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Kaiser Daily Global Health Policy Report

In The News

MDGs Did Not Accelerate Development Progress, Study Says

“A new study suggests that the United Nations’ much-lauded Millennium Development Goals [MDGs], which expire in the year 2015, did not accelerate developmental progress globally after they were announced in September 2000,” U.S. News & World Report writes. “The study, which was done by a statistician with the U.N. Population Fund (UNFPA) while on a two-month sabbatical, was published independently this weekend after the U.N. declined to release it,” according to the news service. Author Howard Friedman examined data for some of the eight MDGs, but not all of them, U.S. News notes. U.N. spokesperson Vannina Maestracci “distanced the agency from the research on Monday in an emailed statement, saying it ‘does not represent the United Nations or UNFPA’s position,'” according to the news service. U.S. News includes reaction to the statistical analysis from Charles Kenny, a senior fellow at the Center for Global Development; Stephan Klasen, a professor of development economics at the University of Göttingen in Germany; John McArthur, a senior fellow at the U.N. Foundation and the Brookings Institution; and Jeffrey Sachs, the U.N. secretary general’s special adviser on the MDGs (Flock, 8/6).

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Yale Report Says U.N. Should Apologize, Establish Claims Commission For Haitian Cholera Outbreak

“The United Nations peacekeeping mission in Haiti should be held accountable for introducing cholera into the Caribbean nation, a Yale University report [.pdf] said Tuesday,” the Associated Press reports. “In the report ‘Peacekeeping Without Accountability,’ researchers from Yale Law School and the Yale School of Public Health said there is ample scientific evidence to show U.N. troops from Nepal inadvertently brought cholera to Haiti in October 2010,” the news agency writes, noting the U.N. has declared legal immunity from victims’ claims for compensation. “The Yale report said the world body ‘violates obligations under international law by not providing a forum to address the grievances of cholera victims,'” the news agency states, adding, “By failing to hold itself accountable for causing Haiti’s cholera outbreak, ‘the United Nations violates the very principles of accountability and respect for law that it promotes worldwide,’ it said.” Though the U.N. promised to establish a standing claims commission in Haiti, it has not yet done so, the report noted, according to the AP. “The report calls for a claims commission, a public apology, support for victims and adequate funding for the prevention and treatment of cholera,” according to the news agency, which notes the cholera outbreak has killed thousands and sickened more than a half million people.

Johan Peleman, head of the U.N.’s Office for the Coordination of Humanitarian Affairs in Haiti, said the study should be presented to U.N. headquarters, according to the AP, which notes he added, “The reality on the ground is we need money to respond” to the outbreak. “U.N. Secretary-General Ban Ki-moon announced in December a $2.27 billion initiative to help eradicate cholera in Haiti and the Dominican Republic, which share the island of Hispaniola, but the ambitious 10-year plan remains mostly unfunded,” the news agency writes. The AP notes, “Also Tuesday, the U.N. mission in Haiti and the Haitian government renewed an appeal to fund the Humanitarian Action Plan, which is meant to help nearly two million Haitians vulnerable to cholera, hunger and natural disasters. This effort is seeking $39 million in emergency donations” (Daniel, 8/6).

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Researchers Report First Person-To-Person Transmission Of H7N9

“Researchers have reported the first case of human-to-human transmission of the new bird flu that has emerged in China,” BBC News reports (Thomas, 8/6). “A father, who became sick in March, passed the H7N9 virus to his daughter, epidemiologists report Tuesday in BMJ,” NPR’s “Shots” blog writes (Doucleff, 8/6). “The scientists who led the study stressed, however, that the virus has not yet gained the ability to transmit from person to person efficiently — meaning the risk is very low that it could cause a human pandemic in its current form,” according to Reuters (Kelland, 8/6). “Scientists have long feared the virus would mutate into a form that transmits easily from person to person,” Agence France-Presse writes (Le Roux, 8/4). “Researchers say most patients appear to have visited live poultry markets or otherwise had close contact with live birds seven to 10 days before the onset of the illness, which has sickened more than 100 people and resulted in 43 deaths since first appearing in March,” VOA News notes (8/6).

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U.N. Releases New Guidelines On Mental Health Care For Trauma, Loss

“The United Nations health and refugee agencies [on Tuesday] released new guidelines and clinical protocols on mental health care for adults and children suffering from post-traumatic stress disorder and bereavement,” the U.N. News Centre reports. “The guidelines — released by the WHO, in conjunction with the U.N. High Commissioner for Refugees (UNHCR) — are designed to give non-specialized health workers and primary health care workers enough information to provide ‘psychological first aid’ and stress management, and to help people identify and strengthen positive coping methods and social support,” the news service writes (8/6). “This is the first time the [WHO] has issued guidelines dealing with the mental health consequences of trauma and loss,” according to VOA News, which notes, “This 270-page report is geared toward nurses, doctors and other health workers who do not specialize in mental health disorders” (Schlein, 8/6). “Using the new protocol, … primary health care workers can offer basic psychosocial support to refugees as well as people exposed to trauma or loss in other situations,” a WHO press release states. “Types of support offered can include psychological first aid, stress management and helping affected people to identify and strengthen positive coping methods and social supports,” the press release adds (8/6).

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More Data Needed On Populations At Risk Of HIV In Emergency Settings, Experts Say

“More information about groups vulnerable to HIV infection during emergencies — including those labeled ‘most at-risk populations’ (MARPs) — is needed to improve humanitarian HIV programming, experts say,” IRIN reports. “‘In tense situations where everyone is watching everyone else to see what other people get their hands on, social stigma and stratification are intensified and MARPs may experience heightened versions of whatever forces were marginalizing them to begin with,’ Gary Jones, security and humanitarian adviser for [UNAIDS], told IRIN,” the news service writes, noting, “MARPs include men who have sex with men (MSM), sex workers and their clients, and people who inject drugs (IDUs).” According to IRIN, “HIV risk is increased by social marginalization and punitive laws, but is typically mitigated through targeted, locally tailored services, such as safe spaces provided by community centers or established social networks, often in short supply during emergencies.” The news services notes issues surrounding access to HIV prevention and treatment services during conflict, discusses how mass displacement “may boost HIV vulnerability,” and examines challenges to obtaining data on HIV incidence in emergency situations (8/7).

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E.U., Global Fund Address HIV/AIDS In Eastern Europe

AIDS-related deaths “in Eastern Europe and the former Soviet Union have soared in the last decade while the E.U. continues to put the brunt of its funding for treatment and prevention in developing nations, according to experts who say this is creating a potential health timebomb on the E.U.’s eastern frontier,” EurActiv reports. “Efforts over the last decade from the international community to prevent and treat infections in sub-Saharan Africa have delivered tangible results, with the number of AIDS-related deaths dropping significantly in many countries, … [y]et the same results do not hold true in Eastern Europe,” the news service writes, noting some E.U. member states have experienced increases in the number of AIDS-related deaths between 2001 and 2011. EurActiv discusses efforts by the E.U. and the Global Fund to Fight AIDS, Tuberculosis and Malaria to address HIV/AIDS in Eastern Europe, and the article includes comments from Nicolas Cantau, regional manager at the Global Fund; Mario Raviglione, director of the WHO’s Stop TB Department; and European Commission spokesperson Frédéric Vincent (Jacobsen, 8/5).

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President Clinton, Daughter Traveling Through Africa To Promote Health

President Bill Clinton and his daughter Chelsea Clinton “are currently traveling through Tanzania, Rwanda, Zambia, Malawi, and South Africa to advance various Clinton Foundation and Clinton Global Initiative (CGI) goals,” the Huffington Post’s “Impact” blog reports. “After helping to promote malaria awareness and HIV testing, the high-profile duo visited Cyugaro Primary School in Rwanda to help decontaminate drinking water,” the blog notes, adding, “[T]he Clintons also visited Zanzibar to host a malaria-awareness soccer match, where fans and attendees had access to disease testing.” The blog continues, “On Wednesday, the two will travel to South Africa to attend the Embrace Tomorrow conference hosted by the Clinton Foundation and the Nelson Mandela Centre of Memory” (Salass, 8/6).

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Zambia Faces 'Critical Shortage' Of ARVs

“A critical shortage of antiretroviral drugs (ARVs) has hit most health facilities around” Zambia, the Lusaka Times reports. “Ministry of Health spokesperson Reuben Kamoto Mbewe confirmed that some clinics had run low on Truvada and neviripine while some had completely run out of the drugs,” the newspaper writes, noting, “As a result of the shortage of the life-saving drugs, most patients were being switched to other types while waiting for the recommended ones to be in stock” (7/27). A new procurement of ARVs “will start arriving in the country [this] week, health deputy minister Patrick Chikusu has announced,” the newspaper writes in a separate article. “Chikusu said another consignment of ARVs would arrive in September this year with support of Global Fund and PEPFAR funding,” according to the Lusaka Times (8/1). Zambia Reports interviews a pharmacist at Kabwe General Hospital who “bemoaned the critical shortage of [ARVs] across Zambia, saying HIV patients will suffer the consequences of missing drugs in the future and the government must take responsibility” (Sakal, 8/5).

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Clinical Trials Test Combination Treatments For Visceral Leishmaniasis

Researchers at a hospital in Kenya are testing an experimental combination therapy to treat visceral leishmaniasis, also known as kala azar or black fever, Think Africa Press reports. “[D]espite the spread of the disease and fatalities related to it, a long-standing lack of interest from pharmaceutical companies has meant that medication developed seven decades ago is still in use today,” the news service writes, adding, “This traditional treatment — the use of sodium stibogluconate (SSG) on its own — has been linked with the development of drug-resistance and its high toxicity levels can prove fatal.” However, the “new combination treatment for visceral leishmaniasis involves the use of SSG along with a drug called paromomycin (PM),” Think Africa Press continues, and writes, “According to tests, this treatment has a 93 percent success rate.” Noting the combination therapy has been registered in Kenya and recognized by the WHO as first-line treatment, the news service adds the therapy reduces the number of hospital days and lowers the overall cost of treatment. The article quotes several researchers involved in the testing of the treatment and notes a study of another combination therapy, AmBisome and miltefosine, is ongoing (Kamadi, 8/5).

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Researchers Testing Nitric Oxide As Treatment For Cerebral Malaria In Uganda

GlobalPost’s “Pulse” blog examines how physicians in Uganda are using nitric oxide gas as an experimental treatment for cerebral malaria, “a severe form of the disease in which malaria parasites clog the blood vessels of the brain.” In Mbarara, Uganda, researchers from Epicentre, the research arm of Médecins Sans Frontières, “are having children with cerebral malaria inhale a gas, nitric oxide, … [which] is thought to dilate blood vessels and reduce inflammation in the brain,” the blog writes, adding, “The goal, according to a 2012 article by the Epicentre team, is ‘buying time’ for medicines to kill the malaria parasites while protecting children’s brains from the parasites’ devastating effects.” The blog notes “[a]nother team in Jinja, Uganda, affiliated with the University of Toronto and Uganda’s Makarere University, is conducting similar trials” (Chavkin, 8/6).

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Editorials and Opinions

Lack Of Family Planning, Barriers To Reproductive Rights Hindering Development Progress

“Lack of family planning, along with other barriers to sexual and reproductive rights and health, remain obstacles to progress on several key development indicators,” Mushtaque Chowdhury, vice chair and adviser to the founder and chair of BRAC, writes in The Guardian’s “Global Development Professionals Network” blog. He highlights Bangladesh as an example of a country that successfully lowered its fertility rate, falling “to near replacement level, ‘one of the steepest declines in history,’ according to The Economist.” Noting his involvement in those efforts through the Bangladesh Rural Advancement Committee, he writes, “By increasing demand and expanding access to family planning methods, we helped raise Bangladesh’s rate of contraceptive prevalence from 12.7 percent in 1980 to 61.2 percent in 2011.” Chowdhury continues, “Skeptics will say that cultural resistance to contraception remains a hurdle, yet Bangladesh faced many of the same circumstances.”

“Replicating [Bangladesh’s] success is obviously more complicated than transplanting the same programs to African countries,” Chowdhury states. He highlights “some of the more data-driven approaches [that] are already seeing progress in Africa,” and writes, “To advance the family planning agenda, development organizations should develop their own dual-pronged approaches to empowering girls and women — socially as well as financially.” He adds, “We need to provide access to knowledge and the means to control fertility, along with economic resources that help bolster the social status of females within the home,” concluding, “If we do this, I’m confident we can build the support mechanisms necessary to allow African women to bring about their own reproductive revolution” (8/6).

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Abortion Policies In Latin America, Caribbean Hampering Progress In Ensuring Women's Reproductive Rights

“In the last decade, several countries in the Latin America and Caribbean (LAC) region have had the opportunity to experience economic growth and establish redistributive fiscal policies aimed at reducing poverty, reducing inequality and improving the coverage and quality of health, education and social protection services,” Purnima Mane, president and CEO of Pathfinder International, writes in an Inter Press Service opinion piece. “And yet significant gaps exist in the area of reproductive health and rights, both between countries and as a whole, when it comes to some of the key objectives of the Cairo Programme of Action,” she states. She highlights an overall decline in the region’s maternal mortality ratio, “one of the basic indicators of reproductive health,” noting “there are significant inequities between countries,” and she writes, “A significant proportion of maternal deaths are caused by unsafe abortions, which represent a serious public health concern in the region.” She discusses laws on abortion in various countries in the region, noting, “Abortion is only legal in six countries, and together, these countries account for less than five percent of the region’s women aged 15-44.”

“The conclusion is clear: universal access to reproductive health is still far from being a reality in the LAC region,” Mane states. “Looking specifically at the seven components of the program of action, the LAC countries have achieved much higher rates of contraceptive prevalence than Africa or Asia as a whole,” she continues, and provides examples. “As I said before, the LAC countries have brought down their collective maternal mortality rate,” she notes. “However, in other key areas of the program such as expression of and protection for sexual and reproductive rights including access to safe abortion, post-abortion care, and expression of gender identity or sexual orientation, the LAC region continues to be challenged,” she writes, noting “the lack of progress in ensuring reproductive rights and access to safe abortion in particular comes from the fact that a large number of LAC countries stated formal reservations to many of the rights components in the Programme of Action, including concern over abortion, a national belief and/or laws asserting a need to protect life from the moment of conception, and concern over alternate expressions of family beyond that of formal marriage between a man and a woman.” She concludes, “These reservations have continued to hamper progress in these areas and produced the situation we see today in this region” (8/6).

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From the Global Health Policy Community

Finding Balance In NGOs' Public Health Contributions In Asia

Writing in the East-West Center’s “Asia Pacific Bulletin,” (.pdf) Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, writes, “In Asia, the capacity of [non-governmental organizations (NGOs)] to contribute to public health, both within individual countries and at the regional level, has steadily expanded,” and he states that NGOs “that work on public health issues could potentially have a greater role in enhancing regional security throughout Asia than is currently acknowledged.” He continues, “However, the breadth and depth of engagement by public health NGOs is uneven across specific issue areas.” In order to ensure NGOs “realize their full potential requires a dual track approach. First, a more deliberate, coordinated effort by international funders to support comprehensive public health interventions can help reduce imbalances between resources allocated to specific diseases. The second requirement is to reduce government restrictions that constrain local and international NGOs from engaging in the type of regional cooperation necessary to adequately deal with public health challenges that do not respect borders,” he concludes (7/30).

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USAID Supporting Delivery Of HIV/AIDS Services In Zimbabwe

In a post in USAID’s “IMPACTblog,” Margot Welk, communications and development outreach adviser at USAID in Zimbabwe, reflects on how the agency “is supporting the delivery of high-quality HIV/AIDS services” in the country. “USAID provides infant HIV test kits and [antiretrovirals (ARVs)] to many clinics throughout Zimbabwe,” she writes, highlighting the Epworth Clinic in Harare. “With support from USAID, this local organization is quickly increasing its ability to better address the HIV/AIDS epidemic in Zimbabwe,” she notes, and describes a visit she made to the clinic (8/6).

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Working To Improve Sanitation Practice, Safe Water Supply In Liberia

In a post in USAID’s “IMPACTblog,” Pieter DeVries, chief of party of the Improved Water, Sanitation, & Hygiene (IWASH) Project, examines the program’s efforts to improve sanitation practices and safe water supply in Liberia, where “open defection is the most common sanitation practice.” He notes, “This fact, coupled with a lack of access to safe drinking water results in high levels of fecal-oral diseases and related child deaths,” adding, “Since February 2013, Global Communities (IWASH Implementer) has engaged 120 communities in an aggressive campaign to end open defecation.” He concludes, “Through these activities the exposure of children to fecal-oral disease will be reduced and the promise of a healthier life for children under-five will be renewed” (8/6).

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