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Kaiser Daily Global Health Policy Report

In The News

Obama Administration Backs Away From Anti-Tobacco Efforts Under TPP Proposal, The Hill Reports

“The Obama administration is backing away from plans to protect U.S. tobacco-control measures from legal challenges under a pending Pacific trade deal, earning the wrath of public health groups,” The Hill’s “Global Affairs” blog reports. “The Office of the U.S. Trade Representative (USTR) last year suggested creating a ‘safe harbor’ that would have [made] it difficult for cigarette companies to undermine domestic anti-smoking efforts under the proposed Trans-Pacific Partnership (TPP),” the blog writes, noting, “Instead, critics say, the USTR has opted for weaker language that simply restates existing international trade policy that recognizes countries’ authority to enact health and safety measures.” According to the blog, “The new proposal is scheduled to be shared with U.S. partners when trade negotiators gather in Brunei starting Friday for the latest round of talks,” and the “Obama administration hopes to conclude the trade talks with 11 other partners in Asia and the Americas by the end of the year.”

“‘The new USTR proposal does not recognize tobacco as a uniquely harmful product or provide a safe harbor for nations to regulate in order to reduce tobacco use, as the initial proposal would have done,’ a coalition of five public health groups said in a statement … signed by the Campaign for Tobacco-Free Kids, the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association and the American Academy of Pediatrics,” according to the blog. “The watered-down measure, the groups said, represents ‘a missed opportunity for the United States to lead the fight against this global epidemic,'” the blog adds. “A USTR spokeswoman told The Hill that the new proposal ‘is intended to preserve our ability to apply appropriate public health measures while ensuring that the handling of tobacco in TPP is consistent with our trade policy objectives,'” the blog notes (Pecquet, 8/20).

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U.N.'s Ban Recommends Reducing Troops In Haiti, Re-examining Support For Country

U.N. Secretary-General Ban Ki-moon “recommended a 15 percent reduction in the number of U.N. troops in Haiti on Tuesday and an examination of whether the beleaguered peacekeeping operation remains the best way to support the impoverished Caribbean nation,” the Associated Press reports. “The force has been under intense scrutiny for years and is widely blamed for a massive cholera outbreak likely introduced by a U.N. peacekeeping battalion from Nepal,” the news agency writes, adding, “Ban, in a report to the Security Council, said he intends to hold talks with the government of Haiti and other nations ‘to explore the best way for the United Nations to continue contributing towards greater stability and development in the country.'” He also “urged international donors to ensure the funds and expertise required to eradicate cholera in Haiti, which he called ‘a challenging task requiring a long-term commitment,'” according to the AP. A report from Yale Law School and Yale School of Public Health earlier this month said evidence shows peacekeeping forces brought cholera to the island nation and the U.N. should take responsibility, but Ban “maintains the U.N. enjoys legal immunity from such claims,” the news agency notes (Lederer, 8/20).

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GlobalPost Examines GEMS Study, Need To Address 2nd Most Common Parasite Causing Diarrhea

GlobalPost’s “Pulse” blog examines the Global Enterics Multi-center Study (GEMS), “the largest and most in-depth research project examining diarrheal disease in the developing world to date.” Published in The Lancet in May, GEMS found that “just four pathogens are responsible for the majority of moderate-to-severe diarrhea cases,” and while the “virus that topped the list — rotavirus — has long been regarded as a formidable foe …, the second most common contributor to diarrheal disease was a parasite called cryptosporidium, which has, up to this point, been considered more of a nuisance than a lethal threat to all but the severely immune compromised.” The blog notes, “While there is a vaccine for rotavirus, a weapon against cryptosporidium isn’t even in the pipeline.”

“The research is so sparse that the World Health Organization’s Initiative for Vaccine Research, while it tracks progress toward a vaccine for all three of the other top killers, doesn’t mention cryptosporidium,” according to “Pulse,” which adds, “There is only one approved drug to treat it and it does not work well on infants, who represent the lion’s share of diarrhea deaths.” The blog continues, “Many diarrhea deaths occur, not because of a lack of science, but because children don’t have access to existing medical solutions. More than half of the children who died during the GEMS study died at home” (Stuart, 8/20).

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Washington Post Looks At India's Food Security Programs

Noting “India’s subsidized-grain program has been a pillar of the world’s largest democracy for decades, and in its current form it helps sustain more than 400 million rural villagers and urban slum dwellers with low-cost grains and other staples such as sugar and kerosene,” the Washington Post reports, “India is preparing to launch a massive transformation of the program that would double its size and add a guarantee that two-thirds of India’s population would be granted a legal right to food.” The newspaper writes, “If, as expected, the measure is approved by Parliament in the coming days, India will have committed to one of the largest and costliest entitlement programs in the world — at a time when its economic growth is slowing and its food supply faces pressure from a growing population and diminishing land and water resources.” The Washington Post examines support for and opposition to the plan, as well as challenges to its implementation (Gowan, 8/18).

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IRIN Examines MDR-TB In Myanmar

IRIN examines the issue of multidrug-resistant tuberculosis (MDR-TB) in Myanmar, writing, “Inadequate detection and treatment are major obstacles and can result in cases of drug-resistant TB (DR-TB) such as MDR-TB, say health experts.” According to Peter Paul de Groote, Myanmar’s head of mission for Médecins Sans Frontières (MSF), “Drug-resistant TB is a very significant health concern for Myanmar,” the news service notes, adding, “Around 8,900 new cases of DR-TB are reported [in the country] each year, but only 800 patients had access to treatment at the end of 2012, he said.” IRIN writes, “From August 22 to 23, WHO, along with MSF and Myanmar’s Ministry of Health, plan to hold a DR-TB symposium in Yangon aimed at ramping up services throughout the country, including neglected border regions” (8/20).

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Devex Examines Gates Foundation's First Health Project In LAC Region

Devex reports on “the Bill & Melinda Gates Foundation’s first big health project in Latin America with the Inter-American Development Bank and partners that include the Carlos Slim Foundation, which itself is making its first foray into large-scale public-private partnerships with Mesoamerica.” In a video interview, Devex talks to Gary Darmstadt, director of family health at the Gates Foundation, at the IDB’s 2013 gathering in Panama City about why the foundation is in Latin America and its goals there (Rosenkranz, 8/20).

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Editorials and Opinions

U.N.'s Refusal To Take Responsibility For Haitian Cholera Damages Its Moral Credibility

Highlighting a report in which “researchers from Yale University added their voice to the growing chorus calling upon the United Nations (U.N.) to respond fairly and justly to the cholera epidemic it recklessly caused in Haiti in 2010,” as well as “an article [.pdf] written by the scientists appointed by the U.N. to investigate the source of the epidemic,” Beatrice Lindstrom, a human rights lawyer, and Adam Houston, a global health and human rights specialist working with the Institute for Justice & Democracy in Haiti, write in the Huffington Post’s “World” blog, “These two documents, and the widespread international coverage they have received, bolster a broad, informal network of scientists, lawyers, human rights activists, grassroots leaders, victims groups, and government officials calling upon the U.N. — the organization founded with the purpose of promoting justice and human rights around the world — to practice what it preaches in Haiti.” They add, “As yet, however, the U.N. continues to turn a deaf ear to these calls, to the detriment of both Haiti and the organization itself.”

Lindstrom and Houston provide an overview of the epidemic, writing, “Despite conclusive evidence that the epidemic originated at the U.N. [peacekeeping] camp, the U.N. has refused to accept responsibility.” They write, “The U.N.’s mishandling of the cholera situation has unraveled to a point where, as the Yale report puts it, ‘the United Nations violates the very principles of accountability and respect for law that it promotes worldwide.'” They continue, “For the victims of the epidemic, the consequences are real and devastating,” and “while the U.N. has argued that meeting their liabilities for the cholera epidemic could set a precedent that would be too costly and undermine future missions, the repercussions of avoiding responsibility are far greater.” They conclude, “For an organization that depends on moral credibility to push its mission of promoting human rights for all, the implications of ignoring its own values are severe and far-reaching. It means that the next time the U.N. tries to spread its message, people may simply stop listening” (8/19).

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India's Food Security Bill Does Not Address Root Challenges Of Malnourished Children

“Despite the unprecedented scale of [India’s National Food Security Bill], it feels stale,” Shailey Hingorani, a Fulbright scholar at the Harvard Kennedy School of Government, and Allison Hutchings, a Boston-based social policy researcher, write in the Wall Street Journal’s “India Real Time” blog. “It is an amalgamation and continuation of previous nutrition and food distribution programs in India” that “have failed to adequately address malnutrition in India,” they write, adding, “They do little to address children’s different nutritional needs, which vary according to age and gender. … Malnourished children need a holistic set of solutions, not just more food.” The authors describe the Integrated Child Development Services (ICDS) program, central to the Food Security Bill, saying it “works on the assumption that lack of adequate food intake is the primary driver of malnutrition.”

“The ICDS shouldn’t be the primary vehicle through which malnutrition is addressed in India,” Hingorani and Hutchings write, adding, “But the government, eager to get support as the general election approaches, is trying to push through a populist legislation. It is unlikely to change the status quo.” They conclude, “In its current state, the Food Security Bill will be a whole lot of grain without a whole lot of gain” (8/21).

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End Of Pediatric AIDS Possible With Coordinated Efforts By Governments, Local Communities, Other Partners

“Eliminating new pediatric HIV infections will take coordinated efforts by national governments, local communities, and external partners,” Chip Lyons, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), writes in the Huffington Post’s “Impact” blog. “Governments must be equipped to meet the needs of their populations, and the programs that support HIV-positive people must help to deliver services to keep them healthy and help prevent new infections in un-infected people,” he states. Lyons discusses EGPAF’s efforts in Kenya “to help the national government to improve delivery of health services to its citizens,” highlighting Kenya’s Maisha project, which, instituted in 2010 and led by the government with support from UNICEF and EGPAF, aims “to build the capacity of all levels of government and health facilities to provide services for the elimination of mother-to-child transmission (eMTCT) of HIV.”

“Through the Maisha project, the Rongo District Hospital and 11 other health facilities in Nyanza Province are offering reproductive health services to all women of reproductive age while providing HIV services as part of general outpatient services, with the support of EGPAF and the Kenya National AIDS and STI Control Program (NASCOP),” Lyons writes, noting, “Integration of services is essential to providing comprehensive health care to women and families affected by HIV and AIDS. Maternal and child health, reproductive health, family planning, and HIV services are all integral to maintaining the health and well-being of families.” He adds, “Community engagement and support is often a large factor in maintaining the health of HIV-positive people,” and he concludes, “Innovative projects like Maisha are turning the tide against pediatric HIV/AIDS. With coordinated efforts like these being made in the countries most affected by HIV and AIDS, the goal of eliminating pediatric AIDS is in sight” (8/20).

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Management Development Training Essential For Public Health Program Success

Noting the New Funding Model of the Global Fund to Fight AIDS, Tuberculosis and Malaria — including formula-based funding and incentive funding — Stephen Rabimov, who leads business development at the International Management Development Program (IMDP) in New York, a training program of the International Union Against Tuberculosis and Lung Disease (The Union), writes in the Huffington Post’s “Impact” blog about the IMDP, which “aims to increase capacity to efficiently deliver interventions, retain a responsive and knowledgeable workforce, and offer effective leadership and governance across programs and beyond — all in limited-resource settings.”

He describes lessons learned from the program’s decade of operations, writing, “The more training and education public health program managers receive the greater use of the new knowledge and skills application will be, leading to better performing programs.” Rabimov concludes, “As countries prepare for the next round of GFATM funding by developing and strengthening their national strategic plans, the inclusion of management development training in the countries’ Global Fund proposals remains an important human resources component and a strategic health systems investment” (8/20).

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From the Global Health Policy Community

USAID's MCHIP Helping Prevent Maternal Deaths In Rwanda

Writing in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, USAID’s Maternal and Child Health Integrated Program (MCHIP) Senior Program Officer Susan Moffson, Jhpiego Country Director for Rwanda Jérémie Zoungrana, and Musoni Pascal of MCHIP Rwanda describe a pilot program aimed at training frontline health workers to recognize and treat post-partum hemorrhage (PPH). “Through this Rwandan pilot program — and many other activities being carried out globally — MCHIP is successfully empowering women and their health care providers to prevent PPH,” they write, noting, “As of June 2013, more than 700,000 women giving birth have received lifesaving medicine to prevent PPH, thanks to USAID/MCHIP-supported programs” (8/20).

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Aidspan Publishes New Issue Of 'Global Fund Observer'

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has published Issue 225 of its “Global Fund Observer.” The issue includes an article highlighting the launch of a pilot project to assist 10 country coordinating mechanisms (CCMs) to engage key populations; an article highlighting a letter from Nafsiah Mboi, the new chair, and Mireille Guigaz, the new vice-chair, “to Global Fund Board members outlining where they believe the Board should focus its energy over the next two years”; and an article examining 14 projects that “will be funded from the latest calls for proposals under France’s five percent initiative.” Among other stories, the issue also includes a commentary from Global Fund Executive Director Mark Dybul discussing saving money through improved procurement systems (8/21).

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PLOS Blog Highlights New Articles Published In PLOS Medicine

The PLOS “Speaking of Medicine” blog highlights a number of new articles published in the current issue of PLOS Medicine. A meta-analysis “implies that the risk of early neonatal infection among women with maternal infections is high and presumably even higher in low-resource settings where most women deliver at home without access to health care,” and an essay examines how researchers have adapted the WHO’s Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for use in Nigeria, according the blog. Another trial “evaluate[s] the effect of household water treatment in preventing diarrheal illnesses in children under five years of age in Orissa, a state in southeast India,” the blog writes, noting, “The results provide no evidence that the intervention was protective against diarrhea and raise additional questions about the actual health impact of household water treatment under these conditions” (8/20).

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