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<?xml version="1.0" encoding="UTF-8"?> <?xml-stylesheet type="text/xsl" media="screen" href="/~d/styles/rss2full.xsl"?><?xml-stylesheet type="text/css" media="screen" href="http://feed.cgdev.org/~d/styles/itemcontent.css"?><rss xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:wfw="http://wellformedweb.org/CommentAPI/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" xmlns:feedburner="http://rssnamespace.org/feedburner/ext/1.0" version="2.0"> <channel> <title>Global Health Policy</title> <link>http://blogs.cgdev.org/globalhealth</link> <description /> <lastBuildDate>Wed, 24 Nov 2010 19:08:20 +0000</lastBuildDate> <language>en</language> <sy:updatePeriod>hourly</sy:updatePeriod> <sy:updateFrequency>1</sy:updateFrequency> <generator>http://wordpress.org/?v=3.0.1</generator> <atom10:link xmlns:atom10="http://www.w3.org/2005/Atom" rel="self" type="application/rss+xml" href="http://feed.cgdev.org/cgdev/globalhealth" /><feedburner:info uri="cgdev/globalhealth" /><atom10:link xmlns:atom10="http://www.w3.org/2005/Atom" rel="hub" href="http://pubsubhubbub.appspot.com/" /><item> <title>Report on the Long-Term Burden of HIV/AIDS in Africa to be Launched Monday, November 29</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/RhSObdme104/report-on-the-long-term-burden-of-hivaids-in-africa-to-be-launched-monday-november-29.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/report-on-the-long-term-burden-of-hivaids-in-africa-to-be-launched-monday-november-29.php#comments</comments> <pubDate>Wed, 24 Nov 2010 19:06:09 +0000</pubDate> <dc:creator>Mead Over</dc:creator> <category><![CDATA[HIV/AIDS & Infectious Diseases]]></category> <category><![CDATA[AIDS Transition]]></category> <category><![CDATA[HIV/AIDS]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2135</guid> <description><![CDATA[By Mead Over - About a year ago the Institute of Medicine assembled a committee of 12 to advise the US on the implications for its policy towards Africa of the long-term burden of AIDS there.  The two co-chairs of the committee, Tom Quinn and David Serwadda, will release the report findings to the press on Monday, November 27 [...]]]></description> <content:encoded><![CDATA[By Mead Over - About a year ago the Institute of Medicine assembled a committee of 12 to advise the US on the implications for its policy towards Africa of the long-term burden of AIDS there.  The two co-chairs of the committee, Tom Quinn and David Serwadda, will release the report findings to the press on Monday, November 27 here in DC, and I will help them respond to questions from the press and public.  A formal description of the committee’s mandate and a complete list of the committee members can be found <a href="http://www.iom.edu/Activities/Global/LongTermAIDS.aspx">here</a>.  If you would like to attend, you can register <a href="http://www.surveygizmo.com/s3/416329/Preparing-for-the-Future-of-HIV-AIDS-in-Africa-A-Shared-Responsibility">here</a>.  In view of the recent release of the rather optimistic <a href="http://www.unaids.org/documents/20101123_GlobalReport_em.pdf?utm_&&&">2010 UNAIDS Global Report</a>, journalists are likely to ask why our committee is so pessimistic about the future of epidemic – unless the US Congress, African governments and other policy makers change their policies now in dramatic ways.  A big distinction between us and the UNAIDS report is our perspective – towards 2020 and beyond.  Tune in next week for more. <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/RhSObdme104" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/report-on-the-long-term-burden-of-hivaids-in-africa-to-be-launched-monday-november-29.php/feed</wfw:commentRss> <slash:comments>0</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/report-on-the-long-term-burden-of-hivaids-in-africa-to-be-launched-monday-november-29.php</feedburner:origLink></item> <item> <title>Efficiency: The Missing Link in Global Health</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/xWvZrf7jHqQ/efficiency-the-missing-link-in-global-health.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/efficiency-the-missing-link-in-global-health.php#comments</comments> <pubDate>Tue, 23 Nov 2010 20:17:54 +0000</pubDate> <dc:creator>Amanda Glassman</dc:creator> <category><![CDATA[Global Health]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2130</guid> <description><![CDATA[By Amanda Glassman - In a refreshing and necessary change from the last decade’s focus on more money, the 2010 World Health Report —released yesterday by the WHO—focuses part of its attention on the problem of health system inefficiencies, estimating that 20% to 40% of all health spending ($1.5 trillion USD) is currently wasted. The report indicates that this [...]]]></description> <content:encoded><![CDATA[By Amanda Glassman - In a refreshing and necessary change from the last decade’s focus on more money, the <a href="http://www.who.int/whr/2010/en/index.html">2010 World Health Report</a> —released yesterday by the WHO—focuses part of its attention on the problem of health system inefficiencies, estimating that 20% to 40% of all health spending ($1.5 trillion USD) is currently wasted. The report indicates that this level of waste—a combined result of poorly used inputs and corruption/fraud—is of similar magnitude in both poor and wealthy countries. Although these numbers are merely illustrative (based on specific country studies or systematic reviews and extrapolated to entire groups of countries), the evidence does suggest that the technical efficiency problem is huge. If you add the problems of allocative efficiency to the mix—that countries and their donor partners are not fully financing the set of interventions that would maximize health given the budget constraint—the report makes a convincing case that there is much that governments and donors could do to free up resources for better health. The report’s recommendations for the international community relate to aid effectiveness (national health plans, predictability, unified reporting requirements), but the international community could be more pro-active. Here are three ideas: <ol> <li>Clearly define measures of inefficiency in health systems, include them as part of the WHO’s core indicators, and track them in future World Health Reports. The 2000 Report proposed one metric of (in)efficiency and the 2010 Report uses others, so it’s difficult to know how things are changing over time. Deciding on a set of easy-to-understand, consistent definitions of technical and allocative efficiency indicators would help policymakers measure progress in their own countries, identify and cost possible solutions in their national health strategies, and orient donor spending accordingly.</li> <li>Measure the results of health system strengthening using efficiency measures. New money in global health is destined for health systems strengthening (HSS) —both the U.S. Global Health Initiative and the Health Systems Funding Platform (IHP+) boarded this train. But difficulties remain in defining the expected results from these investments, given their indirect connection to service coverage and health outcomes. Efficiency measures are the missing link between inputs and outputs/outcomes. If you care about health systems strengthening to improve maternal health, for example, you will want to know whether the mix of interventions selected for public financing is the one that will maximize maternal health outcomes, whether the inputs purchased or deployed are used efficiently (i.e., the report describes low capacity utilization in hospitals in Ghana, Nigeria, and Pakistan), and finally whether the provision apparatus is efficient at producing coverage of key services.</li> <li>Use aid to support and monitor efficiency-improving institutions and processes. Institutions such as the UK’s National Institute for Health and Clinical Excellence (NICE) and Thailand’s Health Intervention and Technology Assessment Program (HITAP) are drivers of efficiency improvements in their respective health systems and demonstrate that the difficult political economy of priority-setting is not insurmountable. While not every country will have the resources to set up a HITAP or a NICE, providing technical assistance and financial (and moral) support to establish and expand similar public funding allocation processes in developing countries—that could be tracked by civil society—may represent a global or at least, a regional public good. Civil society monitoring of provision and expenditure is probably a better, more sustainable solution to identifying corruption, waste, and mismanagement than cutting off the public sector from aid anytime an irregularity is detected.</li> </ol> Suggestions for additional or different actions are welcome, or thoughts on what obstacles still need to be overcome in the development of a more effective response. <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/xWvZrf7jHqQ" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/efficiency-the-missing-link-in-global-health.php/feed</wfw:commentRss> <slash:comments>1</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/efficiency-the-missing-link-in-global-health.php</feedburner:origLink></item> <item> <title>Data Revolution: One Vital Registration at a Time?</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/L7pOC3y6WLU/data-revolution-one-vital-registration-at-a-time.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/data-revolution-one-vital-registration-at-a-time.php#comments</comments> <pubDate>Tue, 23 Nov 2010 14:52:07 +0000</pubDate> <dc:creator>Bill Savedoff</dc:creator> <category><![CDATA[Global Health]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2126</guid> <description><![CDATA[By Bill Savedoff - Recent blogs by Nandini Oomman and Karen Grepin have asked whether there’s enough interest to make the necessary investments in improving health systems research and, by extension, in the data necessary for such analysis. I’ve been coming at this same question from a different direction, asking whether we can identify a measurable health outcome that [...]]]></description> <content:encoded><![CDATA[By Bill Savedoff - Recent blogs by <a href="http://blogs.cgdev.org/globalhealth/2010/11/you-say-you-want-a-data-revolution.php">Nandini Oomman</a> and <a href="http://www.karengrepin.com/2010/11/how-do-you-do-research-on-health.html">Karen Grepin</a> have asked whether there’s enough interest to make the necessary investments in improving health systems research and, by extension, in the data necessary for such analysis. I’ve been coming at this same question from a different direction, asking whether we can identify a measurable health outcome that could serve as the basis for a <a href="http://www.cgdev.org/section/initiatives/_active/codaid">Cash on Delivery aid</a> program. Some examples might include payments for each additional child who survives to age five, for each averted maternal death, or for each 1 percent reduction in the incidence of an infectious disease like HIV or malaria. In each case, the effort has been stymied by the poor quality of existing data – even for indicators like child mortality, maternal mortality, and the spread of infectious diseases that are widely cited, but often wildly inaccurate. In a draft working paper, “<a href="http://www.cgdev.org/doc/Cash on Delivery AID/Cash on Delivery for Health Discussion Draft 9 28 10.pdf">COD Aid for Health</a>,” Mead Over, Katherine Douglas, and I assess a range of health outcome indicators that would be easier to measure reliably if good quality vital registration were available. For example, a recipient could overstate the maternal mortality ratio by simply excluding marginal populations with higher mortality rates. A vital registration that captured most births would provide a check on such manipulation. So in addition to considering COD Aid programs that would pay for reducing maternal mortality or the incidence of AIDS, we chose to consider vital registration as a target in its own right, even though it is not a health outcome. If foreign aid agencies are serious about knowing the impacts of their programs, creating incentives for countries to get their vital registration in order would be quite useful. What would happen, say, if an aid agency offered a country $25 for each registered birth, coupled with an independent survey to assess the accuracy of the registration system? The independent verification would not only establish credibility for the payers but also provide feedback on the quality and accuracy of the vital registration system. The existence of a vital registration system would then provide the basis for really determining whether progress is being made against maternal, infant, and child mortality. Of course, we’re not hooked on one particular approach to vital registration. Traditionally, this means setting up administrative systems to register births at formal health facilities. But there is no reason that birth registration cannot be achieved by other approaches in countries where institutional delivery is not widespread, such as utilizing more regular household surveys or outreach programs. My interest in promoting such a program was strengthened further when I came across articles describing the benefits of vital registration beyond the realm of research and public policy and into the realm of civil and human rights. For example, an <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1672979">article by Paula Gerber</a> describes the problems faced by indigenous peoples in Australia when they lack birth certificates: <blockquote>The invisibility that Indigenous people suffer was recently highlighted when participants in the Gippsland East Aboriginal Driver Education Project could not get a driver’s license – not because they could not pass the test, or safely drive a car, but rather because they could not produce the proof of identity documentation required by VicRoads as a condition precedent to obtaining a driver’s license. Sixty of the participants did not have a birth certificate, and the births of 10 of these had never been registered.</blockquote> Now, focusing aid on vital registration – as with health systems and data collection – may not be terribly exciting to everyone. It certainly does not sound as compelling as contributing to save a life or eradicate a disease. Nevertheless, the growing demands for “value for money” and demonstrating results in health assistance are never going to be satisfied if we don’t make these investments. The associated benefits of vital registration in terms of giving marginalized people visibility and legal standing with regard to the public sector could be the ticket to mobilizing efforts on this critical element of public data collection. p.s. We are busy revising the <a href="http://www.cgdev.org/doc/Cash on Delivery AID/Cash on Delivery for Health Discussion Draft 9 28 10.pdf">COD Aid for Health draft</a> and would welcome any comments that would help us improve it! <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/L7pOC3y6WLU" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/data-revolution-one-vital-registration-at-a-time.php/feed</wfw:commentRss> <slash:comments>0</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/data-revolution-one-vital-registration-at-a-time.php</feedburner:origLink></item> <item> <title>You Say You Want a Data Revolution!</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/mxzAWEmPSNc/you-say-you-want-a-data-revolution.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/you-say-you-want-a-data-revolution.php#comments</comments> <pubDate>Thu, 18 Nov 2010 21:58:41 +0000</pubDate> <dc:creator>Nandini Oomman</dc:creator> <category><![CDATA[Health Systems]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2123</guid> <description><![CDATA[By Nandini Oomman - A couple of days ago, I posted a blog on the first ever Global Symposium on Health Systems Research, and raised the question: “Will Research Make Health System Strengthening Sexier?” I’m not in Montreux, but I am following some of the sessions from Washington D.C., thanks to Twitter, Blogs, Webcasts! I’ve seen multiple re-tweets of [...]]]></description> <content:encoded><![CDATA[By Nandini Oomman - A couple of days ago, I posted a <a href="http://blogs.cgdev.org/globalhealth/2010/11/can-research-make-health-systems-strengthening-sexier.php">blog</a> on the first ever <a href="http://www.hsr-symposium.org/">Global Symposium on Health Systems Research</a>, and raised the question: “Will Research Make Health System Strengthening Sexier?” I’m not in Montreux, but I am following some of the sessions from Washington D.C., thanks to Twitter, Blogs, Webcasts! I’ve seen multiple re-tweets of my post and a few references to the blog post in other blog posts. The comment that I’d like to share here is from <a href="http://www.karengrepin.com/2010/11/how-do-you-do-research-on-health.html">Karen Grepin</a>, who builds on the challenge I raise about health system performance and its links to health outcomes. She says: <blockquote>“What struck me after attending these two, relatively distinct discussions, is just how difficult it is conduct good and meaningful health systems research – the focus of this conference – when the outcomes that most people would agree that health systems should target – reductions in mortality and morbidity, improvements in financial risk protection, and improvements in patient satisfaction – are so imperfectly and so incompletely measured – if they are even measured at all.”</blockquote> Yes, we desperately need data to measure health outcomes more accurately and reliably. I would add that we also need systematically collected data to be able to define and measure health system performance. Karen ends her post with a question that motivated me to write this post: <blockquote>“Nandini Oomman recently asked in a <a href="http://blogs.cgdev.org/globalhealth/2010/11/can-research-make-health-systems-strengthening-sexier.php">blog post</a> on the Center for Global Development’s Global Health Policy blog about whether research can make health system strengthening sexier, but I am left wondering if health system research itself will ever be sexy enough for the needed investments in data to be made?”</blockquote> In my view, health system research can be sexy, if we have data! I know that’s a bit of a cyclical argument, but I think it’s time for a Data Revolution campaign. Don’t get me wrong. We don’t necessarily need MORE data (I’m sure we could cut out a lot of useless data that are collected and never used in countries or by donors), but better and relevant (as in most useful) data. What will incentivize global health donors to assist in this data revolution? Perhaps the sobering reminder that dollars spent in the scale up of health service delivery towards universal health coverage, without the right data to measure health system performance and health outcomes, are dollars not well spent. <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/mxzAWEmPSNc" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/you-say-you-want-a-data-revolution.php/feed</wfw:commentRss> <slash:comments>2</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/you-say-you-want-a-data-revolution.php</feedburner:origLink></item> <item> <title>Coke in Africa 2, or Why Soft Drink Supply Chains Could Inspire Better Performance in Global Health</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/a-fHMddNjQQ/coke-in-africa-2-or-why-soft-drink-supply-chains-could-inspire-better-performance-in-global-health.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/coke-in-africa-2-or-why-soft-drink-supply-chains-could-inspire-better-performance-in-global-health.php#comments</comments> <pubDate>Wed, 17 Nov 2010 18:38:58 +0000</pubDate> <dc:creator>Amanda Glassman</dc:creator> <category><![CDATA[Global Health]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2119</guid> <description><![CDATA[By Amanda Glassman - In response to my previous post on Coke in Africa, comments from A. Barnes and Eric Meade draw our attention to the use of Coca-Cola distribution networks as ways to distribute essential medicines and supplies in poor countries. This is one of those nuggets that people always highlight when lamenting lack of access in Africa [...]]]></description> <content:encoded><![CDATA[By Amanda Glassman - In response to my previous post on <a href="http://blogs.cgdev.org/globalhealth/2010/11/coke-in-africa-please-market-diet.php">Coke in Africa</a>, comments from A. Barnes and Eric Meade draw our attention to the use of Coca-Cola distribution networks as ways to distribute essential medicines and supplies in poor countries. This is one of those nuggets that people always highlight when lamenting lack of access in Africa and elsewhere, but is it a good idea? Prashant Yadav is a professor of supply chain management at Zaragoza-MIT Logistics Center that works across the developing world. In a recently released <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1656386">paper</a>, Yadav and his co-authors compare medicine supply chains to soft drink supply chains. While Yadav’s paper doesn’t help us decide if piggybacking on Coke distribution is a good idea, it reveals that soft drink supply chains have plenty of features to emulate: <ol> <li>Supply chain planning: Medicine supply chains tend to rely on old data and strong assumptions about demand and use in front-line clinics, while soft drink supply chains utilize continuous information about deliveries and consumption at points-of-sale, often done cooperatively with many consumer product companies. The result is an always-available product.</li> <li>Competition: In soft drink land, if a distributor doesn’t perform, the manufacturer simply changes distributors. In medicines land, if the Central Medical Stores (CMS) does not perform, the consequences are borne by patients who do not receive life-saving interventions. While recognizing that storage and distribution of medicines may be more complex and likely requires certification, Ministries of Health could structure performance-based contracts with private distributors, or at least set up better contracts with CMS that include…</li> <li>Incentive structures: In soft drink land, distributors are paid based on sales and pricing, resulting in incentives for efficient distribution and larger sales of the product. In medicines land, we don’t want to promote irrational use, but we do want to encourage timely, accurate deliveries, non-expired stocks, and better reporting on medicines use. What if Ministries or donors pay CMS for on-time, accurate deliveries and regular reports on medicines stock and use, then randomly audit facilities on a regular basis to minimize perverse incentives to misreport?</li> </ol> CGD’s <a href="http://www.cgdev.org/section/initiatives/_archive/demandforecasting/dfabout">Demand Forecasting Working Group</a> identified many of these issues in its <a href="http://www.cgdev.org/content/publications/detail/13784">report</a> in 2006, but progress has been slow on implementation. Maybe Coke can use some its corporate social responsibility dollars (or hopefully Yuan) to help set up better medicine distribution chains based on soft drink know-how? <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/a-fHMddNjQQ" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/coke-in-africa-2-or-why-soft-drink-supply-chains-could-inspire-better-performance-in-global-health.php/feed</wfw:commentRss> <slash:comments>1</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/coke-in-africa-2-or-why-soft-drink-supply-chains-could-inspire-better-performance-in-global-health.php</feedburner:origLink></item> <item> <title>Can Research Make Health Systems Strengthening Sexier?</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/5r-cm99_PUw/can-research-make-health-systems-strengthening-sexier.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/can-research-make-health-systems-strengthening-sexier.php#comments</comments> <pubDate>Mon, 15 Nov 2010 22:25:42 +0000</pubDate> <dc:creator>Nandini Oomman</dc:creator> <category><![CDATA[HIV/AIDS and other Infectious Diseases]]></category> <category><![CDATA[Health Systems]]></category> <category><![CDATA[Global Health Initiative]]></category> <category><![CDATA[HIV/AIDS]]></category> <category><![CDATA[USAID]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2074</guid> <description><![CDATA[By Nandini Oomman - Today, researchers, donors, policymakers, and advocates from around the world met in Montreux, Switzerland for the first ever Global Symposium for Health Systems Research. The objectives of the conference, laid out in an interesting Debategraph , are to collectively establish a science-based approach to accelerate universal health coverage. The topic of health systems failure sounds [...]]]></description> <content:encoded><![CDATA[By Nandini Oomman - Today, researchers, donors, policymakers, and advocates from around the world met in Montreux, Switzerland for the first ever <a href="http://www.hsr-symposium.org/">Global Symposium for Health Systems Research</a>. The objectives of the conference, laid out in an interesting <a href="http://www.hsr-symposium.org/index.php/the-debate">Debategraph</a> , are to collectively establish a science-based approach to accelerate universal health coverage. The topic of health systems failure sounds positively humdrum to many of us who have worked in global health. Resources for building, monitoring and evaluating health systems have been woefully inadequate for decades, so, why the interest in health systems now? Quick Response: In the last decade, a critical health threat—AIDS—emerged in low income and middle income countries, especially in sub-Saharan Africa. The unprecedented global response and funding that poured into disease-burdened countries brought health systems failure into high relief, catalyzing interest from donors, country governments, implementers, and researchers to make health systems work for a broad range of health priorities. Longer Version: The AIDS pandemic and global response exposed health system failure as a complex problem, requiring more than financial resources When funding for AIDS grew to unprecedented levels in the last decade (in 2009, <a href="http://facts.kff.org/chart.aspx?ch=950">estimated</a> to be $15.9 billion dollars from all sources), global health became a key development issue, highlighting several challenges that aren’t easily solved by money alone—including functional and comprehensive health systems. In 2008, my <a href="http://www.cgdev.org/section/initiatives/_active/hivmonitor/analysis">colleagues</a> and I published a report (see <a href="http://www.cgdev.org/content/publications/detail/16459">here</a>) from CGD’s <a href="http://www.cgdev.org/section/initiatives/_active/hivmonitor">HIV/AIDS Monitor </a> to describe the ways in which big AIDS donors (such as for PEPFAR and the Global Fund for Aids, TB and Malaria) were either interacting with or avoiding failing health systems in three African countries to achieve ambitious AIDS program goals. The report found that even with the new global health resources available, three key components of the health system: health information systems; supply chains; and the health work force, remained weak beyond AIDS-specific programs. Our recommendations urged donors and countries to seize the opportunity to fix health systems to respond to a broad range of health priorities, learning from some of the best practices that AIDS programs had put into place. Others began to comment on and examine the impact of AIDS funding on health systems in developing countries (see <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60919-3/abstract">here</a>, <a href="http://journals.lww.com/jaids/fulltext/2009/11011">here</a> and <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61984-X/fulltext">here</a>), but found it difficult to define a health system, let alone measure how it has been strengthened or weakened by surges in AIDS funding. New Resources, new policies, and now new research are making health systems sexy! In 2009, President Obama announced the <a href="http://www.whitehouse.gov/the_press_office/Statement-by-the-President-on-Global-Health-Initiative/">Global Health Initiative</a> (GHI), one of the three key development initiatives of this administration’s <a href="http://www.whitehouse.gov/the-press-office/2010/09/22/fact-sheet-us-global-development-policy">new development policy</a>. With a price tag of $63 billion dollars over 6 years (FY 2009-14), the GHI focuses on 9 target areas including: HIV/AIDS, Malaria, Tuberculosis, Maternal & Child Health, Nutrition, Family Planning & Reproductive Health, Neglected Tropical Diseases, AND (drumroll) health systems strengthening!! In September of this year at a public event in Washington, D.C., Raj Shah, Administrator, USAID said, “I, in particular, think a good health system can be quite sexy!” The U.S. government’s effort and <a href="http://go.worldbank.org/0IVEXL4N30">other efforts</a> to tackle weak health systems as a key development objective is creating the space to address a long standing and not-so-sexy global development challenge. But a serious impediment to progress on this front is the lack of a solid evidence base that can support the theory and practice of strengthening health systems. For example, researchers and policymakers have been struggling with developing a set of indicators that can measure the performance of health systems, so that we can measure the effects/impact of health system strengthening interventions. The meeting of global health minds in Montreux to establish and develop a science based approach to strengthening health systems is long overdue. The Challenges Ahead: Relating health systems performance to health outcomes The research agenda that colleagues establish in Montreux should include research that is operational and important for monitoring the status and performance of a health system, but I’m looking forward to learning more about how experts will propose research to study the links of a strong health system to better health outcomes for all. After all, we are strengthening health systems as a means to an end, and not an end in and of itself. See David Bishai’s excellent <a href="http://futurehealthsystems.wordpress.com/">post</a> cautioning us “that our discourse on health systems should not forget that health systems are not the foremost determinants of the health of nations. We would have to open the concept of health systems to include sanitation, water, housing, roads, schools, jobs, and political systems to make health systems truly include the determinants of health.” Time is of essence Sound scientific research is very welcome but it is going to take some time for evidence to emerge. I’m worried that the U.S. and other donors have made big promises to their partner countries about strengthening their health systems, but are struggling to describe what a successful effort will look like on an annual basis, and at the end of their programs. This is critical, not just politically for President Obama and his administration, but for continued investments in global health. I’m hoping that the time lag between research results and useful policy/program applications will not take as long as the establishment of a science-based approach to strengthening and measuring health systems. <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/5r-cm99_PUw" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/can-research-make-health-systems-strengthening-sexier.php/feed</wfw:commentRss> <slash:comments>0</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/can-research-make-health-systems-strengthening-sexier.php</feedburner:origLink></item> <item> <title>Getting More Than a Buzz out of mHealth</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/gjCQ0NvJnYU/getting-more-than-a-buzz-out-of-mhealth.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/getting-more-than-a-buzz-out-of-mhealth.php#comments</comments> <pubDate>Thu, 11 Nov 2010 15:15:56 +0000</pubDate> <dc:creator>Nandini Oomman</dc:creator> <category><![CDATA[Pharmaceuticals & Health Products]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2062</guid> <description><![CDATA[By Nandini Oomman - The mHealth Summit 2010 concluded yesterday in Washington, D.C., after three days of focusing on mobile technologies for health. What’s all the buzz about? (And I don’t mean from the 2000 mobile phones on vibrate mode at the conference center.) I couldn’t attend the summit, so I caught snatches of it from Twitter, by speaking [...]]]></description> <content:encoded><![CDATA[By Nandini Oomman - The <a href="http://www.mhealthsummit.org/">mHealth Summit 2010</a> concluded yesterday in Washington, D.C., after three days of focusing on mobile technologies for health. What’s all the buzz about? (And I don’t mean from the 2000 mobile phones on vibrate mode at the conference center.) I couldn’t attend the summit, so I caught snatches of it from Twitter, by speaking with attendees, and by reading what I could get my hands on via the internet. Related materials included <a href="http://www.huffingtonpost.com/bill-gates/cell-phone-science_b_781602.html">high level endorsements</a> of mobile technologies for health, <a href="http://www.whitehouse.gov/blog/2010/11/09/text4baby-growing-sets-million-mom-goal">call outs</a> for <a href="http://www.text4baby.org/news/t4b_and%20usda_team.html">“successful”</a> public-private partnerships for mHealth programs, <a href="http://blog4globalhealth.wordpress.com/2010/11/10/ted-turner-and-bill-gates-how-they-see-mobile-health/">discussions</a> about mHealth interventions and their potential impact on health outcomes and of course, the usual announcements of further resources for development of new technologies (<a href="http://humanosphere.kplu.org/2010/11/more-gates-foundation-science-grants-for-global-health-mobile-technologies/">here, </a><a href="http://www.smartplatforms.org/2010/11/us-cto-aneesh-chopra-announces-the-smart-health-app-5000-challenge/">here</a>) and <a href="http://www.text4baby.org/news/t4b_comprehensive_platform.html">here</a>. <table class="image" align="right"> <caption><a href="http://www.irinnews.org/">Neil Thomas/IRIN</a></caption> <tbody> <tr> <td><img src="http://blogs.cgdev.org/globalhealth/files/2010/11/Maasai_cell_phone.png" alt="" width="316" height="210" align="right" /></td> </tr> </tbody> </table> What piqued my interest was a <a href="http://mhealthsummit.org/conference/program/super-session-panel-lessons-learned-across-globe-0">“Super Session”</a> on what we’ve learned so far about using mobile technologies for health. A couple of different renditions (<a href="http://wiki.openmrs.org/display/docs/mHealth+Top+10">here</a> and <a href="http://innovationsandstuff.blogspot.com/2010/11/what-lessons-learned-do-you-have-from.html">here</a>) of the list of “top 10 lessons learned” emerged in the blogosphere, on Twitter, and from friends who were in the audience for this session. They vary slightly in how they capture these lessons, but one appeared prominently on all of the different lists that I found: mHealth Interventions Need to be Evaluated. It’s the perfect time to create a Learning Agenda for mHealth Given that we seem to be on the brink of a massive expansion of the use of mobile technologies for health, taking this evaluation lesson forward will require some careful thinking about what we really want to know about mHealth to use the resources we have effectively. As a start, here are a few ideas for next steps: <ol> <li>Create a Learning Agenda to evaluate the impact and outcomes (i.e. did the mHealth intervention work or not) of interventions, AND an implementation research agenda that allows us to assess the HOW and WHY of interventions. Bill Gates endorsed mHealth technologies as a critical health tool, but flagged this point for summit participants in his speech, best captured in <a href="http://blog4globalhealth.wordpress.com/2010/11/10/ted-turner-and-bill-gates-how-they-see-mobile-health/">David Olson’s blog</a>: <blockquote>“..he cautioned that these technologies are very much dependent on local variables (the quality of health personnel and infrastructure, for example) and that “It will be easy to fool yourself into thinking that something that works in one place will work equally well in another.” He believes that the greatest mHealth innovation will come not in the poor countries and not in rich countries but in middle-income countries like Brazil, China and India.”</blockquote> </li> <li>Determine who should lead the development of this Learning Agenda to distill the list of research questions with a range of stakeholders—investors, researchers, program implementers, and USERS (after all they are the key to how an mHealth technology gets used effectively). Following this, identify and vet study designs, select research methods and ensure that baseline data are collected, before programs are launched.</li> <li>Establish a hub for sharing information about program implementation and program assessment. I note that the <a href="http://www.mhealthalliance.org/">mHealth Alliance</a> has created a <a href="http://www.healthunbound.org/">HUB</a> that could play this role. There is a lot of information posted on this website about programs and research, and this is going to increase in volume with the buzz around mHealth. But a smart, information technology driven, knowledge management initiative that could distill and disseminate lessons learned from program implementation and from evaluations (rather than just list them) would be an enormous contribution to development practice in real time!</li> </ol> Comment on this post with ideas for how a Learning Agenda could be created and/or specific questions we need to ask about using mobile technologies to enhance the effective delivery of health services for different health priorities. One final note: I’m disappointed with video capability of the tech savvy mHealth summit organizers. If you didn’t catch a live webcast of a session, you’ve missed it. I sent in a request/query to find out if videos have been archived. No response yet. If I find out, I will update this blog post. <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/gjCQ0NvJnYU" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/getting-more-than-a-buzz-out-of-mhealth.php/feed</wfw:commentRss> <slash:comments>2</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/getting-more-than-a-buzz-out-of-mhealth.php</feedburner:origLink></item> <item> <title>Coke in Africa: Please Market Diet!</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/ugZlwjvKA28/coke-in-africa-please-market-diet.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/11/coke-in-africa-please-market-diet.php#comments</comments> <pubDate>Tue, 09 Nov 2010 16:50:11 +0000</pubDate> <dc:creator>Amanda Glassman</dc:creator> <category><![CDATA[Global Health]]></category> <category><![CDATA[Non-Communicable Disease]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2056</guid> <description><![CDATA[By Amanda Glassman - Last week’s Bloomberg Businessweek reports on Coca-Cola’s efforts to expand its market in Africa, which the reporter Duane Stanford describes as the final frontier in Coke profits. Coke is now in a street-by-street campaign to win drinkers, trying to increase per-capita annual consumption of its beverages in countries not yet used to guzzling Coke by [...]]]></description> <content:encoded><![CDATA[By Amanda Glassman - Last week’s Bloomberg Businessweek <a href="http://www.businessweek.com/magazine/content/10_45/b4202054144294.htm">reports</a> on Coca-Cola’s efforts to expand its market in Africa, which the reporter Duane Stanford describes as the final frontier in Coke profits. <blockquote>Coke is now in a street-by-street campaign to win drinkers, trying to increase per-capita annual consumption of its beverages in countries not yet used to guzzling Coke by the gallon. To do so, Coca-Cola is applying lessons learned in Latin America, where an aggressive courtship of small stores helped boost per-capita consumption in Mexico to the highest in the world.</blockquote> While recognizing the importance of Coke as a contributor to economic development – Coke is Africa’s largest employer – let’s also take a moment to look at this “success” in Mexico and its <a href="http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0036-36342009001000020">implications for health</a>. In 2008, soft drinks represented 20 percent of the average number of calories consumed by adolescents and adults in Mexico. Ninety percent of adolescents drink a soda daily. Large sample studies have <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924923/">linked</a> soda consumption in Mexico with increasing body mass index; about 69% of women 20-49 years old are now overweight or obese, a risk factor for many non-communicable diseases. Consequently, overweight and obesity problems now coexist with micronutrient deficiencies like anemia that have effects on cognitive ability and academic performance. Of course, while Mexico consumes more Coca-Cola than any other country, Coca-Cola drinks are not the only sugary drinks in Mexico – Mexico’s own aguas frescas and other sodas also figure prominently. A question for industry: Your efforts to be good corporate citizens are welcome, but can you market healthier drinks in developing countries as successfully as Coke? See my colleague Rachel Nugent’s recent <a href="http://www.cgdev.org/content/publications/detail/1424546">working paper</a> and <a href="http://blogs.cgdev.org/global_prosperity_wonkcast/2010/10/31/non-communicable-diseases-a-huge-problem-in-developing-world-funding-scant-interview-with-rachel-nugent/">podcast</a> on non-communicable disease for more information on the rising problems of obesity and diabetes in the developing world. <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/ugZlwjvKA28" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/11/coke-in-africa-please-market-diet.php/feed</wfw:commentRss> <slash:comments>3</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/11/coke-in-africa-please-market-diet.php</feedburner:origLink></item> <item> <title>If Medical Science Is Biased, What Does It Mean for Development…?</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/SwBaF5IRu2Q/if-medical-science-is-biased-what-does-it-mean-for-development%e2%80%a6.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/10/if-medical-science-is-biased-what-does-it-mean-for-development%e2%80%a6.php#comments</comments> <pubDate>Tue, 26 Oct 2010 21:23:35 +0000</pubDate> <dc:creator>William Savedoff</dc:creator> <category><![CDATA[Global Health]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2052</guid> <description><![CDATA[By William Savedoff - In “Lies, Damned Lies and Medical Science,” David H. Freedman profiles the work of Dr. John Ioannidis who studies the quality of medical research and finds it to be full of findings that range from misleading and overhyped to completely false. As concerned patients, this raises the big question of whether medical professionals can be [...]]]></description> <content:encoded><![CDATA[By William Savedoff - In <a href="http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269">“Lies, Damned Lies and Medical Science,”</a> David H. Freedman profiles the work of Dr. John Ioannidis who studies the quality of medical research and finds it to be full of findings that range from misleading and overhyped to completely false. As concerned patients, this raises the big question of whether medical professionals can be trusted to give us good advice when the evidence base is so flawed. But the dynamic that Ioannidis reveals in medical research is also a clear problem for anyone working in health policy research. For me, the most troubling issue revealed by Ioannidis’ research occurs when he moves from identifying the specific sources of research errors to asking questions about why such errors are so widespread and systemic. He concludes that the entire research process is full of bias: <blockquote>“At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”</blockquote> This reminded me of another article by De Long and Lang (“<a href="http://www.jstor.org/pss/2138833">Are All Economic Hypotheses False?</a>” JPE 1992) which analyzes published economic research to look for publication bias. They showed that if the published literature were unbiased, it would contain far more negative findings than actually occur (i.e. studies that fail to reject the null hypothesis). The result is a literature that over-represents positive findings and is therefore misleading. Publication bias also figured in the CGD <a href="http://www.cgdev.org/content/publications/detail/7973">Evaluation Gap Working Group’s report</a> which discussed the tendency of development institutions to disseminate positive findings and either soften or hide studies that are less flattering. The pressure to show that a particular medical treatment works is obvious when financial interests are at stake, but it is no less insidious when professional reputations or academic tenure are on the table. For health projects in developing countries, the pressure to claim success is furthered by the fear that any hint of failure or even modest progress will discourage the public and private donations that make development work possible. It may be difficult to stand against these pressures, but we can and should. As Freedman quotes Ioannidis: <blockquote>“If the drugs don’t work and we’re not sure how to treat something, why should we claim differently? Some fear that there may be less funding because we stop claiming we can prove we have miraculous treatments. But if we can’t really provide those miracles, how long will we be able to fool the public anyway? The scientific enterprise is probably the most fantastic achievement in human history, but that doesn’t mean we have a right to overstate what we’re accomplishing.”</blockquote> <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/SwBaF5IRu2Q" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/10/if-medical-science-is-biased-what-does-it-mean-for-development%e2%80%a6.php/feed</wfw:commentRss> <slash:comments>8</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/10/if-medical-science-is-biased-what-does-it-mean-for-development%e2%80%a6.php</feedburner:origLink></item> <item> <title>What’s Not Being Said about the U.S. Government’s Role in the Global Fund Replenishment</title> <link>http://feed.cgdev.org/~r/cgdev/globalhealth/~3/CIN3fWAENEc/what%e2%80%99s-not-being-said-about-the-u-s-government%e2%80%99s-role-in-the-global-fund-replenishment.php</link> <comments>http://blogs.cgdev.org/globalhealth/2010/10/what%e2%80%99s-not-being-said-about-the-u-s-government%e2%80%99s-role-in-the-global-fund-replenishment.php#comments</comments> <pubDate>Wed, 20 Oct 2010 13:46:46 +0000</pubDate> <dc:creator>Nandini Oomman</dc:creator> <category><![CDATA[Donor Community]]></category> <category><![CDATA[Global Fund]]></category> <category><![CDATA[Global Health Initiative]]></category> <category><![CDATA[On the Hill]]></category> <category><![CDATA[PEPFAR]]></category> <guid isPermaLink="false">http://blogs.cgdev.org/globalhealth/?p=2047</guid> <description><![CDATA[By Nandini Oomman - Since the Global Fund received $11.7 billion dollars in donor commitments for its next three years of programming, the media has focused on the over $1 billion dollar shortfall against the lowest resource scenario presented by the Fund in the lead up to its replenishment. Understandably so. Of the three funding scenarios (ranging from $13-$20 [...]]]></description> <content:encoded><![CDATA[By Nandini Oomman - Since the Global Fund <a href="http://www.theglobalfund.org/en/pressreleases/?pr=pr_101005c">received $11.7 billion dollars</a> in donor commitments for its next three years of programming, the media has focused on the over <a href="http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/oct/06/hiv-infection-aids">$1 billion dollar shortfall</a> against the lowest resource scenario presented by the Fund in the lead up to its <a href="http://www.theglobalfund.org/en/replenishment/newyork/">replenishment</a>. Understandably so. Of the <a href="http://www.theglobalfund.org/documents/replenishment/2010/Resource_Scenarios_en.pdf">three funding scenarios</a> (ranging from $13-$20 billion), the lowest scenario was considered the bare minimum of what would be needed to continue to fund existing programs. Under the lowest scenario—which is $1.3 billion more than the actual commitments—Michel Kazatchkine, Executive Director of the Global Fund, warned that new programs would be funded at significantly lower levels, if at all. In the aftermath of this disappointing replenishment, most commenters dwell on specific commitment amounts (for example <a href="http://www.nytimes.com/2010/10/06/world/africa/06aids.html?_r=1">here</a> and <a href="http://www.washingtonpost.com/wp-dyn/content/article/2010/10/05/AR2010100506616.html">here</a>) and perhaps overlook key messages that emerge from high-profile donor pledges. Consider the Global Fund’s lead donor—the United States—and its <a href="http://www.pepfar.gov/press/2010/148639.htm">Call to Action</a> that accompanied <a href="http://www.theglobalfund.org/en/pressreleases/?pr=pr_101005b"> its pledge of $4 billion</a>. I note two important takeaways: <ol> <li>The Global Fund needs dedicated partners and continuous replenishment to be an effective financing model Accompanying their pledge, the U.S. government urged “fellow donors, implementing country partners and other stakeholders to develop and implement a comprehensive set of reforms to maximize the impact of the Global Fund.” The Global Fund cannot succeed alone as a financing entity if it doesn’t have strong partners to develop and implement programs. This is not a new or trivial issue. My colleagues and I have made these observations about the Global Fund (<a href="http://blogs.cgdev.org/globalhealth/2006/10/can-the-global-fund-be-a-finan.php">here</a> and <a href="http://blogs.cgdev.org/globalhealth/2009/06/give-the-global-fund-a-gold-star-for-their-hard-hitting-evaluationnow-comes-the-hard-part.php">here</a>) for a few years now, but the U.S. government’s Call to Action makes this point explicit to the Global Fund Board and to all its partners—other donors, implementing country partners, technical partners and other stakeholders. Partners must play their role (whether it is implementation or technical assistance) for the Global Fund to succeed as an effective financing model and for donors to continue to commit resources to this financing mechanism.</li> <li>U.S. calls for the Global Fund to work more “effectively and efficiently” raise questions about PEPFAR The U.S. has given the Global Fund a solid vote of confidence, but one which has an expiry date if a set of reforms around “efficient and strategic disbursement” of resources AND strengthening country capacity to use and “maximize the impact of Global Fund resources” is not developed and implemented against clear timelines with deliverables. Although the Global Fund has already begun the process of making internal reforms, the U.S. is requesting a more comprehensive agenda—reforms at both the proposal level (development, review, and funding decisions, etc.) and the country level (grant implementation and review of effectiveness, etc.), with, “clear timelines and measures of progress so all parties can be held accountable for concrete steps in their respective areas of responsibility.” It’s hard to take issue with any of the key focuses of the <a href="http://www.pepfar.gov/press/2010/148639.htm">Call to Action</a> for the Global Fund—efficient and strategic disbursement of resources and maximized impact are a must for the Global Fund—BUT will U.S. global health programs (PEFPAR and GHI) be held accountable to the same standards? In taking the Global Fund to task, the U.S. is setting the bar higher for its own global health programs to be more efficient and effective. While the U.S. touts principles of efficiency and effectiveness, it is almost impossible to find any information on how these principles are being applied and to what end. For example, where and how are efficiencies being created in the implementation of PEPFAR? How are resources being re-allocated from these processes? Without any comparative data, how can we compare the Global Fund’s relative efficiency and effectiveness? But, this is ultimately the question the U.S. will want answered if it is considering redistributing aid for AIDS, TB and Malaria from bilateral to multilateral channels in the near future.</li> </ol> <img src="http://feeds.feedburner.com/~r/cgdev/globalhealth/~4/CIN3fWAENEc" height="1" width="1"/>]]></content:encoded> <wfw:commentRss>http://blogs.cgdev.org/globalhealth/2010/10/what%e2%80%99s-not-being-said-about-the-u-s-government%e2%80%99s-role-in-the-global-fund-replenishment.php/feed</wfw:commentRss> <slash:comments>0</slash:comments> <feedburner:origLink>http://blogs.cgdev.org/globalhealth/2010/10/what%e2%80%99s-not-being-said-about-the-u-s-government%e2%80%99s-role-in-the-global-fund-replenishment.php</feedburner:origLink></item> </channel> </rss>