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Kaiser Daily Global Health Policy Report

In The News

New U.N. Framework On HIV/AIDS Treatment Seeks To Give 15M People Access To ART By 2015

“The United Nations [on Saturday] launched a new framework which seeks to give 15 million people with HIV/AIDS access to antiretroviral treatment by the year 2015,” the U.N. News Centre reports. “The framework [.pdf], titled Treatment 2015, offers countries and partners practical and innovative ways to increase the number of people accessing antiretroviral medicines that will enable those living with HIV to live longer and healthier lives, as well as help prevent new infections,” the news service writes (7/13). “Developed in consultation with a range of stakeholders, Treatment 2015 takes into account the new consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection released last month by the [WHO],” according to a UNAIDS press release, which notes, “The guidelines recommend that people living with HIV start antiretroviral therapy (ART) much earlier” (7/13). “The framework noted that 30 countries accounted for nine out of 10 people who were eligible for antiretroviral therapy but who did not have access,” PANA/AfriqueJet writes, adding, “The new strategy emphasized the importance of HIV testing and counseling as a gateway to expand access to antiretroviral therapy in these 30 countries, and outlined three pillars essential to reaching the 2015 target.” The news service notes, “They consist of increasing demand for HIV testing and treatment services, mobilizing resources and improving the efficiency and effectiveness of spending and ensuring more people have access to antiretroviral therapy” (7/14).

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Al Jazeera's 'South2North' Reports On Maternal Health In Africa

Al Jazeera’s “South2North” reports on “maternal health and the impact it has on children, women and the communities in which they live” in Africa, noting, “A recent African Union report shows sub-Saharan Africa is trailing behind its 2015 Millennium Development Goal of reducing maternal mortality by 75 percent.” According to the description, the program asks, “Why is Africa still the world’s most dangerous place to have a baby?” Hans Rosling, the co-founder of Gapminder, “explains how maternal health is a key factor needed for the future development of Africa”; Deliwe Nyathikazi of the International Confederation of Midwifes “explains that women’s ability to control whether or not they get pregnant is a huge determinant for their health”; and Sanjana Bhardwaj, UNICEF’s chief of health, “explains how the state of maternal health is an important indicator of how well countries are doing.” A video of the show is available online (7/13).

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Vietnam Expresses Concern That Donor Cuts In HIV/AIDS Funding Will Hamper Progress, IRIN Reports

“The Vietnamese government warns that multi-million dollar donor cutbacks could undermine progress in the country’s HIV/AIDS services,” IRIN reports. “More than 70 percent of Vietnam’s HIV/AIDS response comes from international donors, which plan to reduce or phase out projects due to the country’s new middle-income status and the global financial crisis,” the news service writes. IRIN discusses funding to Vietnam from PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the U.K. Department for International Development (DfID). Deputy Prime Minister Nguyen Xuan Phuc expressed concern over decreases in aid from development partners in a local news report, “but in response to the ongoing drawdown, he added that the country will attempt to diversify its funding sources by promoting public-private partnerships and health insurance,” according to the news service (7/12).

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South African Health Minister Says TB Is Biggest Threat To Mining Industry Workers

“Accidents and violence get most of the attention, but the deadliest threat to workers in the South African mining industry is tuberculosis, says the minister of health leading new efforts to combat the infectious disease,” The Star reports. Summarizing an interview with South African Health Minister Aaron Motsoaledi, who was in “Ottawa this week to chair a meeting of the coordinating board of the Stop TB Partnership, which sets global strategy for dealing with the infectious disease,” the newspaper writes, “Motsoaledi said most of the tuberculosis in the region originates within the mines that have made South Africa the largest producer of gold in the world and noted the list does not include Swaziland or Lesotho, which send many laborers to work in South Africa’s mines before they return home again infected with the disease.” Motsoaledi also said the mining industry should play a role in efforts to reduce the incidence of TB among its workers, according to the newspaper. “Ahead of the board meeting, Canadian International Cooperation Minister Julian Fantino gave a speech in which he recognized the link between mining and tuberculosis in Africa, and stressed the role partnerships with the private sector can play,” The Star adds (Smith, 7/12).

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New York Times Reports On Mystery Illness Infecting Children In One Of India's Most Impoverished Areas

The New York Times examines a mystery illness infecting children in Muzaffarpur, “one of India’s most impoverished areas.” The newspaper writes, “Although public health statistics are unreliable here, the disease is believed to infect tens of thousands of people a year and kill thousands,” adding, “All doctors know is that the illness is a form of brain swelling, or encephalitis, but that is a huge category, covering a wide spectrum of diseases.” The newspaper continues, “Doctors have tested for known causes of brain swelling, including meningitis and Japanese encephalitis, but the tests almost always come back negative,” noting, “India’s top health officials say the disease, known officially as acute encephalitis syndrome, has them stumped.”

“With help from the [CDC] in Atlanta, [L. S. Chauhan, the director of the National Center for Disease Control in India] started a program this year to train an elite cadre of disease sleuths, part of a recently organized Epidemic Intelligence Service in India that he hopes will eventually undertake the investigations of India’s estimated 1,500 epidemics,” the New York Times reports. “But the outbreak in Muzaffarpur is slowly spreading to neighboring areas, and Dr. Chauhan has thrown everything he can at it, assigning all seven of his trainees — each already an accomplished physician,” the newspaper notes. “Investigators have collected samples of blood, urine and spinal fluid from each of this year’s sick children — there were 133, 59 of whom died — and they asked their parents more than 150 questions about the children’s food, water, sleeping arrangements and villages,” the newspaper writes, adding, “The investigation is like a highly complex puzzle, in which every piece must be solved” (Harris, 7/13).

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World Bank Survey Shows Gaps Between Midwife Knowledge, Care Given In Kenya

“In Kenya, 82 percent of midwives correctly diagnose their patient’s condition but only 28 percent give the full treatment required, the World Bank said on Friday, highlighting the challenge of reducing maternal deaths in the country despite the introduction of free maternal health services last month,” Thomson Reuters Foundation reports. “Giving birth with the help of a trained professional is deemed a critical factor in reducing maternal mortality but the statistics, released in the first Service Delivery Indicators (SDI) survey — an Africa-wide World Bank initiative aimed at improving service delivery in basic health and primary education facilities — shows that pregnant Kenyan women aren’t getting the care they need,” the news service writes. Shahnaz Sharif, Kenya’s director of public health and sanitation, “blamed a lack of training for the gap between diagnosis and the delivery of treatment in the country … [b]ut a member of the doctors’ union said the problem was one of lack of investment in the health sector,” according to the news service. “Similar gaps in diagnosis and treatment were found with nurses and doctors, who gave the correct diagnosis in 72 percent and 86 percent of cases respectively but only gave full treatment in 46 percent and 54 percent of cases,” Reuters notes (Migiro, 7/12).

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U.K.-Supported Initiative In Sierra Leone Aims To Reduce Maternal Mortality

The Guardian examines Evidence 4 Action (E4A), an initiative recently launched in Sierra Leone with support from the U.K. Department for International Development (DfID) that aims “to empower local communities to force health care up the political agenda by giving them the evidence they need to fuel arguments for higher standards.” The program, “led by Freetown obstetrician Dr. Mohamed Yilla, is based on the belief that rapid progress is possible, and maternal and baby mortality can be dealt with if everyone chooses to act,” the newspaper writes, noting “[t]he riskiest thing a woman can do in Sierra Leone is get pregnant; one in every 21 women is at risk of death in child birth.” The Guardian continues, “With the help of E4A, [the health ministry] is running quarterly surveys of clinics; data is shared with all stakeholders in the country’s health system, including politicians, community chiefs, aid agencies and [non-governmental organizations (NGOs)].” In addition, E4A’s advocacy initiative MamaYe! is training “30 journalists … to improve reporting on [blood shortages] and get the message out to men and women that their families’ survival could be helped through blood donation,” the newspaper notes (O’Carroll, 7/12).

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New U.N. Women Head, Phumzile Mlambo-Ngcuka, Discusses Her New Role

“Phumzile Mlambo-Ngcuka, a former South African deputy president, has been appointed by U.N. Secretary-General Ban Ki-moon as the head of the U.N. Entity for Gender Equality and the Empowerment of Women, also known as U.N. Women,” and she discusses her new role in an interview with Al Jazeera. Mlambo-Ngcuka says human rights tops the agenda for issues facing women, and she “would like to take this work to a much larger constituency so the work of the woman is embraced by a larger constituency, beyond the traditional constituency for women,” according to the interview transcript. She talks about regional context for improving women’s rights, as well as addressing violence against women, Al Jazeera notes (Kharsany, 7/14).

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Editorials and Opinions

Editorials, Opinion Piece Address U.N. Secretary General's Response To U.S. Lawmakers' Letter About Haiti Cholera Epidemic

Last week, U.N. Secretery-General Ban Ki-moon responded to a letter from 19 members of Congress — in which they urged the U.N. to pay compensation for a cholera outbreak in Haiti — outlining measures the body has taken and supported in the country so far. The following is a summary of two editorials and an opinion piece addressing Ban’s response.

  • Economist, “America’s View” blog: “Ban Ki-moon, the U.N.’s secretary general, reiterated that the U.N.’s legal office has decided the claims are ‘not receivable’ because of the U.N.’s privileges and immunities,” the blog notes. “Critics argue that the U.N.’s stance is tantamount to claiming impunity — that the U.N., an organization whose mission involves promoting the rule of law, is putting itself above it,” the blog continues, writing, “The U.N. has staunchly refused to entertain the cholera claims in any venue.” The blog concludes, “And although the U.N. launched an initiative to fight cholera in Haiti in January 2012, the program is already falling short: it has raised only $207 million in pledges for the year, $31 million less than it would require. It is another failure that by now will hardly surprise the people of Haiti” (7/15).
  • Tribune-Review: The editorial provides a brief overview of the epidemic and the U.N.’s response so far, noting, “Earlier this year, when the U.N. refused to pay compensation to 5,000 cholera victims and their families, members of Congress wrote to Mr. Ban, urging the U.N. to take the lead in funding the Hispaniola Initiative, which would provide an estimated $2.2 billion to Haiti over the next 10 years to improve access to clean water.” The editorial continues, “Ban’s response to Congress: tough noogies,” and writes, “Supposedly the U.N. has provided $140 million — how much of that is in U.S. funding? — to make the Haiti cholera problem go away.” The newspaper concludes, “For once, Congress should reciprocate by cutting off U.S. funding and sending Ban with his tin cup to collect from other nations” (7/14).
  • Peter Yeo, The Hill’s Congress Blog: “The cholera epidemic that has claimed so many lives in Haiti remains a public health crisis, and it demands action — from all of us,” Yeo, executive director of the Better World Campaign, writes. “In a letter spearheaded by Rep. Maxine Waters (D-Calif.) earlier this summer, [19 members of Congress] urged a ‘nationwide response to the epidemic,'” and “[o]n Friday, Ban responded, outlining major steps that have already helped to decrease the rate of new infection by 90 percent since the outbreak began, and further steps that stand to build on this progress,” he states, noting that “in May, the U.N. pledged $29 million in new funds, bringing the current total pledge in support of the Hispaniola Initiative to $207.4 million.” However, he writes, “[t]he millions already pledged to Haiti are an earnest goal, yet they can only be raised from willing donors — like the United States.” He concludes, “The U.N.’s action clearly demonstrates that it stands by this commitment, and that it will continue its support in Haiti just as it assists countries the world over. Nevertheless, this assistance from the U.N. needs to be coupled with support from the public health community, Congress, and fellow member states to reach the end goal of a better future for all Haitians” (7/12).

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Obama Administration's Support Of Foreign Aid Transparency And Accountability Act 'Critical'

“In today’s polarized political environment, it’s not often that a bill receives a unanimous show of support from the U.S. House of Representatives. However, that’s what happened last December, when the House approved, by a vote of 390-0, the Foreign Aid Transparency and Accountability Act,” Melissa Kaplan, the advocacy manager for aid reform and effectiveness at InterAction, writes in a Roll Call opinion piece. “The bill, which was reintroduced by Reps. Ted Poe (R-Texas) and Gerald E. Connolly (D-Va.), and Sens. Marco Rubio (R-Fla.), and Benjamin L. Cardin (D-Md.), represents a smart, common-sense bipartisan effort to improve our nation’s valuable investment in foreign assistance,” she states, adding, “If signed into law, it would go a long way in making lifesaving U.S. aid and poverty-reducing programs more effective by enacting stronger transparency and accountability measures.”

“How exactly would FATA do this?” she asks, and writes, “First of all, the bill requires the president to establish guidelines on goals, performance metrics, and monitoring and evaluation plans to be applied to U.S. foreign assistance activities,” meaning “necessary scrutiny would be paid to how foreign assistance programs are working, where they are succeeding and where we can do better.” She continues, “Additionally, FATA would put into law the need to make publicly available ‘comprehensive, timely, comparable, and accessible information on United States foreign assistance.'” She writes, “InterAction and other leading U.S.-based non-governmental organizations, many of which carry out foreign assistance work in the field and know firsthand the positive impact FATA can have if it is enacted, have backed the legislation,” adding, “It is critical that the Obama administration support this legislation and its goals of greater accountability and transparency, too” (7/15).

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Clinic In Niger Helping To Heal Physical, Mental Scars Left By Obstetric Fistula

In opinion pieces published on Saturday in the New York Times, columnist Nick Kristof and Erin Luhmann, the winner of Kristof’s annual “Win-A-Trip” contest, discuss obstetric fistula and the experience of Hadiza Soulaye, who received treatment for the condition at the Danja Fistula Center in Danja, Niger. In his column, Kristof writes, “There is nothing more wrenching than to see a teenage girl shamed by a fistula, and I’ve written before about the dreams of a couple of surgeons to build this fistula center here in Danja. Times readers responded by contributing more than $500,000 to the Worldwide Fistula Fund to make the hospital a reality. Last year, the Danja Fistula Center opened” (7/13). Luhmann, writing in the “On the Ground” blog, says, “Hadiza has found a new sense of community with obstetric fistula patients who harbor similar stories of spousal abuse, abandonment, and humiliation. While the morale was high, I noticed that many of the girls we spoke with still attributed their obstetric fistulas to ‘destiny’ or ‘divine intervention.’ I hope they will one day understand that they did nothing wrong. The true culprits — poverty and female disenfranchisement — are much more tangible” (7/13).

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GlobalPost Blog Examines Efforts To Prevent, Treat Pneumonia In Zambia

Writing in GlobalPost’s “Pulse” blog, correspondent Marissa Miley examines efforts to prevent and treat pneumonia in Zambia, where she traveled recently. “Data cited in a 2012 report by Countdown to 2015, a coalition organization tracking progress towards the Millennium Development Goals around child and maternal health, show pneumonia to be the leading single cause of death for children under five in Zambia, as it is for children globally, according to a recent study in the Lancet,” she writes. “And yet, in the many conversations with child and pneumonia health experts, doctors, and researchers I had before I left for Lusaka, it became clear to me that pneumonia is not just the top cause of death among young children. It is also one of the most overlooked,” she writes.

However, “this week, as I was flying the first leg of my journey, the Zambian government officially launched a vaccine to prevent pneumococcus, the leading bacterial cause of pneumonia,” she notes. “For several years, along with Save the Children, Boston University, and other partners, the Zambian Ministry of Health has been working in a remote part of northern Zambia, near the mining areas of the Copperbelt province, to train volunteer community health workers in part how to diagnose and treat pneumonia,” she writes, adding, “Now seems as critical a time as any to take a closer look at efforts to prevent and treat this ‘forgotten killer,’ and give pneumonia a home front and center in the news” (Miley, 7/13).

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From the Global Health Policy Community

Briefing With African Ministers Discusses Malaria Control

In his blog, “Malaria Matters,” Bill Brieger, a professor in the Health Systems Program of the Department of International Health at Johns Hopkins University as well as the senior malaria adviser for JHPIEGO, describes a briefing (.pdf) that “was given to African ministers of health and foreign affairs on July 13, 2013, in Abuja, Nigeria to review progress in Africa’s fight against malaria and to announce a new initiative to support 10 high-burden countries as part of the Special African Union Summit on HIV/AIDS, Tuberculosis and Malaria.” He summarizes the comments of several attendees and describes the Malaria Situation Room, “a way to collate data on funding, intervention, commodities and results” (7/15).

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African Leaders Must Act On Abuja Declaration To Make Progress On HIV, TB, Malaria

Musician Yvonne Chaka Chaka, a Roll Back Malaria and UNICEF Goodwill Ambassador/MDG Envoy for Africa, writes in the ONE blog, “I remember the hope I felt in 2001, when African leaders met in Abuja, Nigeria, and each pledged to take measures to halt the spread of HIV, tuberculosis (TB) and malaria in addition to increasing their country’s funding for health to at least 15 percent of their annual budget.” She continues, “I saw it as a turning point in Africa’s history — a point where our continent would be able to emerge from decades of watching the potential of our citizens, communities, and countries be stunted by disease. But pledges don’t pay doctors, nurses or community workers, they don’t buy medicines, and they don’t keep the lights running in our hospitals.” Noting “[i]n July, our leaders will once again gather in Abuja, Nigeria, to review progress made on HIV, TB and malaria and discuss the state of the continent’s health,” Chaka Chaka writes, “Leaders can no longer look back on the 2001 Abuja Declaration and pat themselves on the back. They can only look forward to the work that must be done, and turn pledges and promises into action and resources” (7/12).

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Advocacy Groups Express Concern Over Misleading Marketing Of Two Tests Designed To Detect Latent TB

“The Treatment Action Group (TAG) and the Global TB Community Advisory Board (TBCAB) sent letters to manufacturers of Quantiferon TB Gold and Immucheck TB Platinum expressing concerns that their tests, blood-based interferon gamma release assays (IGRAs) indicated only for latent TB infection detection, are misleadingly marketed in India as tests for active TB,” the Center for Global Health Policy’s “Science Speaks” blog reports. “IGRAs blood tests do not differentiate between active pulmonary TB disease and latent TB infection, resulting in many patients being misdiagnosed as being infected with active TB and undergoing unnecessary treatment, while leaving those actually infected with active TB undiagnosed,” the blog notes. “In a letter to Immunoshop, which produces TB Platinum, TAG and TBCAB pointed out that the marketing of the product is blatantly misleading and inconsistent with WHO and Indian policy, with advertisements claiming ‘Immucheck TB Platinum — The IGRA test method will be a boon for detection of active TB and LTBI [latent TB infection] and thus for containment of its transmission!!!!!'” The blog adds, “In a letter to Dutch manufacturer Qiagen, which markets TB Gold as an active TB test in India, the groups cited concern about the test being used to diagnose active TB in private clinics in South Africa as well” (Aziz, 7/12).

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