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Kaiser Daily Global Health Policy Report

In The News

Aid Community Variously Affected By Government Shutdown, Devex Reports

“The immediate impact of a government shutdown on U.S. foreign aid programs is expected to be minimal, and guidance given to implementing partners suggests that almost all grants and contracts will continue to be funded for the foreseeable future,” Devex reports. “A longer-term shutdown, though, could delay payments to contractors and may especially impact personal services contractors, according to Alan Chvotkin, executive vice president and counsel at the Professional Services Council, a group representing government contractors,” the news service writes. Devex says operations at the Millennium Challenge Corporation and the federal Food for Peace program would continue because they do not depend on annual appropriations, “[b]ut not all foreign aid programs spearheaded by other government agencies would be so lucky.” The news service adds, “For many with a stake in U.S. aid, the only reasonable option appears to be to forge ahead in the hope that the government shutdown will be short-lived” (Stephens, 10/1).

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Secretary Kerry Commends U.S., Botswana Partnership Against AIDS

In a message to Botswana on the occasion of its 47th independence anniversary on Monday, U.S. Secretary of State John Kerry said the partnership between the U.S. and Botswana in the fight against HIV/AIDS “has made ‘important strides,’ but that the battle is not over,” PANA/AfriqueJet reports (10/1). “Our shared fight against HIV/AIDS is far from over. But together, we have made important strides: those receiving an HIV-positive diagnosis, who were once presumed to be facing an imminent death sentence, are now living satisfying, productive lives,” Kerry said in the statement, adding, “The partnership between the United States and Botswana is an investment in the future” (9/29).

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Report Calls For Cancer-Specific Global Fund To Curb Increasing Rates In Developing Countries

“A global fund is needed to curb ballooning cancer rates in poor nations, where malignancies already kill more people than AIDS, tuberculosis and malaria combined, according to a report by a coalition of researchers” presented at the European Cancer Congress in Amsterdam on Monday, Bloomberg reports (Bennett, 9/30). “In a report on how rates of cancer diagnosis and death are rising across the world while access to diagnosis and treatment is extremely patchy, experts described the economics of the problem as daunting and current financing models as broken,” Reuters writes (9/30). “Cancer is already the biggest drain on the global economy, and costs $895 billion a year in lost productivity alone, the American Cancer Society estimated in 2010,” according to Bloomberg. “By 2030, there will be about 26 million new cases of cancer a year worldwide, compared with 12.7 million in 2008, and most new cases will be in developing nations, according to [the] 500-page report,” the news agency adds.

“‘The big problem is that in the low-resource countries, patients present with advanced disease,’ said Peter Boyle, who led the coalition and is president of the International Prevention Research Institute in Lyon, France,” Bloomberg notes (9/30). “In poorer countries, Boyle said, where equipment, expertise and medicines for cancer are scarce and sometimes non-existent, the increasing burden of the disease threatens to cause ‘devastating damage to entire families,’” Reuters adds. “Boyle, who is also director of the Institute of Global Public Health at Strathclyde University, cited 2009 estimates by the Economist Intelligence Unit that it would cost $217 billion a year to bring cancer diagnosis, care and treatment in poor countries up to the standards of wealthy nations,” the news service writes (9/30).

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Number Of Undernourished Has Fallen, But More Effort Needed To Reach MDG, U.N. Report Says

“The number of people who are chronically undernourished has fallen from an estimated 868 million in 2010-12 to 842 million in 2011-13, according to a U.N. report that celebrates progress made, but warns that ‘considerable and immediate additional efforts’ will be needed to meet global goals to reduce hunger by 2015,” The Guardian reports. “If current rates of progress continue, the report says, the prevalence of undernourishment in the developing world will approach 13 percent by 2015 — close to, but still above, the [Millennium Development Goal (MDG)] target” of 12 percent, the newspaper notes (Provost, 10/1). “The report on food insecurity was compiled jointly by the Food and Agriculture Organization (FAO), the World Food Programme (WFP) and the International Fund for Agricultural Development (IFAD),” Deutsche Welle adds (10/1). “The vast majority of people suffering hunger, or 827 million, live in developing countries, where the prevalence of undernourishment is estimated at 14.3 percent, the report found,” according to Reuters (Flak, 10/1).

According to the report, the successes in reducing the number of undernourished is attributable to “higher economic growth in developing countries, an increase in farm productivity rates and more private and public investments in agriculture,” as well as “remittances from emigrants, which have risen to three times higher than development aid globally, [and] were helping improve diets in countries like Bangladesh and Tajikistan,” Agence France-Presse writes. “The report said 62 countries have already reached the target of halving the proportion of hunger,” but “[d]espite overall progress, marked differences across regions persist, the report said,” the news agency notes (10/1). The report “says hunger is most prevalent in sub-Saharan Africa, where progress has been modest,” VOA News writes, adding, “Improvement has been slow in Southern Asia and Northern Africa, and non-existent in Western Asia. Latin America and Eastern and Southeastern Asia have seen the most progress” (Baragona, 10/1). “The findings and recommendations of [the report] will be discussed by governments, civil society and private sector representatives at the October 7-11 meeting of the Committee on World Food Security at FAO headquarters in Rome,” an FAO press release notes (10/1).

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Minority Groups Suffer Worse Health Outcomes Than Rest Of Population, Report Says

“Minority groups suffer worse health outcomes than the rest of the population, according to a new report published by Minority Rights Group International (MRG)” last week, IRIN reports. The report, “State of the World’s Minorities and Indigenous Peoples 2013, released to coincide with the U.N. General Assembly meeting on the post-Millennium Development Goals (MDGs) agenda, calls for — among other things — greater measures to combat disparities in global health outcomes between minority groups and majority communities,” the news service writes. “‘The MDGs have resulted in much that is good. But one of the fundamental flaws with them has been the lack of a right or equity perspective,’ said Carl Soderbergh, MRG’s policy and communications director,” the news service notes.

“Minority and indigenous communities often are marginalized from all aspects of life in their countries,” he added, according to IRIN. “Soderbergh says that the fields of maternal care, child health and mental health are particularly vulnerable to disparities,” the news service adds. “According to the report, lack of access to health care and systemic patterns of discrimination are major causal factors” and, “[f]or minority indigenous groups, the fight for ownership and access to traditional lands and the right to health are deeply intertwined,” the news service writes. “Soderbergh believes that there are simple solutions that can improve the health care services of minority groups,” such as keeping user fees at a minimum, “getting timely data that is disaggregated by ethnicity,” and investing in infrastructure to improve access to care, IRIN notes (10/1).

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GAVI Alliance Announces 2 New Initiatives Using Private Sector Funds To Improve Vaccine Delivery

“At this year’s Clinton Global Initiative, the GAVI Alliance announced a pair of new initiatives that aim to leverage private sector funds and expertise to improve delivery of vaccines worldwide,” Devex Impact reports. “Maintaining [the] ‘cold chain’ from manufacturing plant to rural clinic is just one of the challenges of maintaining the complex supply chain for vaccines, [David Ferreira, managing director of GAVI's innovative finance department,] told Devex Impact on the sidelines of the 2013 Clinton Global Initiative annual meeting in New York,” the news service writes, adding, “To tackle these challenges, GAVI launched a new Supply Chain Technical Improvement Facility, to be funded by private sector contributions.” The news service notes, “These contributions will be doubled in size via the already existing GAVI Matching Fund, through which the U.K. government and the Bill & Melinda Gates Foundation match contributions.” Devex adds, “GAVI is also founding a Supply Chain Centre of Excellence, in order to ‘incubate solutions’ to problems ranging from bureaucratic inefficiency to outdated computer systems, according to the organization’s news release” (Useem, 9/30).

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Malaysia, Other Southeast Asian Countries Facing Increase In Annual Dengue Cases

“Dengue fever has killed 45 people in Malaysia this year — a jump of more than a third from the same period last year — as the tropical country struggles to tame a mosquito-borne virus outbreak that has plagued the Southeast Asian region for decades,” the Wall Street Journal’s “Southeast Asia Real Time” blog reports. “The disease has claimed hundreds of lives in the Southeast Asian region this year and is a chronic problem from Africa to Asia to Latin America,” with reports of the disease in Europe in recent years, the blog notes. The blog includes data from neighboring countries in the region, including Singapore, Thailand and Laos, where the number of cases has increased, and the Philippines, where there has been a small decline in the number of reported cases this year (Gangopadhyay, 10/1).

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Chinese Data Show More Than 13M Abortions Performed Annually, TIME Reports

“New data published [last week] by China’s National Health and Family Planning Commission indicate that there are more than 13 million abortions conducted in the country every year,” TIME reports. The data “only account for surgical procedures conducted at licensed hospitals and clinics, and don’t take into account medically induced abortions or procedures conducted at the unlicensed clinics seen in poorer parts of the country,” the magazine writes. “[W]hile China’s restrictive one-child policy is certainly one factor influencing the high rate of terminations … [r]ecent surveys have shown a surprising lack of awareness about basic sexual health among China’s youth,” the magazine reports, noting, “Just 1.2 percent of Chinese women take oral contraceptives, compared with 30 percent to 50 percent of women in some developed countries.” TIME adds, “Almost half of the reported [abortion] procedures were conducted on women below the age of 25, the majority of whom were university students” (Jiang, 9/30).

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Editorials and Opinions

Opinion Pieces Address 'Roadmap For Childhood TB' Report

On Tuesday, the WHO, Stop TB Partnership, the International Union Against Tuberculosis and Lung Disease, CDC, USAID, UNICEF, the Treatment Action Group (TAG), and other partners released a report (.pdf), titled “Roadmap for Childhood TB: Towards Zero Deaths,” which “seeks to outline the activities that need to be implemented to accelerate progress toward the elimination of childhood [tuberculosis (TB)],” according to the TAG website (10/1). The following summarize two opinion pieces on the issue of childhood TB.

  • José Luis Castro, Devex: “The painful reality of public health in low- and middle-income countries today is that strategies and tools exist to treat TB effectively, but they do not reach everyone, especially children,” Castro, interim executive director of the International Union Against Tuberculosis and Lung Disease, writes. “One reason is that TB in children often lurks beneath — and is masked by — other diseases and symptoms; and, identifying it is further hampered by difficulties in applying current diagnostic methods to children. Health professionals and health systems in many countries are not adequately prepared to detect and manage childhood TB,” he states. The new report “makes clear that by scaling up the tools we currently have, and investing modestly in improved approaches for the future, those 74,000 boys and girls who die each year [from TB] can indeed be saved,” Castro says, outlining the report’s primary points (10/1).
  • Desmond Tutu, Huffington Post’s “Impact” blog: “That we have allowed this disease to continue to plague our lives and especially our children’s lives is a travesty,” Nobel Peace Prize winner Tutu writes, adding, “I am pleased to see that the global health community is becoming more focused on the specific childhood problem.” He notes the report has 10 steps that can be grouped into three areas. “The first is to activate a sense of urgency beyond the TB community”; “Second, we must include the needs of children in research, policy development and clinical practices”; and, “Finally, we need to increase funding,” he writes. The WHO estimates $80 million a year is needed to end childhood TB deaths, Tutu notes, saying PEPFAR “has provided millions to fight HIV/AIDS and tuberculosis in Africa. But we need more money, from multiple sources, to reach the goal.” He concludes, “[T]his is an eminently solvable problem. All the world needs is a more aggressive commitment to end the disease” (10/1).

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International Community Should Recommit To Improving Child Survival

In a GlobalPost opinion piece, Michael Merson, the founding director of the Duke Global Health Institute and a professor of global health at Duke University, writes that “now is the time to remember the highly successful Child Survival Revolution of the 1980s.” He states, “Preventing childhood diarrhea and pneumonia deaths and vaccinating children in the first six months of life was the essence of the Child Survival Revolution of the 1980s. But sadly, the revolution came to an end as much of the global health community shifted most of its attention and resources to HIV/AIDS.” He highlights Millennium Development Goal (MDG) 4, “a pledge to reduce the global under-five mortality rate by two-thirds by 2015,” and notes “the newly released UNICEF report, ‘Committing to Child Survival: A Promise Renewed,’ tells us that while we have made progress, more than 200 million children have paid with their lives because we failed to regain the momentum we had three decades ago.

“In 2012, most of the 6.6 million under-five deaths were caused by preventable diseases like diarrhea, pneumonia, and malaria. And at our current rate of progress, by 2028 an additional 35 million children will die who would have survived had we met this MDG,” Merson continues. “The level of commitment that the world made to eradicating smallpox and improving access to antiretroviral drugs, especially in low-income countries, now needs to be applied to child survival,” he states, adding, “We need to accelerate our efforts to come as close as possible to achieving MDG 4 and ensure that what is not achieved is included in the post-2015 agenda. The technologies and approaches exist, and they are affordable.” He writes, “The winning formula is global leadership and coordination, political commitment, adequate resources and strengthening of health systems in countries” (9/30).

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Chronic Disease Must Be Addressed In Syria Crisis

“In the midst of a bloody civil war, the biggest killer in Syria may not be the one you expect: chronic disease,” Jerusha Murugen, a research associate for global health, economics, and development at the Council on Foreign Relations, writes in CNN’s “Global Public Square” (GPS) blog. “For many thousands of Syrians who struggle to access medical treatment in a war with no end in sight, everyday medical conditions have now become a matter of life or death,” she states, adding, “Zaher Sahloul, president of the Syrian American Medical Society (SAMS), estimates that as many as 200,000 Syrians have died from chronic conditions, such as cancer, diabetes, hypertension, and respiratory and heart conditions, as a result of lack of access to drugs and treatment, double the number of Syrians killed by combat operations.” She adds, “The United Nations now estimates that over half a million Syrians will require chronic disease treatment for the remainder of 2013.”

“And while daily atrocities and war crimes have gained international attention, most recently August’s horrific chemical weapons attack, Médecins Sans Frontières … stresses that victims who survive combat operations more frequently become ‘silent casualties,’ succumbing instead to previously manageable chronic illnesses as a result of calculated attacks on Syria’s primary health care system and pharmaceutical industry,” Murugen continues. “Syrians are now facing a critical shortage of medicines, particularly for chronic illnesses — WHO surveys indicate that basic supplies, such as insulin for Syria’s 40,000 juvenile diabetes patients, are no longer available,” she notes, adding, “While international organizations are providing medical aid in the country, the Syrian government has issued stringent policies for such groups, authorizing only Syrian government-approved domestic and international organizations to work in the country.” She concludes, “While finding a solution to Syria’s civil war will continue to be difficult, resolving its chronic disease crisis should not be. With the United Nation’s hands effectively tied, other actors must now act where the international community cannot” (9/30).

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Recent Releases

CGD Blog Examines PEPFAR Stewardship And Oversight Act Of 2013

Writing in the Center for Global Development’s (CGD) “Global Health Policy” blog, Policy Outreach Associate Jenny Ottenhoff examines the PEPFAR Stewardship and Oversight Act of 2013 (S 1545/HR 3177), “which aims to extend and modernize the landmark U.S. global AIDS program.” She writes, “The bill is short (18 pages!), has bipartisan support, and doesn’t contain any major overhauls to the (very good) existing policy.” Ottenhoff adds, “The bill isn’t a full reauthorization like in years past; it simply extends provisions in the current law that would otherwise expire on September 30 and updates PEPFAR’s annual reporting requirements to strengthen congressional oversight of the program,” and she outlines some specifics of the bill (9/30).

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Global Leaders Urge U.N. Member States To Include UHC In Post-2015 Development Agenda

“An emerging movement of global leaders of government, civil society and finance is urging United Nations member states … to include universal health coverage (UHC) in the next round of global goals for economic development, just as similar reforms take root in the U.S.,” where enrollment opens on Tuesday “for newly created health care exchanges which aim to expand accessibility for millions of American families,” a Management Sciences for Health (MSH) press release reports. The press release notes “a billion people worldwide are unable to obtain modern health care and 100 million every year are forced into poverty by out-of-pocket health costs” and highlights “a recent statement signed by 15 global civil society organizations (including Management Sciences for Health (MSH), Oxfam, Save the Children, Médecins du Monde/Doctors of the World, among others) urging U.N. member states to include UHC as a priority in the development framework that will replace the Millennium Development Goals” (9/30).

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USAID Helping Families In Cote d'Ivoire

“USAID is helping communities in rural Cote d’Ivoire develop economic resiliency,” Andrea Halverson, deputy health officer for USAID Cote d’Ivoire, writes in the agency’s “IMPACTblog.” She continues, “Through our partners SAVE the Children and AVSI, we are supporting several types of economic strengthening activities, all of which increase the productive resources available for families. Through this work, we target the families and caregivers of children orphaned or made vulnerable by HIV/AIDS.” She describes how savings groups are helping women start businesses, save money for their families, and “shape the future of Cote d’Ivoire” (9/30).

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