KFF Daily Global Health Policy Report

In The News

On World Toilet Day, WaterAid Report Ranks Countries Based On Access To Sanitation Facilities

News outlets discuss a report ranking countries based on ease of finding a toilet, released by WaterAid to mark World Toilet Day on November 19.

The Guardian: World Toilet Day: from South Sudan to Russia, where not to get caught short
“South Sudan, where 93 percent of the population lacks access to an adequate toilet, has fewer safe and hygienic latrines per person than any other country in the world, according to a study highlighting the world’s failure to address the global sanitation crisis. … Among developed countries, Russia had the worst sanitation record, with more than a quarter of its population lacking access to safe, private toilets…” (Kweifio-Okai, 11/18).

Wall Street Journal: India Has the World’s Longest Line for the Toilet
“If the 774 million people living without a household toilet in India stood in line, they would stretch from the Earth to the moon, and maybe beyond, a report released to mark World Toilet Day showed Thursday. … India continues have the largest number of people without toilets at home and the highest number of people defecating in the open, the report titled, ‘It’s No Joke: The State of the World’s Toilets 2015,’ says…” (Agarwal, 11/19).

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U.N., International Community Must Overhaul Efforts To Address Water, Sanitation, Advisory Board Says

Inter Press Service: U.N. Advisory Board Seeks Powerful New Global Arena for Water and Sanitation
“A 21-member U.N. Advisory Board on Water and Sanitation (UNSGAB), which has just completed its 11-year mandate, is calling for a complete overhaul of how the United Nations and the international community deals with two unresolved socio-economic issues on the post-2015 development agenda: scarcity of water and inadequate sanitation…” (Deen, 11/18).

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New Lancet Series Examines Antimicrobial Resistance, Access To Effective Antibiotics

News outlets report on a new series, titled “Access to effective antimicrobials: a worldwide challenge,” published online Wednesday by The Lancet.

CIDRAP News: Experts press for wider scope, evidence in drug resistance battle
“Focused attention on antimicrobial resistance, underscored by coordinated global and national awareness campaigns this week, is welcome, but discussions overlook broader questions such as how to preserve access for populations who need them and how to maintain the effectiveness of the drugs, according to a series that launched in The Lancet [Wednesday]…” (Schnirring, 11/18).

News Hour: Worrying lack of evidence for control policies threatens fight against antimicrobial resistance
“…The series urges renewed focus on understanding which policies will work to combat antimicrobial resistance, but it also points out that globally, lack of access to antimicrobial drugs remains a major issue. Despite the huge advances made in access to medicines in recent years, thousands of people — particularly babies, children, and mothers — are still at risk of serious illness or death from treatable infectious diseases…” (Sifat, 11/19).

Wall Street Journal: Not So Fast on War on Antibiotics Says Lancet Report
“…The dangers of not using antibiotics to treat disease shouldn’t be underestimated, according to the study, which was published in The Lancet, a British medical journal, on Thursday. Data from the report show universal access to antibiotics could avert as many as 445,000 deaths worldwide in children under the age of five — a significant number of those lives could be saved in India…” (Bhattacharya, 11/19).

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Ebola Survivors' Welfare Top Priority, U.N. Envoy Says; Côte d'Ivoire Disallowing Return Of Refugees Who Fled To Liberia

Associated Press: U.N. Ebola chief says priority now is helping 15,000 survivors
“The United Nations Ebola chief said Wednesday his top priority now that the deadly Ebola epidemic appears to be nearing an end is helping more than 15,000 survivors who need medical and psychological support…” (Lederer, 11/18).

U.N. News Centre: Ensuring 15,000 survivors have support they need is ‘my priority number one’ — U.N. envoy on Ebola
“…Saying ‘they have a tough time’ because ‘they’re distressed’ and ‘not trusted,’ as well as being ‘a subject of a lot of stigma,’ [U.N. Special Envoy on Ebola David] Nabarro said he wants to be sure that every person who survived Ebola can access a comprehensive package of care that helps them, and that help their communities…” (11/18).

IRIN: Living in an Ebola limbo: how long must refugees wait?
“…It’s a pertinent question for 38,000 Ivorians who initially fled political violence in 2010 to Liberia, but whose return home is now being blocked by their own government’s fears of the Ebola virus. This is despite the fact that Liberia was declared Ebola-free on 3 September, almost two and a half months ago. The World Health Organization’s answer is, essentially: no time at all…” (Collins, 11/16).

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Lower Drug Prices, Better Access To Treatment, Testing Needed To Eliminate Hepatitis C Worldwide, NEJM Editorial Says

Reuters Health: Price looms as major hurdle in hepatitis C eradication
“New therapies can cure most cases of hepatitis C but lower drug prices, testing, and better access to treatment are going to be needed to eliminate the liver-destroying virus worldwide, according to a New England Journal of Medicine editorial…” (Emery, 11/18).

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Several Southern African Nations Making Progress Toward Eliminating Malaria, UCSF's Richard Feachem Says

Associated Press: Swaziland makes progress in quest to eliminate malaria
“Swaziland could eliminate malaria by the end of 2016 or in early 2017, likely making it the first mainland country in sub-Saharan Africa to get rid of the deadly disease, according to an international health expert. Namibia, Botswana, and South Africa are also making ‘excellent progress’ toward eliminating malaria, said Richard Feachem, director of the Global Health Group at the University of California in San Francisco…” (Torchia, 11/18).

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India Must Spend More To Prevent, Treat TB To Defeat Disease Worldwide, WHO Official Says

Reuters: Global fight against tuberculosis hinges on India stepping up funding: WHO
“India is critical to the global fight to end an epidemic of tuberculosis by 2030 and must step up funding to control the disease, the World Health Organization said, citing concerns over broader cutbacks in government health programs…” (Kalra, 11/19).

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Some European Countries Diverting Foreign Aid To Cope With Refugee Influx Despite Warnings From U.N. Secretary General

IRIN: How the refugee crisis is hurting foreign aid
“Faced with the arrival of record numbers of asylum seekers and shrinking levels of public sympathy, more and more European countries are using their foreign aid budgets to foot the bill of feeding and housing the newcomers. … For example Sweden, which is expecting as many as 190,000 asylum seekers this year, is considering using up to 60 percent of its foreign aid budget in 2016 to fund refugee reception. … U.N. Secretary-General Ban Ki-moon has warned that diverting development aid to care for refugees and asylum seekers is ‘counter-productive’…” (Siegfried, 11/18).

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Donor Contributions Will Allow WFP To Continue Food Aid Operations In Ethiopia

U.N. News Centre: Ethiopia: crucial funding helps U.N. agency avoid cutbacks in food aid to drought-affected people
“Thanks to timely contributions from key donors, the World Food Programme (WFP) announced [Thursday] that it is able to continue food distributions later this month for more than 1.5 million people in the Somali region of Ethiopia, and can scale up nutrition help to more than 700,000 children and nursing mothers in the most drought-affected areas…” (11/8).

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Yemen Conflict Continues To Erode Humanitarian Situation; 14M People Lack Access To Health Care

U.N. News Centre: Yemen: U.N. warns humanitarian situation has deteriorated ‘drastically’ as conflict claims 5,700 lives
“… ‘The collapse of basic services in Yemen continues to accelerate,’ the U.N. Humanitarian Coordinator, Johannes Van der Klaauw, told reporters via videoconference from the Yemeni Capital Sana’a. He added that approximately 14 million people lack sufficient access to health care, with three million children and pregnant or lactating women in need of malnutrition treatment or preventive services, and 1.8 million children have been out of school since mid-March…” (11/18).

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Political Violence In Burundi Forcing Many To Flee Homes, Face Food Insecurity

Thomson Reuters Foundation: Violence, hunger, poverty stalk troubled Burundi, many flee homes
“Political violence, a shrinking economy, and biting aid cuts are worsening poverty and hunger across Burundi, amid reports that thousands of people are internally displaced and unable to get help…” (Migiro, 11/18).

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North Korea Begins First-Ever National TB Survey With U.N. Assistance, UNICEF Spokesperson Says

VOA News: North Korea Launches First National TB Survey
“…Andrew Brown, a regional spokesperson for UNICEF, said North Korea’s Ministry of Public Health launched the rare survey last month, expected to be completed by the middle of next year. Multiple international agencies, including the World Health Organization and UNICEF, provided assistance in the effort, according to Brown…” (Kim, 11/18).

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HIV Incidence Higher In Years Prior To Armed Conflict In Sub-Saharan Africa, Study Shows

Pacific Standard: The Odd Link Between HIV and War
“…[A]ccording to a new paper, HIV infections spread most rapidly in the five years prior to armed conflict [in sub-Saharan Africa], indicating the connection between HIV and war is subtler than previously thought. It’s not that war doesn’t have great potential to spread disease, Brady Bennett and colleagues from the Brown University School of Public Health write in PLOS One…” (Collins, 11/17).

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Editorials and Opinions

U.S. Should Take Action To End Drug-Resistant TB

Los Angeles Times: Do we have the will to stop TB?
Caitlin Reed, director of the Inpatient Tuberculosis Unit at Olive View-UCLA Medical Center and assistant professor of infectious diseases at UCLA’s David Geffen School of Medicine

“…Both [extensively drug-resistant (XDR) and multi-drug resistant (MDR)] TB spring from the same roots: inadequate treatment for regular TB, which is often the result of weak public health systems around the world. … It’s a bleak picture, and one that could get worse. In his 2016 budget, President Obama proposed a cut … in funding for global TB programs. However, earlier this year, the White House also announced the development of an ‘action plan’ to stimulate drug-resistant TB research and treatment at home and abroad. The president should request the funding required to implement the plan. … There will be those who say we can’t afford comprehensive action to stop tuberculosis. But … how can we afford not to?” (11/18).

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International Community Must Enforce Medical Neutrality In Conflict Situations

New England Journal of Medicine: Attacks on Health Care in Syria — Normalizing Violations of Medical Neutrality?
Michele Heisler, Elise Baker, and Donna McKay, all affiliated with Physicians for Human Rights

“…When health care systems come under assault, the losses are far greater than the toll of health workers killed and hospital bricks and mortar demolished. … The longer the international community fails to enforce humanitarian law, the greater the chance that these violations will become the ‘new normal’ in armed conflicts around the world, eroding the long-standing norm of medical neutrality. Left unchecked, attacks on medical care will become a standard weapon of war. … As the global body with the most power to stop these attacks in the short term, the U.N. Security Council should enforce its resolution to protect civilians and civilian infrastructure. Effective protection of medical neutrality would save lives and is a necessary prerequisite to any effective peace process…” (11/18).

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Establishing New Governance Body Under WHO Could Improve Emergency Preparedness Coordination

Financial Times: Ebola is almost gone but the viral threat remains
Anjana Ahuja, science commentator

“…By the start of next year, four influential reports on post-Ebola global health governance will have been published; one … has already called for a separate body within WHO to coordinate emergency preparedness. Other reports are likely to echo its suggestion that the body should be bankrolled by a ring-fenced fund and run fearlessly by its own director, who would have the power to call countries and companies to account. Currently, the WHO cannot force countries to notify it of outbreaks — and cannot penalize unaffected countries that sever trade and travel links. This cold-shouldering turns medical emergencies into economic ones. … Stricken nations thus need to be given incentives (and insured) to reveal epidemics early, and others given incentives not to cut links. A new body under the WHO umbrella just needs political willpower, and it should be the real test of lessons learnt” (11/18).

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Philanthropic, Private Investments In WASH Essential To Achieve Development Goals

Devex: The sanitation challenge: What’s next after toilets?
Brian Arbogast, director of the water, sanitation, and hygiene program at the Bill & Melinda Gates Foundation

“…[The Bill & Melinda Gates Foundation is] supporting work that includes the development of the next generation of toilets that are cheap to run without the need for sewer or water connections, and low-cost approaches to treating fecal sludge that results in usable products, such as energy or fertilizers. … [S]uch investment in sanitation will deliver an immediate return in improved health, a better environment, and increased productivity. … [W]hile sanitation may never be a glamorous subject, without it our wider hopes for development cannot be achieved. It is the key to healthier and more sustainable and resilient cities — and World Toilet Day reminds us that such goals need to be talked about openly, not treated as taboo” (11/18).

The Guardian: World Toilet Day 2015: the fight for global access to effective sanitation
Hannah Greig, private sector adviser at WaterAid U.K.

“…[I]t makes business sense to invest in effective sanitation … The corporate world has a valuable role to play [in achieving the Sustainable Development Goals] by ensuring their employees have access to water, sanitation, and hygiene in the workplace; respecting the human right to water and sanitation; integrating water, sanitation, and hygiene into water stewardship; and looking at their responsibility to help improve public health through good sanitation in the communities in which they work. … Everyone has a right to a safe, private place to relieve themselves, and to live healthy and productive lives without the threat of illness from poor sanitation and hygiene…” (11/19).

The Conversation: Gender equality comes one toilet at a time
Marni Sommer, associate professor of sociomedical sciences at Columbia University, and Bethany Caruso, Phd student in public health at Emory University

“…[W]hile everyone needs access to proper sanitation to be healthy, for girls and women this is also an issue of safety and equal participation in society. … Very often women have the primary responsibility for health, hygiene, and sanitation for their family. Lack of access to sanitation (and water) impacts not only a woman’s health, but that of her whole family. … If we were to assure that all girls and women (and boys and men) had access to toilets that were safe, accessible, and comfortable, we expect that the world would see improvements in health, in educational outcomes, and productivity. Not to mention we would achieve every human’s basic human right to sanitation” (11/19).

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From the Global Health Policy Community

Integrating WASH Into Nutrition Programs Can Help Prevent Undernutrition

USAID’s “Impact”: What does water, sanitation, and hygiene have to do with nutrition? Everything.
In recognition of World Toilet Day on November 19, Merri Weinger, environmental health team leader at USAID’s Bureau for Global Health, discusses the link between water, sanitation, and hygiene (WASH) and nutrition, as well as the release of a jointly produced document from the WHO, UNICEF, and USAID “with guidelines on integrating WASH into nutrition programs in order to achieve positive gains in the fight against undernutrition…” (11/19).

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Ongoing Sanitation Efforts Helped Many Liberian Communities Remain Ebola-Free During Epidemic

Global Network for Neglected Tropical Diseases’ “End the Neglect”: Untouched: How 284 Liberian Communities Remained Ebola-Free
Piet deVries, senior WASH adviser at Global Communities, discusses the organization’s efforts to provide safe sanitation for communities in Liberia, and how those efforts helped many communities remain Ebola-free or significantly lowered their risk (11/18).

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Articles Examine Creating Health Leadership In Academic, Village Settings In Resource-Limited Uganda

Human Resources for Health: Global health leadership training in resource-limited settings: a collaborative approach by academic institutions and local health care programs in Uganda
Damalie Nakanjako of Makerere University College of Health Sciences in Kampala, Uganda, and colleagues examine the results among Ugandan participants in the Afya Bora Global Health Leadership Fellowship, a program sponsored by the Afya Bora Consortium, a consortium of four African and four U.S. academic institutions (11/18).

Pulitzer Center on Crisis Reporting: How Effective Are Uganda’s Community Health Workers with Little Funding?
As part of his project titled “Uganda: Looking at an Under-Resourced Healthcare System,” Washington University student Jae Lee looks at village health team (VHT) “volunteers [who] are appointed by the community either through the town leadership or through popular vote,” including the challenges and benefits of using VHTs as part of the overall health system (11/18).

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