Recent Releases In Global Health
Lancet Viewpoint Examines Malaria In Africa 10 Years After Abuja Declaration
A Lancet Viewpoint examines the problems and prospects in malaria control since the Abuja Declaration was signed 10 years ago with the goal of halving malaria mortality in Africa by 2010. "There is an obvious euphoric sense that elimination might be possible when low levels of transmission have been reached. However, the move from low prevalence to no transmission is not simply a matter of 'more of the same' and a final push. A fundamentally different approach is needed, " according to the authors. The authors advocate "low endemic control" so that the disease can "be reduced from a major public health priority to a fairly minor burden on already stretched health systems." They conclude: "This goal is admittedly less attractive than elimination or eradication, but it is achievable, its financing requirements are predictable, and its effects are measurable. Achieving this public health benefit across Africa within the next 10-20 years would leave a legacy that the global community could be proud of in 2030" (Snow/March, 7/10).
Crossroads For G20 To Lead On Global Health
The recent G8 and G20 summits "provides an opportunity to gauge what we can and should expect in terms of global health governance from two very different groups," according a Lancet editorial. "A welcome cornerstone of the G8's final communique was the Muskoka Initiative, which seeks to raise $30 billion of new funds over the next 5 years to meet Millennium Development Goals 4 and 5 on maternal, newborn, and child health. However, with the 2011 G8 hosts, France, yet to commit to keeping maternal, newborn and child health on next year's agenda, and with the G8 still licking its wounds after falling $15 billion short of its 2005 Gleneagles commitments, there is ample opportunity for the G20 to seize the initiative on global health." The authors also note that Brazil, Russia, India and China "have the political and economic capital to set the G20 agenda on health, so let us hope they recognize that health security is not an optional extra for a stable and prosperous world" (7/10).
Lancet Article Proposes 'National Platform Approach' For Large-Scale Program Evaluation
"Evaluation of large-scale programmes and initiatives aimed at improvement of health in countries of low and middle income needs a new approach," write the authors of a Lancet Health Policy article. They propose a new "national platform approach" that "uses the district as the unit of design and analysis; is based on continuous monitoring of different levels of indicators; gathers additional data before, during, and after the period to be assessed by multiple methods; uses several analytical techniques to deal with various data gaps and biases; and includes interim and summative evaluation analyses." The new approach, they write, will promote "country ownership, transparency, and donor coordination while providing a rigorous comparison of the cost-effectiveness of different scale-up approaches" (Victora, et. al., 7/9).
NIH To Fund 10 Worldwide Malaria Centers
The National Institutes of Health announced "approximately $14 million in first-year funding to establish 10 new malaria research centers around the world," which will be known as the International Centers of Excellence for Malaria Research (ICEMRs), according to an NIH press release. The centers will be established in regions where "malaria is endemic, including parts of Africa, Asia, the Pacific Islands and Latin America." Each center will "integrate clinical and field approaches with laboratory-based immunologic, molecular and genomic methods" and train "researchers from malaria-endemic areas." Nine of the principal investigators are from the U.S., another is from Colombia (7/8).
IOM Outlines Strategy For U.S. Global HIV/AIDS Program Assessment
An Institutes of Medicine report outlines the organization's strategic approach to the evaluation of U.S. global HIV/AIDS programs an assessment mandated by the reauthorization of PEPFAR in 2008. According to the report, the IOM will begin the evaluation "in 2010 and issue a report with findings and recommendations in 2012." Major elements of the evaluation include: assessing PEPFAR's contribution to changes in health impact, "assessing the implementation and effects of program components" and providing guidance to "maximize the potential for programs to have a future positive health impact" (7/7). More information on the IOM report is available on Kaiser's Policy Tracker tool (7/7).
Blog: Use Agriculture, Biofortification To Improve Nutrition
"Increasing the mineral and vitamin content of staple foods through plant breeding, a process known as biofortification, is part of the solution" to improve global nutrition, according to a post on the Chicago Council on Global Affairs' "Global Food For Thought" blog. According to the post HarvestPlus, the author's organization, has "proven that scientists can use" raw materials such as rice with higher levels of zinc to "breed higher amounts of nutrients into popular varieties without affecting yields and that consumer will readily accept them." The author notes that he is "extremely encouraged" by the inclusion of nutritional status in Feed the Future and continues, "It's time for agriculture to be in the forefront of a nutrition revolution Without question, increasing dietary diversity is the ultimate solution to hidden hunger, but this will take decades to accomplish" (Bouis, 7/7).
Blog: Donors Should Adopt 'AIDS Transition' Strategy
A post on the Center for Global Development's Global Health Policy blog, discusses a Foreign Affairs article on the unintended consequences of the United States' HIV/AIDS programs. The author notes the use of the word "'entitlement' to describe the implicit commitment the U.S. has made to each person to whom it provides a daily dose of antiretroviral therapy (ART) under PEPFAR" and argues that providing people with drugs they will be dependent on "effectively constitutes a kind of 'post-modern colonialism'" and that "donors should shift their objective from universal access to AIDS treatment to the achievement of an 'AIDS transition' defined as enrolling enough additional ART patients to hold down AIDS mortality, while improving HIV prevention efforts until the verified number of new cases is pushed below the annual number of AIDS deaths" (Over, 7/7).
PLoS Medicine Examines Limitations In Financing Maternal And Child Health
A PLoS Medicine Policy Forum article examines the limitations in "estimating donor flows and resource needs " in financing maternal and child health initiatives. The authors write, "reliable estimates of current spending on maternal, newborn and child health (MNCH) are a critical precondition for sound policy and decision making." The piece notes that the Countdown to 2015 initiative estimated that donors spent $3.48 billion on MNCH in 2006 but "these estimates suffer from several limitations." The Consensus for Maternal, Newborn and Child Health called for "$30 billion in additional funding" for MNCH; the authors believe the "'price tag' is misleadingly low because it leaves out crucial service delivery costs." The piece makes a number of policy recommendations and says there is "an urgent need to improve both the tracking of MNCH financing flows and the estimation of additional MNCH resources required to reach the child and maternal Millennium Development Goals" before the September 2010 MDG summit (Schaferhoff, et. al., 7/6).
PLoS Medicine Essay Reflects On Need To Bolster Research Capacity In Africa
"The high levels of maternal, newborn, and childhood mortality and morbidity in Africa are cause for an urgent response to implementing interventions," write the authors of a PLoS Medicine essay that examines the need for an improvement in research capacity in Africa. "Strong health research systems and research programmes that address bottlenecks to upscaling effective interventions should be developed without delay. This effort requires substantial and rapid investment in the support of African scientists, institutions, and systems that will focus on solutions to African problems" (Whitworth, et. al., 7/6).
Blog: New Initiative For Neglected Disease Research And Development
A post on the Global Network for NTD's "End the Neglect" blog discusses a new Center for Global Health R&D Policy Assessment initiative "that will conduct in depth assessments of some of the most promising and highly developed ideas to accelerate global health R&D." The new center will "award prizes for significant progress in creating new drugs and diagnostics" and pool donor funds to efficiently allocate resources (Rao/Hecht, 7/6).
Integrate MCH Efforts Into PEPFAR
"We believe that, maternal and child health (MCH) need not to be framed in opposition to PEPFAR," write the authors of an AIDS opinion piece. "The architects of the Obama administration's Global Health Initiative recommend funding the Mother and Child Campaign at the expense of future funding increases for PEPFAR. The idea that differing global health initiatives must compete with each other lacks not only ethical legitimacy but also scientific merit." The piece (.pdf) argues for a "comprehensive approach" to integrating MCH into PEPFAR, saying that "confronting illness in isolation cannot be our way forward" (Leeper/Reddi, 7/2).
Former USAID Head Outlines U.S. Aid System Reforms
Andrew Natsios, a former USAID administrator, "describes what he sees as the most disruptive obstacles to development work in agencies such as USAID: layers and layers of bureaucracy" in a Center for Global Development essay. Natsios "suggests implementing a new measurement system, reducing the layers of oversight and regulation, and aligning programmatic goals with organizational incentives." He discusses the "clash between the compliance side of aid programs the counter-bureaucracy and the technical, programmatic side," which he calls "[o]ne of the little understood, but most powerful and disruptive tensions in established aid agencies" (7/1).
Health Affairs Article Proposes Country-Specific Targets For Health Worker Capacity
"For low-income and at least some middle-income countries, the WHO's target of 2.3 health workers per 1,000 people is not reasonable, given financial constraints," write the authors of a Health Affairs article who propose "country-specific" targets "based on a realistic recognition of the potential financing available" in contrast to the WHO's figure, a "simple needs-based estimate." The authors conclude: "As much as we might agree that there is a compelling need for more resources to achieve major improvements in health in poor countries, there are limits to what can be accomplished within these countries' economies and current circumstances. To achieve what is possible, we need realistic goals rather than an unachievable set of aspirations" (Bossert/Ono, July 2010).