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Kaiser Daily Global Health Policy Report

In The News

House Appropriations Committee Debates FY14 State, Foreign Operations Appropriations Bill

“The House Appropriations Committee met on Wednesday to debate and amend the [FY 2014] State and Foreign Operations Appropriations Bill, which emerged from subcommittee level last week” and “funds U.S. diplomatic and foreign assistance programs, as well as contributions to international multilateral organizations and initiatives,” Devex reports (Igoe, 7/25). The appropriations bill includes funding for U.S. global health programs at USAID and the State Department, according to the Kaiser Family Foundation’s “Policy Tracker,” which also includes details about the bill’s proposed spending for certain global health programs (7/19). “Any amendment that proposed to increase funding beyond the subcommittee’s draft bill was voted down by the Republican majority,” Devex notes. Democrats “passionately defend[ed] contributions to multilateral initiatives the House committee’s bill eliminates or cuts, in particular United Nations agencies like UNICEF and the U.N. Population Fund, the largest multilateral family planning and reproductive health program in world,” the news service notes. “At the hearing, Rep. Barbara Lee (D-Calif.) offered an … amendment to the draft bill, requiring new reporting indicators from the Office of the Global AIDS Coordinator to measure the readiness of PEPFAR partner countries ‘to accept greater ownership of PEPFAR-supported programs,'” Devex writes, adding, “This was the only amendment Democrats offered that garnered enough votes to pass” (7/25). The Center for Global Health Policy’s “Science Speaks” blog details the Lee amendment, noting, “It is unclear when this measure will move to the full House of Representatives for consideration” (Aziz, 7/24).

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Report Questions Progress On 'Country Ownership' Following 2011 Busan Forum On Aid Effectiveness

Nearly two years after the 2011 High Level Forum on Aid Effectiveness in Busan, South Korea, where emphasis was placed on developing countries taking the lead on development aid partnerships, “there are concerns that donors have done little on country ownership, even though it was declared at the time to be the default approach,” The Guardian’s “Poverty Matters Blog” reports. “According to a paper [.pdf] by the U.K. Aid Network (Ukan) and [non-governmental organization (NGO)] umbrella group Bond, the international community may even have gone backwards, despite the rhetoric from donors,” the blog writes, adding, “The concerns have been raised in the runup to this week’s meeting in Addis Ababa of the steering committee of the Global Partnership for Effective Development Co-operation” (Tran, 7/24).

“The document … makes some bold assessments: Development stakeholders have yet to make a final agreement on the indicators proposed, data on country ownership progress remains limited, and ‘political will’ to implement the full Busan Partnership ‘has been sluggish,'” Devex’s “The Development Newswire” states. “The report acknowledges many challenges facing the complete adoption of country ownership by many aid providers, and one of the main obstacles is pressure to produce results,” according to the news service. “The report clearly provides a grim assessment on the progress of country ownership, but admits implementation of the Busan Partnership is still in its ‘early stages,'” and it “also provides several recommendations for donors,” Devex writes (Ravelo, 7/24).

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Nature Examines 'Little-Known' Class Of Antibiotic-Resistant Bacteria

Nature reports on “a little-known class of antibiotic-resistant bacteria: carbapenem-resistant Enterobacteriaceae (CREs),” noting Sally Davies, the United Kingdom’s chief medical officer, “described CREs as a risk as serious as terrorism,” and CDC Director Thomas Frieden has called for an alarm to be sounded over the issue. According to the magazine, CREs — which “cause bladder, lung and blood infections that can spiral into life-threatening septic shock” — “evade the action of almost all antibiotics — including the carbapenems, which are considered drugs of last resort — and they kill up to half of all patients who contract them.” Nature writes, “Looking back, say observers, there are lessons for researchers and health care workers in how to protect patients, as well as those hospitals where CREs have not yet emerged.”

Nature examines the history of CREs, noting they “were first identified almost 15 years ago, but did not become a public health priority until recently, and medics may not have appreciated the threat that they posed.” The magazine details the spread of CREs, writing, “Researchers have spotted other carbapenem-resistance factors moving around the globe; one has already appeared in the United States, and others are clustered in southern Europe and South America.” The magazine states, “It seems unlikely that new drugs will become available soon,” adding, “That means, say infectious disease experts, that their best tools for defending patients remain those that depend on the performance of health personnel: handwashing, the use of gloves and gowns, and aggressive environmental cleaning” (McKenna, 7/24).

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Online Survey Finds Support For MERS Travel Screenings Despite Limited Knowledge About Virus

“Little is known about a SARS-like virus that has infected people in the Middle East, North Africa and Europe, but there is strong support around the globe for screening travelers to prevent the spread of the disease, according to … [a]n Ipsos online survey of more than 19,000 people in 24 countries,” Reuters reports. The survey “showed that fewer than half of people questioned knew much about the disease known as Middle East Respiratory Syndrome coronavirus, or MERS, which has infected 88 people and killed 45 people,” the news service notes. “Although awareness is low, most people said they are concerned about how prepared their nations are and would alter travel plans to avoid countries where cases have been reported,” the news service writes.

“More than 80 percent of people questioned in developed countries said inbound travelers from countries with cases of MERS should be screened for the illness,” Reuters notes, adding, “The [percentage] rose to 90 percent in less industrialized countries.” According to the news service, “Support was highest in China, Indonesia and Saudi Arabia, where the illness has been reported, and Italy, which has also been affected, as well as in Australia, Canada and Argentina.” Reuters adds, “Last week the [WHO] reported six new cases of MERS in United Arab Emirates and Saudi Arabia, including five health workers and one person who had been in contact with an infected person” (Reaney, 7/24).

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Indian School Principal Arrested After Children Died Of Pesticide Poisoning In School Lunch

“[T]he principal of a school in eastern India where 23 children died [last week] after eating a lunch tainted with pesticide was arrested Wednesday by the police,” the New York Times reports. Meena Kumari “was among the most wanted people in India after she fled her school in the village of Dharmasati Gandawa in Bihar’s Saran district when the children in her school started vomiting soon after eating a free lunch,” the newspaper writes, adding, “Kumari bought the cooking oil [which was contaminated with pesticides] from a store owned by her husband, who might have kept the cooking oil in a container once filled with pesticide, the police said.” The New York Times notes, “School lunch programs became universal in India after a 2001 order by the country’s Supreme Court, and free meals are now served to 120 million children — by far the largest such program in the world.” With “nearly half of Indian children suffer[ing] some form of malnutrition, [the program] also serves a vital health purpose,” the newspaper writes, adding, “But like many government programs in India, it is underfinanced and plagued by corruption and mismanagement. Cases of tainted food are fairly routine, and in the days after the Bihar case Indian news media reported other instances of children sickened by school lunches” (Harris/Kumar, 7/24).

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Chinese Man Detained After Murdering Family Planning Officials In Protest Of Country's Laws

“A man who was told by officials they couldn’t register his fourth child because he didn’t pay a penalty for breaking China’s family planning laws stabbed to death two government workers and injured four others, state media and an official said,” the Associated Press reports. “The incident this week is one of a string of grievances against symbols of authority in China that have turned violent in recent months,” the news agency writes, adding, “It also illustrates how disliked China’s family planning limits are, more than 30 years after their introduction limited most urban couples to one child and rural families to two.” According to the AP, “[a] child without a hukou [or resident’s certificate] faces a multitude of problems because the certificate is needed to register for education, health care and government benefits.” China’s family planning policy, “often known as the ‘one-child policy,’ … allow[s] families in rural areas to have a second child if their first is a girl,” the news agency notes (Watt, 7/24).

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Editorials and Opinions

Early ART 'Vitally Important' For All People Living With HIV

The new WHO HIV treatment guidelines, which advocate beginning antiretroviral therapy (ART) “when a person’s CD4 white blood cell count is relatively high,” “are a welcome step forward but fall short of the treatment goals that could and should be set,” a New York Times editorial states. “The missing ingredient is enough financing by international donors and many afflicted countries to make treatments widely available,” because “[t]he new guidelines will widen the gap” between those who are receiving treatment and those who are eligible but not yet receiving therapy, the editorial writes. “Ideally, virtually all people known to be infected should get drug treatments immediately, in a single pill, no matter what their CD4 counts,” the editorial states, adding, “That would greatly reduce the risk of transmitting the virus to others and prolong lives by preventing deterioration of the immune system.” Though “[a] vaccine would be surest way to prevent infection because a person would be protected for a substantial number of years, perhaps for a lifetime, without the need take antiviral drugs indefinitely,” “[e]arly drug treatments will remain vitally important for the foreseeable future,” the editorial concludes (7/24).

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World Needs More Midwives To Reduce Maternal Mortality, Achieve Health MDGs

“[M]aternal mortality remains a heavy burden in sub-Saharan Africa where around 162,000 mothers die every year, leaving close to one million African children motherless,” Ugandan midwife Esther Madudu writes in the Huffington Post’s “Global Motherhood” blog. “The reason is that 40 percent of African women do not receive basic prenatal care, and more than half of all deliveries take place at home without medical assistance,” she states, adding, “With a skilled midwife present at birth, over 90 percent of maternal deaths can be prevented.” She notes, “Pregnant mothers who do receive medical care often have to walk great distances to get to a facility.” Madudu describes her participation at the Africa Regional Conference of the International Confederation of Midwives (ICM) and provides some statistics about midwifery, highlighting a Save the Children report that “estimated that 350,000 more midwives are needed around the world to help reduce maternal and child deaths.” She adds, “Without significant extra funds and effort, the U.N.’s Millennium Development Goals (MDGs) to cut death rates among women and children are unlikely to be met in many countries by the 2015 deadline,” concluding, “Please show your support by sending a letter to America’s leaders asking them to protect global health funding and increase support for maternal, newborn and child-health programs” (7/24).

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Rape, Sexual Violence Continue In Darfur As Crisis Turns 10

“We’re at the 10-year-anniversary of the beginning of the genocide in Darfur, yet, instead of subsiding, it has been amplified this year,” columnist Nicholas Kristof writes in his New York Times column. “Darfur isn’t in the headlines anymore, partly because there has been a lull in the killing in recent years and partly because so much else is happening worldwide,” he states, adding, “The Sudanese government, which tends to calibrate its brutality to the degree of attention it receives, is taking advantage of the lack of scrutiny by stepping up its decade-long campaign in Darfur of mass murder, burned villages and sexual violence.” He notes, “Rape happens all over the world, of course, but, for 10 years, the Sudanese government has used rape as a weapon of war to humiliate the ethnic groups that it targets.”

“Just in the first five months of 2013, according to the United Nations, another 300,000 people in Darfur have been driven from their homes — and untold numbers killed or raped,” Kristof continues. “Granted, there are no magic wands to end the horrors of Darfur, but groups like the Enough Project have outlined solid proposals to put pressure on Sudan” and “[b]ipartisan legislation now in Congress — the Sudan Peace, Security and Accountability Act of 2013 — might help,” he writes. Kristof notes that on the last stop of his annual win-a-trip journey, in which he takes a student on a reporting trip to the developing world, he and trip winner Erin Luhmann of the University of Wisconsin interviewed “six brave women who are refugees from just one Darfur village, AbJaradil,” about their experiences having been raped. He provides quotes from these interviews and writes, “[L]et’s hope that these women’s courage and outspokenness will lead us to find our own voices” (7/24).

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Focus Shifts From Malnutrition To Childhood Obesity In India's Urban Clinics

In a post in the GlobalPost’s “Pulse” blog, the second in a series about child health in India, Harman Boparai, a doctor from India currently working as a Kaiser Health Reporting Fellow at GlobalPost, examines issues surrounding child health in the country, highlighting a shift in focus from malnutrition to childhood obesity in urban centers in Punjab. Boparai highlights a visit to a clinic in his hometown of Amritsar in Punjab, where the majority of patients come for vaccinations and minor illnesses, and contrasts this with to a clinic visit in the district of Panna in Madhya Pradesh, “where the child mortality rate is three times that of Punjab” and “[t]he two biggest killers of children that could easily be prevented are diarrhea and pneumonia.” He writes, “Next I will head to the heartland of the country, where the child mortality rate is many times higher than in my home state, to see what milestone their progress has reached, or where it has stalled” (7/24).

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From the Global Health Policy Community

Jill Biden Reflects On USAID's Maternal, Child Health Efforts In India

In a post in the White House Blog, Jill Biden, wife of Vice President Joe Biden, examines the issue of maternal and child health in India, reflecting on her experiences as she travels through the country. “Yesterday I wrote about my time in Kachhpura and how they are working to end malnutrition,” she states, noting, “Today I attended a roundtable discussion with Government of Maharashtra officials, USAID, UNICEF, Indian civil society and private sector representatives to learn about their efforts to improve nutrition across the country and to make available other proven health interventions to prevent child deaths, such as immunizations, clean water, and treatment of pneumonia and diarrhea” (7/24).

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USAID Blog Interviews Feed The Future's Deputy Coordinator For Development

In a post in USAID’s “IMPACTblog,” published as part of the blog’s “Behind the Scenes” interview series, Tjada McKenna, deputy coordinator for development with Feed the Future, examines the issue of global hunger and discusses the program’s progress. According to the blog, McKenna gives a brief history of Feed the Future, discusses what success looks like for the program, outlines the program’s approach for achieving success, reflects on the future of the program, and advises how others can become involved (7/24).

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Lions Clubs International Pledges $30M To GAVI Alliance Measles Vaccination Program

In a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, David Ferreira, managing director for innovative finance and head of the Washington, D.C., office at the GAVI Alliance, reflects on a recent trip to Hamburg, Germany, for the 96th convention of Lions Clubs International, “a worldwide service organization that helps raise money to improve people’s lives around the world.” Ferreira notes that “the organization made an extraordinary announcement: Lions Clubs worldwide will raise $30 million for GAVI’s measles vaccination programs.” He writes, “Since 2013, GAVI has combined the measles vaccine with one against rubella (German measles), and GAVI plans to provide it to more than 700 million children in 49 countries by 2020, an effort the Lions Clubs now supports.” And he notes that, through an initiative called the GAVI Matching Fund, the U.K. Department for International Development and the Gates Foundation “would match — and therefore double — the Lions’ donation to GAVI” (7/22).

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PLOS, Maternal Health Task Force Update PLOS Collection On Maternal Health

Writing in the PLOS “Speaking of Medicine” blog, Jocalyn Clark, senior magazine editor at PLOS Medicine, “announce[s] the addition of new content to our Maternal Health Task Force-PLOS Collection on Maternal Health.” She continues, “This Year 2 Collection, with the theme of ‘maternal health is women’s health,’ emphasizes the importance of seeing maternal health in the context of a woman’s health over the course of her lifetime,” which “recognizes that while pregnancy is limited to women of reproductive age, maternal health is influenced by the health of women and girls before pregnancy, and it also influences women’s health broadly during and after the reproductive years.” Clark adds, “Inability to access quality health care and family planning resources, low educational attainment, low socioeconomic status, restrictive gender roles, poor nutrition, and a host of other social and biological factors combine to put girls and women at risk for not being able to attain and sustain the health status they deserve throughout their lives.” She lists the articles that were added to the collection (7/24).

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New Issue Of Lancet Global Health Available Online

Writing in a Lancet Global Health editorial, journal editor Zoë Mullan describes the content of the August 2013 issue. “Osman Sankoh and fellow INDEPTH Network colleagues announce a new freely accessible repository of Health and Demographic Surveillance System data generated by its member centers across Africa, Asia, and the Pacific”; NIH “Director Francis Collins and colleagues from eight other research funding bodies announce the launch of a freely accessible online map (World RePORT) showing the location of research programs funded by these organizations in sub-Saharan Africa over the past year”; Denise Baratti-Mayer “and colleagues did an ambitious case-control study in southeastern Niger to try to identify sociodemographic and microbiological risk factors for [the neglected tropical disease noma]”; “Sant-Rayn Pasricha and colleagues’ systematic review and meta-analysis shows that, although daily iron supplements reduce anemia in children aged four to 23 months, they seem to impair length and weight gain, possibly as a result of increased vomiting”; and “Heather Zar and colleagues explore the value of a rapid PCR-based test (Xpert MTB/RIF) in diagnosing tuberculosis in children attending a primary care clinic,” she writes (August 2013).

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