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Kaiser Daily Global Health Policy Report

In The News

Study Finds 'Huge Health Inequalities' In Latin America

“The quality of healthcare offered to people in Latin America and the Caribbean varies dramatically from nation to nation, according to a recent study that calls for a systematic evaluation of health inequalities with the aim of reducing inequities in this region,” SciDev.Net reports. “Researchers from Argentina and Colombia built an index to measure health equality in the 20 countries in the region and the results were published recently in the journal Gaceta Sanitaria,” the news service writes, noting, “To build the index, the researchers looked at 16 health indicators, including child mortality, number of doctors, immunization coverage against measles, birth attendance by skilled health workers, health expenditure and drinking water access over the period 2005-2010.”

“Cuba fared the best, followed by Argentina, Uruguay, Chile, Mexico and Brazil. Haiti came last, with Guatemala, Bolivia, Venezuela, Honduras and Guatemala also lowly ranked,” according to SciDev.Net, which adds, “There is a roughly tenfold difference in health spending per capita between the top spenders, Chile and Uruguay, and those at the bottom, Bolivia and Haiti.” The news service quotes Doris Cardona of the Epidemiology and Biostatistics Research Group at CES University in Colombia, and lead author of the study, who “says that the research helps to show how different economic, social, health and sanitation contexts can affect people’s access to healthcare, and how governments can work to reduce inequalities” and adds that “[t]he study’s index could also be used to monitor inequalities and evaluate the impact of policies on them” (Hirschfeld, 5/6).

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IPS Examines Reaction To Introduction Of Fixed-Dose ARVs In South Africa

Noting “a serious supply shortage [of antiretroviral (ARV) treatment in South Africa last May], the most recent of several stockouts that have plagued the state-funded ARV treatment program since its launch in 2004,” Inter Press Service examines reaction to the introduction of fixed-dose ARVs (FDAs) in the country last month. The news service notes, “Until now, state-funded ARV treatment has comprised three different pills taken at different times during the day. The new FDA combines the three key agents from these pills in a single pill that only needs to be taken once a day.”

“Although welcoming the FDAs as easier and more convenient for patients, activists and health professionals alike have warned that a stockout of the drug could have a catastrophic effect on the country’s public HIV/AIDS treatment program — the largest of its kind in the world,” IPS continues. “The risk of FDAs is that there isn’t really a good fall-back,” Kevin Rebe of the Anova Health Institute, which runs the Health4Men program focusing on HIV prevention and treatment, tells IPS, the news service writes, adding, “He points out that even a few missed doses could result in resistance to treatment.” However, the news service notes, “The introduction of FDAs is also expected to significantly reduce the state’s annual bill for HIV/AIDS treatment” (Bendix, 5/6).

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First Polio Case Identified In Pakistan's Waziristan Since Taliban Immunization Ban

“A child has contracted polio for the first time in Pakistan’s militant-infested tribal belt since the Taliban banned vaccinations a year ago, a U.N. official said Monday,” Agence France-Presse reports. “Tribesmen in North Waziristan, Pakistan’s most notorious stronghold of Taliban and Al-Qaeda linked militants, endorsed the Taliban ban and stopped authorities from vaccinating children under a nationwide campaign,” the news service notes. “We are worried because this new case comes as an example of a bigger impending outbreak of disease in the region,” Elias Durry, the WHO’s senior coordinator for polio eradication in Pakistan, told AFP, the news service writes. According to AFP, “Durry said the United Nations and the Pakistani government are working together to reach out to the children in North Waziristan” (AFP 5/6).

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Editorials and Opinions

Further Cutting U.S. Foreign Aid Would Undermine America's 'Soft Power'

“America’s ability to protect itself and advance its global interests often depends as much on its ‘softer’ power as it does on our nation’s armed forces,” Gen. David Petraeus, former director of the CIA, and Michael O’Hanlon, senior fellow at the Brookings Institution, write in a Politico opinion piece. “That is part of why we have supported a budget deal that would repeal sequestration and achieve most further deficit reduction through savings in entitlement spending with similar increases in revenue generation,” they continue, adding, “Implicit in our approach was the thinking that lawmakers should avoid the temptation to gut foreign aid just because it generally lacks a strong constituency in the United States.”

Petraeus and O’Hanlon briefly discuss recent history with regard to U.S. foreign aid spending, noting aid “was not always as productive as it might have been.” However, they continue, “America’s spending on development and diplomacy and security aid — the so-called 150 account — has strengthened under Presidents George W. Bush and Barack Obama.” They note PEPFAR, “a major initiative of Presidents Bush and Bill Clinton and now President Obama, has played a significant role in helping to turn the tide against the HIV/AIDS epidemic — even if more work remains to be done.” They state, “Given our military contributions to international stability and the global economic growth that results from that stability in various areas, American foreign aid doesn’t need to grow substantially. But it should not be cut further” (4/30).

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Opinion Pieces Address Health, Humanitarian Issues In War-Torn Syria

The following is a summary of opinion pieces addressing health and humanitarian issues in war-torn Syria.

  • Renee Behinfar, The Hill’s “Congress Blog”: “Syrian youths face repeated exposure to trauma, ongoing threats to their lives, and minimal access to food, water, and shelter,” Behinfar, a clinical psychologist and human rights advocate, writes, and asks, “When the Syrian conflict ends, what will become of the Syrian youths?” She continues, “Many will become refugees forced to start new lives, while carrying with them the emotional and physical scars of the past; their identities left behind, moving forward as a blank slate,” and notes a potential for youths to “become radicalized … placing the United States at risk.” Behinfar writes, “There is a moral obligation to do whatever is necessary to save the children of Syria. It is also important to establish an emotional connection rooted in awareness that the United States supports their quest for freedom, and that we are an ally” (5/3).
  • Jacey Fortin, International Business Times:  “More than two years since the uprising in Syria first erupted into a bloody conflict … [f]ood shortages are taking a serious toll on embattled civilians, as is a lack of medical supplies,” Fortin, a political reporter, writes. “This week, the United States sent its first direct shipment of medical and food aid to the Free Syrian Army, the main opposition group,” she states, adding, “But given the ongoing atrocities and the opportunity to weaken Assad allies such as Hezbollah and Iran, plenty of American politicians — including both hawks and doves — have urged stronger American action.” She notes “the U.S. administration is weighing the costs and benefits of an intervention” and discusses some of the options being evaluated at this time. “Evidence of chemical weapons may change the diplomatic strategy of U.S. officials, but Washington will still be walking a very fine line as it settles on a course of action over the coming weeks,” she concludes (5/3).
  • Kinan Madi, Huffington Post U.K.’s “Impact” blog: Noting his role with UNICEF as emergency officer in Syria “is to coordinate partnerships on the ground, follow-up on implementation of projects and delivery of humanitarian assistance, and monitor the impact and results of our work,” Madi writes, “It’s a constant challenge due to the ever changing security and access situation, but thanks to the tireless efforts being made by our partners and the UNICEF team, we have been able to make significant progress.” He discusses his experience in the humanitarian assistance field and working with UNICEF, describes “[t]he complexity of the environment” in which the agency is operating, and notes, “For kids to overcome the stress in which they are living, they need education and they need psychological support in a safe environment.” He concludes, “In a time when not many actors focus on this aspect, UNICEF is the lifeline for children’s wellbeing. … What keeps me going is when I see that we’re making a difference” (5/6).

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Opinion Pieces Address Global Polio Eradication Efforts

The following opinion pieces address the global polio response.

  • Qanta Ahmed, Sania Nishtar, and Ziad Memish, The Lancet: “Today [the] ambitious goal [of global polio eradication] is threatened, partly by misinformed and politicized religious views that not only seed suspicion about polio vaccination but recently led to murder of polio workers,” the authors write, noting “this disease persists only in Nigeria, Afghanistan, and Pakistan, which are countries with substantial Muslim populations.” They continue, “Pakistan’s demoralized public health workers must be supported by a robust international approach that combines both traditional diplomatic and imaginative political responses to draw on the powerful authority of the international Muslim community,” adding, “Saudi Arabia and its health authorities are uniquely placed to bring about change in Pakistan for two reasons.” They write, “First, as the site of Mecca and Medina and host to the Hajj, Saudi Arabia wields enormous influence in Muslim Pakistan. Second, Saudi Arabia has experience of introducing new public health recommendations and strengthening public health outreach by legitimizing new public health measures with both formal Islamic authority, in the form of fatwas, and informally, through public opinion” (5/4).
  • Christine Gorman, Scientific American’s “Observations” blog: “Scientific American’s editorial board strongly believes that the U.S. was wrong to mount a fake hepatitis B vaccination campaign in the effort to kill Osama bin Laden,” Gorman, editor in charge of health and medicine features for the magazine, writes. “Apart from moral issues, the blowback from the clandestine effort threatens the global campaign to eradicate polio from the face of the planet,” she continues, noting, “Polio still spreads in the wild in only three countries: Afghanistan, Nigeria and Pakistan” (5/3).

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To Continue Progress Against Malaria, International Community Must Adjust Approaches To Keep Up With Changing Landscape Of Disease

“[A]s the world commemorated the sixth annual World Malaria Day [on April 25], I was struck by the tremendous progress we have made against this disease — progress that, at the outset, many would have thought impossible,” Kent Campbell, director of the malaria control program at PATH, writes in the  Huffington Post’s “The Big Push” blog. Noting “[m]alaria mortality rates in Africa have decreased by one-third and more than one million lives have been saved over the last decade,” he says “eliminating malaria in Africa is a real possibility.” He continues, “To succeed, however, the global malaria community must recognize that our mission, and what it demands of us, has changed. Now we need to work together and bring every tool we have — our communities, technologies, talent, and commitment — to reach our goal.”

“Lessons learned in our ongoing battles to eradicate polio and guinea worm have taught us that there can be no treading water when it comes to fighting malaria — we must keep pushing the envelope or risk losing the progress we have made,” Campbell states. “So, what will it take to eliminate malaria in Africa?” he asks, writing, “We must continue to expand our work to control the disease in the areas with the highest burden, while working to stop transmission altogether in areas where the parasite is losing its foothold.” He continues, “As our goals change, we’ll need to develop new ways of measuring success,” and concludes, “We cannot continue to use the same approaches to fight an evolving battle. We have good reason to be optimistic and aggressive in our approach — and must be as smart and adaptive as the malaria parasite itself to achieve our ultimate goal: a world free from malaria” (5/3).

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From the Global Health Policy Community

Experts Discuss IOM Evaluation Of PEPFAR, Implications Of HPTN 052 For U.S. HIV/AIDS Efforts At Panel Discussion

The Center for Global Health Policy’s “Science Speaks” blog reports on a panel discussion held April 30, convened by the Kaiser Family Foundation (KFF) and the Center for Strategic and International Studies’ (CSIS) Global Health Policy Center, which focused on the policy implications of an Institute of Medicine (IOM) evaluation of PEPFAR released in February. Focusing on discussion at the event surrounding the HPTN 052 study, which “unequivocally linked early antiretroviral treatment for HIV with a 96 percent drop in transmitting the virus to an uninfected partner,” the blog notes that while the IOM evaluation acknowledged the study, some panelists thought further discussion of the implications for U.S. HIV/AIDS efforts was needed. The panel, which also addressed the transition of PEPFAR programs to countries, the sustainability of efforts, and the PEPFAR Blueprint: Creating an AIDS-Free Generation (.pdf), included J. Stephen Morrison, vice president and director of the CSIS Global Health Policy Center, who moderated the panel; Jennifer Kates, vice president and director of global health and HIV policy at KFF;  Chris Collins, vice president and director of public policy at amfAR, the Foundation for AIDS Research; Julia Martin, Deputy Global AIDS Coordinator; and Kimberly Scott, senior program officer at the IOM (Barton, 5/3).

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U.S. Global AIDS Coordinator Goosby To Visit Vietnam This Week

Ambassador Eric Goosby, head of the U.S. State Department’s Office of Global Health Diplomacy and the U.S. Global AIDS Coordinator “will travel to Vietnam, May 5-7, to engage in high-level discussions on the response to HIV/AIDS by the government of Vietnam and [PEPFAR],” a U.S. State Department press release reports. “Ambassador Goosby will be meeting with key Vietnamese government officials, development partners, and nongovernmental organizations, to see firsthand the important work being done to fight HIV/AIDS in Vietnam,” the press release notes (5/3).

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Examining Use Of Technology In Malaria Control Efforts

“Funding by [the U.S. President’s Malaria Initiative (PMI)] and other stakeholders, together with the leadership of the Zanzibar Malaria Control Program (ZMCP), has resulted in a dramatic decrease in malaria prevalence in Zanzibar,” Lenna Neat, technical program manager for RTI International, writes in USAID’s “IMPACTblog” as part of a series highlighting the agency’s work in global health. “Through the USAID-funded Tanzania Vector Control Scale-Up Program, RTI International has worked closely with the ZMCP and PMI to develop Coconut Surveillance, a mobile application that builds on the Malaria Early Epidemic Detection System (MEEDS),” she notes. “Opportunities exist to expand on the lessons learned from these technology-based activities in malaria programs and introduce them as solutions to other global health projects that encounter similar challenges,” she continues, adding, “The value added by these tools offers the opportunity to greatly increase efficiency, accuracy, and impact across the global health spectrum” (5/3).

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Blog Examines Results-Based Financing Approach For Global Health

“One recurring theme in forum and in the first panel [of the World Bank’s ‘Africa Health Forum: Finance & Capacity for Results’] was that results-based financing (RBF) — where financing is conditioned on achievement of results in health — is a key approach to driving value for money,” Victoria Fan, a research fellow at the Center for Global Development (CGD), and Amanda Glassman, director of global health policy at CGD write in the center’s “Global Health Policy” blog. “By linking payments to specific outcomes, RBF makes a donor more accountable to its constituencies and also increases the mutual accountability between the donor and the country by focusing the contract terms on shared goals and verified results,” they note, adding this is “a reason why RBF represents a paradigm shift in global health and development aid — from what might be called the ‘auditing and accounting paradigm’ to ‘performance and results paradigm.'” They discuss the RBF approach, highlight a number of obstacles to its implementation, and write, “The World Bank’s recent Africa Health Forum highlighted that the World Bank has somehow overcome these historical obstacles, and stands to be a trailblazer in RBF.” They add, “Other donor agencies such as PEPFAR and the Global Fund [to Fight AIDS, Tuberculosis and Malaria] need to take the courageous steps to a much needed paradigm shift” (5/2).

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