Global Health News Last Week

POLITICS AND POLICY

Human Rights Watch has urged the Bahraini authorities to halt what it said was a “systematic campaign” to intimidate doctors and other medical staff suspected of sympathising with recent anti-government protests.

PROGRAMS

  • The GlobalPost has been doing an excellent series of stories examining President Barack Obama’s Global Health Initiative (GHI) is focusing on in Guatemala. Slow in its implementation and hampered by little new money, GHI was supposed to be an example of Obama’s new, innovative commitment to global health.
  • The King of Swaziland has called for all of the men in the South African nation to get circumcised in order to prevent the spread of HIV/AIDS.
  • Results from a pilot program in Philippines have shown that deaths from rabies can be dramatically reduced when taking a community driven bottom up approach.
  • A child in Khartoum, Sudan is the first to receive a rotavirus vaccine, kicking off a campaign to vaccinate children in 40 low and middle-income countries.

RESEARCH

  • A recent report from UNAIDS cites data from a recently released South African study that shows the effectiveness of male circumcision reducing HIV prevalence in men.
  • A campaign to encourage African men to get circumcised to prevent infection by HIV gained a powerful boost on Wednesday by three new studies unveiled at an international AIDS forum in Rome.
  • A new study has found that women in conflict areas want to utilize
    contraceptives, but only 4 to 16 percent are able to gain access.
  • At the International AIDS Society, one of the big stories is a CDC study showing the drug Truvada prevented HIV transmissions in more than 60 percent of heterosexuals. The study’s author Dr. Michael Thigpen discusses how much Truvada costs, why HIV is so pervasive among women in Botswana, and how much people must take the drug for it to be effective.
  • Researchers have discovered that chloroquine, often used to treat malaria, may be effective in treating other autoimmune diseases.
  • An antiviral drug to combat HIV/AIDS synthesised by genetically modified plants is being tested on a small number of women in the UK to establish its safety, reports the Guardian.
  • A recent study has shown that stress experienced by a pregnant mother can have a negative impact on the development of the child in the womb.
  • Researchers presenting at the 6th International AIDS Society Conference on HIV Pathogens, Treatment, and Prevention in Rome, say that they have inched closer to a vaccine by leveraging a genetically altered version of SIV.

DISEASES AND DISASTERS

  • The World Health Organization is sounding the alarm on hospital safety and infections acquired while patients are in a health care facility, saying that a hospital  stay is riskier than air travel.
  • Researchers have determined that Hepatitis C can be transmitted sexually, after performing a 5 year study on HIV positive MSM.
  • Famine in parts of southern Somalia has killed tens of thousands of people, mostly children, the UN said Wednesday in an official declaration of what aid officials describe as the worst humanitarian crisis in the troubled country in two decades.
  • A new study warns that Pakistan “risks becoming the last global outpost of [polio], this vicious disease.” The disease has also resurfaced in four other countries.
  • Even in developing countries where child mortality is falling, the poorest under-fives are at high risk of dying from entirely preventable diseases because they do not receive basic immunization and have no treatment for diarrhea.
  • Peter Hotez, president of the Sabin Vaccine Institute, says new studies indicate a parasitic infection, schistosomiasis, may be one of the most important — and least recognized — co-infections increasing the risk of HIV transmission.
  • An All Africa editorial examines how the price of drugs leads to deaths that could be otherwise averted.

Notes on IH Section Conference Call: Current Developments in MCNH (June 27, 2011)

The IH Section held its third topic-focused conference call on Current Developments in MCNH on Monday, June 27, 2011 from 1:00 to 2:00 EST. We had several members of the IH section offer their commentary and expertise on current issues concerning maternal and child health.

Speakers
Laura Altobelli (Future Generations)
Elvira Beracochea (Midego)
Carol Dabbs (U.S. Department of State)
Miriam Labbock (Carolina Global Breastfeeding Insititute)
Mary Anne Mercer (University of Washington)

Laura Altobelli: Brief presentation of the APHA policy resolution proposal submitted by the IH section entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality.”
Laura discussed the new APHA policy proposal on MCH. There was nothing previously on the APHA policy regarding global action on this issue per se – one previously existing resolution focuses on reducing maternal and child mortality in the US, and one focuses on breastfeeding and has both domestic and global aspects. This, then, is the first policy proposal on global MNCH. Justification for the policy proposal is lack of progress on the MDGs and lack of policy commitment to protect vulnerable populations. APHA will be joining important other organizations that are putting out strategies, including the Partnership for MNCH (WHO), and the UN, and attended global meetings in 2010 in observation of the Year of Maternal Health (some of these mentioned below). There is also an effort to increase attention to this in the Global Fund and GHI. Six other sections/forums are co-sponsoring the resolution.

Elvira Beracochea: Update on the Millennium Development Goals 4 and 5.
A factsheet has been sent out (available upon request – please contact jmkeralis [at] gmail [dot] com). These MDGs and their targets have served us well to measure our progress so far. There have been improvements, though progress has been uneven. MDGs 4 and 5 focus on reducing mortality but not necessarily on improving health, development and well-being, and we need to address this as well. We know where women and children die and how. We also have the knowledge to prevent these deaths. We need to coordinate work at global scale and have a concerted strategy to ensure the rights of all women and children are met. We need to take global health goals to a new level of effectiveness using efficient strategies and a human-rights-based approach. A rights-based approach does not focus on only survival, but also on development. We need new targets and indicators that measure not only deaths but also number of children whose right are fulfilled; the children that are breastfed, fully immunized, drink clean water, are protected from malaria, and that that attend school. We need targets and indicators that measure not only the number of women that died or delivered with assistance of a skilled attendant, but that also measure the number of pregnancy complications effectively treated. We need new MDGs and targets.

Miriam Labbok: An update on reproductive health continuum (birth, breastfeeding and birth spacing promotion, protection, support) as an essential MNCH intervention approach.
It is vital that we pay attention to the reproductive health continuum within the life-cycle approach: birth, breastfeeding and birth spacing. Programming must include not only promotion, but also skill- and capacity-building so that support can be provided. In addition, policy change is needed to: support treating women with dignity, provide NFP knowledge (at least for the times that family planning supplies run out), and create the capacity to support health-supportive birth, breastfeeding and spacing practices. All such programming and policy creation should be carried out with recognition of the rights of both women and children to the best possible health support and with attention to appropriate technologies, as one size does not necessarily fit all. In addition, programs that address cultural change and intimate family and social decisions demand the building of trust that comes with reliability and long-term relationships. Programming should be designed for the long term, with a strong base and phased in activities, and with excellence and sustainability as the focus.

Mary Anne Mercer: Partnership for Maternal, Neonatal and Child Health – what it does and how one can get involved.
The Partnership for Maternal, Neonatal and Child Health is a WHO-based coalition of organizations that support increased funding commitments to MDGs 4 and 5. Any organization that supports MCH can be a member simply by filling out an application from the PMNCH web site at http://www.who.int/pmnch/. Be sure your organization is a member (it’s free!) by checking the member list. Also check out the ‘Knowledge Portal’ that aims to maintain updated programmatic information on current approaches to improving MCH. I am on the Board of Directors of the Partnership as an NGO representative, and we will be electing a new member of the Board this year that will represent an Africa-based NGO or the Africa office of an international NGO — please let me know if you have any suggestions for good candidates for that position.

Carol Dabbs: Trends in US government funding levels for global MNCH.
Funding has increased and is overseen by the State Department. Global Health targets are to be achieved with funding from FY 09-14, generally for implementation in FY 10-15. The Global Health Initiative includes principles supporting country-led plans and to coordination with other partnerships and donors, as well as between USG agencies and health programs. Eight countries have been selected as “plus” countries (places to conduct learning laboratories): Ethiopia, Kenya, Mali, Malawi, Rwanda, Bangladesh, Nepal, and Guatemala. Almost all of the Global Health Initiative funding is from USAID and State (there is also some DHHS funding, but that was not included in this discussion). There are two stages in the fiscal year: requesting funds from Congress and appropriation of funds by Congress. Unfortunately, delays have been a reality this year. However, we should look at trends and context of the rest of foreign assistance and of overall health fundig. The budget now includes nutrition as a separate item, and it’s included in the MNCH numbers here. There has been a trend of increased funding; funding for MNCH has increased about by 22% over two years (FY 2008 to FY 2010), but the full year continuing resolution for FY 2011 allocation to MNCH is still pending. We do not know what the appropriations for FY 2012 and FY 2013 will be.

Discussion: Is this in addition to Dept of State HIV funds? Yes, there are additional funds in USAID for HIV/AIDS, as well as funds for MCH and the rest of the health programs.

Obama’s Global Health Initiative: How does the world view America’s good intentions?

Ever since it was announced in May of last year, President Obama’s Global Health Initiative has been the buzz of the international development community.  In a press release, the president announced that he would ask Congress to allocate $8.6 billion for the 2010 fiscal year, and $63 billion over six years, for a new, comprehensive global health strategy.  $51 billion of these funds would be targeted toward AIDS, malaria, and tuberculosis, with the remaining $12 billion to address other issues such as neglected tropical diseases and family planning.  The strategy is intended to go beyond targeting specific conditions and to focus on strengthening health systems and improving maternal and child health, though 70% of the funding will continue to go to PEPFAR.

This new strategy has been enthusiastically received by international health and development voices.  The initiative has been praised for its emphasis on maternal and child health  and for its recognition that “our greatest plagues — HIV/AIDS, maternal and infant mortality, and poor sexual and reproductive health — are all interconnected, and they are all preventable.”1  Secretary of State Clinton has said that the initiative will become a crucial component of America’s foreign policy.2  It has not, however, been well received by everyone: PEPFAR advocates in particular have pointed out that the president has not lived up to his campaign promises to allocate funds for the program, choosing to provide his pledged $50 billion over six years, rather than five.3  An article published in the journal AIDS last week argues that PEPFAR and support for HIV/AIDS care supports the health sector in general and that cutting support for AIDS damages health systems.4  The authors maintain that funding maternal and child health initiatives at the expense of PEPFAR puts these two health priorities in competition with one another, which “lacks not only ethical legitimacy but also scientific merit.” 

Inevitably, any global health policy (and policy in general) will invite comments from supporters and detractors.  However, a blog entry by Bruce Nussbaum on humanitarian design caught the eye of several people in the international development community.  In several design conferences, he noted that professionals from developing nations often resented the fact that Westerners were trying to come in and solve their problems for them, particularly when they had their own ideas that they felt were more culturally appropriate.  Nussbaum, surprised, began to wonder if humanitarian design was being viewed as a new form of imperialism.  The stalled reconstruction in Haiti is another example of misdirected foreign intervention: ActionAid, a UK-based humanitarian NGO, argued last week that Haitians aren’t being included in reconstruction efforts, and that the current plan is more reflective of donor country interests. These observations raise the broader question of how the global health efforts of the U.S. are viewed by the world, and whether they are as altruistic as they present themselves to be, particularly when funds are pulled or frozen because domestic interests take precedence.  How the U.S. global aid policy is perceived is just as important as it its effectiveness.