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Journal of Internal Medicine. 2008 Nov; 264(5):504-8.Had there been a strong African voice contributing to World Bank decisions, it is unlikely that deliberate sidelining of HIV by health sector reforms would have taken place. However, given Bank's architecture and processes, an adequate response to the crisis was a nonstarter; unlike mediocre responses to Africa's other health needs, it has been less easy for the IDC to duck its responsibility and place the blame on its so-called African partners. Nevertheless, the lack of an African voice distorts historical analyses of the crisis often reflecting a western perspective, emphasizing the lack of political will and African governments' failure to act, whilst underplaying the IDC's shortcomings. The notion itself that the epidemic is 25 years old rather than the more accurate 75 years old reflects this distortion. Most of the responsibility rests with the Bank's Board and top management. OED reports that it 'could find no evidence that other top management raised the issue with borrowers or pushed the issue to a higher level internally'. Where there was positive response by the bank at the country level, 'the initiative for AIDS strategies and lending came primarily from individual health staff in the regional and technical operational groupings of the Bank, but not in any coherent way from the Bank's HNP leadership or top-level management. The current initiative by the British House of Commons Committee for International Development to reform the World Bank effectively reverses the notion that the reform was all but impossible because it was a zero sum game. Today, however, its donor members may find the demonstrable unfairness and ineffectiveness less tolerable. It is unlikely that the next president of the Bank will be chosen solely by the United States. Reformers will now need to revise its constitutional rules, their balancing of stakeholder rights, their decision-making rules and practices and their staffing and expertise. The course of the HIV epidemic means that the status quo is no longer acceptable. (excerpt)
New England Journal of Medicine. 2007 Feb 15; 356(7):653-656.When Dr. Margaret Chan of China was elected director--general of the World Health Organization (WHO) this past November, some observers suspected that the Chinese government had backed her candidacy in hopes of planting a lackey at the United Nations to do its bidding. In contrast, many global health experts have spoken positively about Chan's China connection. "They're hoping she has some sort of a 'red phone' to Beijing that would help WHO and global health," said Kelley Lee, a senior lecturer in global health policy at the London School of Hygiene and Tropical Medicine. But privately, some remain concerned about China's intentions, especially given the country's notorious failure to alert the world to the first cases of severe acute respiratory syndrome (SARS) in 2003. Chan is aware of all these suspicions and has a ready answer. "I have a strong record of being a straight talker," she says. "I speak the truth to power, because there's only one objective for me: whatever decision I make is based on public health evidence." She underscores her point with stories from her 25 years in public health in Hong Kong, the last 9 as director of health. "When vegetables were coming across from mainland China, when food items or any herbal medicine was coming across that did not meet my standards, I stopped them," she said. "That caused economic loss to China, clearly, but my primary consideration is public health." Similarly, Chan prohibited a U.S. company from shipping ice cream with high bacterial counts. The company said its test results were normal, and Chan replied, "Yes, normal is what I would expect for your tests. But my tests are abnormal." Ultimately, other countries found the same problem with the product. "Science speaks for itself," said Chan. (excerpt)
Guttmacher Report on Public Policy. 2002 Aug; 5(3):1-3.This paper discusses the implementation of the US Bush administration's "global gag rule" on international family programs such as the UN Population Fund and the reactions of the development community to these actions. It also details the UN General Assembly Special Session on the Child.