In the Center for Strategic & International Studies’ (CSIS) “Smart Global Health” blog, Phillip Nieburg, senior associate of the CSIS Global Health Policy Center, discusses a recent report (.pdf) he wrote, titled “Improving Maternal Mortality and Other Aspects of Women’s Health: The United States’ Global Role,” “that addresses key challenges to improving maternal mortality and women’s health worldwide and talks about what the related priorities of U.S. foreign policy should be.” He says, “Rather than continuing what appears to me as a piecemeal approach to global aspects of reproductive health, with separate programs to address, e.g., gender-based violence, women and HIV/AIDS, maternal mortality, family planning, cervical cancer, girls’ education, etc., I argue in my report that the United States should develop and implement a comprehensive global plan for women’s health that includes males as well as females, using coordinated prevention and care programming for each stage of the reproductive health life cycle” (10/25).
Access to Health Services
“Though the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been touted as one of our nation’s most successful initiatives in global health (and certainly one of President George W. Bush’s most positive legacies) it continues to miss the mark” when it comes to family planning, global gender specialist and freelance writer Jessica Mack writes in KPLU 88.5’s “Humanosphere” blog. “The essential role of contraception, especially barrier methods, in preventing the spread of HIV/AIDS is intuitive, obvious, and also well documented,” she writes. “While earlier PEPFAR rules did not specifically dictate whether or not funding could be used for contraceptive supplies, the language over the last few years has become increasingly restrictive on this point,” she continues, noting that PEPFAR’s recently released 2013 country operational plan (COP) forbids the use of PEPFAR funds to purchase family planning commodities. Mack concludes, “PEPFAR is simply flying directly in the face of the Global Health Initiative’s vision and the stated objectives of the Obama Administration” (10/25).
Management Sciences for Health’s “Global Health Impact” blog reports on USAID-funded efforts to deliver medicines to the Democratic Republic of the Congo’s Sud Kivu province, which “has been an area of armed conflict for many years, with various rebel factions fighting for control over the resource-rich region.” According to the blog, “The continued fighting has disrupted health services — which were weak to begin with — due to geographic isolation and poorly supported health workers,” and “[i]n the health zone of Mulungu, there had been no delivery of medicines or supplies for more than six months” (Walsh, 10/24).
Differing Opinions About AMFm 'Unlikely To Be Resolved' After Global Fund Decision On Program's Future
In her “Global Health Blog,” Guardian health editor Sarah Boseley examines the Affordable Medicines Facility-malaria (AMFm), “which aims to enable countries to increase the provision of affordable artemisinin combination therapies (ACTs) through not only the public sector but also the private sector and [non-governmental organizations (NGOs)].” Following pilot projects in seven African countries and an independent evaluation by the London School of Hygiene and Tropical Medicine, the Global Fund to Fight AIDS, Tuberculosis and Malaria, which hosts AMFm, is set to decide the future of the scheme at a board meeting in November. She notes Oxfam recently released a report criticizing the mechanism, saying the evaluation was flawed because it looked at the number of ACTs sold and not lives saved.
The Associated Press examines access to antiretroviral treatment in Myanmar, which “ranks among the world’s hardest places to get HIV care, and health experts warn it will take years to prop up a broken health system hobbled by decades of neglect.” The country, also known as Burma, has been hindered by decades of rule by a military junta and economic sanctions imposed by developed countries, including the U.S., the AP notes, and writes, “Of the estimated 240,000 people living with HIV [in the country], half are going without treatment.” However, “as Myanmar wows the world with its reforms, the U.S. and other nations are easing sanctions,” the news agency writes, adding, “The Global Fund [to Fight AIDS, Tuberculosis and Malaria] recently urged Myanmar to apply for more assistance that would make up the shortfall and open the door for HIV drugs to reach more than 75 percent of those in need by the end of 2015,” as well as medications to fight tuberculosis (TB). The AP details one man’s efforts to obtain antiretrovirals, which are reserved for patients with CD4 cell counts below 150 cells, versus the WHO recommended 350 (Mason, 10/22).
Central African Republic Town Struggling To Provide Health Care Since Withdrawal Of Foreign Companies, VOA Reports
VOA News examines how the 2009 withdrawal of foreign diamond-mining companies from the small town of Carnot in the Central African Republic (CAR) affected the local economy and access to health care for residents. Initially, Medecins Sans Frontieres (MSF) “ran emergency nutrition programs for the first year, but then discovered deeper health problems in the region, including a child mortality rate that is three times above what is considered an emergency level, as well as elevated rates of HIV and tuberculosis,” the news service writes.
In the last of a series of posts on the U.K. Department for International Development’s (DfID) blog examining the department’s work in Malawi, Neil Squires, DfID head of profession for health, looks at the sustainability of the country’s HIV/AIDS program. “Malawi’s success in increasing access to antiretroviral drugs for HIV is highly dependent on donor funding for medicines,” he writes, adding, “Malawi has to actively consider its resource allocation in order to maximize the benefits and the health gained from the limited resources available.” He notes a report commissioned by UNAIDS on Malawi concluded that “unless Malawi can reduce the incidence of new infections, the scale up in access to antiretroviral drugs will not be sustainable in the medium to long term.” He concludes, “This is an important issue for the Government of Malawi, but also for the key donors who have supported the massive scale up in access to drugs, particularly the Global Fund. Malawi will need to maintain high levels of funding from the Global Fund if it is to maintain its supply of antiretroviral drugs” (10/23).
During a meeting with UNAIDS Executive Director Michel Sidibe on Tuesday, Indonesia Minister of Health Nafsiah Mboi “pledged to scale up HIV testing and treatment programs” with a “focus on 141 districts where key affected populations are the highest,” a UNAIDS feature story reports. “Indonesia also plans to become one of several countries in the region to offer universal health care by 2014,” with HIV treatment to be covered, according to the health ministry, UNAIDS notes. Sidibe said, “Indonesia is a key partner in the drive to end the AIDS epidemic. … Universal health coverage is a game changer for Indonesia. I am delighted to know that HIV treatment will be included in this national program. This sets the stage for sustainable funding of HIV programs,” the article states. “The Ministry of Health estimates that more than 600,000 people are living with HIV and that there are more than 76,000 new HIV infections each year,” according to UNAIDS, which adds, “Currently HIV treatment coverage is at less than 20 percent” (10/23).
India's Maternal Health Care Benefit Excludes Many Women Because Of Parity Requirement, Women's eNews Reports
Women’s eNews examines India’s Indira Gandhi Maternity Support Scheme, a health care benefit offering $80 cash assistance to pregnant women older than 18 years and who do not have more than two living children. “The benefit requires a pregnant woman to register her pregnancy at a health center, accept immunization of the mother and child and agree to exclusive breastfeeding and growth monitoring of children,” the news service writes. “One 2011 study, however, based on the latest national family health survey, indicated as many as 63 percent of poor women between ages 15 to 49 would be disqualified from the program because they had more than two children,” according to Women’s eNews. “With the scheme being piloted in four [high fertility] states, … health activists contend the government is promoting a coercive two-child policy in the name of population stabilization by offering incentives for only those women who have two children,” the news service writes, adding the program would benefit poor women who do not have access to adequate family planning or health services, income, or nutrition (Majumdar, 10/23).
In the Huffington Post’s “Politics” blog, Serra Sippel, president of the Center for Health and Gender Equity, notes that Secretary of State Hillary Rodham Clinton said at the XIX International AIDS Conference in July that all women should be able to decide “when and whether to have children” and that PEPFAR, in a guidance [.pdf] released last week, said, “Voluntary family planning should be part of comprehensive quality care for persons living with HIV,” and referred to family planning as a human right. “Then, in bold type, they punctuated it with, ‘PEPFAR funds may not be used to purchase family planning commodities,'” she writes. “They take it a step further with a caveat that before anyone decides they’d like their program to have anything to do with family planning, they had best consult relevant U.S. legal counsel first,” she adds. “To be fair, they do say that PEPFAR programs can just refer women to a different program that offers family planning,” but those programs are not always available, Sippel writes, adding, “So the suggestion is flawed from the start.”