This week we had to cover the World Health Assembly going on in Geneva. We also cherry picked some important global health policy and financing updates. We couldn’t pass by the polemic surrounding findings at the Millenium Village project published in The Lancet as it raised a lot of reactions [...]]]> Dear Colleagues,

This week we had to cover the World Health Assembly going on in Geneva. We also cherry picked some important global health policy and financing updates. We couldn’t pass by the polemic surrounding findings at the Millenium Village project published in The Lancet as it raised a lot of reactions across the web. Finally we have some key aid and development issues we want to share with you. 

Enjoy your reading and don’t forget to comment and share the spirit here on our blog or on twitter.

David Hercot,Kristof Decoster, Ildikó Bokros, Basile Keugoung & Wim Van Damme

Editorial

The sector-wide approach and universal health coverage: friends or foes?

By Vincent R. Okungu, Emerging voice 2010

In the 1990s, a few European donors and partner developing country governments acknowledged that the traditional project approach to the delivery and management of aid was not effectively improving population health even though donor assistance for the health sector was increasing. As a result, the sector-wide approach (SWAp) was proposed to replace the project approach.

Read the rest of the editorial here

World Health Assembly

Many things going on out there in Geneva. Find some of our recommended readings below. ITM’s Evelyn Depoortere attended the Assembly for the first time, and she shared her impressions in this blogpost.

1. WHO – Universal coverage is the ultimate expression of fairness

Dr Margaret Chan has been re-elected for a second term after an inspiring speech on the need for all countries to move towards universal health care. Richard Horton gives 12 more month to Chan to reform the WHO before getting into the objectives she gave herself in 2006: “I want us to be judged by the impact we have on the health of the people of Africa, and the health of women.” Civil society organizations call to action by having issued a statement on Monday which calls on world leaders to take a stand for UHC.

It seems we will all be singing UHC together in the coming years, and thanks to Thailand we already have a Global UHC Hymn!

Still, the WHO’s head keeps swinging between “Horizontal” and “Vertical” Approaches as we can see from this new Emergency plan to eradicate Polio.

2. R&D

Following April’s report of the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG), which concluded that a binding convention “is needed to secure appropriate funding and coordination to promote R&D needed to address the diseases that disproportionately affect developing countries and which constitute a common global responsibility.” Debates are taking place at the WHA on whether something should be done or not. US is blocking progress as expected but Argentina also complicates the process.

Global Health Europe‘s Stephen Matlin wrote a policy brief on the issue.

An essay in Plos by Suerie Moon et al. reflects on the importance of a global treaty to advance access to medicine as a global public good.

3. WHO reform

The Deutsche Welle ran an article entitled Who is really helping the WHO? which discusses that according to the People’s Health Movement the reform proposed by Margaret Chan is cosmetic and the influence of big pharmaceutical companies will remain.

Devi Sridhar, Lawrence O. Gostin, and Derek Yach in foreign affairs say that the WHO has to compete with NGOs and other Global Health Initiatives to get funding… but it deserves better!

Global Health Policy and Financing

4. Working Paper 5:  How can Disease Control Programmes Contribute to Health System Strengthening?

Bermejo R. et al.; http://www.itg.be/WPSHSOP

In a recently released working paper Raoul Bermejo and colleagues highlight the options for disease control managers in Liberia to effectively strengthen the health systems in their available leeway. This is the second country application of the model proposed by Van Damme et al. to clarify Health Systems Strengthening for managers of Disease Control Programs (DCPs) in  Sub-Saharan Africa. You can view the entire Working Paper Series of the Studies in Health Services Organisation and Policy here.

5. Global Public Health – Defining and assessing evidence for the effectiveness of technical assistance in furthering global health

Gary R. Westa et al.; http://www.tandfonline.com

Gary R. Westa and colleagues have reviewed the evidence on the effectiveness of Technical Assistance. Despite the fact that it absorbs a large share of ODA, they found limited evidence for its effectiveness.

6. Lancet – The US Global Health Initiative: where does it stand?

Jennifer Kates & Josh Michaud; http://www.thelancet.com/

Kates and Michaud, both working at KFF, comment in the Lancet on the progress of the US global Health Initiative. “Of the $63 billion originally proposed, only 55% ($35 billion) has actually been appropriated, leaving the GHI with a substantial funding gap” they say.

7. GFO – Health Centres Constructed in Ethiopia Were Not in Approved Workplan and Budget, Global Fund Inspector Says

http://www.aidspan.org/index.php?issue=185&article=3

OIG and Principal Recipient of Fund in Ethiopia are in disagreement on the eligibility of spending some of the Global Fund money to build Health Centers reports Global Fund Observer in its latest newsletter. Using Global Fund money to develop health infrastructure – together with health workforce – was one of the key strategies used by Ethiopia to strengthen it’s health system with Vertical programmes.

For those interested, the Aidspan 2011 annual report has been released.

8. AIDS Alliance - Tell the EU take the lead to end aids – The EU’s reponse

http://www.whatspreventingprevention.org/
Earlier in February, the International AIDS Allaince had launched a campaign to urge EU to maintain AIDS funding. The EU reacted by affirming that they would have a Programme of Action on Global Health  in early 2013 and that they willl maintain the principles of the  ‘EU Programme for Action to confront HIV/AIDS, Malaria and Tuberculosis 2007-2011’. They also stated that they would maintain support and advocacy for the Global Fund.

Research

9. Millenium Project Villages polemic

A number of bloggers and scientists have reacted to the paper published by Paul M Pronyk et al. on the reduction in child mortality observed in the “Millennium Villages.” See here, here, here, and here. The authors themselves acknowledged the way some results have been presented is misleading or wrong. In the end we do not see much evidence, only convictions as Andrew Harmer puts it: MPVs WILL work, MUST work. Cesar Victorahad warned us not so long ago that it is becoming more and more irrelevant to compare districts (even more villages I would say) as intervention and non-intervention. Obviously Pronyk did not take that paper into account.

10. Lancet – Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa

Nayyar G et al. ; http://www.thelancet.com/
According to this study published in The Lancet Infectious Diseases, a third of malaria drugs circulating in Asia and Africa are counterfeit, BBC reports.

Aid & Development

11. David Cameron is unfit to chair the UN development panel – and here’s why

http://www.guardian.co.uk/

This Guardian article refers to Cameron’s “anti-development interventions” since the start of this year to prove the point that he is unfit for the job. In May he rejected the introduction of a financial transactions tax that could stabilize markets and raise money for anti-poverty programs globally, in April his government lead the charges against Unctad, in March his government joined the US and Canada in an attempt to remove all references to the human right to water from the declaration of Rio+20….and the list goes on. So is he really fit for the job?
Other important highlights:

• IDS Governance and development website discusses the need to look at cross border tax control if one wants to address evasion in low income countries. The article is entitled Tax Inspectors Without Borders: A Seriously Good Idea
• AfGH – Worrying trends in aid spending: New analysis on 2011 ODA figures: it looks like EU countries are reducing their ODA according to the latest OECD report. Anyone surprised?

• Would a FTT not be part of a solution to address crippling aid and global challenges? AfGH calls on the EU to move forward.

• It still shocks me a little when a colleague would look at me and ask, “Now, what do you mean by downward accountability?”Accountability to whom? Keep asking.

• A partial review of MSF new book on Humanitarian Negotiations

• Sustainable development is the only way forward,  says Jonthan Glennie in the Guardian Poverty Matters blog talking about the upcoming post MDG framework.

There are so many different interests and stakes related to the formal agenda at a World Health Assembly (WHA) that it seems virtually impossible to understand what is going on at all the various levels: the technical, tactical, and political, just to name a few. Here are the impressions of a [...]]]> By Evelyn Depoortere (ITM)

There are so many different interests and stakes related to the formal agenda at a World Health Assembly (WHA) that it seems virtually impossible to understand what is going on at all the various levels: the technical, tactical, and political, just to name a few. Here are the impressions of a newbie, who was only one of several hundreds of people passing through the “Palais des Nations” this week.

A hot potato at the 65^th WHA was the report of the consultative expert working group on research and development (CEWG), which mainly proposes to delink R&D costs from prices of the final market products, and therefore requiring a significant increase in public spending on R&D from all countries. By Wednesday morning four different proposals for resolutions were on the table, ranging from a virtually unconditional implementation of the CEWG’s recommendations, to putting off any commitment until a (in practice undefined?) future. While initially the agenda item was swiftly dealt with by proposing a working group to draft a common resolution proposal (hereby precluding any country statements), this plan failed when Argentina called for a “point of order”,  and the Bahamas were dramatically interrupted in the middle of their statement on maternal and childhood nutrition. An immediate change of the agenda followed, suspending the item on nutrition  and starting the country statements on the CEWG report. Unfortunately, the chair did not allow going overtime (into the lunch break), so only one of the civil society organisations got a chance to speak. (The CSOs issued a joint statement on Monday calling on world leaders to stand for UHC.) On Thursday evening, when leaving the WHA, a drafting group was still working, so I imagine the item will be back on the agenda today.

The Wednesday evening session on IHP+ unfortunately did not attract such a big audience (difficult to compete with a GAVI session taking place at the same time), but the absentees were wrong. The session provided a good variety of speakers, with both high and low income country signatories being quite enthusiastic about their experience with IHP+. Especially the representative from Ethiopia, one of the first signatories, gave a rather compelling presentation; they have implemented a “one plan, one budget, one report” approach which seems particularly convincing. However, it was a bit disconcerting to hear that in spite of all the nice declarations on ownership, alignment, etc.,  donor countries increasingly tend to go back to the project approach,. Also, this perceived need for donor countries to convey simple messages to the tax payers, i.e. in terms of the number of lives were saved still persists, even though some stressed the importance of contribution over attribution.

Finally, it would be impossible to say anything about this WHA without mentioning the WHO reforms, the main agenda item on Thursday. Unfortunately I had to leave before the end of it, but one major point of discussion was the place of social determinants of health (SDH) on the strategic overview of the 12^th general programme of work 2014-2019. While the criteria and categories for priority setting and programmes were based on a consensus reached during a working group meeting in February,Brazil brought the issue back on the table, very strongly advocating for an additional category on the SDH. There is no doubt that everybody in the room agreed on the importance of SDH in this strategic overview; the main difference between the opinions was  whether SDH are to be considered an overall WHO core value and therefore should be present in all activities, or whether they should appear as an additional category, and as such giving them higher visibility and (assumingly) moving them from rhetoric to practice. A relevant discussion, but the reiteration of the same arguments for about two hours in a virtually plenary session clearly exposed the fact that there is a lot of room for improvement in the functioning of the WHA .

In the 1990s, a few European donors and partner developing country governments acknowledged that the traditional project approach to the delivery and management of aid was not effectively improving population health even though donor assistance for the health sector was increasing. As a result, the sector-wide approach (SWAp) was [...]]]> By Vincent R. Okungu, Emerging voice 2010

In the 1990s, a few European donors and partner developing country governments acknowledged that the traditional project approach to the delivery and management of aid was not effectively improving population health even though donor assistance for the health sector was increasing. As a result, the sector-wide approach (SWAp) was proposed to replace the project approach.

SWAp is a process of aid coordination that aims at pooling external and internal funds under recipient governments’ leadership and ownership to provide accessible, equitable and sustainable health services. The SWAp process shares a lot with (and probably inspired) the Paris Declaration of Aid effectiveness (2005) and the Accra Agenda for Action (2008). The SWAP aims and objectives are shared with universal health coverage (UHC), currently a major global health agenda.

Despite their shared aims, one keeps wondering whether SWAps and UHC are friends or foes. As a crucial goal in the health reform agenda, UHC would make health services accessible and equitable for all citizens. If effective, it would also contribute to poverty reduction by reducing the incidence of out-of-pocket payments for health care.

By consolidating internal and external funds, and integrating and harmonizing donor projects into national health programmes, SWAps should strengthen the entire health system capacity, structures and finances. The SWAp process therefore, could in theory very well support UHC by pooling funds and long-term capacity building.

Many SWAps, however, have been disappointing. Most are yet to deliver any tangible benefits to population health. In practice, many SWAps have poor quality and overambitious plans and expenditure frameworks. Many donors and recipient governments have also reduced SWAps to a specific public expenditure programme funded by specific donors according to policy and budget structures set by recipient governments

Ideally, SWAps should involve several actors who must work together to achieve required results. The practice of reducing SWAps to common planning and monitoring, when pooling funds is very limited, has not been conclusive, including in terms of providing accessible health services in an equitable and sustainable manner.

The objectives of greater coordination of aid actors, harmonization of rules and government ownership are relevant. The question then is to what extent UHC initiatives could benefit from these objectives, dear to the SWAp approach.

A first recommendation would be to understand well the logic of some donors: they simply refuse to support SWAps because they need to ensure visibility and profile of their agencies. Other projects are pilots of planned interventions in donor countries, and agencies carrying out these ‘pilot projects’ reject SWAps because they would not be able to measure the results of their interventions. However, one should not blame the donors only because weak government leadership over the health sector offers opportunities for donors to impose their interests on the sector. Locally, SWAps reduce chances for corruption and patronage and have often faced opposition from establishment bureaucrats.

Interestingly enough, this reluctance to work together is also a challenge for UHC. Indeed, fragmentation and multiplication of schemes is an obstacle to UHC.

I believe actors involved in SWAps and those committed to UHC should work together. SWAps should be addressed under the agenda of universal coverage. The UHC agenda should emphasize long-term capacity building plans and policies that prioritize population universal health needs and expectations. A point of action would be to improve local leadership of SWAps with a department specific to the SWAp process. This way, SWAps can support UHC efforts as an all inclusive process with a strong, transparent and accountable recipient government leadership.