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International Quarterly of Community Health Education. 2006; 24(2):99-109.The power of words--and their context in the "American narrative,"--to affect international and domestic health policy, both proposal and implementation, is analyzed. The complexity of the implications for U.S. foreign policy as well as for disease outbreaks and potential bioterrorism are illustrated, with liberal references to the works of novelist James Joyce, film director Frederico Fellini, and economist/political activist Robert Reich. (author's)
Geneva, Switzerland, WHO, 2006 May.  p. (GPW/2006-2015)In giving leadership to the global health agenda, WHO fully supports the ongoing United Nations reform process. WHO acknowledges the importance of complementing it, avoiding duplication and overlap with its own work and that of other United Nations bodies engaged in health-related activities. The document also reflects the values and principles of the WHO Constitution, the Declaration of Alma-Ata, and the United Nations Millennium Declaration. Many of the issues highlighted here are not new. The difficulty lies in promoting joint action within and outside the conventional health sector, securing the commitment of many partners to resolving those issues. Therein lies the challenge of shaping the evolving role of WHO as the directing and coordinating authority in international health work. (excerpt)
New York, New York, IAVI, 2006.  p.Twenty-five years after the first five cases of a novel immunodeficiency disease were described, the AIDS pandemic has become the greatest global public health crisis since the Black Death in the Middle Ages. Although the ideal global response to HIV/AIDS must be a comprehensive approach that includes education, prevention, treatment, and care, the only way to end this epidemic is to develop a safe, accessible, and preventive vaccine. The ultimate goal is an AIDS vaccine that prevents infection from the wide spectrum of globally diverse HIV isolates and is applicable for use in the developing world, where the need is the greatest. However, a vaccine that suppresses viral load and slows progression to AIDS or suppresses and blunts transmission of HIV would have significant public health impact. To achieve that, a host of scientific, public policy, and political actions must be taken in a coordinated, interlinked fashion to make all of the necessary resources available (Figure 4). While scientific challenges continue to be the main obstacle in the search for an AIDS vaccine, countless examples of successful technology breakthroughs show that judicious policy changes and political will matters enormously. It is vital to enlist political leadership, non-governmental organizations, community groups, and a range of strategic coalitions that can amplify and reinforce support for AIDS vaccines. (excerpt)
Washington, D.C., AED, LINKAGES, 2006 Sep. 6 p. (Experience LINKAGES; USAID Cooperative Agreement No. HRN-A-00-97-00007-00; USAID Development Experience Clearinghouse Doc ID / Order No. PN-ADH-497)One of LINKAGES' goals is to assist global and local organizations in integrating results-oriented behavior change interventions, technical information, supportive policies, and other project innovations into their own programs to improve breastfeeding and related complementary feeding and maternal dietary practices. LINKAGES developed a mainstreaming framework to better define, observe, track, and guide the process. This issue of Experience LINKAGES describes what mainstreaming means and how mainstreaming lends itself to the replication, scale up, and sustainability of project innovations. LINKAGES defines mainstreaming as making routine an innovation that successfully addresses an opportunity or problem. Mainstreaming is done by--not for--organizations. Replication, scale up, and sustainability are mainstreaming goals within an organization's "geography" of headquarters, regional centers, national offices, and field projects. (excerpt)
Bulletin of the World Health Organization. 2007 Mar; 85(3):192-199.International health policy-makers now have a variety of institutional instruments with which to pursue their global and national health goals. These instruments range from the established formal multilateral organizations of the United Nations to the newer restricted-membership institutions of the Group of Eight (G8). To decide where best to deploy scarce resources, we must systematically examine the G8's contributions to global health governance. This assessment explores the contributions made by multilateral institutions such as the World Health Organization, and whether Member States comply with their commitments. We assessed whether G8 health governance assists its member governments in managing domestic politics and policy, in defining dominant normative directions, in developing and complying with collective commitments and in developing new G8-centred institutions. We found that the G8's performance improved substantially during the past decade. The G8 Member States function equally well, and each is able to combat diseases. Compliance varied among G8 Member States with respect to their health commitments, and there is scope for improvement. G8 leaders should better define their health commitments and set a one-year deadline for their delivery. In addition, Member States must seek WHO's support and set up an institution for G8 health ministers. (author's)
Non-communicable diseases and global health governance: Enhancing global processes to improve health development.
Globalization and Health. 2007 May 22; 3(1):2.This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health). The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy. (author's)
Lancet. 2007 Jul 7; 370(9581):15-16.A new spirit of cooperation and coordination between the key global players in the fight against HIV/AIDS was cemented at a meeting for programme implementers in Kigali, Rwanda, in mid-June. The partnership comes amidst concerns about rising infection rates in some countries where infections had slowed, as well as worries about the unpredictability of funding for HIV/AIDS activities. The collaboration is expected to curb duplication of efforts and wastage of resources, and to ultimately scale-up AIDS prevention and treatment. The meeting-usually an annual gathering for the US President's Emergency Plan for AIDS Relief (PEPFAR) and its grantees-opened up for the first time to include the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, the World Bank, UNICEF, WHO, and the Global Network of People Living with HIV/AIDS (GNP+), who were all co-sponsors of the conference. (excerpt)
Social Science and Medicine. 2003 Nov; 57(9):1547-1557.Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process. (author's)
How to bridge the gap between policies and implementation -- is effective AIDS control presently possible in sub-Saharan Africa? [editorial]
Tropical Medicine and International Health. 2003 Sep; 8(9):765-766.The leaders of sub-Saharan states must act now, and the international community must be prepared to respond effectively to save these societies from further destruction. The international response would have to include a revision of current policies in the light of experiences gained. We need a mixed approach: support for both for ‘sustainable’ strengthening of the whole system in line with health sector reforms and non-sustainable project support for specifically directed temporary efforts in line with the thinking behind the establishment of the Global Fund to fight AIDS, tuberculosis and malaria. We owe this to the suffering people in these countries. We also owe it to taxpayers in industrialized countries who are both willing to pay and have a genuine desire to help. (excerpt)
Washington, D.C., National Academies Press, 2003. xii, 57 p.The present monograph--on rebuilding the health sector in East Timor following the nation's struggle for independence--is the second in this series. It provides an overview of the state of the health system before, during, and after reconstruction and discusses achievements and failures in the rebuilding process, using an informative case study to draw conclusions for potential improvements to the process in other post-conflict settings. Other topics under consideration in the series include reviews of current knowledge on psychosocial issues, reproductive health, malnutrition, and diarrheal diseases, as well as other case studies. (excerpt)
Cahiers du Médecin. 2002 Dec; 6(58):45-46.This article presents a report from the macroeconomic and health committee to determine the place of health in economic and social development created by the WHO in the year 2000. The main conclusions for all aspects were presented when the report was submitted to the WHO general assembly in 2002. The observations thus raised indicated that economic losses linked to poor health have been underestimated, especially in developing countries and that the role of health in economic growth has been strongly undervalued. Because of this several pathologies are still responsible for a high percentage of avoidable deaths, particularly maternal and perinatal pathologies and infectious diseases in children. It is also noted that the level of health expenses is insufficient and that the recommended financing strategy is based on growth in budgetary credits consecrated to health and to an increase in donor subsidies. The report emphasizes the different essential actions capable of reaching disadvantaged populations and on the correct steering by the public authorities of contributions from donors in the public and private sectors. Other remarks were collected about the various financing mechanisms on the global scale to combat certain endemic infections, specifically AIDS, tuberculosis, and malaria. Efforts to improve access by the populations to essential and indispensable drugs are also being made. The report underlines the need for the signing of a health pact between governments and development agencies in order to increase resources allocated to health. For the development of health in Morocco, the author emphasizes all aspects raised in this report and suggests the creation of a "Health and development" commission as advised by the WHO.
[A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration] Reflexôes sobre a amamentação no Brasil: de como passamos a 10 meses de duração.
Cadernos de Saude Publica. 2003; 19 Suppl 1:S37-S45.In 1975, one out of two Brazilian women only breastfed until the second or third month; in a survey from 1999, one out of two breastfed for 10 months. This increase over the course of 25 years can be viewed as a success, but it also shows that many activities could be better organized, coordinated, and corrected when errors occur. Various relevant decisions have been made by international health agencies during this period, in addition to studies on breastfeeding that have reoriented practice. We propose to review the history of the Brazilian national program to promote breastfeeding, focusing on an analysis of the influence of international policies and analyzing them in four periods: 1975-1981 (when little was done), 1981-1986 (media campaigns), 1986-1996 (breastfeeding-friendly policies), and 1996-2002 (planning and human resources training activities backed by policies to protect breastfeeding). The challenge for the future is to continue to promote exclusive breastfeeding until the sixth month, taking specific population groups into account. (author's)
Geneva, Switzerland, UNAIDS, . 13 p.For over 25 years, our world has been living with HIV. And in just this short time, AIDS has become one of the make-or-break global crises of our age, undermining not just the health prospects of entire societies but also their ability to reduce poverty, promote development, and maintain national security. And in too many regions AIDS continues to expand - every single day 11 000 people are newly infected with HIV, and nearly 8 000 people die from AIDS-related illnesses. Yet, despite the magnitude of the AIDS crisis, today we are at a time of great hope and great opportunity to get ahead of the epidemic. Our crisis-response tactics have led to real progress against AIDS. Funding for efforts against AIDS has risen from 'millions' to 'billions' in just a decade. Political commitment and leadership on AIDS is higher than ever before. In more and more countries - including some of the world's poorest - we are seeing real results in terms of lives saved because effective HIV prevention and treatment programmes are being made widely available. Leaders of both developing and rich countries have now committed themselves to working together so as to get close to universal access to HIV prevention, treatment, care and support by 2010 - a critical stepping stone to halting the epidemic by 2015, as set out in the Millennium Development Goals. (excerpt)
American Journal of Public Health. 2008 Sep; 98(9):1594-7.In 1948, after its first World Health Assembly, the WHO took action to form a Secretariat in Geneva. It was given space for its initial years in the Palais des Nations, which had been the last home of the League of Nations. As stated in Chapter I of its Constitution, WHO was "to act as the directing and coordinating authority on international health work." This was a much broader scope than any other international agency in the orbit of the UN. (excerpt)
Trips and public health: solutions for ensuring global access to essential AIDS medication in the wake of the Paragraph 6 Waiver.
Journal of Contemporary Health Law and Policy. 2008 Fall; 25(1):142-65.In 2003, the World Trade Organization (WTO) proposed a waiver to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), known as the "Paragraph 6 Waiver," in order to create flexibility for developing countries and to allow easier importation of cheap generic medication. ... To the companies who own pharmaceutical patents, the notion that a government can use their product without the permission of the patent holder seems unfair and counterproductive. ... Canada was one of the first countries to enact legislation for the sole purpose of exporting generic drugs to developing countries and its experience is indicative of the problems presented by compulsory licensing and the Paragraph 6 Waiver. ... Exact amounts and methods for determining remuneration vary but presumably a fair system would compensate patent holders for the loss of their patent rights while maintaining the system's cost effectiveness for countries issuing the compulsory licenses. (excerpt)
Global Public Health. 2009; 4(2):131-49.Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.
Reproductive Health Matters. 2009 May; 17(33):91-104.This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public–private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.
A practical guide to integrating reproductive health and HIV / AIDS into grant proposals to the Global Fund.
[Washington, D.C.], Population Action International, 2009 Sep. 61 p.Starting in recent proposal rounds, The Global Fund for AIDS, Tuberculosis and Malaria (GFATM) has stated more explicitly that countries can include reproductive health as part of their proposals on AIDS, tuberculosis and malaria, as long as a justification is provided on the impact of reproductive health (RH) on reducing one of the three diseases. This document is for countries and organizations, including CCMs, government and nongovernmental organizations and civil society organizations, to help in integrating reproductive health, including family planning (RH) and HIV / AIDS in proposals submitted to the Global Fund. The document takes a country approach to integration since the Global Fund seeks to support proposals that build on and strengthen national programs. (Excerpt)
Coordination, management and utilization of foreign assistance for HIV / AIDS prevention in Vietnam. Assessment report.
Ha Noi, Vietnam, CCRD, 2006 Oct. 82 p. (CCRD Assesssment Report)International assistance for HIV / AIDS prevention and control in Vietnam has significantly contributed to combating this epidemic. However, while current resources have not yet fully met the needs, the management and utilization of resources still had many limitations which affect the effectiveness of foreign assistance and investments. The independent assessment was prepared for the Conference on “the Coordination of Foreign Assistance for HIV / AIDS Prevention and Control”. Analytical assessment and comments on the management and coordination of foreign aid were made on the basis of Government’s official procedures and regulations on those issues. This research was carried out in October, 2006.
Trends in development assistance and domestic financing for health in implementing countries. Global Fund to Fight AIDS, Tuberculosis and Malaria third replenishment (2011-2013).
Geneva, Switzerland, Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Mar.  p.Donors at the Mid-Term Review of the Global Fund's Second Voluntary Replenishment 2008- 2010 held in Caceres in March 2009 requested a report on the progress made by African countries with regard to the Abuja Declaration. This declaration, adopted at a 2001 summit of the Organisation of African Unity, was a commitment of African states to allocate at least 15 percent of their annual budgets to the health sector. Donors at the Mid-Term Review meeting also requested information concerning counterpart funding from middle-income countries. 2. This update begins with an explanation of current trends in development assistance for health (DAH) and the role that these external resources play in the total expenditure on health in low- and middle-income countries. It examines progress in 52 African countries and a sample of 20 non-African middle-income countries. It utilizes data from the Organisation for Economic Co-operation and Development (OECD) / Development Assistance Committee's (DAC) aggregated aid statistics and the Creditor Reporting System (CRS), the Institute for Health Metrics and Evaluation (IHME) Development Assistance for Health database, the World Bank Development Indicators and the World Health Organization (WHO) National Health Accounts database. 3. Since the Abuja Summit in 2001, many African countries have increased the proportion of their national budget allocated to health. Over half of African countries recorded increases in health budget allocations between 2001 and 2007. By 2007, three African countries had achieved the Abuja target of 15 percent, and three others had exceeded this amount. For all 52 countries, the average general government expenditure on health as a percentage of total government expenditure rose marginally from 8.8 percent in 2001 to 9.0 percent in 2007. 4. The proportion of gross domestic product (GDP) devoted to health also increased marginally in the period 2001-2007, from 5.0 percent in 2001 to 5.3 percent in 2007. Substantial flows of DAH to these countries (amounting to US$ 4.7 billion in 2007) have contributed to these increased total expenditures on health. 5. Funding of the health sector in the lower-income countries examined contains a substantial proportion of DAH. In the middle-income countries examined, this funding is predominantly from domestic sources and external resources only contribute a negligible proportion of the total expenditure on health. In nearly two-thirds of the middle-income countries assessed for this paper, external resources contributed less than 1 percent of the total expenditure on health in 2007. 6. In the current economic climate, the likelihood of African governments significantly increasing the proportional allocation to the health sector is not encouraging. With the current low per-capita expenditure on health in these countries, inflows of external resources remain critical if African countries are to run national programs at a scale necessary to achieve national and global targets in the fight against the three diseases. 7. Global Fund policy requires lower-middle income countries and upper-middle income countries to contribute substantially to their national program costs, for a number of reasons: to ensure national ownership of programs and their longer-term sustainability of programs, as well as to ensure sufficient funds are available to lower-income countries. In line with the Paris Declaration on aid effectiveness and in an attempt to avoid imposing specific further reporting requirements, it has not been the practice to request middle income countries to identify specific program components that they will fund. It is recognized that data in this domain needs to be strengthened and systematically collected and the Secretariat will explore ways in which to do that with technical partners in a manner that is consistent with aid effectiveness principles. The reform of the Global Fund business model, known as the architecture review, presents an opportunity for progress in this work.
International Journal of Gynaecology and Obstetrics. 2010 Jul; 110 Suppl:S17-9.Unsafe abortion is a recognized public health problem that contributes significantly to maternal mortality. At least 13% of maternal mortality is caused by unsafe abortion, mostly in poor and marginalized women. The International Federation of Gynecology and Obstetrics (FIGO) launched an initiative in 2007 to prevent unsafe abortion and its consequences, building on its work on other major causes of maternal mortality. A Working Group was identified with collaborators from many international organizations and terms of reference provided direction from the FIGO Executive Board as to possible evidence-based interventions. A total of 54 member associations of FIGO, representing almost half its member societies, requested participation in the initiative, with 43 subsequently producing action plans that are country specific and involve the national government and multiple collaborators. Obstetrician/gynecologists have demonstrated the importance of the initiative by an unprecedented level of engagement in efforts to reduce maternal mortality and morbidity in country and by sharing experiences regionally. (c) 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
In: Shaping policy for maternal and newborn health: a compendium of case studies, edited by Sandra Crump. Baltimore, Maryland, JHPIEGO, 2003 Oct. 15-22.In Bangladesh, immediate breastfeeding was not traditionally practiced, and exclusive breastfeeding was virtually nonexistent. Mothers tended to discard colostrum (first milk), substituting prelacteal feeds such as sugar water, honey, or oil instead of breast milk as the first feed for all newborn babies. Initiation of breastfeeding by most mothers took place on the third or fourth day. In the event of illness, mothers would cease breastfeeding. Complementary feeding practices were also unsatisfactory, consisting of bulky, energy-thin feeds, with weaning occurring either too early or too late. Such was the state of affairs in Bangladesh in 1979, when the World Health Organization (WHO) and UNICEF held a meeting in Geneva for the first time to emphasize the importance of breastfeeding--the first in a series of important initiatives to address this issue and other child health and nutrition concerns. Before 1980, there was hardly any discussion within the medical profession in Bangladesh of the importance of breastfeeding, let alone of a public health intervention to promote it. But the leadership of global agencies on this important issue had a significant impact on breastfeeding policy and practice in Bangladesh. This case stud), describes the origins of the breastfeeding movement in Bangladesh, the government of Bangladesh's support for the initiative, and the partnership that was established among the health professions, United Nations (UN) agencies, bilateral agencies, and the World Bank to change breastfeeding practices. The introduction of breastfeeding contributed to better health and nutritional status among the nation's children within a decade. (excerpt)
What's in a name? Policy transfer in Mozambique: DOTS for tuberculosis and syndromic management for sexually transmitted infections.
Journal of Public Health Policy. 2004; 25(1):38-55.In this paper we set out to explore the common assumption that international health policies are imposed on developing countries, owing to their high level of dependence on international aid. We examine how far two globally promoted infectious disease policies - directly observed short course therapy (DOTS) for tuberculosis (TB) and syndromic management for sexually transmitted infections (STIs) were voluntarily or coercively transferred in one particular setting, Mozambique. The findings of this case study are part of a larger study, which looked at global policy making, and compared South Africa and Mozambique. The larger study used the analytical frameworks developed to study policy transfer between jurisdictions. It showed that both policies had evolved in the 1980s through technical networks of national and international experts, and that policy transfer was not a linear, top-down process, but occurred in a series of policy loops over a long period. Experience at the country level fed into the globally promoted policies of the 1990s as part of this ‘looped process.’ The results of the global level research are being reported for policy theorists in a separate article. In this paper, we aim to present the findings of our case study of the transfer process and implementation of the policies in Mozambique and draw appropriate lessons for public health professionals working at the national level. (excerpt)
Global HealthLink. 2000 Nov-Dec; (106):15, 22.The central problem in health research can be summarized as follows: global spending on health research by both the public and private sectors in the world amounts to about US$70 billion per year (1998 estimate). Of this amount, however, less than 10 percent is devoted to 90 percent of the world’s health problems as measured by the number of healthy life-years lost due to morbidity or premature death (often measured in terms of DALYs, or Disability-Adjusted Life Years). The economic and social costs to society as a whole of such misallocation of resources are enormous. The central objective of the Global Forum, an international foundation created in 1998, is to help correct the 10/90 gap and focus research efforts on diseases representing the heaviest burden on the world’s health, by improving the allocation of research funds and by facilitating the collaboration among partners from the public and private sectors in the priority areas of health research. (excerpt)
Blocking progress. How the fight against HIV / AIDS is being undermined by the World Bank and the International Monetary Fund.
Washington, D.C., ActionAid International USA, 2004 Sep. 26 p.This briefing explores the logic of International Monetary Fund (IMF) loan conditions to developing countries and why the IMF insists that keeping inflation low is more important than increasing public spending to fight HIV/AIDS in Africa, Asia, Latin America, and Eastern Europe. In 2003, funding levels for HIV/AIDS prevention and treatment are estimated to have reached almost $5 billion; meanwhile financing needs will rise to $12 billion in 2005 and $20 billion by 2007. But if these large increases in foreign aid become available, will low-income countries be able to accept them? Despite the fact that the global community stands ready to significantly scale-up levels of foreign aid to help poorer countries finance greater public spending to fight HIV/AIDS, many countries may be deterred from doing so due to either direct or indirect pressure from the IMF. The IMF fears that increased public spending will lead to higher rates of inflation, but there is an open question in the economics profession about how high is too high, and what is an appropriate level of inflation. Despite this being an open question among economists, the IMF has taken an extremist position that lacks adequate justification. Such a position seriously undermines the best efforts of the global community to meaningfully address the HIV/AIDS epidemic and other health issues such as tuberculosis (TB) and malaria. (excerpt)