Global Health Policy
August 21, 2008
Donors Officials Discuss HIV/AIDS Monitor Report on Health Systems at the 2008 International AIDS Conference
Posted by David Wendt at 05:54 PM
From Aug 2-9, the Center for Global Development's HIV/AIDS Monitor team and its research partners from Mozambique and Uganda attended the international AIDS Conference in Mexico City. In addition to taking advantage of the fantastic opportunity for learning and exchange with the over 23,000 participants committed to addressing HIV/AIDS globally, our team also launched its new paper "Seizing the Opportunity on AIDS and Health Systems." This turned out to be a very timely piece of research, as discussions on health systems strengthening dominated much of the conference.
August 19, 2008
The World at Seven Billion: Global Demographic Trends in the First Decades of the 21st Century
Posted by Rachel Nugent at 04:03 PM
"Current population growth is alarming and killing efforts to combat poverty."- Sufian Ahmed, Ethiopian Minister of Finance and Economic Development
"You can't keep going with a completely upside-down age distribution, with the pyramid standing on its point. You can't have a country where everyone lives in a nursing home."- Carl Haub, Senior Demographer at the Population Reference Bureau
The 40th anniversary of World Population Day came and went last month with nary a whisper around D.C. In the U.K., rather more attention was paid, including a House of Lords reception featuring Sarah Brown, the PM's wife, and 150 other notables sipping champagne in honor of the International Planned Parenthood Federation. Beyond the protocol-filled receptions, what does World Population Day mean now, and why should we keep it on the calendar?
Commemorating World Population Day may seem like celebrating the anniversary of the Motion Picture Society's movie rating system (G, PG, R, and so on) – another relic created in 1968 that is clearly out of touch with today's world. Was the day rendered unremarkable because of successful efforts to curb rapid population growth? Have new technology, changed cultural mores, and economic progress obviated the need for World Population Day, just as they've made motion picture censorship irrelevant?
Simon Mphuka
Posted by Nandini Oomman at 12:28 PM
Simon Mphuka, the Executive Director of the Churches Health Association of Zambia (CHAZ) and a good friend of the Center for Global Development (CGD), passed away on Monday, August 4th. The world, and particularly Zambia, has lost a skilled physician and public health professional, and above all, a man of faith and passion who worked tirelessly to battle AIDS in Zambia. My thoughts are with his wife and three daughters, who so generously shared Simon with many of us in the global health and development world. The world is poorer without Simon, but his dedication and commitment to saving lives will endure and will continue to enrich our efforts in the fight against AIDS.
I was expecting to see Simon in Mexico City at the International AIDS Conference, where he had kindly agreed to participate in an HIV/AIDS Monitor event on AIDS funding and health systems, so I was shocked and deeply saddened by this news. I had the great pleasure of getting to know Simon over the last few years as we developed the HIV/AIDS Monitor research initiative at CGD. Simon was an important member of the Global Fund Working Group and a key member of the advisory group for the HIV/AIDS Monitor. I will miss his sharp and real, on-the-ground insight about the Global Fund and PEPFAR donor programs, as the head of an important recipient of funding from both. Forever congenial, but never concessional, Simon spoke knowledgeably about what was working and not working in the fight against AIDS in Zambia and ways in which donors could improve their policies and practices.
I knew Simon only as a professional colleague/friend, but Pastor Conrad Mbewe of the church that Simon belonged to has written a very personal and moving account of Simon's life as an active member of his church and about the last few weeks off his life before his sudden demise and another about the funeral proceedings.
August 18, 2008
Le Raison de Résistance: Substandard TB Drugs Found in South Africa
Posted by Scott Kniaz at 10:39 AM
The Times of South Africa recently reported the recall of two TB drugs, manufactured by Pharmascript, after the national health department found them to be substandard. Initial tests at the local WHO laboratory found they did not contain the needed amount of active ingredients, as claimed on the label, and concluded that they "would most likely not have effectively treated 'thousands' of TB patients."
The author, Yazeed Kamaldien, seems to find solace in the fact that "these drugs are used only to treat primary TB, however, and not other cases, such as multi-resistant TB." He appears to completely misunderstand a primary cause of MDR-TB (multi-drug resistant TB) and drug resistance in general. While he is correct to breathe a sigh of relief that this discovery will, hopefully, not cause any MDR-TB cases to become the virtually untreatable XDR-TB (extremely-drug resistant TB), episodes such as this undoubtedly increase the risk of resistance among uncomplicated, primary TB patients. As MDR-TB can cost up to 300 times as much (in time, money and human resources) to treat as primary TB, these errors can put incredible strain on an already weak health system.
Continue reading "Le Raison de Résistance: Substandard TB Drugs Found in South Africa"
August 14, 2008
The World Tuberculosis Cup - Score One for Global Health Innovation
Posted by Kristie Latulippe at 01:41 PM
What do you get when you cross cartoonists with public health experts? You get a bunch of baccili-busters! The WHO-hosted Stop TB Partnership released a comic book on July 24 aimed at teaching children and teens about tuberculosis and how to prevent it. The Stop Tuberculosis Team is captained by the Portuguese soccer star, Luis Figo, who in the comic book leads his team to victory against a team of tuberculosis germs. In a statement issued on the occasion of the comic book launch, Figo urges young people to take the comic book's message seriously:
Tuberculosis is a killer, and I want all of you to stay safe from it. I am passing the ball to you -- you can help reach the goal of stopping tuberculosis.
The comic book is the result of a global competition in January 2008 to reward the best comic design aimed at preventing TB. At stake in the competition was a US$5000 cash prize from the Stop TB Partnership along with worldwide acclaim from cartoon and comic circles (most likely a greater incentive than the cash!).
Continue reading "The World Tuberculosis Cup - Score One for Global Health Innovation"
August 11, 2008
New Round in Tug of War on Nurse Migrants
Posted by Rachel Nugent at 10:59 AM
Somewhere in the cross-oceanic battle over where doctors and nurses are allowed to work, I saw a rather pathetic cartoon: a bunch of little paper dolls with stethoscopes and nurses caps being suspended along a rope traversing half the globe – they were each hanging from their own little noose. Behind this story, real people are indeed victims, and the world is treating them like two-dimensional dolls.
In spite of what is now an abundance of reports, calls to action, inquiries, and task forces on the subject of human resources in health, we seem to be no closer to solving the fundamental problem: how to match supply and demand of health workers? Just last week, I was at a Gates Foundation conference on malaria vector control and the question was put to the entire group: how to meet human resource needs in health? No-one had a ready answer, including, I hasten to add, moi-meme.
My colleague, Michael Clemens, is passionate about this topic. He has posted frequently and eloquently on this blog and CGD's Views from the Center about it. His bottom line:
Continue reading "New Round in Tug of War on Nurse Migrants"
August 07, 2008
PEPFAR Reauthorization V: Science = Life
Posted by Ruth Levine at 11:16 AM
While AIDS activists in the 1980's were surely right that Silence = Death, it was not voices and attention alone that brought the life-sustaining advances of AZT treatment and its successors. For all the flaws in process along the way, it was breakthroughs in biomedical science that yielded the therapies that literally raise people from their deathbeds to be productive and active members of their families and communities. Without the investments in the science behind the drugs, the conversation today at the XVII International AIDS Conference in Mexico City would be far different – or would not be occurring at all.
In sharp contrast to the biomedical and pharmacological advances, though, the science of implementation of large-scale programs is far less developed. We have relatively little solid evidence to go on to ensure that the billions of donor dollars on offer are going to bring about the greatest individual and social benefit, with the fewest costs to nations' ability to deal with other health priorities. Instead of findings from systematic study, for the most part we are left with common sense, instinct and belief, shaped by the occasional compelling anecdote or observational study.
The early "emergency"-oriented nature of PEPFAR, which eschewed "the R word" (research), did little to fill the knowledge gaps. As the Institute of Medicine noted in its 2007 assessment of PEPFAR's performance, "There are still more questions than answers about how to best provide ART" in low-income, high-burden countries. And the paucity of knowledge about the effects of PEPFAR's HIV prevention efforts has been even more profound – and more lethal.
Continue reading "PEPFAR Reauthorization V: Science = Life"
August 04, 2008
AIDS 2008 in Mexico City: New Focus on High Risk Behavior in all Countries
Posted by Mead Over at 03:30 PM
Mexico City, August 4, 2008: The biannual international AIDS conference opened last night with great fanfare here in the capital of one of the countries that has the greatest success in combating AIDS. To me, the biggest surprise is the noticeable increase in attention to the need to assure prevention coverage among those at highest risk, including sex workers, men who have sex with men, and other groups at high risk.
Since the Stockholm conference in 1988, which was the fourth ever held, I have attended almost all of these international conferences and a substantial number of the regional conferences in between. During the early conferences, most attention was on HIV prevention with only the most specialized medical researchers and activists from the rich countries talking about treatment. Then as triple-drug therapy was developed and improved, attention turned towards extending access to poor countries. In 1997, when Martha Ainsworth and I launched our book on the economics of AIDS at the African AIDS conference in Abidjan, effective treatment still cost $20,000 or more per patient-year with only about a 50% price reduction in Thailand and Brazil. So our book's major message was that efficiency, equity and public health arguments all compellingly converged to support government action to prevent HIV infection, especially among those most likely to contract and transmit the epidemic. Our message on treatment was one of horizontal equity. Countries should subsidize AIDS treatment to the same degree they subsidized the treatment of equally expensive chronic adult illness. These two messages were and have been very unpopular. Indeed, ACTUP and other activist groups sometimes marched through the auditorium chanting hostile slogans when I was on the list of speakers. Even the World Bank turned its back on the first of our messages.
Now, 20 years after I attended my first AIDS conference and 11 years after the launch of Confronting AIDS, I think I detect a movement towards both of our 1997 messages. On treatment, after worldwide efforts have substantially lowered treatment costs and expanded access, there are now calls (including here at the Mexico conference) for horizontal equity between AIDS and other diseases within developing country health sectors, but the more dramatic change is on prevention.
Continue reading "AIDS 2008 in Mexico City: New Focus on High Risk Behavior in all Countries"
PEPFAR Reauthorization IV: Target Formula May Unintentionally Prevent Improvements in PEPFAR Implementation
Posted by Mead Over at 11:54 AM
This is a joint posting with David Wendt
The PEPFAR reauthorization bill, now signed by President Bush, is historic for several reasons. In our last blog we addressed the implicit entitlements to treatment confirmed by this bill. Today we discuss the role that unit cost measurement is mandated to play in determining the targets set for future administration performance.
This may be the first time in history that any government has mandated performance targets based on estimates of the unit costs of meeting those targets. The language of the bill says: "the treatment goal...shall be increased...by the same percentage that the average US Government cost per patient...has decreased ..." [Sec 403(3)(d)(3)].
July 29, 2008
PEPFAR Reauthorization III: US Funding is Life or Death for 1.73 Million and Counting
Posted by Mead Over at 04:49 PM
This is a joint posting with David Wendt
Does the new AIDS bill constitute recognition that AIDS treatment has become a de facto "entitlement"? If so, will AIDS continue to be exceptional in this respect -- or will Americans and the citizens of other relatively rich countries increasingly be willing to accept that the recipients of their assistance are "entitled" to its continuation.
The US congress passed last week and has sent to President Bush for signature the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act (H.R. 5501). This bill extends the US commitment to treat foreign AIDS patients by doubling the time period (from 5 years since 2003 to 10 years) and increases the target number of patients to be enrolled in treatment from 1.73 now to 2 or more million in five years.
