With the prospect of being included in the next generation of ‘change makers’ in the discussions at Forum 2012 and with the aim to create a long-standing global youth network, some Emerging Voices and members of Youth in Motion gathered in Cape Town, [...]]]> guest editorial by Mabel Carabali, Emerging Voice 2010 from Colombia

With the prospect of being included in the next generation of ‘change makers’ in the discussions at Forum 2012 and with the aim to create a long-standing global youth network, some Emerging Voices and members of Youth in Motion gathered in Cape Town, South Africa during the last week of April.

For me, personally, the motivation to participate in this adventure was “to make my voice heard.” To try to show the world what is happening in the South – in my case, Latin-America. However, as the Forum took place in Africa, the protagonist in Cape Town would obviously be the ‘Cinderella of all times’,  Africa. And by the way, due to my African ancestry, I was sure to  benefit from this African focus: I was going to learn about the South African health system, their current processes, and their culture. I wanted to become aware of their limitations and solutions, just as I would like them to know more about the Latin American ones. The Forum was an excellent opportunity to gather researchers, students and policy makers from all around the world and network with them. One of my key objectives, though, besides trying to make my voice heard, was to better understand the meaning of “aid” and therefore, what the Forum’s slogan “Beyond aid … Research and Innovation as key drivers for Health, Equity and Development” meant for us as participants of the event.

Once arrived in this beautiful city of an “almost developed” country (at least that was my first impression), I fully understood all the troubles I had faced when applying for a South African visa as a Colombian citizen. I was pleasantly surprised: the Africa I “knew” from the newspapers did not look at all like this city! My expectations had been totally wrong. In order to clear my mind and get acquainted with the environment, I went sightseeing. I strolled through the ‘Green market’, the place where the native Africans gather to sell their handicraft to tourists. A tourist trap, obviously. Then I walked along the nearby ‘Long street,’ which, as the name implies, is a long avenue in the downtown area with pubs, restaurants and all types of stores – a street which made me feel as if I was in Europe or in North America.  But no, I was not in the North, I was in Cape Town, an amazing, developed city that happens to be situated in the south of the African continent. Nevertheless, by the end of my walk, two words had popped up in my mind, two words that are often associated with Africa as well: aid and resources.

With the definition of aid as “a voluntary transfer of resources from one country/government to another, given at least partly with the objective of benefiting the recipient country”(Browne, 1990), and after observing the aid distribution during the last years, the notion of going “beyond aid” became more comprehensible to me. Yet, it also seemed more complicated to achieve. As a ‘change maker’, my goal had to be to exchange ideas on moving beyond aid, though. Luckily, the first satellite session I attended was called “Moving Beyond Aid with Global Health Initiatives – An Interactive Workshop” and it gave me an idea of what ‘aid’ and ‘beyond aid’ can mean or represent for others. It showed me how countries like Angola, Mozambique and of course South Africa fight against diseases and deal with aid. These Southern-African (and many other) countries manage disease treatment and health promotion partly according to the aid they receive. This aid is, in turn, handled either by the government, the donors or by both. In the workshop I also learnt how important aid is for some countries and how the fight for sustainability has arisen.

But one thing still lingered on my mind. Aid is linked to resources, one way or another. This was perhaps not explicitly mentioned during the event, but tacit knowledge nevertheless for all participants.  There is an unbreakable dependency between aid and resources. Why do you give aid? Why do you receive aid? The answer is always the same: because of the resources. A country might lack them, or it might consider it can afford to give some away. There are of course other structural reasons for aid, such as ‘the other’ needs it, ‘the other’ cannot produce it, ‘the other’ wants it, or, without any doubt the worst reason, ‘the other’ is accustomed to receiving it. My role was to go beyond the actual facts and try to find solutions to go ‘beyond aid’. But what does this actually mean? Does it mean that we should stop the aid? Or simply redistribute aid resources? Or use the aid to build capacity? Or develop our own resources and stop the aid? Knowing that in terms of aid dependency per capita, in 2005, Colombia was more or less where South Africa was in 2000, and the fact that now both countries are upper middle-income countries, I realized how similar these countries could be with different amounts of aid.

Before going beyond aid, my first challenge was thus to understand the meaning of it. Putting on my hat of ‘change maker’, then, I would argue that to facilitate change in my own country, the responsible use of aid and own resources should be encouraged, rather than just waiting for the ‘others’ to help.

There is an urgent need for debate around this topic and the obligation to produce something more than just words. However, the clock was ticking mercilessly in Cape Town, and the number of ideas decreasing, as more and more participants went home. Although the three days were enough to catch up with the Emerging Voices (or at least some of them) and other colleagues, and to start networking with the dynamic Youth in Motion around the fire, due to the short time there were no concluding proposals written, nor could I make my voice heard as much as I had wanted.

The day after the event, the South African Freedom day took place, under the theme “Working Together to Build Unity and Prosperity for All.” By then, my own motto had turned into this one: “let’s go beyond the facts and push for actions, to get meaningful change.” Back home, I immediately began to work towards achieving this goal.

Plenty of news this week, or as François Hollande might say, “l’embarras du choix”. In the guest-editorial, Raoul Bermejo reflects on the Regional Forum on Health Care Financing in Pnomh Penh, Cambodia. A CoP on Health Care Financing in Asia was launched there, but the event also inspired Raoul and many other participants [...]]]> Dear Colleagues,

Plenty of news this week, or as François Hollande might say, “l’embarras du choix”. In the guest-editorial, Raoul Bermejo reflects on the Regional Forum on Health Care Financing in Pnomh Penh, Cambodia. A CoP on Health Care Financing in Asia was launched there, but the event also inspired Raoul and many other participants in a number of other ways.   

Enjoy your reading.

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

Editorial

Where three rivers meet

Raoul Bermejo

Emerging voice from the Philippines & PhD student at ITM

Changkes mouy bach kach min bak.  –Khmer saying

(A bundle of sticks cannot be broken.)

One of the most striking discussions during the Regional Forum on Health Care Financing in Phnom Penh on May 2-4, 2012 was the proliferation in the Mekong sub-region of financing schemes aimed to improve access to quality health services.

Read the rest of the editorial here

New episodes in ongoing global health debates

a. Millennium Villages

1. Lancet (Comment) – The Millennium Villages project

Grace Malenga et al.;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)60369-9/fulltext?_eventId=login

Good news on the Millennium Villages’ impact on child mortality, according to a new study by Paul Pronyk and colleagues in the Lancet. Malenga et al. comment.

Jeffrey Sachs obviously wanted to get the message out (in the Huffington Post ), and the inevitable Michael Clemens had his say in Nature. Tom Paulson (from Humanosphere) reckons the shouting between the two camps will continue.

b. Fungibility

2. Plos – Does Development Assistance for Health Really Displace Government Health Spending? Reassessing the Evidence

Rajaie Batniji et al.;

http://www.plosmedicine.org/article

Rajaie Batniji and Eran Bendavid dispute recent suggestions that health aid to developing countries leads to a displacement of government spending and instead argue that current evidence about aid displacement cannot be used to guide policy.

The two new articles on health statistics inspired Andrew Harmer. He wonders whether health statisticians are the new post-modernists. Recommended reading.

c. Funding imbalances for global diseases

3. CGD (blog) – How Does HIV/AIDS Funding Affect a Country’s Health System?

Victoria Fan;

http://blogs.cgdev.org/globalhealth/2012/05/how-does-hivaids-funding-affect-a-countrys-health-system.php

Fan comes back on the recently published paper by Shepard et al. (in American Journal of Tropical Medicine & Hygiene) evaluating the impact of HIV/AIDS funding on Rwanda’s health system. “Bottom line: The jury is still out on whether HIV/AIDS funding has displaced or improved efforts on other disease control priorities.”

WHO reform

4. Nature medicine – The WHO must reform for its own health

Tikki Pang & Laurie Garrett;

http://www.nature.com/nm/journal/v18/n5/full/nm0512-646.html

The WHO is facing an unprecedented crisis that threatens its position as the premier international health agency. To ensure its leading role, it must rethink its internal governance and revamp its financing mechanisms, according to the authors.

Tom Paulson called Laurie Garrett about the piece, and he got five reasons from her why the world needs a (revamped) WHO. Meanwhile, American voters seem to support the WHO, according to a recent survey. (we are baffled that 9 out of 10 American voters say it’s important for the US to support the global health efforts of the WHO, as this would imply that even more Americans know what the WHO is).

5. The European Union’s voice and influence on global health and the reform of the World Health Organisation: the role of diplomacy

Samantha Battams et al.;

http://www.globalhealtheurope.org/images/stories/120509_Article_-_EUvoice_influence_WHO_BrusselsPostConference.pdf

This paper explores the implications of the Lisbon Treaty for the EU role in global health. It also considers the EU position at the WHO and specifically on the reform debate where the WHO’s core business, financing, governance and management operations are under review.

Global Fund

6. Irin Plus – HIV/AIDS: Global Fund will have US$1.6 billion more

http://www.plusnews.org/Report/95434/HIV-AIDS-Global-Fund-will-have-US-1-6-billion-more

The Global Fund has announced that it will have US$1.6 billion more to invest in life-saving programmes between 2012 and 2014. (Let’s call it the “Jaramillo wave”.)

A new GFO issue covers this cheerful news, and also pays attention to the role of CSOs after the managing reform, and audits in Ethiopia.

Finally, the Global Fund started its own newsletter. Was about time.

Family planning and population growth

7. Newsweek – Melinda Gates’ New Crusade: Investing Billions in Women’s Health

http://www.thedailybeast.com/newsweek/2012/05/06/melinda-gates-new-crusade-investing-billions-in-women-s-health.html

Melinda plans to use (part of) the Gates Foundation’s billions to revolutionize contraception worldwide. The Catholic right is pushing back. Is she ready for the political firestorm ahead, Newsweek wonders.

As you know, it’s Mother’s day this weekend. Former supermodel Christy Turlington Burns argues moms should skip Mother’s day this year, referring to the dire situation in countries like Niger (ranked as the worst country to be a mother, according to a recent Save the Children report).

A new KFF issue brief provides the statutory requirements & policies governing U.S. Global Family Planning and Reproductive Health Efforts.

8. CGD – People and the Planet

John May;

http://blogs.cgdev.org/globalhealth/2012/05/people-and-the-planet.php

John May has joined CGD recently. In this blog post he comes back on the new report ‘People and the Planet’ by the Royal Society. We hope you also find the time to read his splendid book – World Population Policies.

9. KFF – Copenhagen Consensus Report Argues For Expanding Family Planning Programs In ‘High-Fertility’ Countries

http://globalhealth.kff.org/Daily-Reports/2012/May/04/GH-050412-Opinion-Population-Growth.aspx

Expanding family-planning services to all women with unmet needs — 215 million women — would require an annual expenditure of $6.7 billion.

Child mortality

10.   Lancet (online) – Global child survival: beyond numbers

Zulfiqar A. Bhutta;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)60686-2/fulltext?_eventId=login

Bhutta comments on the new Lancet study by Liu et al. on child mortality. With just 3 years left for the MDG 4 targets, there is an urgent need to go beyond the numbers, the author argues. Do mere numbers and proportions give sufficient detail about causes of mortality? A pathway analysis to understand the determinants and issues related to mortality is urgently needed.

Nevertheless, commenting on another new (WB) study, Michael Clemens reckons  African child health is thé success story in development. Child mortality rates are declining in a number of countries, and the decrease is accelerating.

Health Policy & financing

11.   KFF – Increased Investment In Nurses Will Help Strengthen Health Systems Worldwide

http://globalhealth.kff.org/Daily-Reports/2012/May/09/GH-050912-Opinion-Nurses.aspx

Sheila Davis, director of global nursing at Partners In Health, writes the following in a Huffington Post “Impact Blog” opinion piece, noting this is International Nurses Week. “But although nurses deliver 90 percent of all health care services worldwide, they remain largely invisible at decision-making tables in national capitals and international agencies. Their absence constitutes a global health crisis.”

We totally agree, so it’s a pity the Lancet editorial on International Nurses Day (‘Science for action-based nursing’) carefully avoids this tricky governance issue.

12.   Humanosphere – Why the global health council closed

http://humanosphere.kplu.org/2012/05/why-the-global-health-council-closed/

Paulson reposts a Devex blog post that gives some reasons for the end of the Global Health Council. Cynthia Schweer has another theory on the closure.

13.   Lancet (Offline) – 25×25—the survival of the leanest

Richard Horton;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)60728-4/fulltext

At a symposium held last week in London to launch the new Centre for Global Non-Communicable diseases, Ruth Bonita pointed to the need for a clear goal: 25 × 25, a 25% reduction in non-communicable disease mortality rates by 2025.

(Nice target, but we wonder when the global health community will start using the one set of figures that actually matters – 1 vs 99 %.)

14.   New Internationalist – The flip side to Bill Gates’ charity billions

Andrew Bowman

http://www.newint.org/features/2012/04/01/bill-gates-charitable-giving-ethics/

To get a bit in the “1 vs 99 %” mood, we recommend this article – nothing new, perhaps, but interesting nevertheless. David McCoy and Devi Sridhar are being quoted.

The Global May manifesto of the Occupy Movement is also out. Tomorrow is the day.

Before you take to the streets tomorrow, make sure you read this essay, ‘Capitalism: a ghost story’, by Arundathi Roy. It already appeared in the Indian magazine Outlook in March, but it blew us away this week.

15.   CGD – Quantifying the Quality of Health Aid: Health QuODA

Amanda Glassman and Denizhan Duran;

http://www.cgdev.org/doc/full_text/QuODAH/1426169.html

Back to the more mundane world of health aid, then. This brief summarizes and updates results of the Quality of Official Development Assistance (QuODA) index applied to health aid and compares these results to the overall QuODA assessment.

16.   Lancet (World Perspective): FDA maps out global strategy

Susan Jaffe;

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(12)60743-0/fulltext

The US Food and Drug Administration is calling for greater reliance on global partners to improve the safety of America’s foreign imports. Susan Jaffe reports from Washington, DC.

17.   Epianalysis – An update on global access to medicines

Sanjay Basu;

http://epianalysis.wordpress.com/2012/05/07/medaccess/

Basu provides an update on access to medicines, Trips, compulsory licenses, etc.

18.   Health Diplomacy Monitor (May issue)

http://www.ghd-net.org/sites/default/files/Health%20Diplomacy%20Monitor.pdf

The new Health Diplomacy Monitor has editorials on the reform of the WHO and the new WB boss. Other artices tackle the upcoming WHA, and the need to keep the momentum on NCDs.

Finally, some US news (other than the news on gay marriages -  you probably already know by now that Obama is pro, and that Romney was involved in some anti-gay pranks as a teenager, no surprises there):

• The (current) House pretty much lived up to its reputation, with a draft of the FY 2013 appropriations bill  (think ‘axes’, Paul Ryan, …).
• CGD gathers this mood isn’t going to change anytime soon, and this led to the following report : ‘Engagement amid austerity – a bipartisan approach to reorienting the international affairs budget’ (with a number of concrete suggestions, also for PEPFAR). Speaking of PEPFAR, check out also its 8^th annual report to Congress.

Second global Symposium on HSR in Beijing – preparations

• The Symposium secretariat has extended the deadline of film proposals to 15 May. Films can be submitted through the same website as the abstract submissions (but abstracts can no longer be submitted). The films do not have to be professionally made, be of a certain length or a specific “genre”. They should document examples of health systems strengthening or illustrate health systems research. If you have any questions regarding the film submission process, you can write to the Symposium mail box (hsrsymposium2012@who.int) with the subject title “FILMS”.
• Some more (commissioned) background papers  were put online on the Alliance website to provide a conceptual underpinning for the WHO Global Strategy on Health Systems Research that is currently under development.

ITM was involved in one of the papers – a health systems research mapping exercise in 26 LMICs, with narratives from policy makers, policy brokers and health systems researchers. Country teams of Emerging Voices and ITM alumni provided the indispensable feet (and interviewers) on the ground. Many thanks to all of them!

Development & Aid

Rio+20 and post-MDGs

•  This week, ODI launched a new website on the post2015 preparations.  The site already features this opinion by Claire Melamed – “Rio+20 must do the impossible”. On the ODI website, you can also find an ODI background note on the need to bring environment and development back together in Rio.
•  Two more heads of state were appointed in the development goals panel: Liberia’s Ellen Johnson Sirleaf and Indonesia’s Susilo Bambang Yudhoyono.

Other D&A news

• As you probably already know, the Gates foundation is trying to find out whether the advertising industry can give aid a much needed makeover.
• In the UK, the Cameron-Cleg government will not enshrine the 0.7 % ODA commitment into a bill, at least for now.
• Worrying news on the water front, according to the first U.S. Intelligence Community Assessment of Global Water Security. (an assessment of the report by Patrick Stewart, CFR fellow, in the Atlantic).
• The Africa Progress panel (chaired by Kofi Annan) has released its new report (“Jobs, Justice and Equity”). African leaders are urged to launch a ‘big push’ towards meeting the MDGs.  Mark Tran reports in the Guardian.

(A bundle of sticks cannot be broken.)

One of the most striking discussions during the Regional Forum on Health Care Financing in Phnom Penh on May 2-4, 2012 was [...]]]> By Raoul Bermejo

Changkes mouy bach kach min bak.  –Khmer saying

(A bundle of sticks cannot be broken.)

One of the most striking discussions during the Regional Forum on Health Care Financing in Phnom Penh on May 2-4, 2012 was the proliferation in the Mekong sub-region of financing schemes aimed to improve access to quality health services.

Cambodia might be an extreme example where you have so many health equity funds –for maternal and child health services, in-patient hospital care, out-patient care, for chronic diseases, et cetera. On top of that, there are various incentive schemes aimed at specific individual providers. Each donor, each disease control program has spawned its own incentive scheme for each specific output. An extreme example is one hospital in Battambang where there are as many as 50 incentive schemes. Is this a perversion of success of the initial pilots? Or a symptom of our collective inability to work together?

It appears to me that it is to a large extent driven by donors, well-meaning ones who want to get on the bandwagon of a successful model. I see no problem with having many players in the same wagon, or with some having their own wagon, if they all want to go together in the same direction. One Cambodian expert notes that fragmentation is not a problem if the various schemes are more or less similar (payment mechanism, incentives etc.); it becomes problematic if the schemes are too different.

The situation underscores the importance of government leadership and stewardship of the health sector, with donors respecting and helping to strengthen that government role. I see no alternative way to avoid the tendency of many good intentions from creating an unintended mess.

The lively discussion on this issue and many others during the forum highlights the value of sharing experiences. There was a strong sense of openness with participants from mostly the Mekong sub-region (but also from Indonesia and the Philippines) to discuss the challenges they face in health financing. A very candid participant from Myanmar pointed out that his country is like the neonate in this forum with so much to learn from the experience of other countries. Indeed universal health care (UHC) is abuzz in the region. Countries, in different stages, are making strides to improve their health systems towards UHC.

It is in this spirit of sharing and learning that the Community of Practice on Health Care Financing in Asia was launched during the forum. The idea is to take off where the forum ended by providing an online platform (mixed with face-to-face meetings) for practitioners and experts in health care financing in Asia to come together.

A bundle of sticks is so much stronger than the strength of each stick added together.