious diseases of poverty
Submission deadline: 30 September 2014

TDR, the Special Programme for Research and Training in Tropical Diseases celebrates 40 years in 2014 and has a longstanding commitment to improve gender equity in health. TDR is inviting letters of interest from women scientists and research managers in low- and middle-income countries (LMICs ) to develop their ideas on how to improve career development for women research scientists working in the area of infectious diseases of poverty. Letters of interest that are selected will receive funding of US$ 10 000 to develop and elaborate a full concept.


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