The U.S. Government Accountability Office (GAO) recently released two reports on issues related to global health. In “Ensuring Drug Quality in Global Health Programs,” the agency writes, “Concerns have been raised about the potential for substandard drugs to enter the supply chains of global health programs,” and notes that it concluded, “U.S.-funded global health programs have put regulatory and policy requirements in place to help prevent procurement of substandard drugs” (8/1). In another report looking at the WHO, titled “Reform Agenda Developed, but U.S. Actions to Monitor Progress Could be Enhanced,” GAO found, “The United States has provided input into WHO’s reform agenda, particularly in the areas of transparency and accountability, but the Department of State’s (State) tool for assessing progress in the area of management reform could be enhanced” (7/23).
Access to Health Services
BBC News reports on a $15 million college in northern Nigeria’s Jigawa state that is working to train nurses and midwives. The first class of the three-year program is expected to graduate in September, and “[t]he hope is these new nurses and midwives will stay in Jigawa’s villages once their training is complete, rather than drifting to towns and cities where the work is usually better paid,” BBC notes, adding, “The college represents a start in addressing what has been a gaping lack of resources.” Four years ago, there were 14 midwives trying to serve “the state’s population of 4.5 million people” and “cover more than 600 small health centers,” BBC continues. However, a British-funded project called Paths 2, which aims “to reduce the state’s high level of preventable deaths among pregnant women,” has helped facilitate the creation of training programs for local health care workers, the news service notes (Dreaper, 8/2).
The XIX International AIDS Conference (AIDS 2012) that took place last week in Washington, D.C., “ignited momentum to shift from ‘fighting AIDS’ to ‘ending AIDS,'” Mohga Kamal-Yanni, senior health adviser at Oxfam International, and Urvarshi Rajcoomer, policy and advocacy adviser at Oxfam in South Africa, write in a Mail & Guardian opinion piece. “Oxfam believes investing in health systems such as infrastructure and health worker, drug supply chain and health information systems, is a critical prerequisite to ending AIDS,” they write. However, “to make this a reality,” pharmaceutical companies, donor governments, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank “must now do their part,” they continue.
On the first stop of a 10-day tour of Africa, Secretary of State Hillary Clinton stopped at the Phillipe Maguilen Senghor Health Center in Dakar, Senegal, where Awa Marie Coll-Seck, the country’s minister of health, “explained to Secretary Clinton how these operational centers dramatically improve maternal and child health,” according to a post in USAID’s “IMPACTblog.” Coll-Seck “also noted that USAID-supported distribution of insecticide impregnated mosquito nets across the country had drastically reduced the incidence of malaria,” according to the blog, which adds that Clinton “was pleased to hear that the United States is playing a key role in helping meet one of its biggest challenges: decentralizing services so they are available at the village level throughout the country.” In an address several hours later, “Clinton invoked the Senghor center … saying she was highly impressed by the integrated nature of the facility” and that “[i]t was a successful model she hoped could be duplicated throughout Senegal and the entire West African region” (Taylor, 8/1).
IRIN Examines Conditional Cash Transfer Program Aimed At improving Maternal Health In The Philippines
“A nationwide conditional cash transfer program in the Philippines is slowly improving maternal health, but more is needed to reverse the climbing maternal mortality ratio, say women’s groups,” IRIN reports. “Known locally as ‘Pantawid Pamilyang Pilipino Program’ (4Ps), five-year conditional cash transfers (CCTs) were first rolled out in 2007 as a pilot program to cut poverty,” the news service writes, adding, “Now, with a budget of $227 million, the Department of Social Welfare and Development (DSWD) aims to make CCTs available to 5.2 million eligible households by 2015.”
Inter Press Service examines efforts Laos is taking to improve its maternal mortality ratio (MMR) of 470 deaths per 100,000 live births, especially among rural populations that do not have access to health care services. “A majority of the country’s 6.5 million people live in rural communities scattered across this mountainous Southeast Asian nation, and over 80 percent of the women give birth at home, according to studies by the United Nations Population Fund (UNFPA),” the news service writes. “June saw 80 midwives graduate from a special program shaped by the ministry of health, international donors and the UNFPA, … add[ing] to the initial group of 140 midwives who qualified last year,” IPS notes. The news service continues, “And as the community midwives program forges ahead, focus is shifting to more professional care in isolated communities in the mountainous areas and rural lowlands,” with the goal of reaching the U.N. Millennium Development Goal of reducing MMR by 75 percent between 1990 and 2015 (Macan-Markar, 7/31).
Lawrence Altman, former senior medical correspondent for the New York Times, writes in an opinion analysis in the newspaper that while there was much discussion about “ending the AIDS epidemic” and an “AIDS-free generation” at the XIX International AIDS Conference (AIDS 2012) last week in Washington, D.C., “[o]ne obstacle is a failure to clearly define the epidemic or what it means to have an AIDS-free generation.” He continues, “Definitions of terms like these may help determine how many billions of dollars the world devotes to the battle against AIDS and how many millions of lives will be extended. A failure to meet ill-defined goals could lead to public misunderstandings that limit investments and the number of people who have access to the lifesaving antiretroviral drugs in the future.”
Bloomberg Businessweek reports that “[c]ircumcision is in the spotlight again after a German court ruling has pitted those who support it for religious and health reasons against those who say boys should have the right to decide for themselves” and discusses how the procedure’s role in “helping prevent the spread of AIDS in Africa” is “[l]ost in the debate.” According to the news service, “Circumcision is picking up in Africa as a pragmatic health measure to ward off disease,” including HIV, herpes, and human papillomavirus (HPV). “Some mild adverse effects may occur, especially when circumcision is done when the patient is older or when the practitioner hasn’t been properly trained, according to a review of more than 50 studies published in 2010,” which also found severe complications are uncommon, the news service writes. Bloomberg examines circumcision policies and laws of the WHO and several countries (Wainer/Bennett, 7/29).
Some members of Congress “are advocating deep cuts to funding for domestic programs such as [the Ryan White CARE Act] and international programs such as the Global Fund [to Fight AIDS, Tuberculosis and Malaria] and PEPFAR,” but “[w]hat these critics fail to realize is that though we have won a multitude of battles, we are still losing the war in many communities,” Rep. Michael Honda (D-Calif.) writes in a U.S. News & World Report opinion piece. “We must continue to find innovative, targeted solutions in the fight against this dreaded disease,” he continues, adding, “There are many of us in Congress who recognize this important fact, chief among those are my dear friend Rep. Barbara Lee [D-Calif.], whose upcoming ‘Ending the HIV/AIDS Epidemic Act of 2012’ targets at-risk populations both domestically and internationally.” Honda concludes, “From legislative action on the federal level to grassroots efforts in state communities, we need to make targeting these communities a top priority in order to move forward. This requires advocacy, this requires commitment, and most importantly, it requires more investment” (7/27).
Noting “the total clinic-level cost of providing a year’s worth of antiretroviral drugs … ha[s] dropped” in some countries, Charles Kenny, a fellow at the Center for Global Development and the New America Foundation, discusses “disagreement over the effectiveness of the global AIDS response” in this Bloomberg Businessweek opinion piece. Kenny highlights a debate that took place last week on the sidelines of the XIX International AIDS Conference (AIDS 2012) that “focused on the question: should we use resources for antiretrovirals at a cost (including overhead) of perhaps $350 per patient per life year saved if we could use those resources to provide a course of drugs to cure victims of tuberculosis at a cost of $5 to $50 per life year, or of extending childhood immunizations at the cost of $2 to $20 per life year?” He writes, “Simply, millions of people are dying unnecessarily, for lack of $350 a year or less. It may be those who don’t get AIDS treatment, or those that don’t get other treatments because the available money is being used to buy antiretrovirals.” He continues, “If anything could open treasury accounts in the rich world to provide a larger flow of resources to global health, perhaps it is to get policymakers in those countries to think through these gut wrenching decisions that limited funding (and lack of funding flexibility) forces doctors and ministers and activists alike to make every day” (7/27).